HomeMy WebLinkAbout2007-288 Contract - So Oregon Automatic Door
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FAX NO. :1-541-471-6065
SE:p. i2 21307 03: mr-t'1 p.!.
SOUTHERN OREGON FAX
AUTOMATIC DOOR TRANSMISSION
200 Rogue Ri11t Dr. Merlin, Oregon 97532
Dllte: Sept. J2, aoo,?
TOt City of Ashland Please call to co1Jftrm receipt
FAX NUMBER: S"s:;l-~S01"
FROM: Bob Keller 1 # oJpageR irwluding cover
Our phone: (541) 6.21.-9506
Home: (541) 471-9506
Our flu.: lMI.) 471-6065 CCB#~47247
A7TN: Dalepeters
RE: Community Development doors
Dale,
The following quote is to supply and install two aluminum
doo1" and sidelite assemblies t'o match B%l.sting e~teri.o.,. frames.
The doo,.s will be handicap assessable, medium style with :114"
tempel"edclear 9ttL~S and continuous hinges. The doors will
hinge to the interior wall and SUJing out to the lobby.
hardware, ucept hinges, not supplied.
PRICE...".... ........."................... ...... ....... ............ . ....$56JJ.00
Supply and install VonDuprin panic hardware, electric strike
for dOOJ. rekasel' Besmn OJltOnttltiC door operatoJ-s1 pOloer
supply, push buttons und 'Wire ull necessury low '\KJltage
wiMng for complete operation.
~~~~..................................................................~-~JlliJ!.()()
q you are supplying the hardware I will need to know the
(aaet prep. at the time of door orderi.ngfor u.s. Aluminum to
macl\ine ea.ch door.
Door prep. charges not included in door prices.
120 volt power supply to door header by others.
Thank Youfor the opportunity to Quote 111
Bob Keller-estimator
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: Southern Oregon Automatic Door
CONTACT: Bob Keller
ADDRESS: 200 Rogue Rim Drive, Merlin, OR 97532
TELEPHONE: 541-621-9506
DATE AGREEMENT PREPARED: November 13, 2007 FAX: 541-471-6065
BEGINNING DATE: November 19, 2007 COMPLETION DATE: February 1,2008
COMPENSATION: $5,611.00 - Per attached proposal dated 09/12/2007
GOODS AND SERVICES TO BE PROVIDED: Contractor to supply and install two aluminum door and sidelite
assemblies to match existing exterior frames. The doors will be handicap assessable, medium style with 1,4" tempered
clear glass and continuous hinges. The doors will hinge to the interior wall and swing out to the lobby. Hardware, except
hinQes, not supplied. 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. Citv'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 mav 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/Liabilitvof 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 t~ Contract; or attempts to assign rights in, "\
or delegate duties under, the Contract. ~ / A ( '0 E'f3f,/<.L~$ --,.Fu/f" /9& G Kd ~~ ';/
16. Insurance. Co s a a se provide the follow(ng insurance: ~ .
a. orker's Com ensa 10 urance in compliance with ORS 656.017, which requires subject employers
to provide Ore s 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 000000, or Not A licable for each accident for Bodil ln'ur and Pro ert Dama e,
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 Contrflctor 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.
CONTRA OR CITY OF ASHLAND:
BY
BY
TITLE
tPtu JJe/L
DATE
DATE
//-/'/~ 7
CON
By:
Date: I) 2 0
;f~ CJ CJ g ~/fJ tfJ ~ .-;',(J ~ ~ t'JC)
(For City purposes only)
tJ-rt:f74J
FederallD#
~77-~~~
ACCOUNT #
'Completed W9 form must be submitted with contract
PURCHASE ORDER #
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 ID (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:
X
'K
~
~
(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 0 liability insurance relating to the labor or services to be provided.
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)
Oepanment of the Treasury
Internal Reverue Service
N Name
~
<0
a.
c:
o
l~
~U
15S
!.e
Q.u
u::
1
en
CIl
~
~/L
O 0 Exempt from backup
Other ~ .... _.. _.. _..... _ _ 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 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.
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 (I RS) that I am subject to backup withholding as a result of a failure to report all interest or dividends. or (c) the IRS has
notified me that I am no longer subject to backup withholding. and
3. I am a U.S. person (including a U.S. resident alien).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions. item 2 does not apply.
For mortgage interest paid. acquisition or abandonment of secured property. cancellation of debt. contributions to an individual retirement
arrangement (IRA). and generally. payments other than in rest and dividends. you are not required to sign the Certification. but you must
provide your correct TIN. (See the' structions on pag .)
