HomeMy WebLinkAbout2007-284 Contract - Chown Security
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: Chown Hardware
CONTACT: Greg Schauer
ADDRESS: 333 NW 16th Ave., Portland, OR 97209
TELEPHONE: 541-998-9760
DATE AGREEMENT PREPARED: November 13, 2007 FAX: 541-998-6694
BEGINNING DATE: November 19, 2007 COMPLETION DATE: February 1,2008
COMPENSATION: $18,432.65 - Per attached proposal dated 10/17/2007
GOODS AND SERVICES TO BE PROVIDED: Installation of all hardware and wiring to include 16 door
controller, including computer programming per attached proposal dated 10/17/2007. Location: Community
Development, 51 Winburn Way
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. City may terminate or modify this contract, in whole or in part, effective upon delivery of
Contract for Goods and Services Less than $25,000, Revised by Legal 06/30/2007, Page 1 of 6
written notice to Contractor, or at such later date as may be established by City under any of the following
conditions:
i. If City funding from federal, state, county or other sources is not obtained and continued at levels
sufficient to allow for the purchase of the indicated quantity of services;
ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way
that the services are no longer allowable or appropriate for purchase under this contract or are
no longer eligible for the funding proposed for payments authorized by this contract; or
iii. If any license or certificate required by law or regulation to be held by Contractor to provide the
services required by this contract is for any reason denied, revoked, suspended, or not renewed.
d. For Default or Breach.
i. Either City or Contractor may terminate this contract in the event of a breach of the contract by
the other. Prior to such termination the party seeking termination shall give to the other party
written notice of the breach and intent to terminate. If the party committing the breach has not
entirely cured the breach within 15 days of the date of the notice, or within such other period as
the party giving the notice may authorize or require, then the contract may be terminated at any
time thereafter by a written notice of termination by the party giving notice.
ii. Time is of the essence for Contractor's performance of each and every obligation and duty under
this contract. City by written notice to Contractor of default or breach, may at any time terminate
the whole or any part of this contract if Contractor fails to provide services called for by this
contract within the time specified herein or in any extension thereof.
iii. The rights and remedies of City provided in this subsection (d) are not exclusive and are in
addition to any other rights and remedies provided by law or under this contract.
e. Obliqation/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 of ORS 279A.11 0 or the administrative rules implementing the Statute.
12. Asbestos Abatement License: If required under ORS 468A.71 0, 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 QRF status pursuant to
the QRF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a
QRF if Contractor has qualified as a QRF 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 Damaqe,
Contract for Goods and Services Less than $25,000, Revised by Legal 06/30/2007, Page 2 of 6
including coverage for owned, hired or non-owned 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.
CONTRACTOR
BY~
., J ('. A. Signature
'^" V~-C(,u'"
Print Name
CITY OF ASHLAND:
BY
~e--
FINANCE DIRE OR
TITLE
.
PV101t~-r
DATE
I / /2.-? 0
DATE
II (BJul
CONTR CT AWARD AND FI
By:
DETERMINED BY:
FederallD#
'1 ') -01 ~q)7f6
ACCOUNT #
2. ~
171/ tl~ ~~ CV '7~~ I'~ 0
(For City purposes only)
Date:
'Completed W9 form must be submitted with contract
PURCHASE ORDER #
tt:J74173
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:
v/ (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.
V' (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( ( " ( dl
(Date)
Contractor
Contract for Goods and Services Less than $25,000, Revised by Legal 06/30/2007, Page 4 of 6
Form W-9
Request for Taxpayer
Identification Number and Certification
Give form to the
requester. Do not
send to the IRS.
(Rev. January 2003)
Department of the Treasury
Internal Revenue Service
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rvr 0 0 0 empt from backup
~ Corporation Partnership Other ~ __ __ _ __. __ . __ .., U' withholding
Requester's name and address (optional)
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 net 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.
O Individuall
Check appropriate box: Sole proprietor
Address (nupO' &~nd 2~ no.)
City, state,i'o ~ 0
list account number(s) here (optional)
WB
or
Certification
Under penalties of pedury. 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. perso
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).
Date ~
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. 10231 X
Form W-9 (Rev. 1-2003)
Contract for Goods and Services Less than $25,000, Revised by Legal 06/30/2007, Page 5 of 6
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 the
employee's time in that month
working on a project or
~per 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
l~ [l 0 Wl\\ SECURITY
October 17, 2001
City of Ashland
Dale Peters / Building Maintenance Supervisor
Dale:
Listed below are the revised components including the expansion of your Schlage
SMS networked access control system to the Community Development Building.
I've added the auto operators to the two front entry (reception area) doors as we
discussed. (Note: They are push side mount, if pull side is needed instead of push side
just let me know)
Todd Boyd (my IT guy) will hook up and test the access control components at Chown
before they come down to the jobsite. He feels the balance of the configuring can be
done using our new Bomgar network support system while he communicates with you
on the telephone.
