HomeMy WebLinkAbout2007-088 Contract - Pacific Paving
Contract for GOODS AND SERVICES Less than $25,000
CITY OF
ASHLAND
20 East Main Street
Ashland, Oregon 97520
Telephone: 541/488-6002
Fax: 541/488-5311
CONTRACTOR: Pacific Paving, Inc.
CONTACT: Terry Schoen leber, Terry Simcoe
ADDRESS: 7420 Kershaw Road, White City, OR 97503
TELEPHONE: 541-772-4616
DATE AGREEMENT PREPARED: Mav 22,2007 FAX: 541-830-4612
BEGINNING DATE: May 24,2007 COMPLETION DATE: June 1,2007
COMPENSATION: $4.00 Per square foot, estimated to be 5,151 sq ft for a total of $20,604.00, due to actual
condition of street actual footage will be measured in field when patch is done.
GOODS AND SERVICES TO BE PROVIDED: Patch trench on Beach Street with 4" of asphalt. Per quote
dated May 15, 2007.
ADDITIONAL TERMS:
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. Goods shall be paid for within 30 days of an invoice after delivery of goods
conforming to the standards and specifications. Once work commences, invoices shall be prepared and submitted by
the tenth of the month for work completed in the prior month. 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 2798.220, 2798.225, 2798.230, 2798.235, 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 $16,936 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 8 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). 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 deliverv of
Contract for Goods and Services Less than $25,000, Revised by Legal 03/26/2007, Page 1 of 6
written notice to Contractor, or at such later date as may be established by City under any of the following
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. Obliqation/Liabilityof 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.11 0 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.
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 ORF status pursuant to
the ORF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a
ORF if Contractor has qualified as a ORF 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. It shall include contractual liability coverage for the indemnity provided under this contract.
c. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000,000, or Not A licable for each accident for Bodil In"ur and Pro ert Dama e,
Contract for Goods and Services Less than $25,000, Revised by Legal 03/26/2007, Page 2 of 6
including coverage for owned, hired or non-owned vehicles, as applicable.
d. Notice of cancellation or chanae. 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 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 Councilor 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.
CONT~AC.~O~. . \ ~.
BY . \:.. .
<:- Signa ure
uC -
Print Name
~/-r~?
I
CITY OF ASHLAND:
BY
TITLE
DATE
FederallD#
q.~ .. lOCo4toce
ACCOUNT #
DATE
5 . t.. 3 .0'1
'Completed W9 form must be submitted with contract
PURCHASE ORDER #
tfJ~~61
Contract for Goods and Services Less than $25,000, Revised by Legal 03/26/2007, Page 3 of 6
-
Bt/13/2007 21:33
5417726111
PACIFIC PAVING INC
PAGE 02
PROPOSAL SUBMllTED TO:
N~
City of Ashland
STREE~ N Mountain
I
Ashland
DA
May 15. 2007
We hereby submit specifitations and "'ma1I!I for:
Ashland
Commercial Patching
S ATE
1. Patch tmlCh with 4" of asphalt @ $4.00 per sq.ft.
"'*NOTE: Due to condition of street actual footage will be mcasuted in field when patch is done.
TO ACCEl.'PT stGN &
:RETtrr.~.N Tor ("JOT"Y
We hl:Rb1 pnlpOIIt III fiImiIII tile IIIuw IIbar ... 'IIIIlaiIII;.. ____ wilta .... .... ~1lclIIl-.1llr die un of!