Sign
Here
Purpose of Form
A person who is required to f e 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).
Dale ~
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 ASHL,AND, OREGON
EXHIBIT B
City of Ashland
LIVING
ALL employers described
below must comply with City
of Ashland laws regulating
payment of a living wage.
~......
~ !6~ '1
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
a!lDp.er hour effective June 30,.200'
flncreasesannually every June 30b,tbe
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
r~8M-~9JRAD
FAi< HO. : 1-541-471-6065
~;c?, 12 ,280: [:3~ 02C't...! p.~
SOUTHERN OREGON FAX
AUTO..MATIC DOOR TRANSll-IISSION
:l00 Rogue Rim Dr. Merlin, Oregon 97532
Date: Sept. .1.2, 2007
TO: City of Ashland Please call to co1Jfirm receipt
FAX NUMBER: ~s".;l-~SOf"
FROM: Bob Keller 1 # of pages including cover
Our phone: (541) 6:11-9506
Home: (.541) 471-9506
Our.fax.: (541) 471-6065 CCB#147247
ATTN: Dale Pete.,,,s
RE: Community Development doors
Dale,
Thefollowing quote is to supply and install tuJo aluminum
door and sidelite assemblies to match tttisting e:rte'rior frames.
The doo7's will be handicap assessable, medium style with L/4"
tempe1"ed clear glass and continuous hinges. The doors will
hinge to the inferior wall and StVing out to the lobby.
hardware, except hinges, not supplied.
PRICE....... ............ ................... .... ........ ........ ... .. ...$5611 ..00
Supply and install VonDuprin panic hardware, electric strike
for door ,.ekase~ Besam OJltomatic door operators? pOIDe.,..
supply, push. buttons a.nd wire all necesS{lry {ow '\Klltage
wiring for complete operation.
~~~~..................................................................~!jJl~J!.()()
If you are supplying the hardware I will need to know the
exact prep. at the time of door ordering for u.s. Aluminum to
tnachine each door.
Door prep. charges not included in door prices.
120 volt pawer supply to doo.,. header by others.
Thank Youfor the opportunity to Quote !I!
Bob Keller-estimator
7/ 12/17/2007 09: 13
Bancorp Insurance
Beth Winter-'City of Ashland
115
ISANCORPWSURANCEAGENCY
PO BOX 327
LA PINE, OR 97739
(800 }452-6826
Fax # 541-536-1568
To: City of Ashland
from: Beth Winter
no. of pages: 5
subject: Certificate
Fax Message
Certificate of Liability on Robert Jerome Keller including Auto
Coverage
i 12/17/2007 09:13
Bancorp Insurance
Beth WInter -+Cl ty of Ashland
2/5
ACORD". CERTIFICATE OF LIABILITY INSURANCE DATE IMMlDD/YVYYj
11/27/2007
P~ODUCE~ (541)536-1726 FAX: (541) 536-1568 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Little River Investments ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Bancorp Insurance ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
P.O. Box 327, 51477 Hwy 97
La Pine OR 97739 INSURERS AFFORDING COVERAGE NAIC#
INSU~ED INSURER A. Am Hallmark Ins Co of TX
----------...-
Robert Jerome Keller, DBA: Southern Oregon INSURER B:
200 Rogue Rim Dr INSURER C:
INSURER D.
Merlin OR 97532 INSURER E:
CnvERAGI=~
THE POliCIES OF INSURANCE LISTED BELOI/\/ HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWlTHSTANDlNG ANY
REQUIREMENT, TERM OR CONDIT10N OF ANY CONTRACT OR OTHER DOCUMENT V\IITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED BY THE POL::~:n,~;~RIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDIT10NS OF SUCH POLICIES.
AGGR"G T" I ,..,TS Fl"" U, FlY PAIn C' AIM!':
I~~! I~~t;;~ TVPE OF INSU~ANCE POLICY NUMBER ~}+~';~:68/~~ "g~'fJ,~':XJ'~N LIMITS
~ERAL LIABILITY URRFNCF $ 1,000,000
X COMMERCIAL GENERAL LIABILITY ~~~t~U91=~ENTED $ 100,000
A X l CLAIMS MADE [!] OCCUR 44CL446596 10/10/2007 10/10/2008 MED EXP IAnv one oerson\ $ 5,000
- PERSONAL & ADV INJURY $ 1,000,000
- GENERAL AGGREGATE $ 2,000,000
-il'L AGGREAE ~~~ AFlES PER - r.nUPln'" An.n, $ 2,000,000
X POLICY :lIer.T LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
- $
(Ea acc~enl)
- ANY AUTO
A X - ALL OWNED AUTOS BODIL Y INJURY
(Per person) $
~ SCHEDULED AUTOS 44CL446596 10/10/2007 10/10/2008
~ HIRED AUTOS BODILY INJURY
$
~ NON-OINNED AUTOS (PAl' accident)
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~. ANY AUTO OTHER THAN ". .,...,... .
