HomeMy WebLinkAbout2007-182 Contract - Key Line Construction
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Specializing in underp"md construction cable pIowiag
66f:1 TOLO RD.
CENTRAL POINT, ORE. 97502
(ijficc(S41) 66S-S41S
Fax (S41) 66S-S411
Pager (541) 770-0798 CEIL (541)660-0172
CCB# 150310
JUNE-19-07
Job Estimate
JOB LOCATION;
ASHLAND ELC.
581 SPRINGeR.
ASHLAND OR.
PP&L WO ##
Key line construction is pleased to submit tbsUOllowina cost estimate
'l'RBNCHFROM NEWMEBTER. ON WALL TO CONCRETB DRIVEWAY. BORE UNDER CONCRETE
DRIV'BWA Y AND PULL IN 3" CONDUIT . SET HAND HOLE NEXT TO eXISTING MEETER..
Job will be cleaned up to DOrmal job standards. All prlmuy, maiD line, secondary cables
audlor service drop wires 8re the responsibility of the customer to mauge with their local
utilities. Ally rock encountered tIIat c.mot be bored or plowed will be dealt with on a time and
ma1aial basis. Any 1DOl'e then two rips will be extra cost on job. nus PROPOSAL MAY BE
W1lliDRAWN BY US If NOr JtO.;rr 1m" WI11UN 30 DAYS
EQUIPMENT AND LABOR: 5,581.24
WITH PAYMENT TO BE MADE AS FOLLOWS:
50% AT START OF JOB AND REMAINDER DUE UPON COMPLETION.
All material is guaranteed to be as specified. All work is completed in a workmanship
m&JJDer according to stBDdard practkes. Any a1ta'ations Ol' deviation from the above
specificatiOlll involving extra costs. win be executed oaly upon writtm orden, and will
become aD extra duqe over aDd above the estimate.
AurHORIZED SIGNATURE: STEVE COLSO~
PRESIDBNTOP KEYLINE CONSTRUCTION INC.
ACCEPTANCE OF ES11MATE
The ..... ...... ....iIk.... ... co..udo_ are _tiaflldery uti .re hereby
.ce~ You an .....orlzed to do 6e .erk.. .pedfied. Pa~t wiD be....te as
.outlDed abo\te
SIONA1URE DATE
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: Key Line Construction Inc.
CONTACT: Jim Lake
ADDRESS: 6687 Tolo Road, Central Point, OR 97502
TELEPHONE: 541-665-5415
DATE AGREEMENT PREPARED: Jul 26,2007 FAX: 541-665-5418
BEGINNING DATE: Au ust 1,2007 COMPLETION DATE: Se tember 30,2007
COMPENSATION: $5,582.24, Per attached proposal dated June 19, 2007. Full payment will be processed
u on the successful com letion of the 'ob.
GOODS AND SERVICES TO BE PROVIDED: Contractor to trench from new meter on wall to concrete
driveway, bore under concrete driveway and pull 3" conduit. Hand hole will be set next to existing meter. Job
location is 581 S rin Creek Drive, Ashland, Ore on.
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 279B.220, 279B.225, 279B.230, 279B.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 $17,342 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 B 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. Cit ma terminate or modif this contract, in whole or in
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. Obliaation/Liability of 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 $1,000,000 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 $1,000,000
for each accident for Bodil ln'ur and Pro ert Dama e, includin covera e for owned, hired or non-owned
Contract for Goods and Services Less than $25,000, Revised by Legal 03/26/2007, Page 2 of 6
vehicles, as applicable.
d. Notice of cancellation or chanqe. 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.
CONTRACIQfl CITY OF ASHLAND:
BY
BY
/
I
TITLE
V?
DATE
r- /J- C/ 7
DATE <6 /' ( --v .1-.
FederallD# ACCOUNT #
'Completed W9 form must be submitted with contract
PURCHASE ORDER #
Contract for Goods and Services Less than $25,000, Revised by Legal 03/26/2007, Page 3 of 6
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.
~
,..---
(Date)
Contract for Goods and Services Less than $25,000, Revised by Legal 03/26/2007, Page 4 of 6
Form W-9
(Rev. January 2003)
Department of the Treasury
Internal Reveooe Service
Request for Taxpayer
Identification Number and Certification
Give form to the
requester. Do not
send to the IRS.
