HomeMy WebLinkAbout2007-109 Contract - Wilson-Heirgood Assoc
CITY OF CONSULTANT: W.H.A. INSURANCE AGENCY, INC.
ASHLAND- dba Wilson-Heirgood Associates
20 East Main Street CONTACT: T amalyn Fitch
Ashland, Oregon 97520 ADDRESS: PO Box 1421, Eugene, OR 97440-1421
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-342-4441
DATE AGREEMENT PREPARED: Mav 31,2007 FAX: 541-484-5434
BEGINNING DATE: April 1 ,2007 COMPLETION DATE: Aoril1, 2008
COMPENSATION: Annual cost for 04/01/2007 to 04/01/2008 - $17,600.00. Payments will be billed in quarterly
installments. Plus an additional $3,000 for potential trainings to be presented at multiple staff meetings, $1,500
per topic. Total contract amount not to exceed $20,600.00.
SERVICES TO BE PROVIDED: Risk Management Consulting Services as outlined in the attached letter dated
April 9, 2007, from Tamalyn Fitch to Lee TuneberQ
ADDITIONAL TERMS: None
Contract for PERSONAL SERVICES Less than $25,000
CIN AND CONSULTANT AGREE:
1. All Costs by Consultant: Consultant shall, at its own risk and expense, perform the personal services described
above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance
of such service.
2. Qualified Work: Consultant has represented, and by entering into this contract now represents, that all personnel
assigned to the work required under this contract are fully qualified to perform the service 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.
3. Completion Date: Consultant shall start performing the service under this contract by the beginning date indicated
above and complete the service by the completion date indicated above.
4. Compensation: City shall pay Consultant for service performed, including costs and expenses, the sum specified
above. 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.
5. Ownership of Documents: All documents prepared by Consultant pursuant to this contract shall be the property of
City.
6. Living Wage Requirements: If the amount of this contract is $16,936 or more, Consultant 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 service work under
this contract. Consultant is also required to post the notice attached hereto as Exhibit B predominantly in areas where
it will be seen by all employees.
7. Indemnification: Consultant 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 Consultant (including but not
limited to, Consultant's employees, agents, and others designated by Consultant to perform work or services
attendant to this contract). Consultant 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.
8. 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 Default or Breach.
i. Either City or Consultant 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 art ivin the notice ma authorize or re uire, then the contract ma be terminated at an
Contract for Personal Services Less than $25,000, Revised by Legal 03/26/2007, Page 1 of 5
time thereafter by a written notice of termination by the party giving notice.
ii. Time is of the essence for Consultant's performance of each and every obligation and duty under
this contract. City by written notice to Consultant of default or breach may at any time terminate
the whole or any part of this contract if Consultant 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.
d. Obliaation/Liability of Parties. Termination or modification of this contract pursuant to subsections a or b
are 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 or c of this section, Consultant shall immediately cease all activities under this contract,
unless expressly directed otherwise by City in the notice of termination. Further, upon termination, Consultant
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 Consultant for work performed prior to the
termination date if such work was performed in accordance with the Contract.
9. Independent Contractor Status: Consultant is an independent contractor and not an employee of the City.
Consultant shall have the complete responsibility for the performance of this contract. Consultant shall provide
workers' compensation coverage as required in ORS Ch 656 for all persons employed to perform work pursuant to
this contract. Consultant is a subject employer that will comply with ORS 656.017.
10. Assignment and Subcontracts: Consultant 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. Consultant 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.
11. Default. The Consultant shall be in default of this agreement if Consultant: commits any material breach or default
of any covenant, warranty, certification, or obligation it owes under the Contract; or loses any license, certificate or
certification that is required to perform the Services; 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.
12. Insurance.
a.
Consultant shall at its own expense provide the following insurance:
i. 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.
Professional Liability insurance with a combined single limit, or the equivalent, of not less
than $500,000 for each claim, incident or occurrence. This is to cover damages caused by
error, omission or negligent acts related to the professional services to be provided under
this contract.
General Liability insurance with a combined single limit, or the equivalent, of not less than
$500,000 for each occurrence for Bodily Injury and Property Damage. It shall include
contractual liability coverage for the indemnity provided under this contract.
Automobile Liability insurance with a combined single limit, or the equivalent, of not less
than $500,000 for each accident for Bodily Injury and Property Damage, including
coverage for owned, hired or non-owned vehicles, as applicable.