Please let me know if you have any questions or need anymore additional information
or pricing.
Sincerely,
Greg Schauer / Security Consultant
Chown Security
CCB #91135
2ea. 3'0"x 7'0" Bronze S.F. Door/Frame (BO) Hardware & AlC Components:
2ea. HES #9600613 Bnz. 12/24VDC Elect. Strikes - $265.14ea. $530.28
2ea. HES #2006P Plug-in Buzzer - $18.90ea. $37.80
2ea. HES #2005: Smart-Pac II Rectifier, MOV / 2-8 sec. adj. timer - $31.266ea.$74.52
2ea. Locknetics #660-PB SPOT Momentary Pushbuttons- 50.35ea. $100.70
2ea. Von Duprin #99EO 48" 10B Bronze Exit Devices - $409.92ea. $819.84
1ea. Von Duprin #996L 10B RHR Lever Trim - $182.40
1ea. Von Duprin #996L 10B LHR Lever Trim - $182.40
2ea. Schlage #20-022 E 613 Rim Cylinders - $19.36ea. $38.72
2ea. LCN #9142REG PC Brnz MC 27" Push Side Mt. Auto Opt. - $1367.70ea. $2735.40
4ea. Curran #CE-625FM 4-1/2" Hardwired Push plates - $30.82ea. $123.28
4ea. Curran #CE-620NA-FM 4-1/2" Rd. Flush Mt. Wall Box - $24.12ea. $96.48
2ea. Schlage #S5355K Prox/Pro Prox Reader w/Keypad(wall mt.) - $520.00ea.$1 040.00
2ea. Schlage #SRINX-2 Reader Interfaces - $440.00ea. !i880.OO
Material Sub-Total:
$6841.82
Portland
333 NW 161h Avenue
Portland, OR 97209
Portland: 503.243.6500
Fax: 503.243.6519
Nationwide
PO Box 2888
Portland, OR 97208
Nationwide: 800.547.1930
Fax: 800.758.7654
l1{.l!!tW-,cl1gwn.&Q.!!1.
Local
460 Timothy St.
Junction City, OR 97448
Local: 541.998.9760
Fax: 541.998.6694
c [ [ () \'V l>r SECURITY
Conference Room Access Control:
1 ea. Locknetics #352+ x 335 Double Mag Lock (Satin Black Finish) ~
1 ea. Locknetics #3524F 1-1/4"x %"x 25" 335 Filler Plate -
1 ea. Securitron #XMS Motion Sensor (Black) -
1ea. Locknetics #653-05pNS Narrow Style SPOT Momentary Keyswitch p
1 ea. Schlage #20-001 E 1-1/4" 626 Mortise Cylinder -
1 ea. Schlage #S5355K Prox/Pro ProxReader w/Keypad (wall mt.) -
1ea. Schlage #SRINX-2 Reader Interface -
Material Sub-Total:
Misc. Components. Installation. Confiauration & Wirina:
1 ea. Schlage #SRCNX-16 16-Reader Controller -
1 ea. Schlage #SIPNX-1 00 IP Addressable Module -
1 ea. Schlage #S16H-NX 16V AC 4.0 Amp Hardwire Power Supply -
1ea. Altronix #AL600ULX Power Supply-
2ea. BAT Werker #WKA12-7.5F Back Up Batteries - $24.40ea.
Chown Hardware Installation -
Geoffrey System Design & Configuration -
(Chown Set-Up & Pre-Test w/Bomgar Phone support for configuration)
Electrical Wiring Drawings -
Low Voltage Electrical Wiring & Permit -
Material Sub-Total:
Grand Total: $18,432.65
Pg.#2
$456.86
$31.80
$120.60
$75.79
$20.68
$520.00
~440.00
$1665.73
$2500.00
$730.00
$100.00
$261.30
$48.80
$2060.00
$800.00
$300.00
~3125.00
$9925.10
Portland
333 NW 16th Avenue
Portland, OR 97209
Portland: 503.243.6500
Fax: 503.243.6519
Nationwide
PO Box 2888
Portland, OR 97208
Nationwide: 800.547.1930
Fax: 800.758.7654
~:~~Q!!l
Local
460 Timothy Sl.
Junction City. OR 97448
Local: 541998.9760
Fax: 541.998.6694
USI
11/29/2007 12:18:36 PM
PAGE
1/008
Fax Server
~]
"~.d1k~~~~~
I-~"(-ft,~
FAX
700 NE Multnomah Street, Suite 1300
Portland, OR 97232-2174
Main Phone: (503) 224-8390
Main Fax: (503) 224-8319
Page 1 of 8
Date: 11/29/2007 12: 17: 56 PM
From: Gladys Stanton
To: Kari Olson - City of
Ashland
Phone: 503-299-3403
Company:
FAX: 503-731-7617
FAX: 15414885320
"Confidentiality Notice. The information contained in this Facsimile message, and in any accompanying
documents, constitutes confidential information which belongs to USI Northwest. This information is
intended only for the use of the individual or entity named above. If you are not the intended recipient of
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action in reliance of this information, is strictly prohibited. If you have received this Facsimile message in
error, please immediately notify us by telephone at the number listed on this cover note, to arrange for its
return to us. Thank youl"
USI
11/29/2007 12:18:36 PM
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ACORDTM CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY)
11/29/2007
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
USI Northwest ONLY AND CONFERS NO RIGHTS UPON THE CERTIACATE
700 NE Multnomah, Suite 1300 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POUCIES BELDW.
Portland, OR 97232
503224-8390 INSURERS AFFORDING COVERAGE HAlCt#
INSURED INSURER ""- Phoenix Insurance Company NONE
Chown, Inc. INSURER B; Travelers Indemnity Company 25658
POBox 2888 INSURER c; Charter Oak Fire Insurance Company 25615
Portland, OR 97208 INSURER D;
INSURER E;
Client#: 325772
CHOWNINC
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 CONDfTlON 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 CONDfTlONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSRr TYPE OF INSURANCE POLICY NUMBER PD<}i~1i~@Y'1 P8'A1fJ l':rtb~~N LIMITS
A ~NERA1. LIABILITY 9762C114 03101/07 03/01108 EAOi OCCURRENCE 51 000.000
~ COMMERCIAL GENERAL LIABILITY ~~~~?E~E~~encel 51 000 000
f-- tJ a..AIMSMADE [!] OCCUR MED EXP (Any ane pernan) 510000
PERSONAL & ADV INJU RY 51,000,000
f--
f-- GENERAL AGGREGATE 52.000.000
GEN'L AGGREGATE LIMIT APPUES PER; PRODUCTS - COMP/OP AGG 52,000,000
n POUey-n- ~~& n LOG
C ~OMOBILE LIABILITY 9762C845 03101/07 03/01108 COMBINED SIN GLE LIMIT
~ ANY AUTO (Eo ocddont) 51,000,000
- ALL ONNED AUTOS BODILY INJURY
(Per pernan) S
- SCHEDULED AUTOS
~ HI RED AUTOS BODILY INJURY
5
~ NON-ONNED AUTOS (Per acddenl)
PROPERTY DAMAGE 5
(Per acddenl)
=1GE LIABILITY AUT 0 ONLY - EA ACCIDENT 5
ANY AUTO OTHER THAN EA ACC 5
AUTO ONLY; AGG 5
B 0ESSlUMBRELLA LIABILITY CUP5944Y135 03101/07 03/01108 EAOi OCCURRENCE 55 000 000
X OCCUR D a..AIMS MADE AGGREGATE 55,000,000
5
R DEDUCTIBLE 5
RETENTION 50 5
WORKERS COMPENSATION AND I T~y5[~~;.1 IDJ~-
EMPLOYERS' LIABILITY E.L. EAOi ACCDENT 5
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCUJDED? E,L. DISEASE - EA EMPLOYEE 5
If Y66. dmcribe under E.L. DISEASE - POLICY UMIT 5
SPECIAL PROVlSIONSbelaw
OTHER
DESCRIPTION OF OPERATIONS I LOCIITIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPEaAL PROVISIONS
The City of Ashland and it's elected officials, officers and employees are included as
additional insureds per form attached
City of Ashland
AUn: Kari Olson
901 N Mountain Ave
Ashland, OR 97520
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NOTICE TOTHE CERTlACATE HOLDER NAMED TOTHE LEFT, BUT FAILURE TO DO so SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENT S OR
CERTIFICATE HOLDER
ACORD 25 (2001108) 1 of 2
#S1815234/M 1683083
GLSJT
@ ACORD CORPORATION 1988
U51
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3/008
Fax 5erver
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 2S-S (2001/08) 2 of 2
#S1815234/M1683083
PAGE
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4/008
COMMERCIAL GENERAL lIABILITY
f)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
MANUFACTURERS AND WHOLESALERS XTEND
ENDORSEMENT
This endorsement modifies Insurance provided under the following'
COMMERCIAL GENERAL LIABILITY COVERAGE PAR I
GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. The following listing is a
general coverage description only. Limitations and exclusions may apply to lhese coverages. Read all U,e PRO-
VISIONS of this endorsement carefully to determine rights, duties, and what is and is not covered.