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.
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Name
/, e... J I 'NV
Con S T!<-l-Lc.._i, () V\.
Business name. if different from above
O Individuall
Check appropriate box: Sole proprietor
Addres7.(number. street, and apl. or suite no-1 I
u'ui~7 ~/~ ~,1
City. stat;. and ZIP code . ----::>.
C &'1 (7!-f9-1 1 {". ~ +
List account number(s) here (optional)
0Corporation
6^,-
o Partnership 0 Other ~ ...................
O Exempt from backup
withholding
Requester's name and address (optional)
q 7r;;L" )"'-
Social security number
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or
Certification
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 (cl 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 Z 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
Here
Signature of
U.S. person ~
Date ~
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-9 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 requesters 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).
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. '-2003)
Contract for Goods and Services Less than $25,000, Revised by Legal 03/26/2007, Page 5 of 6
11 04:21 p
....,
~
Specializing iu underp'ound conIttUdion cable plowing .
66fn TOLO RD.
CENTRAL POINT, ORE. 97502
~cc(S4])66S-5415
Fax (S41) 665-S418
Pager (541)770-0798 CELL(S41)660-0872
CCB# 150310
JUNE-] 9-07
Job Estimate
JOB LOCATION;
ASHLAND ELC.
58] SPRINGeR.
ASHLAND OR.
PP&L WO 1#
~ line construction is oleased to submit the f,Qllowini cost estimate
eM PROM NEWMBBTER. OM WALL TO CONCRETB DRIVEWAY. BORE UNDER CONCRETE
i)ilveWA Y AND Pm.L IN 3" CONDUIT . seT HAND HOLE NEXT m EXISTING MEETBR..
Job will be c1eaDcd tip to normal job standards. All primary. main line, secondary cables
audlor service drop wires are the responsibility of the customer to mange with their local
utilities. Ally rock encountered 1IIat CaaDot be bored or ploWed will be dealt with on a time and
mataial buis. Any mm:e then two rips will be extra cost 011 job. nus PROPOSAL MAYBE
WInmRAWN BY US JF NOr NXtwJr.u wrnuN 30 DAYS
EQUIPMENT AND LABOR: 5,582.24
WITII PAYMENT TO BE MADE AS FOLLOWS:
50% AT START OF JOB AND REMAINDER DUE UPON COMPLETION.
All material is guaranteed to be as specified. All work is completed in a workmanship
IJ'RI1Nlt acconting to staDdard practices. Any alterations ()[' deviation from the above
specificatiOlll involving extra costs, will be executed ODly upon wrium orders, and win
become an extra cbarge over aod above the estimate.
AUfHORIZED SIGNATURE: STEVE COLSON
PRESIDENTOP KEYLINE CONSTlWCTlON INC.
ACCEPTANCE OF ESTIMATE
The a1Mrv. ..... ....Wk...... ... coadldD- are _tlafade." ad an ".reby
ace~ You are a.thorbed to do tile work as lpec:ified. Pa,..t 1riU be .ade as
.outiDed .mo.e
SJONAruRE DATE
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PAGE
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OREGON WORKERS' COMPENSATION
CERTIFICATE OF INSURANCE
~~~t!
CERTIFICATE HOLDER:
CITY OF ASHLAND
90 N. MOUNTAIN AVE.
ASHLAND, OR 97520
The policy of insurance listed below has been issued to the insured named below for the policy
period indicated. The insurance afforded by the policy described herein is subject to all the terms,
exclusions and conditions of such policy.
POI rcy NO.
937629
POI ICY PFn.rOD
01/01/2007 TO 01/01/2008
rSSUF DATF
08/01/2007
INSURED:
KEY LINE CONSTRUCTION INC
6687 TOlO RD
CENTRAL POINT, OR 97502-9350
BROkER OF RECORD:
CONTRACTORS INSURANCE SERVICES
PO BOX 4410
TUAlATIN, OR 97062
LIMITS OF LIABILITY:
Bodily Injury by Accident $500,000 each accident
Bodily Injury by Disease $500/000 each employee
Bodily Injury by Disease $500/000 policy limit
DESCRIPTION Of OPERATIONS/LOCATIONS/SPECIAL ITEMS:
ALL OPERATIONS
IMPORTANT:
The coverage described above is in effect as of the issue date of this certificate. It is subject to
change at any time in the future.