."SEE ABOVE."
clo1bn(S
TERMS: CIIb 011 compIetioa orjob,lIIIIas adIer .... .-sIR medc m wri&iIJI. A ~ pet mmtI\ 'J:NANCe CHAROE 1riII be Idded on 11\ pIIt due ICCXIlIlIlS,
In ANNUAL PERCENTAGE RATE OF 24 111 die naIl8IY bIIlIIoc is __ cmr" III ~ b ~ or if.1awsIIit is ftled to CIllIIect IIIIY bIJmce,
incIddiDa IppeIIIhIIllriII, die pm.'inI ~ I11III be IIIliIIed 10 bit re--'*' .ancy '* IUd .-on.b1e ~ oflidpdon, sudla inftltipllioa,
cIeposition. ~ ~ and odaIr 1_ apeIIIeI..AIl ~ is ..--....110 be .1pIlIlifbI. All wade to be ........ 1ft . ~Jib IIIIIIIIeI' IICCOnImg
ID IIIIIUrd JlI'Idicrs. AIry IIIIndoa ... ___ thJmlboft ~ ~ ~ wvrt ... f:ldrI 0dIII 'Wift becclIDe lit aII'I '*-P IIIftI" IIId llbcm:
the esIiIIIIIL IfMlllblle 1IIClI...... is pnlIBId by 0lIIm, 1beD........., 1jf "",l:l.,..AiIp. The ftOI'IIIII roiI---- procell willICJl kill. tn* of
w~ -' we wiD not be ...... ~ 8IY dImIpd plIftUWQl \kIP: 110 * ~ Q/ '~4d. All ....\:lCIIlflIIiS ClCftiD&ent upon Ittibs, ICCidInts or de1I1I
Ileyoad 0lIl' COIinlllfdlis COIIII8l:t IllIIlIIdI $1,000. dID 0Ma ~ ~ of'lIIc ....I\..,l..tlon NoIice 10 HoaIIcJwIlas abolIl CoIIJtrugdon LicDs.. 't'his
pnlIlOIIII may be wItIIdrIlwn by. ifftll( KCqIIIlcJ wbI1in 30 .. CCB *'083'
_t;~. ~r~ TeuyWSim<:oe
Acceptance of Proposal
..
The above prices. spccifiCllioas mcl conditions are Ildisfilctory IIId an: berdJy accqDd. You III'C 8Uthorit.ed 10 do all of the work IIlI specified.
Payment will be made as outlined ~.
Signamte
Date
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 10 (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 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) I 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.
~k
~\ 'lr!
Contractor
YJ' ~3,b'1
(Date)
Contract for Goods and Services Less than $25,000, Revised by Legal 03/26/2007, Page 4 of 6
Form W-9
Request for Taxpayer
Identification Number and Certification
Give form to the
requester. Do not
send to the IRS.
(Rev. January 2003)
Department of the Treasury
Internal Reve,.,e Service
N
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as
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1
(II
Q)
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Name
1~3
O 0 0 Exempt from backup
Partnership Other ~ __.. __. __ __ .... __ _ withholding
Requester's name and address (optionaO
Enter your TIN in the appropriate box. For individuals. this is your social security number (SSN).
However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on
page 3. For other entities. it is your employer identification number (EIN). If you do not have a number.
see How to get a TIN on page 3.
Note: If the account is in more than one name. see the chart on page 4 for guidelines on whose number
to enter.
~
or
Under penalties of perjury. I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me). and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding. or (b) I have not been notified by the Internal
Revenue Service (I RS) that I am subject to backup withholding as a result of a failure to report all interest or dividends. or (c) the IRS has
notified me that I am no longer subject to backup withholding. and
3. I am a U.S. person (including a U.S. resident alien).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions. item 2 does not apply.
For mortgage interest paid. acquisition or abandonment of secured property. cancellation of debt. contributions to an individual retirement
arrangement (IRA). and generally. payments other than interest and dividends. you are not required to sign the Certification. but you must
provide your correct TIN. (See the instructions on page 4.)
Sign Signature or---f/
Here u.s. person ~ \
Certification
Purpose of Form
A person who is required to file an information return with
the IRS. must obtain your correct taxpayer identification
number (TIN) to report. for example, income paid to you. real
estate transactions. mortgage interest you paid. acquisition
or abandonment of secured property. cancellation of debt. or
contributions you made to an IRA.
U.S. person. Use Form W.g only if you are a U.S. person
(including a resident alien). to provide your correct TIN to the
person requesting it (the requester) and. when applicable. to:
1. Certify that the TIN you are giving is correct (or you are
waiting for a number to be issued).
