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HomeMy WebLinkAbout2015-323 Contract - Pacific Mobile Structures Contract for GOODS AND SERVICES Less than $25,000 CITY OF CONTRACTOR: Pacific Mobile Structures -AS H LA N D CONTACT: Ron Young 20 East Main Street Ashland, Oregon 97520 ADDRESS: 13970 Fir St. Oregon City, OR 97045 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: 503-722-2998 DATE AGREEMENT PREPARED: 9-14-2015 FAX: 503-722-2988 BEGINNING DATE: 11-9-2015 COMPLETION DATE: 3-9-2016 COMPENSATION: Not to exceed $6,500 GOODS AND SERVICES TO BE PROVIDED: 8'x20' and 8'x30' mobile office rental including delivery, setup, tear down, pickup, and PPT ADDITIONAL TERMS: (See attached Addendum) 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 prima 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 27913.220, 27913.225, 27913.230, 27913.235, 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) which is limited to delivery, installation, removal and cleanup, but not any use or occupancy by the customer. Contractor shall not be held responsible for any losses, expenses, claims, subrogations, actions, costs, judgments, or other damages, directly, solely, and proximately caused by the negligence of City. 9. Termination: a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties. b. City's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing and delivered by certified mail or in person. C. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of Contract for Goods and Services Less than $25,000, Revised 06/02/2015, Page 1 of 5 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. N/A 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, $2,000,000, or Not Applicable for each accident for Bodily Injury and Property Damage, including coverage for owned, hired or non-owned vehicles, as applicable. Contract for Goods and Services Less than $25,000, Revised 06/02/2015, Page 2 of 5 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 1 By By Signature Department Head Print Name Print Name ~o 5 r`~ rEjt~' CF c) Title Date W-9 One copy of a W-9 is to be submitted with Purchase Order No. the signed contract. APP pS M la ty ttorney Date_ t t I r Contract for Goods and Services Less than $25,000, Revised 06/02/2015, 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 represents and warrants that throughout the duration of this Contract and any extensions, that it complies and will comply with all tax laws of this state and all applicable tax laws of any political subdivision of this state. Should Contractor breach this provision, City may terminate this contract and seek damages and other relief available under the terms of this contract or under applicable law. 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) 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. ?adc OAiL Sffa&"C~', TrV-'. 104011:5 Contractor (Date Contract for Goods and Services Less than $25,000, Revised 06/02/2015, Page 4 of 5 ADDENDUM TO CITY OF ASHLAND CONTRACT FOR GOODS AND SERVICES LESS THAN $25,000 Addendum made this day of 2015, between the City of Ashland ("City") and Pacific Mobile Structures ("Contractor"). Recitals: A. On 2015, City and Contractor entered into a "City of Ashland Contract for GOODS AND SERVICES LESS THAN $25,000" (further referred to in this addendum as "the Contract"). S. Contractor intends to use subcontractor for delivery of mobile structures and paragraph no. 13 of City of Ashland contract requires City to give written consent. City and Contractor agree to amend the agreement in the following manner: 1. "Additional Terms" are amended to read as folllows: "City approves Pacific Mobile Structures' use of subcontractor and approves automobile liability insurance in the amount ;T_$1,000,000, naming the City of Ashland as an additional insured, as approved by their individual insurance policies for business use for delivery of the mobile offices to the City of Ashland." 