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HomeMy WebLinkAbout2008-035 Contract - Applied Geotechnical Engineering Contract for PERSONAL SERVICES Less than $25,000 CITY OF ASHLAND 20 East Main Street Ashland, Oregon 97520 Telephone: 541/488-6002 Fax: 541/488-5311 CONSULTANT: Applied Geotechnical Engineering And Geologic Consulting, LLC (AGEGC) CONTACT: Robin Warren ADDRESS: 1314-8 Center Dr. #452, Medford OR 97501 TELEPHONE: 541-226-6658 DATE AGREEMENT PREPARED: 3-12-08 FAX: 541-956-8762 BEGINNING DATE: March 12,2008 COMPLETION DATE: April 12,2008 COMPENSATION: Time and Materials Not to Exceed $12,000 in accordance with the attached rates schedules from Western States Soil Conservation and AGEGC SERVICES TO BE PROVIDED: Geotechnical Exploration at Hosler Dam ADDITIONAL TERMS: As shown in the attached plan drawing and as directed by Engineering Geologist on site Peter Friz of Hatch Energy Corporation FINDINGS: Pursuant to AMC 2.52.040E and AMC 2.52.060, after reasonable inquiry and evaluation, the undersigned Department Head finds and determines that: (1) the services to be acquired are personal services; (2) the City does not have adequate personnel nor resources to perform the services; (3) the statement of work represents the department's plan for utilization of such personal services; (4) the undersigned consultant has specialized experience, education, training and capability sufficient to perform the quality, quantity and type of work requested in the scope of work within the time and financial constraints provided; (5) the consultant's proposal will best serve the needs of the City; and (6) the compensation negotiated herein is fair and reasonable. NOW THEREFORE, in consideration of the mutual covenants contained herein the CITY AND CONSULTANT AGREE as follows: 1 . Findings I Recitations. The findings and recitations set forth above are true and correct and are incorporated herein by this reference. 2. All Costs by Consultant: Consultant shall, at its own risk and expense, perform the personal services described above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance of such service. 3. Qualified Work: Consultant has represented, and by entering into this contract now represents, that all personnel assigned to the work required under this contract are fully qualified to perform the service to which they will be assigned in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are so registered, licensed and bonded. 4. Completion Date: Consultant shall start performing the service under this contract by the beginning date indicated above and complete the service by the completion date indicated above. 5. Compensation: City shall pay Consultant for service performed, including costs and expenses, the sum specified above. Once work commences, invoices shall be prepared and submitted by the tenth of the month for work completed in the prior month. Payments shall be made within 30 days of the date of the invoice. Should the contract be prematurely terminated, payments will be made for work completed and accepted to date of termination. 6. Ownership of Documents: All documents prepared by Consultant pursuant to this contract shall be the property of City. 7. Statutory Requirements: ORS 279C.505, 279C.515, 279C.520 and 279C.530 are made part of this contract. 8. Living Wage Requirements: If the amount of this contract is $17,342 or more, Consultant is required to comply with chapter 3.12 of the Ashland Municipal Code by paying a living wage, as defined in this chapter, to all employees performing work under this contract and to any Subcontractor who performs 50% or more of the service work under this contract. Consultant is also required to post the notice attached hereto as Exhibit B predominantly in areas where it will be seen by all employees. 