2. Certify that you are not subject to backup withholding.
or
3. Claim exemption from backup withholding if you are a
U.S. exempt payee.
Note: If a requester gives you a form other than Form W-9
to request your TIN, you must use the requester's form if it is
substantially similar to this Form W-9.
Foreign person. If you are a foreign person. use the
appropriate Form W-8 (see Pub. 515, Withholding of Tax on
Nonresident Aliens and Foreign Entities).
Date ~
;5';<'?YO
Nonresident alien who becomes a resident alien.
Generally. only a nonresident alien individual may use the
terms of a tax treaty to reduce or eliminate U.S. tax on
certain types of income. However. most tax treaties contain a
provision known as a "saving clause." Exceptions specified
in the saving clause may permit an exemption from tax to
continue for certain types of income even after the recipient
has otherwise become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an
exception contained in the saving clause of a tax treaty to
claim an exemption from U.S. tax on certain types of income.
you must attach a statement that specifies the following five
items:
1. The treaty country. Generally. this must be the same
treaty under which you claimed exemption from tax as a
nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that
contains the saving clause and its exceptions.
4. The type and amount of income that qualifies for the
exemption from tax.
5. Sufficient facts to justify the exemption from tax under
the terms of the treaty article.
Cat. No. 10231X
Form W-9 (Rev. 1-2003)
Contract for Goods and Services Less than $25,000, Revised by Legal 03/26/2007, Page 5 of 6
May. 22-2007
16: 35 :48
Pg. 001 of 1 3 3 3 2 2 10 10 10 10 10 10 10 10 10 10 2 DOE
ACORDN CERTIFICATE OF LIABILITY INSURANCE OP 10 K~ DATE (MM/DDIYYYY)
I?ACI05W OS/22/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
KI?D Insurance, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
I?O Box 784 AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
springfield OR 97477
I?hone:54l-741-0550 Fax:541-741-1674 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A SAIF Corporation - Salem
INI,URER B
I?acific I?aving, Inc. INI,URER ('
I?O Box 2370 INSIIRER [,
White city OR 97503
INSIIRER E
COVERAGES
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.
LTR NSRl:: TYPE OF INSURANCE POLICY NUMBER PD~';!~1rJ~fJ~~E Pgk~1,Y(~~bf}f~~N LIMITS
GENERAL LIABILITY EACH OC,~IIRRENCE $
- co, ,,~"c ,,, ~c"'c,,
r."MMERCIAL GENERAL LIABILITY PREMISES (EM OCCIJt'HflCH) $
- ~ ,~LAIMS MADE D\~)CI-:lJR
MED EXP (Any orop p""onJ $
-
PERSOt,AL & ADV IN.II.lRY $
-
GENERAL AGGREGATE $
-
GEN'L AGGREGATE LIMIT APPLIES PER PRODU"TS I-OMP/OP A\."?G $
I nPR0' nLI)l..
F'UULY JEer
AUTOMOBILE LIABILITY ,-,'IMBINE[' ,C1NRE LIMIT
- IE"'i'1(,('jdRnt) $
ANY At )T\)
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ALL n\/'/NED Al IT ()S 6('[IIL y IN.IIIRY
f-- (PH pH ,,()[I) $
SCHE[Jl JLEC' Al JTeiS
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NON ~lV"NE[l AUT "-JS
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- PR0PERTY C>AMA(;E $
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GARAGE LIABILITY At lTO ONL Y EA AC'-IC>Etn $