AUTO ONLY. AGG $
EXCESS/UMBRELLA LIABILITV FACH nr.r.URRFNCF $
o OCCUR 0 CLAIMS MADE AGGREGATE .
$
R DEDUCTIBLE $
RETENTION ~ .
WORKERS COMPENSATION AND I T~~T ~J,ys I IOJ~-
EMPLOYERS' UABILITV
ANY PROPRIETORiPARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFlCERIMEMBER EXCLUDED? E L. DISEASE - EA EMPLOYEE $
If yes, describe under
SPECIAL PROVISIONS below EL. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONSlLOCATIONSlVEHICLEs/EXCLUSIONS ADOEO BY ENDORSEMENT/SPECIAL PROVISIONS
Certificate ho~der is ~isted as an additional insured per attached MP 97 67 06 05
CERTIFICATE HOLDER
CANCELLATION
(541) 488 -5320 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE
City of Ash~and EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
Purchasing Representative 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
Attn: Kari Olson -
FAILURE TO DO so SHALL IMPOSE NO OBLIGATION OR UABILlTY OF ANY KIND UPON THE
90 N Mountain Avenue
Ashland, OR 97520 INSURER ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~. .r..-~~
Pam Dressler/BETH .- .
ACORD 25 (2001/08)
INS025 (0108).08a
@ ACORD CORPORA nON 1988
Page1of2
t 12/17/2007 09:13
Bancorp Insurance
Beth WInter -+CIty or Ashland
3/5
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 (2001/081
INS025 (0108).08;0
Page 2 of 2
71 12/17/2007 09: 13
NAME (First Named & Other Named Insureds)
Southern Oregon Automatic Door
Southern Oregon Automatic Door
OFAPPINF
Bancorp Insurance
Beth Winter~Clty of Ashland
4/5
ADDITIONAL NAMED INSUREDS
Doing Business As
Doing Business As
COPYRIGHT 2000, AMS SERVICES INC
t 12/17/2007 09: 13
Bancorp Insurance
Beth Wlnter -+Cl ty of Ashland
5/5
The deductible of $500 does not apply to rental reimbursement expenses.
General Liability Additional Coverages
The following Additional Coverages are added to the COMMERCIAL GENERAL L1AB1L1TY COVERAGE FORM.
A. Blanket Additional Insured Coverage
1. SECTION 11- Who Is An Insured ofthe COMMERCIAL GENERAL LIABIUTY COVERAGE FORM is amended to inclu
as an insured any person or organization (referred to as Additional Insured) whom you are required to add as
Additional Insured on this policy under:
a. A written contract or agreement; and
b. Where a certificate of insurance showing that person or organization as an additional insured has been issued; a
c. When the written contract or agreement and certificate of insurance are currently in effect or becoming in eff4
during the term of the policy and executed prior to the "bodily injury," "property damage," or "personal and advertisi
injury."
2. The insurance prOvided to the Adcfltional Insured{s) is limited as follows:
a. The Additional Insured(s) is only an additional insured for:
(1) "Bodily injury," "property damage," or "personal and advertising injury" caused in whole or in part by negligE
acts or omissions of the Named Insured or anyone directly or indirectly employed by the Named Insured or :
whose acts a Named Insured may be liable.
(2) liability arising out of your ongoing operations for the Additional Insured(s) by or for you. A person's
organization's status as an insured under this coverage ends when your operations for that insured ~
completed.
b. The Limits of Insurance applicable to the Additlonallnsured{s) are those specified in the written contract or agreem
but nor more than the Limits of Insurance specified in the Declarations for this policy. The Limits of Insuran
applicable to the Additional Insured(s) are inclusive of and not in addition to the Limits of Insurance shown in 1
Declarations for the Named Insured.
