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HomeMy WebLinkAbout2000-108 CONT Chg Order -Tobiasson Excavaton CITY OF ASHLAND DEPARTMENT OF PUBLIC WORKS CONTRACT CHANGE ORDER No. Z I Project: SISKIYOU BLVD. SANITARY SEWER Date: JULY 31, 2000 Location: SISKIYOU BLVD - INDIANA TO WALKER Project: 99-23 Contractor: TOBIASSON EXCAVATION You are requested to perform the following described work upon receipt of an approved copy of this document or as directed by the Engineer: Item Description Quantity Unit Price Amount No. STA 13 +00 to 14 +00, substitute 5 sack LS concrete backfill for 2 sack slurry 2 Reconstruct approximately ~J~L~F~of 8" storm LS $ drain 3 Lower 4-3 IA telephone conduits (to be LS $ ~. $ _~ reimbursed by US Wes0 4 [ Remove and replace concrete sidewalk [ 100SF Remove and replace concrete curb & gutter 25 LF 5 $ $ 6 Remove and replace existing sanitary sewer Lump Sum $ manhole No. 102-18 Total this Change Order Previous Change Orders -0- Revised Contract Total The time provided for completion of this contract is increase by three calendar days. This document shall become an amendment to the Contract and all provisions of the contract will Recommended by: Approved by: Accepted by: 'C~ t3 Date G:Dawn~Engineer~Project199-23 Ch Od 2 Tobiasson.doc CITY OF ASHLAND CITY HALL ASHLAND, OREGON 97520 NOTICE OF TRANSMITTAL TO: BARBARA CHRISTENSEN SHARLENE STEPHENS KARI OLSON DATE: PROJECT: JOB NO.: SUBJECT: JULY 3, 2000 SISKIYOU BLVD SANITARY SEWER CONSTRUCTION 99-23 CONTRACT DOCUMENTS THE FOLLOWING ITEMS ARE BEING SENT TO YOU: Barbara C. - Original Contract and bond for filing Sharlene - Insurance certificates and copy of contract Kari O. - Original requisition No. 2014 and copy &contract ENCLOSED UNDER SEPARATE COVER REMARK S: COPIES TO: Paula Mike M. Pieter Karen H. Department of Public Works Engineering Departmen~ ~tl~) By: James H. Olson ,--flea '- Title: Engineering Services Manager G:Dawn\Engineer\Proj ecl\99-23 Contract Document In House NOT.doc CITY OF ASHLAND CONTRACT FOR PUBLIC WORKS CONSTRUCTION Contract made this z0~ day of~, , 2000, between the City of Ashland, ("City~') and Tobiasson Excavation, Inc. "(Contractor"). City and Contractor agree: 1. Contract Documents: This contract is made as a result of an Advertisement for Bid issued by City for the Siskiyou Boulevard Sanitary Sewer Construction Project, No, 99-23. Contractor was awarded the bid as the lowest responsible bidder. In the event of any inconsistencies in the terms of this contract, the contract documents defined in the Advertisement for Bid and Contractor's bid, this contract shall take precedence over the contract documents which shall take precedence over the bid. 2. Scope: Contractor shall begin and complete the project described in the contract documents within the time prescribed in the contract documents. The following exceptions, alterations, or modifications to the contract documents are incorporated into this contract: 3. Price & Payment: City shall pay Contractor amounts earned under the contract. All payments will be made at the times and in the manner provided in the contract documents. 4. Bond: Contractor shall, within five days after execution of the contract and prior to doing any work under the contract, furnish bond to the City of Ashland in a form and with a surety satisfactory to City in the penal sum of $95,930 conditioned upon the faithful performance of this contract upon the part of the Contractor. 5. Default: A default shall occur under any of the following circumstances: 5.1 If the Contractor fails to begin the work under contract within the time specified, or fails to perform the work with sufficient workers or equipment or with sufficient materials to insure the prompt completion of the project, or shall neglect or refuse to remove materials or perform anew such work as shall be rejected as defective or unsuitable, or shall discontinue the prosecution of the work. 5.21f the Contractor shall become insolvent or declared bankrupt, or commit any act of bankruptcy or insolvency, or allow any final judgment to stand against the Contractor unsatisfied for a period of forty-eight (48) hours, or shall make an assignment for the benefit of creditors. 5.3From any other cause whatsoever, shall not carry on the work in an acceptable manner. 