9. Indemnification: Consultant agrees to defend, indemnify and save City, its officers, employees and agents harmless from any and all losses, claims, actions, costs, expenses, judgments, subrogations, or other damages resulting from injury to any person (including injury resulting in death), or damage (including loss or destruction) to property, of whatsoever nature arising out of or incident to the performance of this contract by Consultant (including but not limited to, Consultant's employees, agents, and others designated by Consultant to perform work or services attendant to this contract). Consultant shall not be held responsible for any losses, expenses, claims, subroaations, Contract for Personal Services Less than $25,000, Revised by Legal 03/26/2007, Page 1 of 10 actions, costs, judgments, or other damages, directly, solely, and proximately caused by the negligence of City., 10. 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 written notice to Consultant, 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 Consultant 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 Consultant may terminate this contract in the event of a breach of the contract by the other. Prior to such termination the party seeking termination shall give to the other party written notice of the breach and intent to terminate. If the party committing the breach has not entirely cured the breach within 15 days of the date of the notice, or within such other period as the 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 Consultant's performance of each and every obligation and duty under this contract. City by written notice to Consultant of default or breach may at any time terminate the whole or any part of this contract if Consultant fails to provide services called for by this contract within the time specified herein or in any extension thereof. iii. The rights and remedies of City provided in this subsection (d) are not exclusive and are in addition to any other rights and remedies provided by law or under this contract. 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, Consultant shall immediately cease all activities under this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination, Consultant shall deliver to City all contract documents, information, works-in-progress and other property that are or would be deliverables had the contract been completed. City shall pay Consultant for work performed prior to the termination date if such work was performed in accordance with the Contract. 11. Independent Contractor Status: Consultant is an independent contractor and not an employee of the City. Consultant shall have the complete responsibility for the performance of this contract. Consultant shall provide workers' compensation coverage as required in ORS Ch 656 for all persons employed to perform work pursuant to this contract. Consultant is a subject employer that will comply with ORS 656.017. 12. Assignment and Subcontracts: Consultant shall not assign this contract or subcontract any portion of the work without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be void. Consultant shall be fully responsible for the acts or omissions of any assigns or Subcontractors and of all persons employed by them, and the approval by City of any assignment or subcontract shall not create any contractual relation between the assignee or subcontractor and City. 13. Default. The Consultant shall be in default of this agreement if Consultant: commits any material breach or default of any covenant, warranty, certification, or obligation it owes under the Contract; its QRF status pursuant to the QRF Rules or loses any license, certificate or certification that is required to perform the Services or to qualify as a QRF if consultant 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. 