A. Broadened Named Insured J. Extension of Coverage - Bodily Injury
B. Blanket Broad Form Vendors K. Infury 10 Co-Employees and Co-Volunteer
C. Limited Wortdwide Liab~ity Coverage -Indemnity Workers
Basis L Aircraft Chartered with Crew
D. Damage To Premises Rented To You Extension M. Non-Owned Watercraft - Increased
. Perils of fire, explosion, lightning, smoke, water from 25 feet to 50 feet
. limil increased to $300,000 N. Increased Supplementary Paymenls
E. Blanket Waiver of Subrogation . Cost for bail bonds increased 10 $2,500
F. Blankel Addilionallnsured - Managers or . Loss of earnings increased to $500 per day .
Lessors of Premises O. Meui{;al Payments - Limit increased to
) G. Blanket Additional Insured - lessor of $10,000 per person
Leased Equipment P. Knowledge and Notice of Occurrence
H. Incidental Medical Malpractice or Offense
Personal Injury - Assumed by Contract Q. Unintentional Omission
'-
R. Reasonable Force - Bodily Injury or
Property Damage
PROVISIONS
A. BROADENED NAMED INSURED
1. The Named Insured in IIem 1. of the Declara-
tions is as follows:
The person or organization named in Hem 1.
of the Declarations and any organization,
other than a partnership or joint venture, over
which you maintain ownership or majority in-
terest on the effective date of the policy.
However, coverage for any such organization
will cease as of the date during the policy pe-
riod that you no longer maintain ownership of,
or majority inleresl in, such organizahon.
2. WHO IS AN INSURED (Section II) lIem 4.a.
is deleled and replaced by the following:
a. Coverage under this provision is afforded
only until the 180th day after you acquire
or form the organization or the end of the
policy period, whichever is earlier, unless
reported in writing to us within 180 days.
J. This Provision A. does not apply to any per-
son or organization for which coverage is ex-
cluded by endorsement.
B. BLANKET BROAD FORM VENDORS COVER-
AGE
WHO IS AN INSURED (Section II) is amended 10
include as an insured any person or organization
(referred to below as "vendor") with whom you
have agreed in a written contract, executed prior
to loss, 10 name as an additional insured, bul only
with respecl to ~bodily injury" or "property dam-
age" arising oul of .your products' which are dis-
CG 01 8711 03
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COMMERCIAL GENERAL LIABILITY
The Damage To Premises Rented To You
Linul will be the higher of:
a. $300,000; or
b. The amount shown on the Declarations
for Damage To Premises Rented To You
Limit
4. Under DEFINITIONS (Section V), Paragraph
3. of the definition of "insured contract" is
amended so that it does not include that por-
tion of the contract for a lease of premises
that indemnifies any person or organization
for damage to premises while rented to you,
or temporarily occupied by you with permis-
sion of the owner, caused by:
3. Fire;
b. Explosion;
c. Lightning;
d. Smoke resulting from such fire, explosion.
or lightning; or
e. Water.
5. This Provision D. does not apply if coverage
for Damage To Premises Rented To You of
COVERAGE A. BODILY INJURY AND
PROPERTY DAMAGE LIABILITY (Section I -
Coverages) is excluded by endorsement.
E. BLANKET WAIVER OF SUBROGATION
We waive any right of recovery we may have
against any person or organization because of
payments we make for injury or damage arising
out of premises owned or occupied by or rented
or loaned to you; ongoing operations performed
by you or on your behalf, done under a contract
with that person or organization; .your work"; or
"your products". We waive this right where you
have agreed to do so as part of a written contract,
executed by you prior to loss.
F_ BLANKET ADDITIONAL INSURED - MANAG-
ERS OR LESSORS OF PREMISES
WHO IS AN INSURED (Section II) is amended to
include as an insured any person or organization
(referred to below as "additional insured") with
whom you have agreed in a written contract, exe-
cuted prior to loss, to name as an additional in-
sured, but only with respect to liability arising out
of the ownership, maintenance or use of thaI part
of any premises leased to you, subject 10 the fol-
lowing provisions:
1. Limits of Insurance. The limits of insurance
afforded to the additional insured shall be the
limits which you agreed to provide, or the lim-
PAGE
5/008
its shown on the Declarations, whichever is
less.
2. The insurance afforded to the additional in-
sured does not apply to:
a. Any "occurrence" that takes place after
you cease to be a .tenant in that premises;
b. Any premises for which coverage is ex-
cluded by endorsement; or
c. Structural allerations, new construction or
demolition operations performed by or on
behalf of such additional insured_
3. The insurance afforded to the additional in-
sured is excess over any valid and collectible
insurance available to such additional in-
sured, unless you have agreed in a written
contract for this insurance to apply on a pri-
mary 0( contributory basis.
G. BLANKET ADDITIONAL INSURED - LESSOR
OF LEASED EQUIPMENT
WHO IS AN INSURED (Section II) is amended to
include as an insured any person or organization
(referred to beJow as "additional insured") with
whom you have agreed in a written contract. exe-
cuted prior to loss, to name as an additional in-
sured. but only with respect to their liability arising
out of the maintenance. operation or use by you
of equipment leased to you by such .additional in-
sured, subject to the fotlowing provisions:
1. Limits of Insurance_ The limits of insurance
afforded 10 the additional insured shall be the
limits which you agreed to provide, or the ~m-
its shown on the Declarations, whichever is
less.