3. Except as modified above the terms of the Contract shall remain in full force and effect. Contractor: PACT 1 MOBILE ST UCTURES C~TY OF ASHLAND: BY- BY L Its D artmen Head Date ~fl I -T DATE a0 r S Purchase Order # Acct. No.: (For City purposes only) ASP jV ARM As and Ity Attorney DatA I- CITY OF ASHLAND, ADDENDUM TO CONTRACT FOR GOODS AND SERVICES Client#: 704959 PACIFMOB DATE (MM/DD/YYYY) ACORD,. CERTIFICATE OF LIABILITY INSURANCE 1/26/2015 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 NAME: US[ Northwest CL1 PHONE FAX A/C, No, Ext): 503 224-8390 A/c, o): 610 362-8130 700 NE Multnomah, Suite 1300 E-MAIL ADDRESS: angela-christiansen@usi.biz Portland, OR 97232 503 224-8390 INSURER(S) AFFORDING COVERAGE NAIC INSURER A: American Economy Insurance Comp 19690 INSURED INSURER B : American Insurance Company 21857 Pacific Mobile Structures Inc INSURER C : Liberty Northwest Insurance Cor 41939 P.O. Box 1404 INSURER D : 1554 Bishop Rd. INSURER E Chehalis, WA 98532 INSURER F : COVERAGES CERTIFICATE NUMBER: 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE - INSR- WVD _ POLICY NUMBER _MMIDD/YYYY) (MM/DD/YYYY1_ LIMITS A GENERAL LIABILITY 01C131839060 1/31/2015 01/31/201 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAG ESOEa NTT enee $200,0_0_0 1-1 _ CLAIMS-MADE OCCUR MED EXP (Any one person) $10,000 X WA Stop Gap $1MM PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 2,000,000 -1 POLICY X PRO- LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (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 B X UMBRELLA LIAB X OCCUR SU048773568 1/31/2015 01/31/201 EACH OCCURRENCE s5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 $ DED RETENTION $ wcsrAru-- OT1- C WORKERS COMPENSATION WC41NC018531 1/31/2015 01131/201 X ITQRY_LIMITS Y/N I ER--. A/MEMBER EXCLUDED? ELEACHACCIDENT _ $1,000,000_ N- (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,0_0_0 A Installation 01C131839060 1/31/2015 01/31/201 $1,000,0001$1000 Ded DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Ashland, Oregon, and its elected officials, officers and employees are additional insured as respects the operations of the named insured. CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S14232726/M14232429 RRBZP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1 10/19/2015 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 Andre y NAME: y Choice One Insurance PHONE (503) 387-'55211 q/C No: (503) 367-5750 .,C N 9111 SE Saint Helens St E-MAILADDREScustomerservice@choiceoneinsuranceinc.com INSURER(S) AFFORDING COVERAGE NAIC # Clackamas OR 97015 INSURERA:Northland Insurance Company 27987 INSURED INSURER B : Field Transportation, Inc INSURER C 10815 SW 135th INSURER D: INSURER E Beaverton OR 97008 INSURER F: COVERAGES CERTIFICATE NUMBER:AL/MTC 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 SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER !MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 100,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence A CLAIMS-MADE 1-1 OCCUR 3/17/15 3/15/16 MED EXP (Any one person) $ 5 , 000 160411 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO- LOC $ JECT AUTOMOBILE LIABILITY EOa aBIEDfSINGLE LIMIT 1,000,000 ANY AUTO BODILY INJURY (Per person) $ A ALL OWNED X SCHEDULED r160411 3/15/2015 3/15/2016 AUTOS AUTOS BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident Uninsured motorist combined $ 100,000 UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH-I FE AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Motor Truck Cargo 160411 3/15/2015 3/15/2016 Single Conveyance/$75,000 Deduct/1,000 Phsical Damage 16041 3/15/15 /15/16 Comp/Collision DED $1000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder named as Additional Insured as their interest may appear CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Andrey Shulik/PAMV ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn25 rvmnns m Thn Al"OPI1 name -11 Innn am rnniefnrerl mar4e of Arnpin PACIF35 OP ID: RS ACtI 'RO DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 01/23/2015 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). CONTACT PRODUCER Phone: 360-736-7601 NAME: Nicholson & Associates - 118 W. Pine Street Fax: 360-330-0970 sA/c°, No, Exn: - a/c Nol._ Centralia, WA 98531-4290 E-MAIL Todd Working ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: American States Insurance Co. 19704 INSURED Pacific Mobile Structures Inc INSURERS: Attn: Nick Ververis P.O. Box 1404 INSURER C Chehalis, WA 98532 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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. I LTR NSR TYPE OF INSURANCE ADDL UBR POLICY NUMBER MM/DDY/YYYY MMLDDY/YYYY LIMITS V1fVD i- - GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE COMMERCIAL GENERAL LIABILITY PREMISES ( S ( RENTED - Ea occurrence) $ CLAIMS-MADE . OCCUR MED EXP (Any one person) $ F L PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ - POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 it ~ ) $ A X ANY AUTO X 01C13162926 01/31/2015 01131/2016 BODILY INJURY ELY(Per _person) ALL OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS $ AUTOS NON OWNED rPROPERTY DAMAGE - HIRED AUTOS AUTOS ~racciden~ 1,000,000 - $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION WC