6. Remedies: In addition to the rights and remedies to which the City may be entitled by law for the enforcement of its rights under this contract, City shall have full G:Dawn\Engineer\Project~99-23 Accept Ltr & Contract Docs.doc power and authority, without violating this contract, to take prosecution of the work from the Contractor, and appropriate or use any or all of the materials and equipment on the ground that may be suitable and acceptable and may cause a contract for the completion of this contract according to its terms and provisions, or use such methods as required for the completion of the contract, in any acceptable manner. All costs and charges incurred by the City together with the costs of completing the work under the contract, shall be deducted from any money due or which shall become due the Contractor. In case the expense so incurred by the City shall be less than the sum which would have been payable under the contract if it had been completed by the Contractor, then the Contractor shall be entitled to received the difference less any damages for delay to which the City may be entitled. In case such expense shall exceed the sum which would have been payable under the contract, the Contractor and the surety shall be liable and agree to and shall pay the City the amount of the excess with damages for delay of performance, if any. 8. Prevailin~q Wa,qe Rates: The Contractor shall pay a fee equal to one- tenth of one percent (0.1 percent) of price of this Contract. The fee shall be paid on or before the first progress payment or 60 days from the date work first begins on the Contract, whichever comes first. The fee is payable to the Bureau of Labor & Industries and shall be mailed or otherwise delivered to the Bureau at the following address: Bureau of Labor & Industries Wage & Hour Division Prevailing Wage Unit 800 N.E. Oregon Street #32 Portland OR 97232 The Contractor shall fully comply with the provisions of ORS 279.348 through 279.365 pertaining to prevailing wage rates. CONTRACTOR By: By: CITY ~'"I'~AS HLAN D M ~ejFj~eman Citv'llV;J'ministratorv Its: REVIEWED AS TO FORM: By: }/~ City Attorney Date: ~ REVIEW~.~S TO CONTENT: Dep/airtfnent Head Date: Coding: r,?~', e~,. rTo ~. ?¢4 (For Git,/use only) G:Dawn'~Engineer\Project~99-23 Accept Ltr & Contract Docs.doc PROPOSAL Mayor & City Council Ashland, Oregon The undersigned bidder declares that the bidder has examined the plans and specifications, has visited the site, and made such investigation as is necessary to determine the character of the materials and conditions to be encountered in the work and that if this Proposal is accepted, the bidder will contract with the City of Ashland, Oregon for the construction of the proposed improvement in a form of contract contained in the bid documents, will provide the necessary equipment, materials, tools, apparatus, and labor, in accordance with the plans and specifications on file at the City Engineering Office, Ashland, Oregon, under the following conditions: 1. It is understood that all the work will be performed under a lump sum or unit price basis and that for the lump sum or unit price all services, materials, labor, equipment, and all work necessary to complete the project in accordance with the plans and specifications shall be furnished for the said lump sum or unit price named. It is understood that the quantities stated in connection with the price schedule for the contract are approximate only and payment shall be made at the unit prices named for the actual quantities incorporated in the completed work. If there shall be an increase in the amount of work covered by the lump sum price, it shall be computed on a basis of "extra work" for which an increase in payment will have been earned and if there be a decrease in the lump sum payment, it shall be made only as a result of negotiation between the undersigned and the Owner. Furthermore, it is understood that any estimate with respect to time, materials, equipment; or service which may appear on the plans or in the specifications is for the sole purpose of assisting the undersigned in checking the undersigned's own independent calculations and that at no time shall the undersigned attempt to hold the Owner, the Engineer, or any other person, firm or corporation responsible for any errors or omissions that may appear in any estimate. 