2. The insurance afforded to the additional in-
sured does not apply to:
a. Any "occurrence" that takes place after
the equipment lease expires; or
b. "Bodily injury"' or "property damage" aris-
ing oul of the sole negligence of such ad-
ditional insured.
3. The insurance afforded 10 the additional in-
sured is excess over any valid and collectible
insurance available to such additional in-
sured. unless you have agreed in a written
contract for this insurance to apply on a pri-
mary or contributory basis.
H. INCIDENTAL MEDICAL MALPRACTICE
1. The definition 01 "bodily injury" in DEFINI-
TIONS (Section V) is amended to include -In-
cidental Medical Malpractice Injury".
8
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"' .
1'-"'"
-:)
2. The following definilion is added to DEFINI-
TIONS (Section V):
"Incidental medical malpr-actice injury" means
bodily injury, mental anguish, sickness or dis-
ease sustained by a person, induding death
resulting from any of these at any time, aris-
ing out of lhe rendering of, or fallure to ren-
der, the lollowing services:
a. Medical, surgical, dental, laboratory. x-ray
or nursing service .or treatment, advice or
instruction, or the related furnishing of
food or beverages;
b; The furnishing or dispensing of drugs or
medical, dental, or surgical supplies or
appliances; or
c. First aid_
d. -Good Samaritan services." As used in
this Provjsion H., "Good Samarilan ser-
vices" are those medical services ren.
dered or provided in an emergency and
for whidl no remuneration is demanded
or received.
3. Paragraph 2.a.(1)(d) of WHO IS AN IN-
SURED (Section II) does not apply to any
registered nurse, licensed pradical nurse,
emergency medical technician or paramedic
employed by you, but only while performing
the services described in paragraph 2. above
and while acting within the scope of their em-
ployment by you. Any "employees" rendering
"Good Samaritan services" will be deemed to
be acting within the scope of their employ-
ment by you.
4. The following exdusion is added to paragraph
2_ Exdusions of COVERAGE A. - BODILY
INJURY AND PROPERTY DAMAGE LIABIL-
ITY (Section I - Coverages):
(This insurance does not apply to:) Liability
arising out of the willful violation of a penal
statute or ordinance relating to the sale of
pharmaceuticals by or with the knowledge or
consent of the insured.
S. For the purposes ot determining the applica-
ble limits ot insurance, any ad or omission,
together with all related acts or omissions in
the furnishing of the services described in
paragraph 2. above to anyone person, will be
considered one "occurrence".
6. This Provision H. does not apply if you are in
the business or occupation of providing any of
the services described in paragraph 2. above.
CG 01 87 11 03
PAGE
6/008
COMMERCIAl GENERAL UABILlTY
7. The insurance provided by this Provision H.
shall be excess over any other vaJidand col-
lectible insurance available to the insured
whether primary. excess, ~ntingenl or ~.
any other basis, except tor insurance pur-
chased specifically by you 10 be excess of
this policy.
'- PERSONAL INJURY - ASSUMED BY CON-
TRACT
1. The Contractual liability EXclusion in Part
2., Exclusions of COVERAGE B. PER-
SONAL AND ADVERTISING INJURY LIABIL-
ITY (Section I - Coverages) is deleted and
replaced by the following:
(This inSllfance does not apply to:)
Contractual Liability
"Advertising injury" for which the insured has
assumed liability in a contract or agreement.
This exclusion does not apply to liability for
damages that the insured would have in the
absence of the contract or agreement
2. Subparagraph f. of the definition of -insured
contract* (DEFINITIONS - Section V) is de-
leted and replaced by the following:
t That part of any other contract or agree-
ment pertaining to your business [mclUd-
ing an indemnification of a municipality in
connection with work performed tor a
munidpality) under which you assume the
lort liability of another party to pay for
"bodily injury, * "property damage" or .per-
sonal injury" to a third party or organiza-
tion. Tort liability means a liability that
would be imposed by law in the absence
of any contract or agreement
3. This Provision I. does not apply if COVER-
AGE B. PERSONAL AND ADVERTISING IN-
JURY LIABILITY is excluded by endorse-
ment
J_ EXTENSION OF COVERAGE - BODilY IN-
JURY
The definition of "bodily injury" (DEFINITIONS -
Section V) is deleted and replaced by the follow-
ing:
"Bodily injury" means bodily injury, mental an-
guish, mental injury, shock, fright. disability, hu-
miliation, sickness or disease sustained by a per-
son, including death resulting from any of these at
any time.