STATU- ~OTH- ANDEMPLOYERS'LIABILITY TORY_LIMfTS.; ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ E L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E1 DISEASE EA EMPLOYEE If yes, describe under - - DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ i I DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Ashland, Oregon, and its elected officials, officers and employees as additional insured with respects to auto liability. Coverage is primary and non contributory. Job located at 95 Winburn Way Ashland, OR 97520 CERTIFICATE HOLDER CANCELLATION CITY059 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main St Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ® DATE (MM/DD/YYYY) A~ Ro CERTIFICATE OF LIABILITY INSURANCE 10/28/2015 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 NAME: Big Rigs Insurance, Inc. PHONN ,Ext: -503-759-3773 (A/C, No): 503-759-3774 - EMAIL 14510 S. Vaughan Rd AooRgss: bigrigsins@molalIa.net - Molalla, OR 97038 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: NATIONAL CASUALTY CO INSURED INSURERS: NORTHFIELD INSURANCE CO EDWARD L HUFF INSURER C DBA: MASTER MECHANICAL WORKS INSURERD: PO BOX 90457 INSURER E PORTLAND OR 97290 INSURER F : COVERAGES CERTIFICATE NUMBER: 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYW MM/DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY X WS218545 1 10/12/15 10/14/16 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED J CLAIMS-MADE E1OCCUR PREMISES (Ea occurrence) $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 s 2,000,000 GE_N'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ POLICYFJE PRODUCTS - COMP/OPAGG $ 2,000,000 X PROCT - LOC OTHER. $ A AUTOMOBILE LIABILITY X LT00019437 10/12/15 10/12/16 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident)___ _ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED X SCHEDULED j BODILY INJURY (Per accident) $ AUTOS AUTOS rROPERTYDAMAGE NON-OWNED $ _ HIRED AUTOS AUTOS r~Peraccident~__ ~ I $ l UMBRELLA LIAB OCCUR EACH OCCURRENCE - $ 4 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' ANFY PRO RIETOER/ ARTN RDE,XECUTIVE Y❑I N /A EL . EACH ACCIDENT ER 111 (Mandatory in NH) I E.L. D_ISEASE_ - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A CARGO LT00019437 10/12/15 10/12/16 LIMIT: $30,000 DEDUCTIBLE: $1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) THE CITY OF ASHLAND IS NAMED AS ADDITIONAL INSURED IN REGARDS TO THE ABOVE AUTO LIABILITY AND GENERAL LIABILITY POLICIES. CERTIFICATE HOLDER CANCELLATION CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 EAST MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND, OR 97520 ACCORDANCE WITH THE POLICY PROVISIONS. 541-552-2250 AUTHORIZED REPRESENTATIVE ©1988-2013 ACORD CORPORATION. All rights reserved. ACORD 25 (2013/04) The ACORD name and logo are registered marks of ACORD PACIFIC 8/20/2015 City of Ashland 20 East Main Street Ashland, OR 97520 RE: Quote 104291 Lonny Flora: Thank you for giving us the opportunity to provide you with a quote. We appreciate your business and look forward to being of further service to you and your company. ORDERING PROCESS: To schedule delivery, please check the box next to the unit and any additional items you wish to order and simply fax or e-mail the signed quote back to us. Upon receipt of the signed quote, an order confirmation will be sent to you summarizing your order and confirming your delivery date. Sincerely, Amy Hartnell ML 13970 Fir St. Oregon City, OR 503.722.2998 paciftmobile.com RENTAL QUOTE PACIRC Date: 8/20/2015 ; Quote Number: 104291 Lease Term: 5 Months Sales Consultant: Ron Young City of Ashland SITE ADDRESS P (503) 722-2998 F (503) 722-2988 20 East Main Street ron@pacificmobile.com Ashland, OR 97520 95 Winburn Way Lonny Flora 541-552-2250 Ashland, OR 97520 lonny.flora@ashland.or.us Date Needed: Description • Please check your desired unit(s) and options ® 08x20 08x30 Rental Rate 1 $175.00 1 Q $235.00 Steps - OSHA Compliant 1 $0.00 2 $0.00 Counter File 1 Q $0.00 1 21 $0.00 Plan Table(s) 1 0 $0.00 1 21 $0.00 Personal Property Taxes 1 Q $7.50 1 $9.00 Sec Bars - Window 3 $0.00 4 $0.00 Total monthly rental cost (checked items only) $182.50 $244.00 Delivery Freight 1 $1,100.00 1 $1,100.00 Standard Set 1 0 $60.00 1 $65.00 Damage/Cleaning Deposit 1 $0.00 1 $0.00 Total setup cost (checked items only) $1,160.00 $1,165.00 Return Freight 1 $1,100.00 1 Q $1,100.00 Standard Breakdown 1 Q $60.00 1 $65.00 Total return cost (checked items only) $1,160.00 $1,165.00 Damage Waiver ❑ $15.75 ® $21.15 Total property damage waiver cost (checked items only) T! L Note: Items manually checked will be