2. The undersigned will furnish the bonds required by the specifications and comply with all the laws of the Federal Government, State of Oregon, and the City of Ashland which are pertinent to construction contracts of this nature even though such laws or municipal ordinances may not have been quoted or referred to in these specifications. 3. All items for the contract for which forms are provided in the bid documents have been completed in full by the showing of a lump sum price or prices for each and every item and by the showing of other information indicated by the proposal form. The undersigned submits the unit prices set forth as those at which the bidder will perform the work involved. The extensions in the column headed "Total" are made up for the sole purpose of facilitating comparison of bids and if there are any discrepancies between the unit prices and the totals shown, the unit prices shall govern. 4. The undersigned agrees that the "Time of Completion" shall be as defined in the specifications and that the bidder will complete the work within the number of G:Dawn\Engineer\Project~Blank Document 10 consecutive calendar days stated for each schedule after "Notice to Proceed" has been issued by the Owner. Bidder furthermore agrees to pay as liquidated damages, for each calendar day thereafter, the sum of one hundred dollars for each day the project remains incomplete. 5. The undersigned, as bidder, acknowledges that addenda(s) numbered / through I have been received by the bidder and have been examined as part of the contract documents. 6. The undersigned, as bidder, acknowledges that provisions of Oregon Revised Statute (O.R.S.) 279.350 relating to workers on public works to be paid not less than prevailing rate of wage shall be included in the contract. 7. Instructions for First-Tier Subcontractors Disclosure. Bidders are required to disclose information about certain first-tier subcontractors (those subcontractors contracting directly with the bidder) when the contract price exceeds $75,000 (see ORS 279.027). Specifically, when the contract amount of a first-tier subcontractor is greater than or equal to: (I) 5% of the project bid, but at least $15,000, or (ii) $500,000 regardless of the percentage, you must disclose the following information about that subcontract within four hours of bid closing: 7.1 The subcontractor's name and address; 7.2 The subcontractor's Construction Contractor Board registration number, if one is required, and; 7.3 The subcontract dollar value. If you will not be using any subcontractors that are subject to the above disclosure requirements, you are required to indicate ,'NONE" on the form. THE CITY MUST REJECT A BID IF THE BIDDER FAILS TO SUBMIT THE DISCLOSURE FORM WITH THIS INFORMATION WITHIN FOUR HOURS OF BID CLOSING. To determine disclosure requirements, the City recommends that you disclose subcontract information for any subcontractor as follows: 1) 2) Determine the lowest possible contract price. That price will be the base bid amount less all alternate deductive bid amounts (exclusive of any options that can only be exercised after contract award). Provide the required disclosure information for any first-tier subcontractor whose potential contract services (i.e., subcontactor's base bid amount plus all alternate additive bid amounts, exclusive of any options that can only be exercised after contract award) are greater than or equal to: (I) 5% of the lowest contract price, but at least $15,000, or (ii) $500,000 regardless of the percentage. Total all possible work for each subcontractor in making this determination (e.g., if a G:Oawn\Engineer\Project\Bla nk Document 11 subcontractor will provide $15,000 worth of services on the base bid and $40,000 on an additive alternate, than the potential amount of subcontractor's services is $55,000. Assuming that $55,000 exceeds 5% of the lowest contract price, provide the disclosure for both the $15,000 services and the ($40,000 services). The disclosure should be submitted on the following form: G:Dawn\Engineer\project\Bla nk Document 12 SISKIYOU BOULEVARD SANITARY SEWER CONSTRUCTION PROJECT 99-23 1 2 \ 5 6 7 8 9 10 * Attach additional pages if needed. G:Dawn\Engineer\Project\Blank Document 13 SISKIYOU BOULEVARD SANITARY SEWER CONSTRUCTION PROJECT BID SCHEDULE ITEM ITEM (UNIT PRICE DOLLARS) ESTIMATE UNIT PRICE AMOUNT NO. Quantity & Units (FIGURES) Mobilization for Lump Sum $ $ t Dollars L~. 