14. Insurance. Consultant 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. Professional Liabilitv insurance with a combined single limit, or the equivalent, of not less than $1,000,000 for each claim, incident or occurrence. This is to cover damages caused by error, omission or negligent acts related to the professional services to be provided under this contract. c. General Liabilitv insurance with a combined single limit, or the equivalent, of not less than $1,000,000 for each occurrence for Bodily Injury and Property Damage. It shall include contractual liability coverage for the I indemnity provided under this contract. Contract for Personal Services Less than $25,000, Revised by Legal 03/26/2007, Page 2 of 10 , d. Automobile Liabilitv insurance with a combined single limit, or the equivalent, of not less than Enter one: $1,000,000 for each accident for Bodily Injury and Property Damage, including coverage for owned, hired or non- owned vehicles, as applicable. e. 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 Consultant or its insurer(s) to the City. f. Additional Insured/Certificates of Insurance. Consultant 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 Consultant's services to be provided under this Contract. As evidence of the insurance coverages required by this Contract, the Consultant shall furnish acceptable insurance certificates prior to commencing work under this contract. The certificate will specify all of the parties who are Additional Insureds. Insuring companies or entities are subject to the City's acceptance. If requested, complete copies of insurance policies; trust agreements, etc. shall be provided to the City. The Consultant shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self-insurance. 15. 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 Consultant 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. Consultant, 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. 16. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT, MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT. CONSULTANT, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND CONDITIONS. 17. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Consultant understands and agrees that City's payment of amounts under this contract attributable to work performed after the last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this contract without penalty or liability to City, effective upon the delivery of written notice to Consultant, with no further liability to Consultant. Certification. Consultant shall si n the certification attached hereto as Exhibit A and herein incorporated b reference. CONSULTANT Il CITY OF ASHLAND: BY c;l W~ BY J? pignature noJ'l.", WCl~rtj,') Print Name TITLE f~\A(/4 DATE DATE 7(17/CI; CONTRACT AWARD AND FINDINGS DETERMINED BY: By: 'Completed W9 form must be submitted with contract ity Department Head Date: 6'71) tJeJ l q ~ 7&'~ ACCOUNT # t? t7 I / t:P-c 7 tJ I' ~ (For City purposes only) PURCHASE ORDER # t? ~ ( 76 FederallD# Contract for Personal Services Less than $25,000, Revised by Legal 03/26/2007, Page 3 of 10 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: ~ ~ 4- ~ (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 pursuan~ 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. M ltJ~. Contractor J//l/dfJ ( Date) Contract for Personal Services Less than $25,000, Revised by Legal 03/26/2007, Page 5 of 10 ~ G ~ :1 ,-- ler!; ~-~ :\i!j -~~-AJi.i'kI ~ w ~ F! l'" ~ ~ lSC!..........I3!ltr6 - ili MOO+l: i f lII-;'II.IIf<.tofl i Ii> ~ MOo--~- "".t" a i'''~''. * ; J........ i i . · , !<: <> $! :;:.lil i x g ~_lil.... ;:;-~-l::i l::i : 00--0--- ~,-ie-.... ~ '" "'! : Ul , 1; ~ :ill: 41.",,,,. "''''. ~ ~ '3 00-- ~ .. :III --_. -- =7~~ :~~,::~~:<~, :.~. W ....I _M_tr 0::' i 0.. ~ 0\ .~.. ~- Wi N ('If 0...,1 - .--6t' ....1\ W' >1 Wt "'0 12\ " N W ~"'... ',_...n... '.~'" '!':::.~'" "I ,. ~ '" ~a ~'? 