This certificate is issued as a matter of information only and confers no rights to the certificate
holder. This certificate does not amend, extend or alter the coverage afforded by the policies
above.
CANCELLATION:
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE
THEREOF, THE ISSUING COMPANY WILL MAIL 30 DAYS' WRITTEN NOTICE TO THE ABOVE NAMED
CERTIFICATE HOLDER.
AUTHORIZED REPRESENTATIVE
'-""~'"
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(~) SAIF CORPORATION I 400 High St SE I Salem, OR 97312 I P: 800.285.8525 I www.saif.com
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ACORD", CERTIFICATE OF LIABILITY INSURANCE I DATE (MMJDD/YYYY)
8/1/2007
PRODUCER (541) 772-1111 F1IX: (541)772-3785 THIS CERTIFICATE IS ISS U ED AS A MATTER OF INFORMATION
Giles Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Cramer & HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR
707 Murphy Road AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Medford OR 97504 INSURERS AFFORDING COVERAGE NAIC #
--.---. ~-- ---~. -- -- ~------
INSURED INSURER A. Financial Pacific
Key Line Construction, Inc, INSURER 8:
6687 Tola Rd INSI JRER C
INSURER D:
Central Point OR 97502 INSURER E
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
Rl:QUIREMEN r, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICA rE 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. --I POLICY EFFECTI~ I POLlCy,r-PIRA TlgN -- -- ---.-
I~~: ~~~~i TYPE OF INSURANCE I POLICY NUMBER DATE MM/DDIYY DATE MMIDDIYY LIMITS
~ERAL LIABILITY I I 1,000,000
1 EACH aCGI JRRENCE" $
, I 8~~r~~~J,9E~~~~~n~e\ -----
~MMER[;IAL GENERAL LIABILITY I $ 100,000
A _ CLAIMS MAU" D OCCUR 173496B 11/22/2006 11/22/2007 MED EXP IAm~ on~ [l~rsllnl $ 5,000
d-~----- PERSONAL &. A[iV IN.IUHY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
@'L AGGREGATE LIMIT AAES PER PRODtlCTS - r:OMP/OP AGe; $ 2,000,000
nPRO-
X POLICY ,IEO LOC
ROMOBILE LIABILITY CUMBINED SINC;LE LIMIT 1,000,000
(Ea accident) $
ANY AUTO
A ALL DWNED AlJ r o.'i 173496B 11/22/2006 11/22/2007 BODILY INJURY
I X I SCH EDLlLED AUTOS (Per per~r'ln) $
IX i HIREU AUTU~ I
I ! BODILY IWIJRY I.
- I (P~r acr:ldPnt) I'
~ NUN OWNED AUT OS
I
f-- PROPERTY DAMAGE:: 1$
{Per accident}
~AGE LIABILITY AUTO ONLY EA ACCIDEtJ.1:.... c!_~ --"-
ANY AIITO OTHER THAN EA ACC $
AIITO ONLY AC;'(~ $
EXCESS/UMBRELLA LIABILITY c^rH rrr. 'QccNrc $ 2,000,000
~ OCCUR D CLAIMS MADE AGGREG"TE $
.~---~ -- 0'-- _ --.. -
A ~ DEDUCTIBLE 922533B 11/22/2006 11/22/2007 --~-_. ~ - $ -
X RETENTION s 0 $
WORKERS COMPENSATION AND I T~f[tJtYS I IOJ~-
Ef1iFLOYERS' LiABiLiT'{ I
AN,' PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $
DFFICERJMEM8ER EXCLt IDED" E.L DISEASE - EA EMPLOYEE $
If ye~, desCflbe I.mjer $
SF'ECIAL PR(JVI~IONS below E.L. DISEASE - POLlCY LIMIT
OTHER
DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLESlEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Re: Verification of Insurance
l(l Day Not~ce of Cancellat~on f-or Nan-Payment of Prem~um. SUbJect to Po~~cy Ll.ml.tsr Terms Condit~ons and Exclus~on5.