~ ANY AUTd e'THER THAN cAA(,( $
At iT\.1 \JNL Y A\;\-::' $
EXCESS/UMBRELLA LIABILITY EACH OCCI JRRENCE $
~C'CCUR D CLAIM,_ MA['E AGGREI:;ATE $
-,
$
=1 [iEDU,TIEiLE $
RETENTION $ $
WORKERS COMPENSATION AND X IT')RY L:~I'T~ I I "EFr
A EMPLOYERS' LIABILITY 812919 10/01/06 10/01/07 E L EACH A,~'-I['ENT $5 i1Jl..".Q.() Q._
ANY PR0PRIET0R/PARTNER/EXEClITIVE
(iFFICER/MEMEiER E/CLlIDED? E L [JI~-;E;\SE EA EMF'L,'YEE $500,000
If yec, nw,cnhR IJnder E L [II~EASE - POLI\~'Y LIMIT $500,000
SPECIAL PR0VISION~ tJelow
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RE: All Operations
CERTIFICATE HOLDER
CANCELLATION
CITAS02
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
city of Ashland
90 N Mountain Ave.
Ashland OR 97520
@ACORD CORPORATION 1988
ACORD 25 (2001/08)
BeecherCarlosn/JBLK
5/22/2007 1:09:59 PM
PAGE 001/003
Fax Server
A CORD,. CERTIFICA TE OF LIABILITY INSURANCE I DATE (MMIDDIYYYY)
5/22/2007
PRODUCER (541)772-1111 FAX: (541) 772-3785 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
JBL&K Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
707 Murphy Rei ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Medford OR 97504 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A Travelers
Pacific Paving Inc INSURER B Developers Surety and Ind
INSURER C
PO Box 2370 INSURER D
Whi te Ci ty OR 97503 INSlJRER E
COVERAGES
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 CONDITlONS OF SUCH POLICIES.
Ac:.1 REGATF liMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD'L POLICY NUMBER Pgki~~~~6g'WIE Pg~lfJ(~~f\'~~I~N LIMITS
LTR INSRD TYPE OF INSURANCE
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
f-- 8~~~~JoE~~~~~nce)
~ OMMERCIAL GENERAL LIABILITY . 300,000
A CLAIMS MADE ~ OCCUR DTC0526DB417TIL07 3/20/2007 3/20/200tl MED EXP (Anyone pe,"'n) $ 5,000
I -
PERSONAL &. ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER r-EI3DOlJCT'i.: C::DMF'~ AC,iL~_ 2,000,000
~. -n- PRO. n
POLICY ,IECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
- (Ea ,jr:(:ldt"n(1 $
X ANY AUTO
- 3/20/2007 3/20/200B
A ALL Ow-JED AUT OS OTB1D526DB417TIL07 BODIL Y INJURY
~.. (Pt"r pt"r:-.on) $
SCHEDULED AUTOS
-
- HIRED AUTUS BOOI L Y INJI IRY $
(Per c:accld~nt)
- NON-O\I\'NED Aur,').5 ----
- - F'ROPERTY DAMAG E $
(Per a.;cidE;lnt)
GARAGE LIABILITY ,a.UTO ONLY. EA ACCIDENT $
~ ANY AlJTO DTHER THAN FA ACC $
,1\llTO ONL 'r' AGG $
EXCESs/UMBRELLA LIABILITY EACH OCCIJRRENCE $ 1,000,000
mOr-C\lR D CLAIMS MADE ,l\GGREGATE --- ri 1,000,000
- ~
$ ~
A R DEDlJr.TIBLE DTSMCUP526D8417TILD7 3/20/2007 3/20/200B $
X RFTFNTION < 10 000 $
WORKERS COMPENSATION AND I T~-IT~JNs I 10TH.
ER
EMPLOYERS' LIABILITY
ANY f'RUf'RIETORlf'ARTNER/EXECUTIVE Eo L. EACH ACCIDENT $
OFFIr.ERIMEMBER EXCLUDED? E:. L DISEASE- EA EMPLOYEE.
If ve:i, ues.;ribl;:! Undtlf E L DISEASE- POLICY LIMIT $
SPECIAL PROVISIONS below
B OTHER Contractors License 2470BBC 7/15/2005 7/15/200B LJ.ml.t $lO,OOO
Bond I I
i i
DESCRIPTION OF OPERA TIONSlLOCATIONSlVEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate holder incl.uded as additional insured per attached endorsement #CGD246080S where required by contract.
