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.