HomeMy WebLinkAbout2007-258 Contract - Brotherton Pipeline Corporatio
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GOLD HILL, OBBGON (&41) BH-707I- Fax (541) __7284 - CCB 108721
PROPOSAL
NAME:
CITY OF ASHLAND ELECTRIC
00 N. MOUNTAIN AVE.
ASHLAND, OR 07520
DAVE TYGERSON
So. Plon-.-SI
DATE: 7112/2001
ATTN:
L0CA11ON:
'NOt:
PHONE: 488-5357
FAX: 552-2438
CELL:
WE HEREBY SUBMIT THE FOLLOWING ESTIMATE:
T'nnch and ~ and Irwtal13. condulla IIIId r conduits for prtmary,
..condmy, __1IghIs IUId cable TV and dilcuUacl at the waIllthRl
and laid out on the print.
ESTIMATE _.422
CONDITIONS
City to atl1lnge with property owners for 8CC8li& and pnMde aU pennlls as needed.
If lOck or other obIItructlons are 8IlCOuNered that cannot be tnmc:tlecl or bored, .,
hoully lIIte may be chllllled for their removal.
Brotherton will not be ~l18Ible for utilitIeS that ere not located or are mls8loc81ed
privlIte or pubIlc. City to provlcle and lI8I vaults In BrOtherton provided holes.
CallIe TV co. to provide 2" conduits for their part.
AUTHORIZED SIGNATURE
NOTE: THIS PROPOSAL MAY BE W1TltORAWN BY US IF NOT ACCEPTED WITHIN 1IO DAYS
ACCEPTANCE OF PROPOSAL
The _..-. ~..1ltlCI co_.... .....rw..,Illd.. herebr eccopod. Yau.1I ...-toclOlhe_
_ _1IIod. PAYMENT WILL BE MADE AS OUTLINED ~
ACCEPTED: SIGNA TUM
DATE
eod
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Contract for Goods for Services
CITY OF
ASHLAND
20 East Main Street
Ashland, Oregon 97520
Telephone: 541/488-6002
Fax: 541/488-5311
CONTRACTOR: Brotherton Corporation
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CONTACT: Michael Cantrell
ADDRESS: 11 Frontage Road, PO Box 738,
Gold Hill, OR 97525
BROTHERTON
TELEPHONE: 541-855-7075
DATE AGREEMENT PREPARED: October 16, 2007 FAX: 541-855-7284
BEGINNING DATE: November 5, 2007 COMPLETION DATE: December 31, 2007
COMPENSATION: $52,422.00, Per attached proposal dated 07/12/2007
GOODS AND SERVICES TO BE PROVIDED: Trench, bore, and install 3" and 2" conduits for primary,
secondary, street lights and cable TV. Set and plumb three (3) vaults and secondary splice boxes. AFN and
Charter to supply own ccnduit. City to supply vaults and secondary splice boxes. Re-asphalt as needed.
Location: Pioneer Street
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 cf Documents: All documents prepared bj 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. Citv's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing
and delivered b certified mail or in erson.
Contract for Goods and Services Less than $25,000, Revised by Legal 06/30/2007, Page 1 of 6
c. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of
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/Liabilitv 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 ot 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 Liabilitv 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 Liabilitv insurance with a combined single limit, or the equivalent, of not less than Enter
one: $200,000, $500,000, $1.000,000, or Not Applicable for each accident for Bodily Injury and Property Damage,
including coverage for owned, hired or non-owned vehicles, as applicable.
d. Notice of cancellation or chance. There shall be no cancellation, material chance, reduction of limits or
Contract for Goods and Services Less than $25,000, Revised by Legal 06/30/2007, Page 2 of 6
intent not to renew the insurance coverage(s) without 30 days' written notice from the Contractor or its insurer(s) to
(he 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.
CONTRACTOR CITY OF ASHLAND:
8Y .-1A:L. / f.l4 BY,6Y.
~--- - '1 Signature FINANCE RECTOR
1'Y\, c41Qe- \ ' an
Print Name
TITLE
DATE
1/1~{)7
DATE
10/'lCJ/Vl
FederallD#
(17, - /I k-2C; r::
ACCOUNT #
Gift' /(100C7o.<f'lcC
(For City purposes only)
'Completed W9 form must be submitted with contract
PURCHASE ORDER #
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Contract for Goods and Services Less than $25,000, Revised by Legal 06/30/2007, 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:
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(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.