Copyright. The Travelers Indemnity Company, 2003
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7/008
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COMMERCtALGENERAL L1AB~L1TY
K. INJURY TOCO-EMPLOYEES AND CO-VOLUN-
TEER WORKERS
1. Your ~employees" are ins.ur~ds with iespecl
to "bodily injury" to a co-"employee" in the
course of lhe co."ernployee's" employment by
you, Of to your "volunteer workers" while per-
forming duties related to the conduct at your
business, provided that this coverage for your
"employees. does not apply to acls outside
the scope of their employment by you or while
perfonningduties unrelated 10 the conduct of
your business.
Z. Your "volunteer workers. are insureds with
respect to "bodily injury'" to a co: "volunteer
worke~ while performing duties related to the
conduct of your business, Of 10 your "employ-
ees" in the course of the "employee's. em-
ployment by you, provided that this coverage
for your "volunteer workers. does not apply
while performing duties unrelated to the con-
duct of your business.
3. Subparagraphs 2.3.(1)(a), (b) and (c) and
3.3. of WHO IS AN INSURED (Section II) do
not apply to ~bodily injurf for which insurance
is provided by paragraph 1. or 2. above.
L AIRCRAFT CHARTERED WITH CREW
1. The foRowing is added to the exceptions con-
tained in the Aircraft, Auto Or Watercraft
Exclusion in Part 2., Exclusions of COVER-
AGE A. BODILY INJURY AND PROPERTY
DAMAGE LIABILITY (Section I - Coverages):
(This exclusion does not apply to:) Aircraft
chartered with crew to any insured.
2. This Provision L does not apply if the char-
tered aircraft is owned by any insured.
3. The insurance provided by this Provision L
shall be excess over any other valid and col-
lectible insurance available to the insured,
whether primary, excess, contingent or on
any other basis, except for insurance pur-
chased specifically by you to be excess of
this policy.
M. NON-OWNED WATERCRAFT
1. The exception contained in Subparagraph (2)
of the Aircraft, Auto Or Watercraft Exclu-
sion in Part 2., Exclusions of COVERAGE A.
BODIL Y INJURY AND PROPERlY DAMAGE
LIABILITY (Section I - Coverages) is deleted
and replaced by the following:
(2) A watercraft you do not own that is:
(ei) Fitly feet long or leSs; and
(b) Not being used to carry persons Of
property for a charge.
2. This Provision M. applies to any person who,
with your expressed or implied consent, either
uses or is responsible for the use of a water-
craft
3. The insurance provided by this Provision M.
shall be excess over any other valid and col-
lectible insurance available to the insured,
whether primary, excess, contingent Dr on
any other basis, except for insurance pur-
chased specifically by you to be excess of
this policy.
N. INCREASED SUPPLEMENTARY PAYMENTS
Parts b. and d. of SUPPLEMENTARY PAY-
MENTS - COVERAGES A AND B (Section I -
Coverages) are amended as follows:
1. In Part b. the amount we will pay for the cost
of bail bonds is increased to $2500.
Z. In Part d. the amount we will pay for loss of
earnings is increased to $500 a day.
O. MEDICAL PAYMENTS - INCREASED UMITS
1. Paragraph 7. of LIMITS OF INSURANCE
(Section 111) is amended to read as follows:
7. Subject to 5. above, the Medical Expense
Limit is the most we will pay under Cov-
erage C. for all medical expenses be-
cause of "bodily injury" sustained by any
one person, and will be the higher of:
(a) $10,000; or
(b) The amount shown on the Declara-
tions for Medical Expense Limit
2. This Provision O. does not apply if COVER-
AGE C. MEDICAL PAYMENTS (Section I -
Coverages) is excluded either by the provi-
sions of the Coverage Part or by endorse-
ment.
P. KNOWLEDGE AND NOnCE OF OCCUR-
RENCE OR OFFENSE
1. The following is added to COMMERCIAL
GENERAL LIABILITY CONDITIONS (Sedion
IV), paragraph 2. (Duties In The Event of Oc-
currence, Offense, Claim or Suit):
Notice of an "occurrence" or of an offense
which may result in a daim under this insur-
ance shall be given as soon as practicable af-
ter knowledge of the "occurrence" or offense
e
.,
j
Page 6 of 7
Copyright, The Travelers Indemnity Company, 2003
CG D1 87 11 03
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. /.
~~
has been reported to any insured listed under
Paragraph ,. of Section II - Who Is An In-
sured or an ~employee~ (such as an insur-
ance, loss control or risk manager or adminis-
trator) designated by you to give such notice.
Knowledge by other Remployee(s)" of an "oc-
currence" or of an offense does not imply thai
you also have such knowledge.
2. Notice shall be deemed prompl if given in
good faith as soon as practicable 10 your
workers' compensation insurer. This applies
only jf you subsequently give notice to us as
soon as practicable after any insured listed
under Paragraph 1. of Section II - Who Is An
Insured or an "employeeR (such as an insur-
ance. Joss control or risk manager or adminis-
trator) designated by you to give such notice
discovers that the .occurrence", offense or
claim may involve this policy.