1-3: <~ :2 0+ j::N U . w< (/)t;; ~~i w I IX t :::l~! Cl 1 u: ===:. ~..?! \ -=1 :-==I ~ 'a to E I'll o "- Ql u; o ::t: - o \I) s::: o '0:; t.) <II en "0 s::: I'll ..:!:! ;;:: e a.. s::: .!l! a.. 00+0 41 Oa., ~<;'" \ 2: <t -' a.. , " l:\1~')' ~ h.,u:~1i"))l~q:..M:M ". .. '.... I- W '. <( 0 ,If z n ,~~~.G 0 + \:"~l'-~ ~ . ~~,. . l/) <ll ,/ STANDARD FEE SCHEDULE Effective October 1, 2007 The compensation to Applied Geotechnical Engineering and Geologic Consulting, LLC (AGEGC) for our professional services is based upon the following hourly rates and conditions. Personnel Principal $ 130/hr. Senior Professional $ 100/hr. Project Professional $ 80/hr. Staff Engineer/Geologist $ 65/hr. AutoCAD Drafting $ 60/hr. Office Manager $ 60/hr. Senior Technician $ 58/hr. Technician $ 39/hr. Technical Typist $ 37/hr. Legal Testimony & Preparation (min. 2 hours) $ 195/hr. Other Direct Costs Expenses Subcontractors Equipment Vehicle Cost Plus 10% Cost Plus 10% As Quoted $0.60/mile BILLING - Fees and other charges will be billed monthly, as the work progresses, and the amount of each invoice shall be due within 15 days of receipt. A service charge of 1 Y2% per month will be charged on all accounts not paid within 30 days. All expenses incurred for liening or collection of any delinquent amount, including, but not limited to, reasonable attorney fees, witness fees, charges at current billing rates for time spent by AGEGC personnel, document duplication, and court costs, shall be paid to AGEGC in addition to the delinquent amount. SERVICES, SUPPLIES PRPVIDED BY OTHERS, AND REIMBURSABLE EXPENSES Charges for services, equipment, and supplies not provided directly by AGEGC will be computed at cost plus 10 percent. This includes surveying services, land subsurface explorations, construction equipment, contract labor, shipping charges, living expenses, printing and reproduction, communication and miscellaneous supplies and rentals. Western States Soil Conservation, Inc. 19100 Western Rd. NE Aurora, OR 97002 Phone (503) 678-9777 Fax (503) 678-9776 \)(,\~w> t~\~.QI\'1 Tuesday, March 11, 2008 Robin Warren AGEGC l3l4-B Center Dr #452 Medford, OR 97501 Project: City of Ashland Water Supply Dam This proposal includes the estimated equipment, labor and supplies necessary to drill and abandon (2) 30 foot Mud Rotary borings with up to 30 feet of rock coring. The cost breakdown is as follows: Mobilization Bctended 1 $2,080.00 $2,080.00 0V1E55 Track Rg 16 $220.00 per hr $3,520.00 &lpport Truck 2 $95.00 per day $190.00 Water Trailer 2 $150.00 per day $300.00 Fer Diem 2 $200.00 per day $400.00 B3ntonite O1ips 6 $12.00 ea $72.00 Quick Gel 2 $12.00 ea $24.00 Core 8::>xes 6 $25.00 ea $150.00 Core Bt Usage 10% $810.00 ea $81.00 8::>ri ng Logs 2 $25.00 ea $50.00 R:>rtland Cerrent 3 $12.50 ea $37.50 Quick Grout 2 $9.50 ea $19.00 Please note there is a four hour minimum charge. This proposal is based on a time and material basis and will be billed accordingly. The total amount for Western States Soil Conservation to complete the project as described in this document is $6923.50. Thank you for the opportunity to bid on this project. Please call our office at (503) 678-9777 if you have any questions. We look forward to working with you. ....~j w~.1 Q:: ====! ::l <<:Ill..:D i C) OIOlII1II:'lI.li _ :::==: I 1.1. a..::::a I ioo<- ! -=:r::: I ~l "'..1 ~ " ;;: ~' ,.~~' ~,_._,",.,-~, .~. ..... <; "~::~=~"~:.,,:...' },t' r:'.~. .r 1:-:"'\ ., 'I:" ..' ,,,,,,,,~,.,.;J,.,.,~'~ ,-.' ! .... E l'lI o ... Ql -;; o :r: - o I/) s:: o .. to) Ql en "C s:: l'lI .! ;;:: e a- s:: ..! a. "'" If t l!I.fc'.~.\lll ;iF ~ Q I-~ ~I' <(;> ;;j ~.,.".zi 7'" ,.'.. . ,';':.. ..... ',. Q + -;fr....--- '-'--. ..';", I- N ~ ,~"\:~ ",.3;::~~.~.,~~ ~'~~:._'N~~ , U . "I ? ..... W <( ~. .... . , .1' r","""~""" l/) t; ct == M 00+1; ~ ~ ~ f '" .(..~."<Il "+~ .. \ \. tb ~ w ~ MOIl->~ , .1Il~'" ...,lII.... ~ ... Il '" ""'00,., .., III W -I ... ---rr i I I g: I .~. ~-I-~ -~ .~. ~- fi} J i I!' -.--&t -It W! >1 .~t_ t:> '* , t ~"lI:.l!. *'lllt"" . , oo+ou-~-i-~- (I)' ~ ~ 2: <( ...I a- M' :i ! '* .t.4"~."* ; , oo~ .... ~ ~ 'il ';I Oo+~ f tI "t' II ~.fI; Il 'it , :c (.) = :c ~ \~fII~ .. " lUn ~ a Jaq;u!;)UHI.N\ ~ M i . 