~;.~.I ~
Co~tr~r
10/;1-0/,/1
(Date) ,
Contract for Goods and Services Less than $25,000, Revised by Legal 06/30/2007, Page 4 of 6
Fmm W-g
Request for Taxpayer
Identification Number and Certification
Give form to the
requester. Do not
send to the IRS.
(Rev. November 2005)
Department of the Treasury
Intemal Aevenue Service
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Name (as shown on your income tax return)
BROTHERTON CORPORATION
Business name, if different from above
D Individual!
Check appropriate box: Sole proprietor
Address (number, street, and apt. or suite no.)
11 S FRONTAGE RD
~ Corporation
City, state, and ZIP code
GOLD HILL, OR 97525
List account number(s) here (optional)
Tax a er Identification Number (TIN)
o Partnership D Other'"
o Exempt from backup
withholding
Requester's name and address (optional)
Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid
backup withholding. 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
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 (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
Here
Signature of
U.S. person ~
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 te 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.
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-9 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 jf you
are:
J
Date ~
'0
. 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-9 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-9 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,
Form W-9 (Rev. 11-2005)
Cat. No. 10231X
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 $17,342 or more.
~ For all hours worked in a
month if the employee spends
50% or more of lhe
employee's time in that month
working on a project or
3BDper hour effective June 30, 2007
(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 $17,342.
~ 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 Goods and Services Less than $25,000, Revised by Legal 06/30/2007, Page 6 of 6
ACORD. CERTIFICA TE OF LIABILITY INSURANCE CSR ME I DATE (MMIDDIYYYY)
9BROTPI 10/29/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Hart Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. ~) . Box 1240 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Grants Pass OR 97528
Phone: 541-479-5521 Fax:541-474-1890 INSURERS AFFORDING COVERAGE NAIC#
----___________n__.'_ - - ------...-------..---------- +------------ - -
INSURED ! INSURER A: Travelers Indemnity Co. 10647
.- .-- ~-~--
INSURER B Travelers Property Casualty Co 10647
Brotherton Pipeline, Inc. SAIF CORP --
Brotherton Corporat1on INSURER C
..-
11 South Frontage Road INSURER 0:
Gold Hill OR 97 25 --
INSURER 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.
IN~~~9 - PD~1;J~rri~r~E~J!Xe I P~M::EYf~~hPif'~'f~
LTR NSR TYPE OF INSURANCE POLICY NUMBER LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1,000,000
- IB~~~~~~ (E~~~~~nce)
A X X COMMERCIAL GENERAL LIABILITY DTC0526D9764IND07 06/10/07 06/10/08 $300,000
I CLAIMS MADE ~ OCCUR -
MED EXP (Anyone person) $10,000 -
1 r- -----1 I PERSONAL & ADV INJURY ,$1,000,000
! GENERAL AGGREGATE 1$2,000,000
r----- -
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $2,000,0~
n 'II-:RO- n ---
POLICY JECT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000
B ex ANY AUTO DT810526D9764TIL07 06/10/07 06/10/08 (Eaaccidenl)
r--- --
ALL OWNED AUTOS BODILY INJURY
1- (Per person} $
SCHEDULED AUTOS
I- I -
I
, HIRED AUTOS BODILY INJURY
I r-! (Peraccidenl) $
, NON-OWNED AUTOS
--I --- -~'-- ---.-
H--- ."~--- PROPERTY DAMAGE $
(Peraccidenl)
GARAGE LIABILITY , AUTO ONLY - EAACCIDENT $
R ANY AUTO --
OTHER THAN EA ACC $
-- -------.-
1 AUTO ONLY AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $2,000,000
~ OCCUR D CLAIMS MADE 06/10/07 , 06/10/08 ----'---- --::-----
B DTSMCUP526D9764TIL07 AGGREGATE $2,000,000
-----~ -~---
$
--~---.. -
~ DEDUCTIBLE 1----- $
----.-
X RETENTION $10000 , $
WORKERS COMPENSATION AND XlrO'Ry'c',MITS i I vER-
- -- --- ----
C EMPLOYERS' LIABILITY 810614 10/01/07 10/01/08 E.L. EACH ACCIDENT $ 500000
ANY PROPRIETOR/PARTNER/EXECUTIVE i ---~- ..-
OFFICER/MEMBER eXCLUDED? , i ~_L. DISEASE - E~ EMPLOYEEi $ .?OOOOO
i If~es, deSCflbeunder , , ---
r S ECIAL PROVISIONS below i I E.L DISEASE-POLICY LIMIT i $ 500000
i OTHER I I
I I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDEO BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate Holder is named as Additional Insured.