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 Consultant
or its insurer(s) to the City.
Additional Insured/Certificates of Insurance. Consultant shall name the City and its elected officials,
officers and employees as Additional Insureds on any insurance policies required under this
agreement herein but only with respect to Consultant's services to be provided under this Contract.
As evidence of the insurance coverages required by this Contract, the Consultant 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 Consultant shall be financially responsible for all pertinent
deductibles, self-insured retentions and/or self-insurance.
13. 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 that arises from
or relates to this contract shall be brought and conducted solely 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
ii.
iii.
iv.
b.
c.
Contract for Personal Services Less than $25,000, Revised by Legal 03/26/2007, Page 2 of 5
solely and exclusively within the United States District Court for the District of Oregon filed in Jackson County.
14. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE
PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL
BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT,
MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR
THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR
REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT.
CONSULTANT, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT
HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND
CONDITIONS.
15. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and
authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Consultant
understands and agrees that City's payment of amounts under this contract attributable to work performed after the
last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow
City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In
the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this
contract without penalty or liability to City, effective upon the delivery of written notice to Consultant, with no further
liabilit to Consultant.
CONSUl7 ~~T \
BY ("tJtC7J {~j
j ----- .---$ignature
l ~ +h i a.. -YO -( '"
Print Name
CITY OF ASHLAND:
BY
R
TITLE
6 -e n f^{uQ ~C:l H.(1 rre}--'
DATE
DATE
~I- 15-07
CONTRACT AWARD AND FINDINGS DETERMINED BY:
By:
Federal 10#
q~ -c -1 tj-:S ) <20
City Department Head Date: ~ ~7 b 7
ACCOUNT # -; ::z t1 (' '3 c C tr' c 6 t'/ ~I C' 0
(For City purposes only)
'Completed W9 form must be submitted with contract
PURCHASE ORDER #
[/7~e'p
Contract for Personal Services Less than $25,000, Revised by Legal 03/26/2007, Page 3 of 5
Form W-g
(Rev. November 2005)
Department of lhe TreaSury
Internal RlWenue Service
N Name (as shown on your Income lax return)
~ WHA Insurance Agency, Inc
[ Business name, if different from above
S DBA: Wilson-Heirgood Associates, Inc
G)CIl
j ~ 0 IndividuaV '
.. () Check appropriate box: Sole proprietor
..oc 2
t; Address (number, slreet, and apt. or suite no.)
'1: .5 2930 Chad Drive
Q.()
!E
()
8-
I/)
3l
CIl
Request for Taxpayer
Identification Number and Certification
Enter your TIN In the appropriate box. The TIN provided must match the name given on Une 1 to avoid
backup withholding. For Individuals, this Is your social security number (SSN). However, for a resident
allen, 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 8 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.
Certification
III Corporalion
City, state. and ZIP code
Eugene, OR 97408
List account number(s) here (optlonaQ
Give form to the
requester. Do not
send to the IRS.
o Partnership 0 Other ~ ....n.......___..
o Exempt from baCkup
withholding
Requester's name and address (optiona~
I Social security number
I I t I + I
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 (IRS) 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 dlvlaends, you are not required to Sign the Certification, but you must
provide your correct TIN. (Se~.the Instructions on page 4.)
Sign Signature of /
Here u.s. person ~L,
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-S 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.
In 3 above, if applicable, you are also certifying that as a
U.S. person, your allocable share of any partnership income
from a U.S. trade or business is not subject to the
withholding tax on foreign partners' share of effectively
connected Income.
Note. If a requester gives you a form other than Form w-s to
request your TIN, you must use the requester's form if It is
substantially similar to this Form W-9.
For federal tax purposes, you are considered a person if you
are:
Date ~
" -I.:;J- D?
. An Individual who Is a citizen or resident of the United
States,
. A partnership, corporation, company, or association
created or organized in the United States or under the laws
of the United States, or
. Any estate (other than a foreign estate) or trust. See
Regulations sections 301.7701-6(a) and 7(a) for additional
Information.
Special rules for partnerships. Partnerships that conduct a
trade or business In the United States are generally required
to pay a withholding tax on any foreign partners' share of
Income from such business. Further, in certain cases where a
Form W-S has not been received, a partnership Is required to
presume that a partner Is a foreign person, and pay the
withholding tax. Therefore, if you are a U.S. person that Is a
partner In a partnership conducting a trade or business in the
United States, provide Form W-S to the partnership to
establish your U.S. status and avoid withholding on your
share of partnership income.