CERTIFICATE HOLDER
CANCELLATION
(541)488-5320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
c~ty of Ashland EXPIRA TION DATE THEREOF, THE ISSUING INSURER WILL EN DEA VOR TO MAIL
90 N Mountain Avenue 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
Ashland, OR 97520 --
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSlIRER. ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE (].A,AG-P Slau('f
AmhEr Sla t.t:fery / AMBE:;L
ACORD 25 l2001/08)
INS025 (0100) nR~
@ ACORD CORPORATION 1988
Pagp 1 of 2
Deeuner~ar~05n/JDLK
ts/l/Z00" 11: 54: 42 AM
PAGE 003/003
Fax 5erver
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this
certificate dues not cunfer rights to the certificate holder in lieu of ::;uch endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an
endorsement A statement on thiS certificate does not confer rights to the certificate holder in lieu of such
endo rseme nt( s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing
insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively
amend, extend or alter the coverage afforded by the poliCies listed thereon.
ACORD 25 12001/08)
INS025 (0108) 08.
Psge20f 2
tleeCn6rcar~OSn/JHLK 8/1/2007 11:54:42 AM
PAGE 001/003
Fax Server
JRBJv:~
Date:
To:
Company:
Phone:
Fax:
FAX TRANSMITTAL
... .....
8/1/200711 :53:32 AM
Kari Olsen
City of Ashland
5414885320
Num of Pages:
(including cover)
From:
Direct Phone:
Direct Fax:
Email Address:
AMB46B07446BD22
3
Amber L. Slattery
(541) 494-2655
(541) 772-3785
am ber.slattery@jblk.com
707 MurphyRd Medford, OR 97504 (541}772-1111 Main (541)772-3785 Fax
dba JBL&K Insurance Agency
CA License #OF09618 OR License #816307 WA License #252204
...a Beecher Carlson Company
CiTY RECORDt:H/~ vut" y
Page 1 / 1
r.,
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
~~- ~
8/8/2007
r
VENDOR: 008877
KEY LINE CONSTRUCTION, INC
6687 TOLO ROAD
CENTRAL POINT, OR 97502
SHIP TO: Ashland Electric Department
(541) 488-5354
90 N MOUNTAIN
ASHLAND, OR 97520.
FOB Point:
Terms: Net
Req. Del. Date:
Speclallnst:
Req. No.:
Dept.: ELECTRIC
Contact: Scott Johnson
Confirming? No
Contractor to trench from new meter on
wall to concrete driveway, bore under
concrete driveway and pull 3" conduit.
Hand hole will be set next to existinQ
meter. Job location is 581 SprinQ Creek
Drive, Ashland, OreQon.
5,582.24
Contract for Goods & Services
Date of contract: July 26, 2007
BeQinninQ date: AUQust 1 , 2007
Completion date: September 30, 2007
Insurance reQuired/On File
BILL TO: Account Payable
20 EAST MAIN ST
541-552-2028
ASHLAND, OR 97520
SUBTOTAL
TAX
FREIGHT
TOTAL
82.24
0.00
0.00
5,582.24
PA ~ J7~7
Author! 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: I 0'1123/2007
Required Date of Delivery/Service: ~
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
K~ I irua t"'.rv..CltnIMinn
AAR7 TnIn ROM
rAl\trlll Point Ol'flgon 97!iO?
541-665-5415
..,.,,.',.... ~~
"lata Procurement
(3) Written Quotes
(Copies attached)
State of ORIWA contract
Other government agency contract
invitation to BId
(Copies on file)
Sole Source
Written findings attached
Description of ERYleE.
Reauest for ProDOSlI
(Copies on file)
SDlClaII ExemDt
Written findings attached
Emeraency
Written findings attached
o Copy of contract attached
o Contract #
~ Per attached PROPOSAL Trench from new meter on wall to concrete driveway. Bore
under concrete driveway and pull 3" conduit. Set hand hole next to existing meter. Job location is
581 rin Creek Drive I Ashland Or on
Item" Qu.ntlty Unit
Description of MATERIALS
Unit Price
Tot.1 Cost
Project Number 000021.999
o Per attached QUOTE
Account Number _690.11.18.00.704100
· Items and services must be charged to the appropriate account numbers for the finaneials to reflect the actual expenditures accurately.
By signing this requisition form, I certify that the information provided above meets the City of Ashland public contracting requirements,
aW~~~~ ~
Employte Signature c . _ Suporvlool1Dopt. - Signature: 1iJ ~