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HomeMy WebLinkAbout2020-018 20200266 Polaris Land SurveyingSERVIUES AUKLl+.tV1EA l ASN� itsD 0 20 East Main Street Ashland, Oregon 97520 Telephone: 541/488-5587 Fax: 541/488-6006 CONSULTANT: Polaris Land Surveying, LLC CONTACT: Shawn Kampmann ADDRESS: PO Box 459 Ashland, OR 97520 TELEPHONE: (541) 482-5009 EMAIL: Shawn@polarissurvey.com This Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and. Polaris Land Surveying, LLC ("hereinafter "Provider"), for land surveying consulting at Ashland Creek Park. 1. PROVIDER'S OBLIGATIONS 1.1 Provide surveying services as needed as set forth in the "SUPPORTING DOCUMENTS" attached hereto and, by this reference, incorporated herein. Provider expressly acknowledges that time is of the essence of any completion date set forth in the SUPPORTING DOCUMENTS, and that no waiver or extension of such deadline may be authorized except in the same manner as herein provided for authority to exceed the maximum compensation. The services defined and described in the "SUPPORTING DOCUMENTS" shall hereinafter be collectively referred to as "Work." 1.2 Provider shall obtain and maintain during the terrri of this Agreement and until City's final acceptance of all Work received hereunder, a policy or policies of liability insurance including commercial general liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 (two million dollars) per occurrence for Bodily Injury and Property Damage. 1.2.1 The insurance required in this Article shall include the following coverages: • Comprehensive General or Commercial General Liability, including personal injury, . contractual liability, and products/completed operations coverage; and • Automobile Liability. 1.2.2 Each policy of such insurance shall be on an "occurrence" and not a "claims made" form and shall: • Name as additional insured "the City of Ashland, Oregon, its officers, agents and employees" with respect to claims arising out of the provision of Work under this Agreement; • Apply to each named and additional named insured as though a separate policy had been issued to each, provided that the policy limits shall not be increased thereby; • Apply as primary coverage for each additional named insured except to the extent that two or more such policies are intended to "layer" coverage and, taken together, they provide total coverage from the first dollar of liability; • Provider shall immediately notify the City of any change in insurance coverage • Provider shall supply an endorsement naming the City, its officers, employees and agents as additional insureds by the Effective Date of this Agreement; and • Be evidenced by a certificate or certificates of such insurance approved by the City. Page 1 of 5: Agreement between the City of Ashland and Polaris Land Surveying LLC 1.3 Provider shall, at its own expense, maintain Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide workers' compensation coverage for all of its subject employees. 1.4 Provider agrees that no person shall, on the grounds of race, color, religion, creed, sex, marital status, familial status or domestic partnership, national origin, age, mental or physical disability, sexual orientation, gender identity or source of income, suffer discrimination in the performance of this Agreement when employed by Provider. Provider agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. Further, Provider agrees not to discriminate against a disadvantaged business enterprise, minority -owned business, woman - owned business, a business that a service -disabled veteran owns or an emerging small business enterprise certified under ORS 200.055, in awarding subcontracts as required by ORS 279A.110. 1.5 In all solicitations either by competitive bidding or negotiation made by Provider for work to be performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Providers of the Provider's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 1.6 Living Wage Requirement: If the amount of this Agreement is $21,127.46 or more, Provider is required to comply with Chapter 3.12 of the Ashland Municipal Code by paying a living wage, as defined in that chapter, to all employees performing Work under this Agreement and to any subcontractor who performs 50% or more of the Work under this Agreement. Provider is also required to post the notice attached hereto as "Exhibit A" predominantly in areas where it will be seen by all employees. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider the sum of $3,310.00 provided herein as full compensation for the Work as specified in the SUPPORTING DOCUMENTS. 