The person who gives Form W-9 to the partnership for
purposes of establishing Its U.S. status and avoiding
withholding on Its allocable share of net Income from the
partnership conducting a trade or business In the United
States is in the following cases:
. The U.S. owner of a disregarded entity and not the entity,
Cat. No. 10231X
Form W-9 (Rev. 11-2005)
CITY OF ASHLAND, OREGON
EXHIBIT B
City of Ashland
LIVING
ALL employers described
below must comply with City
of Ashland laws regulating
payment of a living wage.
~~,
Employees must be paid a
living wage:
~ For all hours worked under a
service contract between their
employer and the City of
Ashland if the contract
exceeds $16,936 or more.
~ For all hours worked in a
month if the employee spends
50% or more of the
employee's time in that month
working on a project or
~per hour effective June 30, 2006
(Increases annually every June 30 by the
Consumer Price Index)
portion of business of their
employer, if the employer has
ten or more employees, and
has received financial
assistance for the project or
business from the City of
Ashland in excess of $16,936.
~ If their employer is the City of
Ashland including the Parks
and Recreation Department.
~ In calculating the living wage,
employers may add the value
of health care, retirement,
401 K and IRS eligible
cafeteria plans (including
childcare) benefits to the
amount of wages received by
the employee.
~ Note: "Employee" does not
include temporary or part-time
employees hired for less than
1040 hours in any twelve-
month period. For more
details on applicability of this
policy, please see Ashland
Municipal Code Section
3.12.020.
For additional information:
Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator, City Hall,
20 East Main Street, Ashland, OR 97520 or visit the city's website at www.ashland.or.us.
Notice to Employers: This notice must be posted predominantly in areas where it can be seen by all
employees.
CITY OF
ASHLAND
Contract for Personal Services Less than $25,000, Revised by Legal 03/26/2007, Page 5 of 5
WILSON-HEIRGOOD
ASS 0 C I AT E S
April 9, 2007
Lee Tuneberg
Finance Director
City of Ashland
20 E Main Street
Ashland, OR 97520
RE: Proposal for Risk Management Personal Services
Dear Lee,
Our agency has completed a one year contract for consulting services related to the City's
risk management. During this time we have provided services for three levels of
identified exposures and issues. Level one involved critical and basic insurance
functions. Level two dealt with coordinating the insurance coverage with non-insurance
City practices' for risk management. The third level is a proactive focus on activities
designed to reduce the City's risk through loss prevention and loss control.
The culmination of the activities was completion and presentation of the Risk
Management Strategic Plan. It was designed to focus time, efforts and resources to
positively impact liability exposures, reduce injury and accidents through effective
policies, training and adopted safety culture that will be embraced by all City employees.
Our early indications from your current carrier are the services and activities that we are
proposing are directly in line with their risk management focuses. This should allow for
premium credits on your renewal to offset the cost of our consulting services.
Following is our proposal for consulting services for the City of Ashland for the next
twelve months. The contract will start effective April I, 2007 for a twelve month period.
We enjoy our association with the City of Ashland and the Risk Management Team. It is
our hope to partner our consulting talents and resources to address the risk management
and safety concerns of the City.
Sincerely,
~~~
2930 Chad Drive, Eugene, OR 97408 . 806 North A Street #B, SpringfieleJ, OR 97477 . PO Box 1421, Eugene, OR 97440-1421
541-342-4441 . 800-85~-6140 . fax 541-484-5434 541-342-3786 . email info@w~lainsurance.com
WILSON-HEIRGOOD
ASS 0 C I AT E S
Proposed Risk Management Consulting services for the Personal Services Contract with
the City of Ashland (April!, 2007 - April!, 2008)
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$17,600.00
Additional activity: At the City's option they may elect to receive up to two all staff
trainings to be presented at multiple staff meetings for a cost of $1500 per topic.