3. In addition to the other exclusions applicable to Section I, Coverages A., B. and C. of the COMMERCiAL GENER
UABILITY COVERAGE FORM, the insurance provided to the Additionallnsured(s) does not apply to:
a. "Property damage" to:
(1) Property owned, used, occupied by, loaned or rented to the Additionallnsured(s);
. (2) Property In the care, custody or control ofthe Addltionallnsured(s) or over which the Additionallnsured(s) are
any purpose exercising physical control; or
(3) "Your work" performed for the Additional Insured(s).
b. "Bodily injury," "property damage," or "personal and advertising injury" arising out of an architect's, engineer's
surveyor's rendering or failure to render any professional services for you, for the Additionallnsured(s) or for othe
including, but not limited to:
(1) The preparing, approving or failure to prepare or approve maps, drawings, opinions, reports, surveys, chan
orders, designs or specifications; or
(2) Supervisory. inspection or engineering services.
c. "Bodily injury" or .property damage" occurring after:
(1) All work., including materials, parts or equipment furnished in connection with such work, on the project (otl
than service. maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of
covered operations has been completed; or
(2) That portion of .your work" out of which the Injury or damage arises has been put to its intended use by <<
person or organization other than another contractor or subcontractor engaged In performing operations fc
principal as a part of the same project.
B. Mobile Equipment Broadened Coverage
V.12.f.(1) ofthe COMMERCIAL GENERAL LIABILITY COVeRAGE FORM is replaced by the following:
(1) Equipment designed primarily for:
Page 12 of 15 Includes copyrighted materiel of ISO Pl'Opertiea, Ino. and MP 97 67 06 0
American Aasochillon of InEl\.l'Bnoe Services, Inc., used with their permlss.ion
rA'
CITY RECORDER
CITY OF
-A~!: ~~~ D I
ASHLAND, OR 97520
(541) 488-5300
Page 1 / 1
VENDOR: 004702
SO OREGON AUTOMATIC DOOR
200 ROGUE RIM DRIVE
MERLIN, OR 97532
SHIP TO: Ashland Building Maintenance
(541) 488-5358
90 N MOUNTAIN AVENUE
ASHLAND, OR 97520
FOB Point:
Terms: Net
Req. Del. Date:
Speciallnst:
Req. No.:
Dept.: PUBLIC WORKS
Contact: Dale Peters
Confirming? No
Install two aluminum door and sidelite
assemblies to match existinQ exterior
frames. The doors will be handicap
accessible, medium style with 1/4"
tempered clear Qlass and continuous
hinQes. The doors will hinQe to the
interior wall and swinQ out to the
lobby. Hardware, except hinQes, not
supplied.
5,611.00
Location: Community Development
Address: 51 Winburn Wa~
G,,~~ ~
Contract f~ 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
~
VENDOR COPY
,
CITY OF
ASHLAND
REQUISITION FORM
THIS REQUEST IS A:
o Change Order(existing PO #
Date of Request: I ~ ~bvDT I
Required Date of Delivery/Service: 1~J:i \ ~~
SO'"'.t"~I2"'. 0lz.61CI'J A\.&-kh1~T1C -:DclOft..
2..00 ~~\.l ~ '"R. """ "J)~, \1 E
~~\;N I OR 9r~;32.
s<-\ 1 - fc.21- 950("
5"41-~1-1 - bOGr.f>
~b L.< E' LL.6""-
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
SOLICITATION PROCESS
Small Procurement
o Less than $5,000
o Quotes (Optional)
Invitation to Bid
(Copies on file)
Intermediate Procurement
jiil. (3) Written Quotes
(GQpies aUached) \
'Se'1 Ha?lZJ~eE ~6$e: NO
-bo 1>~~-b~-\:G
Copy of contract attached
Contract It
Reauest for Proposal
(Copies on file)
Special I Exempt
Written findings attached
Quote or Pro aI attached
Emeraencv
Written findings attached
Quote or Pro sa! attached
Description of SERVICES
-Lt..J S~J4 c...L~ 7taJ
o Per attached PROPOSAL
Item # Quantity
Unit
Description of MATERIALS
Unit Price
Total Cost
SEe: t"\tq TS~II'lL L;Si 5~ll cIS
0 Per attached QUOTE TCn:AL ~OST
.,.
Project Number ______ - ___ $ S4> n <i!!
Account Number ~ lQ -QB ~~ -OC> lP!'JJ~
'/terns 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 documentation can be provided upon request.
Employee Sign.\ure~ ~ Supervlsor/Depl Head Sign.lure:~\.. ~ .
G: Finance\Procedure\AP\Forms\8_Requisition form revisEld.doc
Updated on: 5/17/2006
~