3. However, this Provision P. does not apply as
respects the specific number of days within
which you are required to notify us in writing
of the abrupt commencement of a discharge,
release or escape of Rpollutants" which
causes -bodily injuryR or .property damage~
which may otherwise be covered under this
policy.
CG 01 871103
PAGE
8/008
COMMERCIAL GENERAL LIABILITY
Q. UNINTENTIONAL OMISSION
The following is added to COMMERCIAL GEN-
ERAL L1ABIUTY CONDITIONS (Section IV).
paragraph 6. (Representations):
The unintentional omission of, or unintentional
error in, any information provided by you shall not
prejudice your rights under this insurance. How-
ever, this Provision Q. does not affect our right to
collect additional premium or to exercise our right
of cancellation or nonrenewal in accordance with
applicable slale insurance laws, codes or regula-
tions.
R. REASONABLE FORCE - BODILY INJURY OR
PROPERTY DAMAGE
The Expected Or Intended Injury Exclusion in
Part 2.. EJltclusions of COVERAGE A BODILY
INJURY AND PROPERlY DAMAGE LIABilITY
(Section I - Coverages) is deleted and replaced
by the following:
(This insurance does not apply to:)
Expected or Intended Injury or Damage
"Bodily injuryR or "property damage- expected or
intended from the standpoint of the insured. This
exdusion does not apply to ~bodily injury" or
.property damage~ resulting from the use of rea-
sonable force to protect persons or property.
Copyright. The Travelers Indemnity Company, 2003
Page 7 of 7
From Jessica for Julie Clark At. Fullerton & Co FaxlO. Fullerton and Co To Karl Olson
Fax
From:
Pages:
Date:
Subject:
Jessica for Julie Clark To:
3 Fax:
11/29/2007 10:23:01 AM Phone:
Cert for City of Ashland / Chown, Inc.
Oate. 11129/2007 10.23 AM Paae. 1 of 3
Phone: (503) 790-9330
Fax: (503) 274-6524
Kari Olson
(541) 488-5320
( )
Message:
From Jessica for Julie Clark At: Fullerton & Co FaxlD' Fullerton and Co To: Kari Olson
Date 11/29/2007 10:23 AM Page: 2 of 3
ACORD~ CERTIFICATE OF LIABILITY INSURANCE OP ID 3~ DATE (MMIDDIYYYY)
CHOWN 3 11/29/07
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Fullerton & company HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P. O. Box 29018 AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Portland OR 97296-9018
Phone: 503-274-6511 Fax:503-274-6524 INSURERS AFFORDING COVERAGE NAIC#
-------"- ~- __._u.,_._~_ .-- ..--- -
INSURED 11"'ClIRER A SAIF Corporation
IN"IIREFi Ei
Xen 1 Client #950928 IWIIRER,
Xeniwn Resources IIN~,IIRER [)
7401 sw Washo ct S#200
Tualatin OR 97062 C--- ~-- -------------- --- -
i IN:'.lIREF E
COVERAGES
: Hf- ~" II:- ~ I IF I~J'.";'IIRANtE: L 1'- -11::1' HELl >1/,,' HAv'F REEr\J I~"':'<"':l !E[) TI 1 THF IN~-.;l JRE[) NAME[) A8\ I','E F' !F,' THE Fl; 'Lh Y PEh'l( Il' IN[ III ATE[; N( 'T'~VITH:- TAN[ )IN(~-
PL\JI JIREMENT, TERM I"IF-: I~'-'N[IITI!-IN '-IF Ahf,' '-'~INTRA,-T (Jp I-ITHER [I(),-I JMENT '.\lITH RE~.F'E:-T T'-' NHICH THI<:: ~~ERTIFII-ATE MAY BE I'~{'::,( JE[I ,jR
M,':-' ~ PEr:iTAli'>l THE IN~,1 JRANCE AFF. lR[lE[1 8\ THE P'JLI,-IE~ DES.,-RIBE['I HEREIN I~ SUB,JE., T T', 1 ALL THE TERM;- E;-;,'~LI JS!()N;- AND C':JN['ITION;- .iF ';:;UCH
F" 'lI' I[ A,-:.,,;,RE,;ATE LlMIT~ :-::;::HC1\.\iN MAY HA,lE 5EEN RE['11 JCE['I 5Y PAID CLAIMS
L'
L TR NSR TYPE OF INSURANCE
l "'r: u^'''~
: ' 'MMEh" IAL '.~l::.NCh'AL ~IAQllI' 'I'
U I Lf'.IM~ MAl'E [J ,,- "IF.