3 OO+Z I-W <(0 ZM 0+ --i= .... u' we( tnt; ~...I (".j UJ rE'- m__ ;+::;7-'~--'"7,~:;--:- i'.,",,',- , : ~~<, "~.:; :.' ~..' .' .,~.. ~ ,'..~~, n Mar 14 08 06:40a Applied Geotechnical Eng - I V .. 11 e 1"er ......;)n-; e..&il( 541-956-8762 p.1 FaIn W-9 1RIw. Jan-v2OllSJ ~aru.r-.r, laIIalII ..... SIntce CIi ....,. c- Il1lIWI'l 011 your inclonle _ reIIm) 8. APPlied Geotechnical Engineering & Geologic Consulting, LLC a B__ _.If dwr..nt "-' ....... 6 JI ~I 1& 1 I CD Request for Taxpay., Identlftcatlon Number and Certification Indlvilllall a.ck IIPPl'llPriIIle bale 0 Sole PRJprteIlar .IdcIlIMa (...mbIr. lIIr8It. _ ept. or SlIile no.) 1314-8 Center Drive. tI 452 City. ...... 8'lCI ZIP code Medford, OR 97501 UIIt__~h_~ Give10nn to the nIqII8IIbw. Do not 881d to 1he IRS. o CDrpoIlllion 0 p____ III Other ~ .1:~4?."hn..__.. 0 =::: b8cIwp ~ _aJW:t ~ (opli~ Enter YOIr"TIN In tta. apprgpriale box. The 11N pnMded must malch 1he name giv8n on Une 1 to awId beclcup wIIt1hddlng. For incINiitfIals. IhIs Is your llClClaIlI8Cl.dy number lSSN). foIowevw. tar a I8Iident alen, sole proprietor. Dr ~ entity, Me" ~ r fnllIrucllana on pege 3. For oa............ 1:.. }tOUr ....,. IdentitIc8Ilon number (ElN). If you cIo not have a nlllY1ber, ... How to get a TIN on pege 3. Nota. "__.::cawrt {5 Tn IJlOIV ftJM one ,.,.., _the dI/ft on PfIf1e 41or~ on ~ number to en"". .... CerWlcation lkIder penalties of P81jury. I certify thet: 1. 1l1e num_ shown on this farm .. my .CClmICt tsxpay.- IclentIiC8tlon number (or J am 'MIllIng for a number to be I8sued to me), .-1(f 2. I am not subject to backup wIhhoIcIll'll bec8use: (a) I am C8mpt from b8cIcup wIthhofdinp, or tbt I hawe not b.... notiIied ~ Ihe l"*-nal ..,.,.. SeMce (IRS) "'1 am SUbI8c:t to backup wlhbolJlno as . lWtIUIt of a failure to I1IpOIt aI mer.t or dlvtcfencls, or (C) 1ha IRS has noIIfilMI me that I am no longer eubject to bedwp witI'I1oIcfl'lg, -.:i 3. 'am a us. F*8Qn (h:IucIng a U.s. l"Mident *n). CenIfIcation "'strudIons. You muat <:RIS8 out 11m 2 8bo\Ie if you halie been notIIed by the IRS th8t you .... c~ ~ to b8d<up wittlholdlng bec:au8e )'OU hrMt faIIBd to 11IpOlt" inI8nIst a'ld dIuIdlmds on your _ r8hrn.. For ,... 88I8t8~, Jtem 2 does not apply. For mortgage Interest peld, acquIsitiol'l or ablllldcnnent of 8eCII'8d pruperty. cenceIdon of debt, c:ol'llltlulions to an fndIvldlalletllonTl8nt IftBng8m8nt (lRAI, and ~. payments CJe.1han intler8at and dMdends, you ant not requll8d to sign the ClIrIIlicIIIlon, but you must provide your conct TIN. (See the InsIructlons on page <t.. =I~~ P_ of Form U - ._~ A person who is required to file an information return with the IRS, must obtain yaw COI'NCt 1a:lcpayer identilicaliun nwnber (T1N) to report. for example, income paid to you, .... estate 1ranS8Ctlons, mortgage interest you p&id, acquisition or abandonment or secured property, cancellation of debt, or conIriJutIons you made to an IRA. U.s. perean. Use Form W-9 only if you are a U.S. peISOn (includng Ii resident 811en), to provide your correct TIN to the person requesting It (the requester) Ind, when ~e, to: 1, Certify that the TIN you we giving is correct (or you we lMIitlng for a number to be iesued). 2. Certify that you are not subject to backup withholding, or 3. Clai'Tl exemption from backup wilhholclng if you are a U.s. exempt payee. Nate. If a ~ gWes)'OU a am other than Form W-S to I8QUeSt your TIN, you must use the requaster's torm " It Is substantially sfmHar 10 this Form W-9. For f8dera11ax purposes you ... considered a P8'8OI'l if you are; · An Individual who Is a citizen or resident of the United Slates. · A ~ership. corporation. company, or associa11on creeled or organized in the United Sf8I8s or under lite laws of 1he Unilecl Stales. or Ti Id8Iltification Number ~ or ~ 2 0 2 3 901 7 2 DIIta ~ -('(\~ \"1l ~~ · Any estate (oIher than a foreign estate) or trust. See Regulations sections 301.7701-6(8) &n:I 7(8) tOr additional information. FGreIIIo. persan.lf you are a fonlign person, do not use Form W-e. fnste&d, use the appropriate Fonn W-8 (see Pilbllcatlon 515, ~dWlg 01 Tax on Nonresident Aliens and Foreign Entities). NcHINsIdent .1.... who beoom.. a ....dent 86en. Generally, only a no....eslclent 8fien IndIYidueI may use the terms of 8 lax treaty to reduce or eliminate U.s. 