2930 Chad Drive, Eugene, OR 97408 . 806 North A Street #B, Springfield, OR 97477 . PO Box 1421, Eugene, OR 97440-1421
541-342-4441 . 800-852-6140 . fax 541-484-5434,541-342-3786 . em ail info@whainsurance.com
ACORD... CERTIFICATE OF LIABILITY INSURANCE I D;~~ (riD/YYYY)
6 18 2007
PRODUCER (800)852-6140 FAX: (541)342-3786 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wilson-Heirgood Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2930 Chad Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO Box 1421
Euqene OR 97440-1421 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Hartford Casualty 00914
WHA Insurance Agency Inc, DBA: Wilson-Heirgood INSURER B: Hartford Underwriters 30104
PO Box 1421 INSURERc:Utica Mutual Insurance
INSURER D:
Eugene OR 97440 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 CERTIACATE 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.
: BEE I r.LAIM!':
I~~ ADD'L TYPE OF INSURANCE POLICY NUMBER PJ>A"li~:~g~ Pg~W,:A,~~N LIMITS
IN!:An
~NERAL UABIUTY $ 1,000,000
X COMMERCIAL GENERAL LIABIUTY DAMAGE TO RENTED $ 300,000
A X I CLAIMS MADE GU OCCUR 52SBAPM9298 7/31/2006 7/31/2007 MED EXP {Anv one oerson\ $ 10,000
$ 1,000,000
GENERAL A $ 2,000,000
@LAGGREGATE LIMIT nES PER: - $ 2,000,000
X POLICY n ~,Qr II ~
~OMOBILE UABIUTY COMBINED SINGLE LIMIT $ 1,000,000
X ANY AUTO (Ee accldent)
I--
B X f-- ALL OWNED AUTOS 52UECUS5685 7/31/2006 7/31/2007 BODILY INJURY
(Per person) $
~ SCHEDULED AUTOS
~ HIRED AUTOS BODILY INJURY $
NON-OWNED AUTOS (Per accldent)
f--
f-- PROPERTY DAMAGE $
(Per accldent)
GARAGE UABIUTY AUTO ONLY - EA ACCIDENT $
R- ANY AUTO OTHER THAN ~AA(".r. Is
AUTO ONLY: Ar..r..ls
EXCESSlUMBRELLA L1ABIUTY Is 1,000,000
tJ OCCUR D CLAIMS MADE AGGREGATE Is 1,000,000
$
A ~ DEDUCTIBLE 52SBAPM9298 7/31/2006 7/31/2007 $
X s 10.000 s
WORKERS COMPENSATION AND WCSTAru-,I 10J;tl-
EMPLOYERS' UABIUTY $
ANY PROPRIETORlPARTNERlEXECUTIVE E.L EACH ACCIDENT
OFFICERlMEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE S
~=~I~~ under ~ I nl"~A"~ _ "'" ''''' I 'UIT S
C OTHER Errors , Omissions 31968491:0 3/21/2007 3/21/2008 Bach Loee 3,000,000
Aggregate 6,000,000
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENOORSEMENTISPECIAL PROVISIONS
City of Ashland and its elected officials, officers and employe.s are listed as additional insureds in regards to
liabili ty.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Ci ty of Ashland EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
Purschaing Representative 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
Attrl: Kari Olson -
90 N Mountain Avenue FAILURE TO DO so SHALL IMPOSE NO OBLIGATION OR UABIUTY OF ANY KIND UPON THE
Ashland, OR 97520 INSURER ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE c=---""~~ 5~~
Jeffrey Griffin/ARJ
ACORD 25 (2001/08)
IN~n'~ /ninA' l\Ao
@ ACORD CORPORATION 1988
P"",.1 nf?
ACORDru CERTIFICATE OF LIABILITY INSURANCE I i~~ (~'rDIYYYY)
6 18 2007
PRODUCER (800)852-6140 FAX: (541)342-3786 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Wilson-Heirgood Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
2930 Chad Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO Box 1421
Euaene OR 97440-1421 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: SAIF Service Center
WHA Insurance Agency Inc, DBA: Wilson-Heirgood INSURER B:
PO Box 1421 INSURER C:
INSURER D:
Eugene OR 97440 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.
: liMIT!': ''''''<>
I~~ ~ TYPE OF INSURANCE POLICY NUMBER P~A~~::68~ Pg~W,~,b~~N LIMITS
~NERAL L1ABIUTY $
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $
I CLAIMS MADE D OCCUR MED EXP (Anv one oerson\ $
.. An\J ,.. IIIDV $
-
- GENERAL A $
~L AGGREn LIMIT nES PER: - .-- $
POI WY ~~R,: Ln"
~TOMOBILE L1ABIUTY COMBINED SINGLE LIMIT $
ANY AUTO (Ee eccldent)
-
- ALL OWNED AUTOS BODILY INJURY
(Per person) $
- SCHEDULED AUTOS
- HIRED AUTOS BODILY INJURY $
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO OTHER THAN ~A A"" I!