POLICY NUMBER
DATE (MMIDDIYY)
DATE (MMIDDIYY)
LIMITS
EAIH '~I( '~I JRREr"J1 'E $
$
$
rEP'-1 lNAL ,~ ;..r'I' IN.Jl JRY
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AI IT'" nNL Y - EA AC-( 1[IENT
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949996
01/01/07
01/01/08
E L EA'H A' ' I[IENT
E L DI::::EA;:'E - F'\->LIC)' LIMIT
$ 1000000
$ 1000000
$ 1000000
E L ['i:'EN".E - EA EMPL,",YEE
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
As respects the operations of Chown, Inc. 333 NW 16th Ave, Portland OR,
97209
Verification of Insurance.
CERTIFICATE HOLDER
CANCELLATION
CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
-
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL
City of Ashland IMPOSE NO OBLIGATION OR LIABILITY OF ANY I\lND UPON THE INSURER. ITS AGENTS OR
90 North Mountain
Ashland OR 97520 REPRESENTATIVES.
AUTHORIZj? REPRES(1TAT~
\.. I J./A . I
ACORD 25 (2001/08)
@ACORDCORPORATlON1988
From Jessica for Julie Clark At: Fullerton & Co FaxlD: Fullerton and Co To' Karl Olson
Date' 11/29/2007 10:23 AM Page' 3 of 3
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)
~A'
CiTY RECORDER
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
Page 1 / 1
~
~~~
07973
VENDOR: 000687
CHOWN SECURITY, CHOWN INC DBA
POBOX 2888
PORTLAND, OR 97208
SHIP TO: Ashland Building Maintenance
(541) 488-5358
90 N MOUNTAIN AVENUE
ASHLAND, OR 97520
FOB Point:
Terms: Net 30 days
Req. Del. Date:
Speciallnst:
Req. No.:
Dept.: PUBLIC WORKS
Contact: Dale Peters
Confirming? No
Access Control System
Location; Community Development
Address: 51 Winburn Way
Installation of all hardware and wirinQ
to include 16 door controller. Includes
computer proQramminQ.
18,432.65
Contract for Goods & Services
BeQinninQ date: November 19, 2007
Completion date: February 1, 2008
Insurance required/On file
BILL TO: Account Payable
20 EAST MAIN ST
, 541-552-2028
ASHLAND, OR 97520
SUBTOTAL
TAX
FREIGHT
TOTAL
~~
.~ 1~2?~7
Aut razed Signature
VENDOR COPY
CITY OF
ASHLAND
REQUISITION FORM
THIS REQUEST IS A:
o Change Order{existing PO #
Date of Request: I" No\) 6?---1
Required Date of Delivery/Service: I Nit. \ FIS"8"O~
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
C~ I'l {j.:('1Zdv.3 ~Re:
353 "\ L0 ll..-ll.,. A v Fi
-:POe.TUq~1)1 oe ~ t~o<1
59\- 9<18 - c..~O
~'t1~8 -I. '=-9Y
~ R. s.c;;; Sc- "-t q lit E f2..
SOLICITATION PROCESS
Small Procurement bl Sole Source o Invitation to Bid
o Less than $5,000 o Written findings attached (Copies on file)
o Quotes (Optional) o Quote or ProDosal attached
Cooperative Procurement o Reauest for Proposal
o State of OAN/A contract (Copies on file) ,
Intermediate Procurement o Other government agency contract 0 Special I Exempt
~ (3) Written Quotes 0 Copy of contract attached 0 Written findings attached
(Copies attached) Iru:& 0 Quote or Prooosal attached
815'LL- }/l'/fi!lJWI'1le-O ,; 0 Contract it 0 Emeraency
/\JOT '"]'1:) '?J'le.TaJ'lt1rEC 0 Written findings attached
0 Quote or Proposal attached
Description of SERVICES
If':) CS'T'"lA LL I.q,.. 10 IV e r=- IA. L ~ ti A p,)~ .qiQ. R: A N l~
\J.-' \ r2.. \ tV G. ~o \ lU <.: l.. \A 0 IE' I (.,. b 00(< ce tU'lRO L&.E'\(
f-'~\u.dE-J' ~ Qt IN' pu-~a.. ?RC)~jI2.~f'1^-~ ~-) ·
o Per attached PROPOSAL ~ L it,:t Y / ~)( .~ e # rn-~ k If...<- ~.
;;;;>1 ~K..~h:rA..
Item # Quantity Unit Description of MATERIALS
Total Cost
Se=E A~-b4QH~D M~T@21~L IS. ~ 3E'.. 4.S-
L,s;r
TOTAL COST
o Per attached QUOTE
Project Number _ _ _ _ _ _ - _ _ _ $ t8,t..132~
Account Number ~ 1 Q .Q8- ?j.~~. ~ L ~Q
. Items and services must be charged to the appropriate account numbers for the financials 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,
and the documentaYon can be provide on request ..A _
Employee Signature: Supervisor/Dept. Head Signature: ~ A~ r ~"y..lZI ~
G: Finance\ProcedureIAP\Forms\B_Requisition form revised.doc
Updated on: 5/1712006