Subject to pol.icy terms, conditions and exclusions.
CERTIFICATE HOLDER
CANCELLATION
(541)488-5320 SHOULO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
The city of Ashland, its officers, agents EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL
and employees 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER ~AMED TO THE LEFT BUT
90 North Mountain Avenue FAILURE TO DO so SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANV KIND UPON THE
Ashland, OR 97520
I~SURER, ITS AGENTS OR REPRESENTATIVES.
AUTHO RIZED REPRESENT A TlVE ~~~,W~_
S \fvilson, l\AI, AIC/SU
ACORD 25 (2001/08)
INS025 (010HI OBa
@ ACORD CORPORATION 1988
Page 1 at 2
BeecherCarlosn/JBLK 5/22/2007 1:09:59 PM
PAGE 002/003
Fax Server
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
(CONTRACTORS)
This endorsement modifies Insurance provided under the follOWing:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. WHO IS AN INSURED - (Sedan II) is amended
to include any person or organization that you
agree In a "written contract requiring insurance"
to include as an additional insured on this Cover-
age Part, but:
a} Only with respeclto liability for "bodily injury",
"property damage" or "personal injury"; and
b) If, and only to the extent that, the Injury or
damage is caused by acts or omissions of
you or your subcontractor in the performance
of "your work" to which the "written contract
requiring insurance" applies. The person or
organization does not qualify as an additional
insured with respect to the independent acts
or omissions of such person or organization
2_ The insurance provided to the additional insured
by this endorsement is limited as follows:
a} In the event that the Limits of Insurance of
this Coverage Part shown in the Declarations
exceed the limits of liability required by the
"written contract requiring insurance", the in-
surance provided to the additional insured
shall be limited to the limits of liability re-
quired by that "written contract requiring in-
surance". This endorsement shall not in-
crease the limits of insurance described in
Section 111- Limits Of Insurance.
b) The insurance provided to the additional in-
sured does not apply to "bodily injury", "prop-
erty damage" or "personal injury" arising out
of the rendering of, or failure to render, any
professional architectural, engineering or SUI--
veying services. including'
i. The preparing, approving, or failing to
prepare or approve, maps, shop draw-
ings, opinions, reports, surveys, field or-
ders or change orders, or the preparing,
approving, or failing to prepare or ap-
prove, drawings and speCifications; and
ii. Supervisory, inspection, architectural or
engineering activities
c) The insurance provided to the additional in-
sured does not apply to "bodily injury" or
"property damage" caused by "your work"
and included in the "products-completed op-
erations hazard" unless the "written contract
requ iring insurance" specifically requires you
to provide such coverage for that additional
IIlsured, and then the insurance proVided to
the additional insured applies only to such
"bodily injury" or "property damage" that oc-
curs before the end of the period of time for
which the "written contract requiring insur-
ance" requires you to prOVide such coverage
or Ihe end of Ihe policy period, whichever IS
earlier.
3_ The insurance provided to the additional Insured
by this endorsement is excess over any valid and
collectible "other insurance", whether primary,
excess, contingent or on any other basis, that IS
available to the additional insured for a loss we
cover under this endorsement. However, if the
"written contract requiring insurance" specifically
requires that this insurance apply on a primary
basis or a primary and non-contributory basis,
this insurance is primary to "other insurance"
available to the add tional insured which covers
that person or organization as a named insured
for such loss, and we will not share with that
"other insurance", But the insurance provided to
the additional insured by thiS endorsement still IS
excess over any valid and collectible "other in-
surance", whether primary, excess, r,ontingent or
on any other basis, that is available to the addi-
tional insured when that person or organization IS
an additional Insured under such "other insur-
ance".
4. As a condition of coverage provided to the
additional insured by this endorsement:
a) The additional insured must give us written
notice as soon as practicable of an "occur-
rence" or an offense which may result in a
claim. To the extent possible, such notice
should include:
CG 02 46 08 05
@ 2005 The St. Paul Travelers Companies, Inc.