2.2 In no event shall Provider's total of all compensation and reimbursement under this Agreement exceed the sum of $3,310.00 (three thousand three hundred and ten dollars) without express, written approval from the City official whose signature appears below, or such official's successor in office. Provider expressly acknowledges that no other person has authority to order or authorize additional Work which would cause this maximum sum to be exceeded and that any authorization from the responsible official must be in writing. Provider further acknowledges that any Work delivered or expenses incurred without authorization as provided herein is done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement. 3. GENERAL PROVISIONS 3.1 This is a non-exclusive Agreement. City is not obligated to procure any specific amount of Work from Provider and is free to procure similar types of goods and services from other providers in its sole discretion. 3.2 Provider is an independent contractor and not an employee or agent of the City for any purpose. 3.3 Provider is not entitled to, and expressly waives all claims to City benefits such as health and disability insurance, paid leave, and retirement. Page 2 of 5: Agreement between the City of Ashland and Polaris Land Surveying LLC 3.4 All Work product or documents produced in furtherance of this Agreement belong to the City, and any copyright, patent, trademark proprietary or any other protected intellectual property right shall vest in and is hereby assigned to the City. 3.5 This Agreement embodies the full and complete understanding of the parties respecting the subject matter hereof. It supersedes all prior agreements, negotiations, and representations between the parties, whether written or oral. 3.6 This Agreement may be amended only by written instrument executed with the same formalities as this Agreement. 3.7 The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 27913.220, 27913.230 and 27913.235: 3.7 This Agreement shall be governed by the laws of the State of Oregon without regard to conflict of laws principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is in federal court, in which case exclusive venue shall be in the federal district court for the district of Oregon. Each party expressly waives any and all rights to maintain an action under this Agreement in any other venue, and expressly consents that, upon motion of the other party, any case may be dismissed or its venue transferred, as appropriate, so as to effectuate this choice of venue. 3.8 Provider shall defend, save, hold harmless and indemnify the City and its officers, employees and agents from and against any and all claims, suits, actions, losses, damages, liabilities, costs, and expenses of any nature resulting from, arising out of, or relating to the activities of Provider or its officers, employees, contractors, or agents under this Agreement. 3.9 Neither party to this Agreement shall hold the other responsible for damages or delay in performance caused by acts of God, strikes, lockouts, accidents, or other events beyond the control of the other or the other's officers, employees or agents. 3.10 If any provision of this Agreement is found by a court of competent jurisdiction to be unenforceable, such provision shall not affect the other provisions, but such unenforceable provision shall be deemed modified to the extent necessary to render it enforceable, preserving to the fullest extent permitted the intent of Provider and the City set forth in this Agreement. 4. SUPPORTING DOCUMENTS 4.1 The following documents are, by this reference, expressly incorporated in this Agreement, and are collectively referred to in this Agreement as the "SUPPORTING DOCUMENTS:" • The Provider's invoice dated November 7, 2019. 4.2 This Agreement and the SUPPORTING DOCUMENTS shall be construed to be mutually complimentary and supplementary wherever possible. hi the event of a conflict which cannot be so resolved, the provisions of this Agreement itself shall control over any conflicting provisions in any of the SUPPORTING DOCUMENTS. In the event of conflict between provisions of two of the SUPPORTING DOCUMENTS, the several supporting documents shall be given precedence in the order listed in Subsection 4.1. Page 3 of 5: Agreement between the City of Ashland and Polaris Land Surveying LLC 5. REMEDIES 5.1 In the event Provider is in default of this Agreement, City may, at its option, pursue any or all of the remedies available to it under this Agreement and at law or in equity, including, but not limited to: 5.1.1 Termination of this Agreement; 5.1.2 Withholding all monies due for the Work that Provider has failed to deliver within any scheduled completion dates or any Work that have been delivered inadequately or defectively; 5.1.3 Initiation of an action or proceeding for damages, specific performance, or declaratory or injunctive relief; 5.1.4 These remedies are cumulative to the extent the remedies are not inconsistent, and City may pursue any remedy or remedies singly, collectively, successively or in any order whatsoever. 