2 Traffic Control for Lump Sum $ $ Dollars 48" Manhole for 6 EA $ 3 Dollars · \~-~ ~-.~ Outside Drop Manhole for 1 EA $ ! $ 4 Dollars 8" PVC Pipe (C.R. / slurry backfill) for 32 LF $ $ 5 Dollars 12" PVC Pipe (sand slurry backfill) for 1,511 LF $ 6 Dollars ? Pavement Removal for 8,000 SF $ $ Dollars 8 Pavement Patching for 8,000 SF $ ~ $ Dollars Install Four 6" Sanitary Sewer Service 9 Lateral Connections for 20 EA $ · ' Dollars 10 Remove Existing Sewer Manhole for 1 EA $ $ Dollars 11 Rechannel Existing Sewer Manhole for 1 EA $ $ Dollars Sewer Line Connection to Existing 12 Sanitary Sewer Manhole for ,. 1 EA $ $ Dollars 13 Replace Detector Loops for I LS $ ~L~ ~ $ Dollars 12" Storm Drain (sand slurry backfill) for ~4 77 LF $ $ Dollars ~5 Install Storm Inlet for 1 EA $ $ Dollars 16 forlnstall Connection to Existing CatChDollarsBaSin I EA $ BID TOTAL I $ DEPARTMENT OF PUBLIC WORKS ENGINEERING DIVISION G: Dawn\Engine er\Project\Bla nl( Document The City reserves the right to reject any and all bids, waive formalities, or accept any bid which appears to serve the best interests of the City. The foregoing prices shall include all labor, materials; equipment, overhead, profit, insurance, and all other incidental expenses to cover the finished work of the several kinds called for. Unit prices are to be shown in both words and figures. In case of discrepancy, the amounts shown in words will govern. Upon receipt of written notice of the acceptance of this bid, Bidder shall execute the formal contract attached within ten days and deliver surety bond or bonds as required. The bid security attached in the sum of five percent of the total price for the bid or combination of bids is to become the property of the Owner in the event ~he contract and bond are not executed within the time above set forth as liquidated damages for the delay a~l additional expense to the Owner caused thereby. / The Bidder is v' or is not a resident Bidder as defined in O.R.S. 279.029. Firm or Name of Bidder Printed Nam~ of Bidder Official Title State of Incorporation Dated this ~'~ Name of Bidder Address Telephone No. day of CCB Number 2000. G:DawntEngineer\Project\Blank Document 15 Bond No PB9973 Premium: $2,398.00 PERFORMANCE&PAYMENTBOND The undersigned TOBTA,R.RON EYCAVATION, TNC. _._._., as principal, further rarefied to-in this bond as Contractor, and c.c~n~A~.q ]~D]I'~ AND C0['~ as surety, further referred to in this bond as Surety, are jointly and severally bound unto City of Ashland, as obligee, further referred to in this bond as City, in the sum of~N~n~J~y .]~-iw Thn~,sand Nine Hu~d,T~O0lIars ($.95,930.QQ*_***). Thirty and no/100 Contractor and City have entered into a wdtten contract dated . for the following project: SJsk'_n, ou Boul~e¥~rd S{~nltary Sewer Proiect No.-99-23. This contract is further referred to in this bond as the Contract and is incorporated into this bond by this roference. The conditions of this bond a~e: If Contractor faithfully performs the Contract within the time prescribed by the Contract, and promptly makes payment to all claimants, as defined in ORS 27'9.526 through 279.542, then this obligation is null end void; otherwise it shall remain In full force and effect. If Contrector is declared by City to be in default under the Contract, the Surety shall promptly remedy the default, perfon'n all of Contractor's obligations under the contract in accordance with its terms and conditions and pay to City all damages that are due under the Contraot 3. This. bond is subject to claims under ORS 279.526 through 279.542. 4. This obi' ation jointly and severally binds Contractor' and Surety and their respectiv~heirs, execotors, ~dml~istrators, successore. 5. ..Suraty wai~,es notice of modificefion of the Contract or extension of the Contract tilne. 6. Nonpaymlnt of the bond premium shall not invalidate this bond. G:De wn'.EnGine er~'mJed~39-23 Accep~ tlr & Cohtracl Doo~.doc The bond number and the name, address, and telephone number of the agent authorized lo receive notices concerning this bond are as follows. Bond Number: Bond Agent Address: Telephone: SIGNED this WITNESS: WITNESS: (C~ate 8e~ PB9973 ........ ~o~ ~ 972~3 ..... (503)~7-~ day of J~ 20~. CONT~CTOR: t~S~. ~V~[~, Legal Address: ~~7 66 -- ~d, ~egon 97520 / Co.ate Se~em~ Title: A[~o~ey ~n Legal Address: [827 ~ 44~h Ave S~e ~Po~[a~d. 0~ 97213 , Attest: P~r of Atto~ey At~d Co~pomto G.'Oa'aw~Englneet!ProJecl~23 Accel~ L~' & Ce~ract Limited Power of Attorney Home Office: 1213 Vallsy Street P,O. BDX 9271 Seattle, WA 98109-0271 (206) 622-7053 KNOW ALL MEN BY THESE PRESENTS that CONTRACTORS BONDING AND INSURANCE COMPANY, a corporati~ du~y o~ganized and existing under the laws of the State of Washington, and having its principal office in Seaffie, King County, Washington, does by these presents make, constitute and appoint TOM DYMENT, Vancouver, Washington, its true and lawful Attomey-in-Fact, with full power and au thndty hereby cenfu ned in ~ name, place and stead, to execute, acknowledge and deliver on beheff of th e Company any and bi l ponds and u nde d akings of suretyship givan for any p u rpose, provided, however, that noABorney-in-Fast shbil be authedzed 1o ex~cuta and dbiNer any bond or undertaffing that shbil ohligafo the Company for any portion of the panal sum thereof in excess of $6,o00,0ttO, and provided, further, that noAItomey-in-Fact shbil have the autporityto issue a bid or pr(~osal bond for any project wberffi if a contractis awai'ded, any bond or undertaking would bo required with a panalsum in excass of $ and to bind the Company thereby as fully and to the same extent as if such bonds were signed by the Preffidenl, sealed with the corporate seal of the Company and duly aBested by its Secretary; hereby ratifying and confirming all that the said Attomey-ffi-Fact may do in the premises. Said appointment is made under and by authorify of the following resolutions adopted by the Board of Directors of the CONTRACTORS BONDING AND INSURANCE COMPANY on September 8, 1998: RESOLVED that the President of the Company is authorizeif to app~ts any parson as the Company's true and tawfui Attorney-in-Fact w~h power and authority to execute and deliver on behalf of the Company any and all bonds and under~ngs of suretyship given for any purpose, subject to such limits as shall be dste~nsted by the President of the Company; provided, however, that no such person shall be authored to execute and deliver any bond (x undertaking that shall obligate the Company for any portion of the penal sum thereof in excess of $10,000,000, and provided, further, that no ABorney-in-Fact shall have the authority to issue a bid or proposal head for any project where, if a contract is awarded, any pond or undertaking would be required with penal sum in excess of $10,~O0,C~O. RESOLVED FURTHER that the autho~y of the Secretary of the Company to ce~ty the authenticity and effectiveness of the foregoing msbiution in any Limited Power of Attemey is hereby delegated to the folk)wing porsoeffi the signature of any of the following to bind the Company with respect to the authenbbity and eff~iJveness of the foregoing resotu~s as if signed by the Secretary of the Company: Donald Sirkin, Sfoven A. Gaines, Johr~ Pisprzny, John A. AIk~rffi John D. Minto, Mare A. Mrkvicka, Larry A. Byers, Deanna Davis, GailA. Flynn, Debi Lewis, Jeannie Pedilla, JoAnn Johnson, and Pat Comey. RESOLVED F U RTH ER that the signafu~es (including certification that the Power of A~tomey is ~11 ia force and effect) of the President, Notary Public and person certifying authentic,iy and effectiveness, and the corporate and Notary seals appoadng ~ any bmited Power of Attorney containing ffiffi and tee fumgoing resolutio ns as well as the Limtted Power of Attorney itseff and its transmission, may be by tacalmile; and such Limited Power of Attorney shall be deemed an edginal in afl aspects. RESOLVED FU ETHER that all msbiutions adopted prior to today apbotht~ng the above named as ABomey-in-Fact for CONTRACTORS BO N DING AND I NSU RANCE COMPANY am hereby superseded. IN WlTN ESS W H E REOE CON TRACTO R S BONDING AN D INSU RANC E C OM PA NY has caused these presents to be sig ned by its President and ~ corporate s ealto de hereto affixed this 8th day of S epte m b er, 1998. CONTRACTORS BONDING AND INSURANCE COMPANY STATE OF WASHINGTON~OUNTY OF KING On this 8th day of September, 1998, hersonally appeared ST EVEN A. GAIN ES, to me known to be the President of the corporation tbet executed the foregoing Limited Power of Attomey and acknowledged