reflected on your Order Confirmation. Two weeks notice required for pick up of building. t _ r_ I i lnt ca a .;l:. _i , i v argil ill _ - a ands rr; n ccs upO T,_ .,._..,I, Otis qi , - _ r,T1 a ; P',j_ "rn.r fly. ;±rti-~ili , c-mnd f;lE_ Customer Authorized Representative Date Page I of 2 P.O. Bo 1404 Chehalis VVA 98532 8 LEASE/RENTAL TERMS AND CONDITIONS This is an agreement between Pacific Mobile Structures, Inc. (PMSI) and Renter. I. Basic Terms/Quote Form - The basic terms of this Agreement, including but not 8. Accidents or Claims - Renter shall within 24 hours after any property damage or limited to, rental price, Renter's identity, are set forth in the cover letter and Quote casualty event involving the leased equipment notify PMSI by telephone, and within Form accompanying these Terms and Conditions. Additional terms and details 48 hours notify PMSI in writing. Said report shall state the time, place, and nature of agreed upon after Renter returned its signed Quote Form are set forth in the Order the event, the damage sustained, the names and addresses of persons involved, persons Confirmation. Renter acknowledges that absent written notice within 48 hours of injured and witnesses, and any other information relating to said event and it shall receiving the Order Confirmation, the additional terns and details therein are promptly forward to PMSI all correspondence, notices or documents received in deemed incorporated into this Agreement. The following terms and conditions also connection with any claim or demand relating to the leased equipment or its operation, apply to this Agreement. and shall aid in the investigation and defense of all such claims and demands. Nothing 2. Access/Site Conditions/Utility Service - Renter shall provide free and clear herein shall be deemed to modify the provisions of the paragraph herein in which access for delivery and return of leased equipment by standard mobile transport Renter holds PMSI harmless and indemnifies PMSI against all these matters, and vehicles. Renter shall provide firm and level ground on no more than six-inch slope PMSI shall have no responsibility to lake any action whatsoever in the event of such from one end to the other for safe installation of the leased equipment. Site selection casualty. is the sole responsibility of Renter and PMSI shall have no liability for determining 9. Nun-Liability of PNISI and Indemnification - Unless caused solely by PMSI's the adequacy of any site. Furthermore, PMSI solely reserves the right, for any negligence, PMSI shall not be liable to Renter for any loss, damage, or expense of any reason, to refuse to release delivery to any site it deems inadequate for use or kind or nature caused directly or indirectly by the leased equipment or by the use, installation. Renter shall be responsible for obtaining any permits required to install maintenance, operation, handling or storage thereof, or for the loss of Renter's and operate the equipment. Renter shall provide at Renter's expense adequate business or damages whatsoever or howsoever caused. Renter does hereby indemnify electrical power, water and other utility services with proper connection to leased PMSI and holds PMSI, its agents and employees harmless from any and all losses, equipment. damages, claims, demands, or liability of any kind whatsoever, including legal 3. Other Fees, Expenses and Taxes - In addition to the rental payments provided expenses and attorney's fees arising from the use, condition or operation of the leased for herein, Renter shall pay all expenses, fees, charges, and fuel surcharges incurred equipment. in connection with the leased equipment during its delivery, use and recovery. 10. Maintenance, Damage and Destruction - Renter shall at Renter's own expense Additional charges include, but are not limited to, the following instances: ( I ) where at all [lines keep the equipment in good and efficient working order, condition and travel permits and/or pilots are required for deliverv~ (2) where the delivery site is repair and shall maintain thereon such identification of ownership as PMSI may not a level compacted and accessible site: (3) where tie downs are required - if the require. PMSI will maintain and make any repairs required from normal use to the tie down ontion is not taken Renter assumes liability: (4) where alternate steps are roof, doors, windows, light fixtures, heating, ventilating and air conditioning systems, needed (temnorarv step furnished but steps may not meet all local codes). In except that Renter shall replace heating, ventilating and air conditioning filters