AUTO ONLY: A"'''' It
OESSlUMBRELLA L1ABIUTY It
OCCUR D CLAIMS MADE Ac;GRFGATE $
~ DEDUCTIBLE $
$
t Ie
A WORKERS COMPENSATION AND X I WC STATU- I IO~-
EMPLOYERS' L1ABIUTY 500,000
ANY PROPRIETOR/PARTNERlEXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? 515291 7/1/2006 7/1/2007 E.L. DISEASE - EA EMPLOYEE I! 500,000
~~~':I~~Cribe under E.L. DI!;EA!;E - POI ICW 'iMIT It 500 000
OTHER
DESCRIPTION OF OPERATlONS/LOCATlONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Ashland EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
Kari Olson , Purchasing Representative 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
90 N. Mountain Ave -
Ashland, OR 97520 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ---~<C""'~""~/~~~~':"'" .,_
Raelynn Ortiz/RMO .----"
..,c_~
ACORD 25 (2001/08)
@ACORD CORPORATION 1988
...IQn4l)t:: 11\"""&\ ^D_
D~..^" ...~.,
~6'
CITY RECORDER'S COpy
CITY OF
ASHLAND I DATE I
20 E MAIN S1. . 6f7/2007
ASHLAND, OR 97520
(541) 488-5300
Page 1 / 1
PO NUMBER
07588
VENDOR: 010070
WILSON HEIRGOOD ASSOCIATES
PO BOX 1421
2451 WILLAMETTE STREET
EUGENE, OR 97405
SHIP TO: Ashland Finance Deartment
(541) 488-5300
20 E MAIN STREET
ASHLAND, OR 97520
FOB Point:
Terms: Net
Req. Del. Date:
Speciallnst:
Req. No.:
Dept.: ADMINISTRATIVE SERVICES
Contact: Sharlene Stephens
Confirming? No
Quantity Unit Description Unit Price Ext. Price
Risk Manaqement Services 17,600.00
April 1 ,2007 throuqh March 31,2008
Annual cost of $17,600 to be paid in
quarterly payments.
Plus an additional $3,000 for potential 3,000.00
traininqs to be presented at multiple
staff meetinqs, $1,500 per topic.
Contract for Personal Services
Beqinninq date: April 1 , 2007
Completion date: March 31,2008
Insurance required/On file
SUBTOTAL 20600.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 20,600.00
ASHLAND, OR 97520
Account Number Project Number Amount Account Number Project Number Amount
E 720.03.00.00.6041 OC 20600.00
/
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Aut~gnau.e
VENDOR COPY
CITY OF
ASHLAND
REQUISITION FORM
Date of Request: t./ /r (/01
THIS REQUEST IS A:
o Change Order(existing PO #
Required Date of Delivery/Service:
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
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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 OAN/A contract (Copies on file)
Intermediate Procurement o Other government agency contract o Special I Exempt
o (3) Written Quotes 0 Copy of contract attached '~ _Written findings attached
(Copies attached) ;><:: ~Quote or Proposal attached
/ EmerQencv
0 Contract # o Written findings attached
o Quote or Proposal attached
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L~:r/Per attached PROPOSAL -l.;-- ';'--'{'- '-tj" .') -t:~,:.:>-' \ \-~ ,\ \/ c -' -' n < \:'j , \ '- ," .
Description of SERVICES
Item #
Quantity
Unit
Description of MATERIALS
Unit Price
Total Cost
Project Number _ _ _ _ _ _ . _ _ _
Account Number t~_ - ~-i . Q f!' {?'2- _ ~!'_ t.f j tJO
, Items and selVices must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately.
P-- Per attached QUOTE
By signing this requisition form, / certify that the information provided above meets the City of Ash/and public contracting requirements,
and the documentation can be provided upon request
Employee Signature:
Supervisor/Dept. Head Signature: ~
G: Finance\Procedure\AP\Forms\8_Requisition fcrm revised.doc
Updated on: 4/1012007