5.2 In no event shall City be liable to Provider for any expenses related to termination of this Agreement or for anticipated profits. If previous amounts paid to Provider exceed the amount due, Provider shall pay immediately any excess to City upon written demand provided. 6. TERM AND TERMINATION 6.1 Term. This Agreement shall be effective from, the date of execution on behalf of the City as set forth below (the `Effective Date') and shall continue in full force and effect until June 30, 2020, unless sooner terminated as provided in Subsection 6.2. 6.2 Termination 6.2.1 The City and Provider may terminate this Agreement by mutual agreement at any time. 6.2.2 The City may, upon not less than thirty (30) days' prior written notice, terminate this Agreement for any reason deemed appropriate in its sole discretion. 6.2.3 Either party may terminate this Agreement, with cause, by not less than fourteen (14) days' prior written notice if the cause is not cured within that fourteen (14) day period after written notice. Such termination is in addition to and not in lieu of any other remedy at law or equity. NOTICE Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery, by sending via a reputable commercial overnight courier, or by mailing'using registered or certified United States mail, return receipt requested, postage prepaid, to the address set forth below: If to the City: City of Ashland — Ashland Parks and Recreation Department Attn: Jason Minica 20 E. Main Street Ashland, Oregon 97520 Phone: (541) 552-2254 With a copy to: City of Ashland — Legal Department 20 E. Main Street Ashland, OR 97520 Phone: (541) 488-5350 Page 4 of5: Agreement between the City of Ashland and Polaris Land Surveying LLC If to Provider: Polaris Land Surveying, LLC Attn: Shawn Kampmann PO Box 459 Ashland, OR 97520 (541)482-5009 8. WAIVER OF BREACH One or more waivers or failures to object by either party to the other's breach of any provision, term, condition, or covenant contained in this Agreement shall not be construed as a waiver of any subsequent breach, whether or not of the same nature. 9. PROVIDER'S COMPLIANCE WITH TAX LAWS 9.1 Provider represents and warrants to the City that: 9.1.1 Provider shall, throughout the term of this Agreement, including any extensions hereof, comply with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider; and (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.1.2 Provider, for a period of no fewer than six (6) calendar years preceding the Effective Date of this Agreement, has faithfully complied with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider; and (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.2 Provider's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Provider's warranty, as set forth in this Article 9, shall constitute a material breach of this Agreement. Any material breach of this Agreement shall entitle the City to terminate this Agreement and to seek damages and any other relief available under this Agreement, at law, or in equity. IN WITNESS WHEREOF the parties have caused this Agreement to be signed in their respective names by their duly authorized representatives as'of the dates set forth below. Page 5 of 5: Agreement between the City of Ashland and Polaris Land Surveying LLC CITY OF ASHLAND: By: " p Sa Printed Jame -��"Date Polaris Land Surveying, LLC By:+� ��,-- Signature 5" Printed Nafne f yl +il�C i lily ! �u 1Lc r l:1 �n� S ✓vwo L� r Ze /q'� pqi 44 Title 1/ (y{� Date Purchase Order No. a 4� (w-9 is to be submitted with this signed Agreement) LE Page 6 of 5: Agreement between the City of Ashland and Polaris Land Surveying LLC ACC>REPCERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/14/2018 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 Jon Snowden StateFarm Jon Snowden, Agent : NAMEPHONE (541) 482-2461 FAX (541) 482 4957 420 Bridge St E-MAIL A/c No Ashland, OR 97520 ADDRESS: Jon@jonsnowden.com INSURED Polaris Land Surveying, LLC PO Box 459 Ashland, OR 97520 INSURER A: State Farm Fire and Casualty Company 25143 INSURER B : State Farm Mutual Automobile Insurance Company 25178 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIC IC Tr) r•COT1cV Tun rum' INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CQNDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOLICY WHICH THIRHOS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE. AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY ALL THE TERMS, PAID CLAIMS. INSR ADDL SUBR POLICY EFF LTR TYPE OF INSURANCE POLICY N POLICY EXP (MMIDDrYYYYI LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR EACH OCCURRE E $ 1,000,000 AMEMISA T RENT PRES Ea occurf nce $ 300,000 A Y 97-B6-K806-7 05/07/2018 MED EXP (Any one pe on) $ 5,000 /007/2019 PERSONAL&ADVIN RY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑PRO - LOC ER GENAL AGGREG E $ 2,000,000 JECT PRODUC TS-COMP PAGG $ OTHER: AUTOMOBILE LIABILITY L23 4521-D30-37H 10/30/2018 04/30/2019 COMBINED SINGL LIMIT $ 1,000,000 ANY AUTO Ea accident B OWNED SCHEDULED BODILY INJURY er person) $ AUTOS ONLY AUTOS HIRED NON -OWNED 090 4953-B09-37E 08/09/2018 02/09/2019 BODILY INJURY Per accident) $ PROPERTY D AGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EXCESS LIAB EACH OCC RRENCE $ AGGREG E $ CLAIMS -MADE DED RETENTION $ WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY YIN P ATUTE ERH A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A I 97-CE-T866-3 05/0 /2018 05/05/2019 E.L. CH ACCIDENT $ SOO,000 (Mandatory in NH) E.. DISEASE - EA EMPLOYE $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below .L. DISEASE -POLICY LIMIT $ 500,000 V DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attache more Land Surveying - 151 Clear Creek Dr Ste 101 & 201 Ashland, OR 97520 sp is require r`CDTICIr`ATC unl n�r� CITY OF ASHLAND OREGON AND ITS ELECTED OFFICIALS OFFICERS & EMPLOYEES 20 E MAIN ST Ashland OR 9752D SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE v T aub$-ZU15 ACUKI) CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.12 03-16-2016 '`lk ® a CERTIFICATE OF LIABILITY INSURANCE DATE DDIYYYY) ''-� 7/3/ 7/3/2918 THIS CERTIFICATE 1S 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: Jaci Pierce Assurance Risk Managers, Inc. -PHONEU (303)454-9562 q/c,No1; (303)454-9564 10651 East Bethany Drive EMAIL eztracs@arm-i.com ADDRESS; Suite 300 INSURER1.S AFFORDING COVERAGE NAIC 11-) Aurora CO 80014-2688 INS.URERA Hanover Insurance Company- 22292 INSURED ... __....._ INSURER B : Polaris Land Surveying LLC INSURER C P O Box 459 INSURER D : INSURER E: Ashland OR 97520-0016 INSURERF: COVFRArlFS f CDTICI! ATC err leeo�o.� o_� 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. INSRi 'ADDL 90BR. . _ __..__—f"_POLICY EFF .. __...___- . .. LTR ; TYPE OF INSURANCE POLICY EXP— IN D WVD POLICY NUMBER MMIDD/YYYY MMIDD(YYYY LIMITS COMMERCIAL GENERAL LIABILITY I!CLAIMS-MADE I I OCCUR EACH OCCURRENCE_ S PREMISES (Ea occurrence) _ S 1 i MED EXP (Any one person) —..---------------. S _..... .. I PERSONAL & ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE S POLICY I PRO- JECT I__-- I LOC PRODUCTS - COMP/OP AGG S I OTHER, S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S -- AUTO Ea accident _ - BODILY INJURY ...�ANY _ (� ALL OWNED SCHEDULED AUTOS AUTOS (Per person) BODILY INJURY (Per accident) 5 S HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE S _(Peraccigent) .. S UMBRELLA LIAR OCCUR EXCESS LIAR J IM$-MADE l IC EACH OCCURRENCE S _._ . -----__.__. f _1 . _ -.._.._- - -. ATE S I DED RETENTIONS S WORKERS COMPENSATION P OTH- AND EMPLOYERS' LIABILITY YIN -• _ _,_ S TUT ..._ _ I ER, ANY PROPRIETOP./PARTNER/EXECUTIVE --1 OFFICERiMEMBER EXCLUDED? NIA / E L E H AC (DENT --�.-_-_-- —. _ _ _ ..... S .. .._ .. _ _.. .. .. _ (Mandatory in NH) f yes. describe under E L. DISEASE EA EMPLOYE_ _5 DESCRIPTION OF OPERATIONS below I E.L. DISEAS • POLICY LIMIT I S A !Professional Liability LH4 A349055 04 6/28/201B 6/28/2019 Per Made Form /Cla$1,000,000Claims Anngale $2 00,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may attached if more space is require N City of Ashland, Oregon and It's Elected Officials, Officers & Employees 20 E. Main St. Ashland, OR 97520 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Lisa Isom/LAURA (0 1983-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) Bill TO, - Ashland Parks & Recreation Department 1195 East Main Street Ashland, Oregon 97520 Attn: Jason Minica Date: November 7, 2019 Re: Ashland Creek Park Survey 27 Hersey Street, Ashland Map #391E04CA, TL's 4500 & 5000 DESCRIPTION QTY/HOURS RATE AMOUNT OFFICE: RESEARCH / CORRESPONDENCE 3.5 80.00 280,00 PRINCIPAL LAND SURVEYOR 3.0 130.00 390.00 PROFESSIONAL COMPUTATIONS 1.5 100.00 150.00 DRAFTING / LEGALS / REPORTS 3.0 80.00 240.00 FIELD: SURVEY FIELD CREW ( STANDARD) 15.0 150.00 2250.00 THANK YOU! TOTAL: $ 3,310.00 Payable upon Receipt REMITTANCE Previous Invoice $ 0.00 Payments: $ 0.00 This Invoice $ 3,310.00 Amount Due: $ 3,310.00 Statement #: 001 Project