and addition return costs are to be at the prevailing rate at termination of lease, thus they burnt ,out lamps as required and pay for any damage caused by the Renter. Renter are subject to change depending on special circumstances such as fuel costs and shall bear the risk of damage, theft or destruction of the leased equipment from every delivery routes Sales tax is not included in the return freight deposit and will be cause. except as outlined in paragraph 7, if selected, and shall make all replacements, billed on the final invoice. Renter also agrees to pay any fines, servicing costs, sales repairs or substitution of parts of equipment thereon at its expense, all of which shall taxes, use taxes, personal or real property taxes and other use taxes, and all constitute Renter's obligatory maintenance of the leased equipment. if Renter does not assessments and other governmental charges whatsoever payable on Renter's use, adequately maintain the equipment or adequately repair any damage for which Renter possession, rental, shipment, transportation, delivery or operation thereof. An early is responsible, PMSI shall have the option to perform the maintenance or repair at termination fee may be assessed if lease is cancelled prior to the term end date. Renter's expense. Renter shall at its expense provide adequate janitorial service to 4. Delivery by PMSI / Location and Return of Leased Equipment - PMSI shall keep the leased equipment in good condition, fair wear and tear excepted. On not be liable to Renter for any failure or delav in delivering the leased equipment, termination of this lease, the leased equipment shall be returned to PMSI in the same By taking delivery thereof Renter acknowledges that the leased equipment is in good condition as when delivered, fair wear and tear excepted. working condition, free of any physical defect or damage, and is fit for the purpose 1. Inspection by PMSI - PMSI may inspect the leased equipment at any reasonable leased siteased time, and may post any notice of non-responsibility or interest protecting notice. until for the which it is leased termination . of this Further, the lease, at leased which time equipment shall PMSI shall remain piatck the up the delivery equipment. The leased equipment shall not be moved without PMSI's prior written 12. Default - Renter defaults on this Agreement if Renter fails to: make timely consent. Two weeks' notice is required prior to equipment return date. payment of any rent installment or other amount due and payable; or, comply with the 5. Lawful Use, Assignment, and Subletting - Renter shall use or permit the use of other terms, covenants, or conditions herein. Default also occurs if Renter or its the leased equipment only for lawful purposes and operate in compliance with all creditors files for relief under any, bankruptcy Or similar debtor relief law. or if Renter laws. If the leased equipment is used by m party association with unlawful assigns for the benefit of creditors, or if a receiver is appointed to take possession of Renter agrees to reimburse PMSI upon any y assets of Renter. Upon default, PMSI may at its option immediately terminate activity prior to it being returned to PMSI, any demand for any and all incidental costs PMSI incurs, including, but not limited to, Renter's right to possession of the leased equipment by giving written notice to Renter. time and cost expenses associated with participating in governmental administrative This right is not limited in instances where the unit is being used as commercial office or law enforcement processes, attorney fees, and remedial costs. Renter shall not space or for any other commercial purposes. Renter agrees that the essence of this assign, transfer, sublet, or in any way assign its rights hereunder, and shall not Agreement is that PMSI is leasing equipment. Renter's use of such equipment as pledge, permit to be liened, mortgage, or otherwise encumber its rights or interests commercial office snace or other commercial use is incidental. The leased emunment hereunder. All third-party claims of possession, interest or ownership outside those shall remain personal property regardless of its use or manner of attachment to realty of PMSI's or the Renter, as stated herein, shall be deemed invalid. and real nronerly laws do not apply to this Agreement. Unon PMSI's written notice 6. Insurance - Renter, at its expense, will obtain and keep in force Property damage of default to Renter, Renter agrees that the leased equipment shall be surrendered to insurance-special form, replacement cost coverage, with PMSI