said U mired Power of Att(xney to be the tree and vofu ntary act and deed of said co~poration, for the uses and pu r~s therein mentioned, and on oath stated that he is authpazed to execute the said Limited Power of Attomey. IN WITNESS WHEREOF, I have hereunto sot my hand and affixed my official seal the day and year fimt above wdtten. MOI.LY ~ HUD~PETH Notary Public in and fu~ngton, res~flng at Seattta The undersigned, acting u~.r. aut~dty of the Board of Oi~ectors of CONTRACTORS BONDING AND I NeURANCE COMPANY, hereby cerdfieffi as or in Iffiti of Certificate of the Secretary of CONTRACTORS BONDING AND INSURANCE [iOMPANY, that the above and foregoing is a full, troe and cormot copy of the Original Power of Attorney issued by said Company, and does hereby further corffiy that the said Power of Attemey is still ink__and etfuct. ACORD.CERTIFICATE OF LIABILITY INSURANCF =[ i OATEIMM,DD , 04/24/01 PRODUCER Reinholdt & O'Harra Insurance 383 East Main Street Ashland OR 97520-1896 Phone: 541-482-1921 INSURED Tobiasson Excavation, Inc. 3055 Highway 66 Ashland OR 97520 COVERAGES THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURERA: Berkshire Hathaway Homestate INSURER B: INSURER C: INSURER D: I INSURER E: 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ~R~ POLICY EFFECTIVE I POLICY EXPIRATION1 ILNSR TYPE OF INSURANCE POLICY NUMBER DATE (MMIDD/YY} DATE IMMIDD/YY} LIMITS GENERALLIABIL[TY . EACH OCCURRENCE $ i , 000,000 A X ££MMERClALGENERALLIABILITY! OBP000622 03/17/01 03/17/02 [ FREDAMAGE(Anyonefire) $ 1001000 _ __ ~ CLAIMSMAOE [ X~ OCCUR I MED EXP {Any one person) $ 10 000 PERSONAL &ADV INJURY $ i, 000,000 · . I GENERALAGGREGATE 45 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER I PRODUCTS - COMPIOP AGG $ i , 000 , 000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT A ANYAUTO OBP000622 03/17/01 03/17/02 (La accident) $ 750 , 000 ALL OWNED AUTOS ] ! BODILY INJURY $ LX i SCHEDULED AUTOS i (Per person) , HIRED AUTOS i . BODILY INJURY $ i: II NON-OWNEDAUTOS (P ..... ident) , i i PROPERTY DAMAGE : i I (Per accident) GARAGE LIABILITY I AUTO ONLY - EA ACCIDENT ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESS LIABILITY ~ EACH OCCURRENCE $ I ~ I CLAIMS MADE AGGREGATE $ J DEDUCTIBLE I i $ WORKERS COMPENSATION AND I TWoCR~TL~IUTs' I EMPLOYERS' LIABILITY i E.L EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEEE $ A ! Commercial Applica 0BP000622 03/17/01 03/17/02 I A I Property Section OBP000622 I 03/17/01 03/17/02 i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CITY OF ASHLAND IS ADDITIONAL INSURED CERTIFICATE HOLDER i Y I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION CITY OF ASHLAND IT'S OFFICERS, EMPLOYEES AND AGENTS 20 EAST MAIN STREET ASHLAND OR 97520 CITYOF ACORD 25-S (7/97) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION BATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT'~.~[H~a~O SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. //~ ./ ©~,J~)RD CORPORATION 1988 VENDOR: 002814 TOBIASSON EXCAVATION INC 3055 HIGHWAY 66 ASHLAND, OR 97520 CITY OF ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541) 488-5300 FOB Point: Terms: Net Req. Del. Date: Special Inst: 7/13/00 ][ 01228 SHIP TO: Ashland Public Works (541) 488-5587 27-1/2 N MAIN STREET ASHLAND, OR 97520 Req. No.: DepL: Jim Olson Contact: Jim Olson Confirming? No i IS A REVISED PURCHASE ORDER Sewer Project No. 99-23, Per contracfJ Change Order #1, Dated July 31, 2000 SUBTOTAL 102,410.00 E31LL TO: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 541-552-2010 TOTAL ASHLAND, OR 97520 E 675.08.17.00.704200 102,410.00 VENDOR COPY CITY OF ASHLAND CITY HALL ASHLAND, OREGON 97520 NOTICE OF TRANSMITTAL TO: CINDY HANKS KARl OLSON DATE: PROJECT: JOB NO.: SUBJECT: SEPTEMBER 11, 2000 SISKIYOU BLVD SANITARY SEWER 99-23 CONTRACT CHANGE ORDER THE FOLLOWING ITEMS ARE BEING SENT TO YOU: COPY OF THE CONTRACT CHANGE ORDER NO. 1 PERTAINING TO THE SISKIYOU BLVD SANITARY SEWER PROJECT ENCLOSED UNDER SEPARATE COVER REMARKS: PLEASE NOT THE ADJUSTED CONTRACT TOTAL OF $102,410.00 (ORIGINAL $95,930.00 ) TO BE ADDED TO PURCHASE ORDER NO. 1228. COPIES TO: Paula Brown Mike Morrison Terry Oldfield Pieter Smeenk Department of Public Works / Engineering Departmenl~ By: Jim Olson Title: City Surveyor/Prbject Manager G:\pub-wrks\eng\dcpt-admin~eNGINEER~PROJECT~1999\99-23 CH Od 1 NOT.doc