No.1274-19 Email: contact@polarissurvey.com P. O. Box 459. A.ghiand, Oregon 97520 A Phone: (541) 4,92-5009 Fax: (541) 465-0797 Mobile: (541) 6071-3000 www.poiarigeurve,y com AS 9y v � 25 O B Ashland Parks Commission I ATTN: Accounts Payable L 20 E. Main L Ashland, OR 97520 T Phone:541/552-2010 O Email: payable@ashland.or.us V E POLARIS LAND SURVEYING LLC N PO BOX 459 DO ASHLAND, OR 97520 R Purchase Order S C/O Parks Department H .Admin Office 1 P 340 South Pioneer Ashland, OR 97520 T Phone:541/488-5340 0 Fax:541/488-5314 541 482-5009 Jason Minica 11/20/2019 604 FOB ASHLAND OR Parks Accounts Pa able Survey Ashland Creek Park 1 Research and surveying for Ashland Creek Park 1 $3,310.0000 $3,310.00 Services Agreement (less than $25,000) Completion date: 06/30/2020 Project Account: E-000743-999 $3,310.00 GL SUMMARY 123000 - 704200 $3,310.00 By: Dater Authorized Signature _= $3,310.00 FORM #3 A request for a F''�]V':jlase REQUISITION Vendor Name Polaris Land Surveying, LLC Address, City, State, Zip PO Box 459, Ashland OR 97520 Contact Name Shawn Kampmann Telephone Number (541) 482-5009 Email address Shawn Opolarissurvey.com cn� �or►�w�r_ nmc runn Date of request: CITY OF ASHLAND 11/13/2019 ❑ Exempt from Competitive Bidding ❑ Invitation to Bid ❑ Emergency ❑ Form #13, Written findings and Authorization ❑ Reason for exemption: ❑ AMC 2.50 Date approved by Council: copy of council communication) ❑ Written quote or proposal attached ❑ Written quote or proposal attached _(Attach If council approval required, attach copy of CC ❑E Small Procurement ❑ Request for Proposal Cooperative Procurement Not exceeding $5,000 Date approved by Council: ❑ State of Oregon R Direct Award copy of council communication) Contract # ❑ VerballWritten quote(s) or proposal(s) _(Attach ❑ Request for Qualifications (Public Works) Date approved by Council: (Attach copy of council communication) ❑ State of Washington Contract # ❑ Other government agency contract Intermediate Procurement GOODS & SERVICES Agency Greater than $5,000 and less than $100,000 ❑ Sole Source El Applicable Form (#5,6, 7 or 8) Contract # Intergovernmental Agreement ❑ (3) Written quotes and solicitation attached PERSONAL SERVICES ❑ Written quote or proposal attached Form Agency Greater than $5,000 and less than $75,000 ❑ Form #4, Personal Services >$5K & <$75K El Annual cost to City does not exceed $25,000. ❑ Direct appointment not to exceed $35,000 ❑(3) Written proposals/written solicitation ❑ Special Procurement Agreement approved b Legal and approved/signed b g pp y gy ❑ Form #4, Personal Services >$5K & <$75K ❑ Form #9, Request for Approval El written quote or proposal attached City Administrator. AMC 2.50.070(4) Date approved by Council: ❑Annual cost to City exceeds $25,000, Council Valid until: (Date) approval required. (Attach copy of council communication) Description of SERVICES Irotal cost Research and surveying for Ashland Creek Park $ 3,310.00 Item # Quantity Unit Description of MATERIALS Unit Price Total cost ❑ Per attached quote/proposal Expenditure must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately. 3310.00 Project Number OQ61g3 _ -1c� Account Number 123000 _KI . 704200 _ $ _ _ _ 3,3 1 0_ 0 CJ3 Project Number _____--- __ Account Number _____--- _____ $_,___,___ Project Number _____--- __ Account Number ______-______ $_,___,___�__ IT Director in collaboration with department to approve all hardware and software purchases. By signing this requisition f I certify that t .ty's public contracting requirements have been satisfied. IT Director D Support -Yes/ No Employee: Department Head: (Equal to or greater than $5,000) DepartmentantlSupervisor: City Administrator: (Equal to or greater than $25,000) Funds appropriated for current fiscal year: YES / NO Finance Director- (Equal to or greater than $5,000) Date Comments: orm tf3 - Kariann Olson From: Kariann Olson Sent: Thursday, November 21, 2019 4:33 PM To: Jason Minica Cc: Kariann Olson Subject: Polaris insurance expired Attachments: Blanket additional insured sample.pdf; Sample certificate.pdf; Specific additional insured endorsement sample. pdf Hello Jason, I have attached an example of the insurance and additional insured endorsements required by the City. With Personal Services Agreement, you will also need professional liability. The insurance certs attached to request for a PO to be issued to Polaris are expired. Thank you. Kariann PS Did I talk to you about my tram adventure at Wallowa Lake ... eeeek! Kariann Olson Purchasing Representative City of Ashland 90 N. Mountain Ave. Ashland, Oregon 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. 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.