added as loss payee, PMSI and PMSI may take possession thereof by entering upon Renter's premises ATIMA. Renter will also indemnify PMSI with respect to all liability in accordance without further notice of repossession. Upon repossession, PMSI shall retain all rents with the provision of Paragraph 9 and provide general liability protection in the and any other amounts paid by Renter hereunder. Repossession by PMSI or the amount of $1,000,000 each occurrence listing PMSI as additional insured. If Renter surrender of the leased equipment to PMSI shall not affect the right of PMSI to shall fail to produce the required property insurance coverage certificate within ten recover from Renter any and all damages which PMSI shall have sustained by reason (10) days from the commencement of the Lease, they are automatically opted into of Renter's breach. PMSI reserves the right to (a) relet the leased equipment and apply the Property Damage Waiver Program referenced in Section 7 until proof is any net proceeds as an offset to any unperformed Renter term, or (b) sell file leased presented, equipment and apply the net proceeds as appropriate under the circumstances to 7. Property Damage Waiver Program Option - Renter's participation in the Renters unperformed financial obligations, or (c) cancel and terminate the lease. In Property Damage Waiver program relieves the requirement that Renter provide addition to any other remedies provided for herein, PMSI may recover from Renter the PMSI with a property damage insurance certificate, as required in the preceding worth at the time of the termination of the lease the unperformed value of the lease. Insurance paragraph. However, general liability insurance still needs to tie 13. Renter's Possession on Termination - If Renter retains possession of the leased submitted tier the prior parauranh's requirements. Moreover, the waiver fee is properly beyond the term expiration date without proper written renewal notice, PMSI not an insurance policy, as Pacific Mobile in not an insurance contnanv. The shall have the option of (i) repossessing its property at any time without notice or (it) waiver is specifically for the unit listed and solely limits the customer's property deeming this Agreement renewed as a month to month tenancy. liability in regard to fire, theft, vandalism and malicious mischief. The 14. Attorney's Fees, Collection Fees, Costs, Interest - ]f Renter defaults on this following limitations also apply: The Renter is resnonsible for a $2,000 property Agreement, PMSI shall be entitled to recover from Renter all items of damages, costs damage deductible, per unit/per loss occurrence. The waiver fee only covers the and expenses, including court costs and reasonable attorney's fees, incurred by PMSI unit itself', and Renter is responsible for insuring the contents. The waiver does not to enforce its rights and remedies hereunder. PMSI shall also be entitled to interest on apply if the yrotierty damage is caused by any of the following: acts of God delinquent payments at the maximum rate permitted by law. (earthquake, seismic activity, high winds, hurricane, tornado, flood), acts of 15. Miscellaneous - This Lease shall be construed and interpreted under the laws of terrorism, building contents, damages caused by Renter or its employees, collision the state of Washington. All signed copies shall constitute duplicate originals. damage from vehicles and other equipment, collision damage while being 16. Notices - All notices required under the term and provision of the Lease shall be transported or moved, abuse or neglect by Renter. 'rhe responsibility for property in writing and shall become effective when: deposited in the United States mail, Nvith damage due to these perils is on the Renter. Cancellation: Lather party can cancel proper postage prepaid, addressed to the parties at the respective addresses appearing the waivers with 10 days prior written notice. If the waivers are canceled, the herein; and/or, upon actual delivery by other means, including electronically. customer must provide insurance. The waiver fees must be paid in order for this option to be valid. If the customer fails to pay their rent or the waiver fees the waivers are terminated automatically. Claims: Must be reported by fax or email within 48 hours of their occurrence for the Property damage waiver to be valid. Floor Plan: 8'x20' Off ice Floor plans mEry vary accorrding to buiding model, size and speaficatiorra. Irtericr partitioning is optional and fuly cusiomizat:le. L' , S SPECIFICATIONS: • Built in worktable with file cabinet = Meted entry doors writh dwAboclts • Commercial grade carpet and file floors • Acoustical sound dampening ceilings • Yirrgl wrap interior walls • Built to the state commercial building code Floor Plan: 8'x30' Office Floor plans may vary according to building model. size and specifications. Interior partitioning is optional and fully customizable. i j I ~r w SPECIFICATIONS: • Ducted heating and air conditioning • Metal entry doors with deadbolts • Commercial grade carpet and the floors • Acoustical sound dampening ceilings • Vinyl wrap interior walls • Built to the state commercial building code IRACIFIC ACCOUNTING & BILLING INFORMATION Billing Address Information: Please be sure to include any special mailing instructions Attn: j This is an update to existing billing information I am a new customer with Pacific Mobile Structures I wish to have my invoices emailed to: Please include contact information regarding billing or payment information Accounting or Accounts Payable contact information: Name: Phone: Fax: Any additional billing information specific to this lease: P.O. Box 1404 Chehalis. VVA 98532 8()0.2256539. pacifimobile.com MACIFIC ACCESSORIES PRICE LIST ' Pricing below represents price per item per month. When ordering please write or type the qty in each box. QTY QTY QTY QTY $4.00/ea $3.00/ea f $10.00/ea SIS-00lea ELM l Stackable Chair typically padded Armless Folding Chair Rolling Chair Desk Standard 30"x60" Steel QTY QTY QTY QTY $25.00/ea $s.o0(ea $50.00/ea $27x00/ea 4' counter QTY} f h $60.00/ea 5' counter 12 month lease required Desk & Rolling Chair Combo Plan Table Coffee Bar w/ 15'x15' sink 4' r.v.,Upper cabinet 4'-S' - no electrical included r m Standard 36 depth Coffee Bar w/ 15"x15" sink 5' c;i _ ~waen QTY QTY QTY QTY $10.00/ea 51000/ea $15.OO/ea $5.00/ea _.II T I 1 5'-8' Folding Table 2-Drawer File Cabinet 4-Drawer File Cabinet Security Door Bar plastic or laminate Letter size; legal upon request Letter size; legal upon request QTY QTY QTY QTY $10.00/ea " - "7 $IS00/ea $20.00lea S10.Mea J!7 1 + _ T Bookcase 48" Bookcase 60"-72 Storage Cabinet Security Window Bars 3-4 shelf 5-6 shelf 36"x72"x18" - typicaly metal all windows included Please choose any needed items from the list of accessories. Email or Fax to your Sales Representative to add to your lease by indicating quantity. All items subject to available inventory. Prices shown are suggested and may vary based on quantity or other conditions. P.O. Box 1404 Chehalis WA 98532 800.225.6539. pacifici-nobile.com Page 1 / 1 ASHLAND PARK COMMISSION 20 E MAIN ST. DATE PO NUMBER ASHLAND, OR 97520 11/10/2015 00520 (541) 488-5300 VENDOR: 004545 SHIP TO: PACIFIC MOBILE STRUCTURES INC PO BOX 1404 CHEHALIS, WA 98532 FOB Point: Ashland, Oreqon Req. No.: Terms: net Dept.: Req. Del. Date: Contact: Lonny Flora Special Inst: Confirming? NO Quantity Unit Description Unit Price Ext. Price Mobile Office Rental for 2015-2016 Ice 6,500.00 Rink Season 8'x20' and 8'x30' Mobile Office Rentals Contract for Goods and Services Beginninq date: 11109/2015 Completion date: 03/09/2016 i SUBTOTAL 6,500.00 BILL TO: TAX 0.00 FREIGHT 0.00 TOTAL 6,500.00 Account Number Project Number Amount Account Number Project Number Amount E 211.12.03.02.60691 E 000007.999 6,500.00 VENDOR COPY Author ed Signature COPY FORM #3 CITY OF d~RU u, Ord SHLAND REQUISITION Date of request: O- Required date for delivery: Vendor Name t - f l - Address, City, State, Zip 7C) 9719 Contact Name & Telephone Number Fax Number B 722 Y 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 Attach co of council communication If council approval required, attach co of CC ❑ Small Procurement Cooperative Procurement - Less than $5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon Date approved by Council: ❑ Direct Award -(Attach copy of council communication) 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 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 . (Attach copy of council communication) Description of SERVICES Total Cost mob t l C Off t'c e ~n fia 1 fc~{ ~oIS-!6 6)500 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST ❑ Per attached quotelproposal $ Project NumberQ0Q002- _q,3Q Account Number,21Z - -j3-.02- a.~l Q6-91S" - Account Number--- Account Number 'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: IT Director Date Support-Yes/No By signing this requisition form, I certify that the City's public contracting requirements have been satisfied. Employee: 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., cYt~ll NO / ell Finance Director- (Equal to or reaterthan $5,000) Date Comments: Form #3 - Requisition