Page 1 of 2
BeecherCarlosn/JBLK 5/22/2007 1:09:59 PM
COMMERCIAL GENERAL LIABILITY
i. How, when and where the "occurrence"
or offense took place;
ii. The names and addresses of any injured
persons and witnesses; and
iii. The nature and location of any injury or
damage arising out of the "occurrence" or
offense
b) If a claim is made or "suit" is brought against
the additional insured, the additional insured
must:
i. Immediately record the specifics of the
claim or "suit" and the date received; and
ii. Notify us as soon as practicable.
The additional insured must see to It that we
receive written notice of the claim or "suit" as
soon as practicable.
c) The additional insured must immediately
send us copies of all legal papers received in
connection with the claim or "suit", cooperate
with us in the investigation or settlement of
the claim or defense against the "suit", and
otherwise comply With all policy conditions.
d) The additional insured must tender the de-
fense and indemnity of any claim or "suit" to
PAGE 003/003
Fax Server
any provider of "other insurance" which would
cover the additional insured for a loss we
cover under this endorsement. However, this
condition does not affect whether the insur-
ance provided to the additional insured by
this endorsement is primary to "other insur-
ance" available to the additional insured
which covers that person or organization as a
named insured as described in paragraph 3.
above.
5. The following definition is added to SECTION V.
- DEFINITIONS:
"Written contract requiring insurance" means
that part of any wrilten r.ontrar.l or agreement
under which you are required to include a
person or organization as an additional in-
sured on this Coverage Part, provided that
the "bodily injury" and "property damage" oc-
curs and the "personal injury" is caused by an
offense committed:
a. After the signing and execution of the
contract or agreement by you;
b. While that part of the contract or
agreement is In effect: and
c. Before the end of the policy period.
Page 2 of 2
@ 2005 The SI. Paul Travelers Companies, Inc.
CG D2 46 08 05
~AC~C
~ PAVING, INC.
PROPOSAL SUBMITTED TO:
P.O. Box 2370. White City, Oregon 97503-0370
Office 541-772-4616. Fax 541-830-4612
PHOl\l1E
m 488-5353
JOB NAME
IDATE
May 15,2007
NAME
City of Ashland
STREET
90 N Mountain
CITY
Ashland
ISTATbR 97520
STREET
Beach Street
CITY
Ashland
1ST A TE
We hereby submit specifications and estimates for:
Commercial Patching
1. Patch trench with 4" of asphalt @ $4.00 per sq.ft.
***NOTE: Due to condition of street actual footage will be measured in field when patch is done.
'1'0 ACCEprj"' SIGN I!;r,
RETURJ'T T{)P COpy
We hereby propose to furnish the above labor and materials in accordance with the above specifications, for the sum of:
***SEE ABOVE***
dollars ($
TERMS: Cash on completion of job, unless other arrangements are made in writing. A 2% per month FINANCE CHARGE will be added on all past due accounts,
an ANNUAL PERCENTAGE RATE OF 24%. In the event any balance is turned over to an attorney for collection, or ifa lawsuit is filed to collect any balance,
including appeals from trial, the prevailing party shall be entitled to his reasonable attorney fees and reasonable expenses oflitigation, such as investigation,
deposition, provisional process and other like expenses. All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according
to standard practices. Any alteration or deviation from above specifications involving additional work and extra costs will become an extra charge over and above
the estimate. If subbase and/or base is prepared by others, then guarantee is limited by workmanship. The normal soil sterilization process will not kill all types of
vegetation and we will not be responsible for any damaged pavement due to the growth of vegetation. All agreements contingent upon strikes, accidents or delays
beyond our control. If this contract exceeds $1,000, the owner acknowledges receipt of the "Information Notice to Homeowners about Construction Liens." This
proposal may be withdrawn by us ifnot accepted within 30 days. CCB #50835
i~) A:
r:J/ .) /
Estimator \/--Ut1.-~ C-v . " Z-n-t C~ Terry W Simcoe
IJ Acceptance of Proposal
I V/~J .
The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do all of the work as specified.