CERTIFICATE HOLDER
City of Ashland
Purchasing Representative
90 N. Mountain Avenue
Ashland OR 97520
SINGSH1
//
CANCELLATION
SHOUl.D ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER AM ED T T, BUT FAIl.URE TO DO SO SHALL
PON THE INSURER, ITS AGENTS OR
ACORD 25 (2001/08)
REPRESENTATIVES.
AUTHORIZED REPRE
HART INSU
@ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed A statement
on this certificate does not confer rights to the certificate holder in lieu of such 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 endorsement(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 (2001/08)
r~'
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
CITY RECORDER
Page 1/1
f'~~~i
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VENDOR: 008118
BROTHERTON PIPELINE CORPORATIO
11 S FRONTAGE ROAD
PO BOX 738
GOLD HILL, OR 97525
FOB Point:
Terms: Net
Req. Del. Date:
Special Ins!:
SHIP TO: Ashland Electric Department
(541) 488-5354
90 N MOUNTAIN
ASHLAND, OR 97520
Req. No.:
Dept.: ELECTRIC
Contact: Scott Johnson
Confirming? No
Trench, bore, and install 3" and 2"
conduits for primary, secondary, street
liQhts and cable TV. Set and plumb
three (3) vaults and secondary splice
boxes. AFN and Charter to supply own
conduit. City to supply vaults and
secondary splice boxes. Re-asphalt as
needed. Location: Pioneer Street.
52,422.00
Contract for Goods & Services
Date of aQreement: October 16, 2007
BeQinninQ date: November 5, 2007
Completion date: December 31, 2007
Insurance reQuired/On File
BILL TO: Account Payable
20 EAST MAIN ST
541-552-2028
ASHLAND, OR 97520
SUBTOTAL
TAX
FREIGHT
TOTAL
52 422.00
0.00
0.00
52,422.00
E 690.11,18.00.70410
000115.999
52422.00
VENDOR COPY
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CITY OF
ASHLAND
REQUISITION FORM
THIS REQUEST IS A:
o Change Order(existing PO #
Date of Request: l Jlii,t~1~f::~ 1
Required Date of DeliverylService: L~'$~":" I
Vendor Name
Addresa
City, State, ZIp
Telephone Number
FIX Number
Contact Name
RrnthDrtnn ~~Inn
11 Fmntaae Road I POBox 738
Gold Hili, Oregon 97525
Sole Sourr:e
Written findings attached
InvIIaIlon to BId
(Copies on file)
~1aI8 Procunmont
. (3) Written Quotes
(Copies attached)
State of ORIWA contract
Other government agency contract
Reaulll lor Pro.....1
(Copies on file)
SD8CI.11 ExemDt
Written findings attached
o Copy of contract attached
o Contract #
Emeraencv
Written findings attached
Description of SI! CI!S
181 Per IltIched PROPOSAL Trench and bore and install 3" and 2' conduits for primary,
secondary, streetlights and cable TV and discussed at the walk thru and laid out on the print
rovided b Ci of Ashland Electric de artment
It_ " QuanOty Unit
Description of
Unit Price
Total Coat
Project Numberoa:>L~ ~f9
o Por IltIched QUOTE
Account Number 690.11.18.00.704100
'Items end seN/cas must be cherged to the eppropriate eccount numbers for the finenc/els to mflect the ectuel expend/tums accuratety.
By signing this requisition fol77l, I cerlify that the . ation provided above meets the City of Ashland public conl1acting requirements,
and the documen . vided uest.
upervlsor/Dept. Head Signature:
~
G: Fll18noe\Proc:edurelAP\Fonns\8_Roqulsltion form _.doc
Updalod on: 1011612007