Payment will be made as outlined above.
~ ~ -~-
Signatur- , j
Date
s;i 17~ 7
.
r~'
CITY RECORDER'S COpy
Page 1 / 1
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
~Q~rE
5/23/2007
f i~Pb~~~~ER~1
VENDOR: 000903
PACIFIC PAVING,INC
POBOX 2370
WHITE CITY, OR 97503
SHIP TO: Ashland Wastewater Department
(541) 488-5354
90 N MOUNTAIN
ASHLAND, OR 97520
FOB Point:
Tenns: Net
Req. Del. Date:
Speciallnst:
Req. No.:
Depl: PUBLIC WORKS
Contact: Terry Ellis
Confinnlng? No
c.~
~" 1(.
4.00
Patch trench on Beact Street
Estimate 5,151 Square Feet
Due to the actual condition of road,
the actual footaQe will be measured in
the field when patch is done. Per Quote
dated May 15, 2007
Contract for Goods & Services
Date of aQreement: May 22, 2007
BeQinninQ date: May 24, 2007
Completion date: June 1, 2007
Insurance required/On file
BILL TO: Account Payable
20 EAST MAIN ST
541-552-2028
ASHLAND, OR 97520
SUBTOTAL
TAX
FREIGHT
TOTAL
20 604.00
0.00
0.00
20,604.00
;.\m30~4Ntimjjijc".. .lP~ fi.,"'<tj:@je!;l&!J~~r~.l;'fi :;)' !\mount ,;;;",~ :P'A~couJ:lt~N-..mr66'it' '-:"~:r;.eroj~Etlt'iomieJ)~..il' . '~A;nount'~ )tEl
E 260.08.12.00.70410( 8.604.00
E 675.08.1 7.00.7041 Ot 12.000.00
~ ~ S,dJ~
Au zed Signature ?
VENDOR COPY
A request for a Purchase Order
REQUISITION FORM
CITY OF
ASHLAND
THIS REQUEST IS A:
o Change Order(existing PO #
Date of Request:
Required Date of Delivery/Service:
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
?~\..c.<-
,,1p-o
t> (lUl ^~
Jt0L
~u oS AILv.l 90 If. d---
"7rtP~
SOLICITATION PROCESS
Small Procurement o Sole Source 0 Invitation to Bid
o Less than $5.000 o Written findings attached (Copies on file)
o Quotes (Optional) o Quote or Proposal attached
Cooperative Procurement 0 ReQuest for Proposal
o State of ORNIA contract (Copies on file)
Intermediate Procurement o Other government agency contract 0 Special/ Exempt
~3) Written Quotes 0 Copy of contract attached 0 Written findings attached
(Copies attached) D Quote or Proposal attached
0 Contract # 0 EmerQency
0 Written findings attached
0 Quote or Proposal attached
Description of SERVICES
A<>p~\\- p~ Vl.~ 0 "- ~~ <;.~ .
Y.oX> I f12 -.e':>~M--L.~ e ~ S-I r, <..
.~
t:ili'e
..
D Per attached PROPOSAL
~
Item # Quantity
Unit
Description of MATERIALS
Unit Price
Total Cost
ProjectNumberA-+___~_ "7oy'o:> ~_ i( 8, J 0'-1.'-""
~L.DO , V10 . \~QC) ~ --I J J ~ , b
Account Number"'~ -ce-l""]- LX> .:?QY!Q&J :. f,( I~UXJ.cJO
. Items and seNices must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately.
! !I'TOTALCOST~i
..;.. ',,:' ~~ .,
21. ~,l ~
:: t;l~~
~ Per attached QUOTE
By signing this requisition form, I certify that the information provided above meets the City of Ashland public contracting requirements,
and thedocumentaUon can be provided upon request. ~ .
Employee Signature.:.... ~ C ~ Supervisor/Dept. Head Signatu~e:~ Iv\:.. Lc.v ~, x
~
G: Finance\Procedure\APIFormslB_Requisition form revised.doc
Updated on: 3/1412007