'lax on C8lI8in types of Income. However, most tax 1I8atl8s contain a provision known.. a -saving c:IIuse.- Exceptians specified in 1he saving clause may permit an BlC8mption from tax to continue for certai1 types of Income IWerI after tt1e NCipient has otherwise become a U.s. I'8SIdent ar... for tax purposes. If you are 8 U.S. I'88Iden.t alWt who Is ~ng on .. exception contained in the sa"~.cIause of 8 tax tr8aty to claim an exemption ~ U.s. tax on C81ain types of income, you must attach a statement to Farm W-9 thai specifies the following five items: . 1. The treaty counlry. GIneraJy.1his must be 1he same 1r8aty under which you clafmed exemption from tax as a nonr'B8ida1t afien. 2. The 1r8aty .-ticle addressing the income. 3. The article run... (or ioca6on) in the 18x treaty thai contains the saving clause and Its exceptions. C& No. 10231X Form w..e ".1-2006) A CORDn> CERTIFICA TE OF LIABILITY INSURANCE I DATE (MM/DDIYVVY) 02/28/2008 PRODUCER (503) 829-2255 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Kyllo Insurance Services Northwest, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR PO Box 389 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 248 Center Ave Molalla OR 97038- INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Safeco Insurance Co Western States Soil Conservation, I INSURER B: SAIF CORP. 19100 Western Rd NE INSURER C: INSURER D: Aurora OR 97002- INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DDIYY) DATE (MM/DDIYY) LIMITS A GENERAL LIABILITY / / / / EACH OCCURRENCE $ 1,000,000 t-- ~~~~~H?E~~~~nce) 200,000 X COMMERCIAL GENERAL LIABILITY $ .-J CLAIMS MADE [!] OCCUR 01CG749421-4 03/15/2008 03/15/2009 MED EXP (Any one person) $ 10,000 - PERSONAL & ADV INJURY $ 1,000,000 / / / / GENERAL AGGREGATE $ 2,000,000 ~'L AGGREGATE LIMIT AflES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X .n PRO- / / / / POLICY JECT LOC A AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT 1,000,000 t-- (Ea accident) $ ANY AUTO f-- OS/21/2007 OS/21/2008 ALL OWNED AUTOS 04CC20964301 BODILY INJURY t-- (Per person) $ X SCHEDULED AUTOS f-- / / / / X HIRED AUTOS BODILY INJURY - (Per accident) $ X NON-OWNED AUTOS - / / / / PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ R ANY AUTO / / / / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY / / / / EACH OCCURRENCE $ tJ OCCUR D CLAIMS MADE AGGREGATE $ $ R DEDUCTIBLE / / / / $ RETENTION $ $ B WORKERS COMPENSATION AND 915804 05/01/2007 05/01/2008 I we STAT~- I IOTH- TORY L1MI S ER EMPLOYERS' LIABILITY 1,OeO,000 ANY PROPRIETORlPARTNERlEXECUTIVE E.L. EACH ACCIDENT $ OFFICERlMEMBER EXCLUDED? / / / / E.L. DISEASE - EA EMPLOYEE $ 1,000,000 II yes, describe under E. L. DISEASE - POLICY LIMIT $ 1,000,000 SPECIAL PROVISIONS below OTHER / / / / / / / / / / / / DESCRIPTION OF OPERATlONSlLOCATlONSlVEHICLEs/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ( ) - (541) 956-8762 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT - APPLIED GEOTECH ENG & CONSULTING FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 1314B CENTER DR #452 INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHOR~ED8iaRESENTATlVE MEDFORD OR 97501- Ar .,...",~ ACORD 25 (2001/08) (tn. INS025 (0108).05 ELECTRONIC LASER FORMS, INC. - (800)327-<l545 @ ACORD CORPORATION 1988 Page 1012 Page 1 / 1 r~' CITY Of ASHLAND 20 E MAIN ST. ASHLAND, OR 97520 (541) 488-5300 ~ ~ DATE 3/19/2008 PO NUMBER 08176 VENDOR: 013093 APPLIED GEOTECHNICAL ENGINEER, AGEGC 1314-B CENTER DRIVE #452 MEDFORD, OR 97501 SHIP TO: Ashland Public Works (541) 488-5587 51 WINBURN WAY ASHLAND, OR 97520 FOB Point: Terms: Net Req. Del. Date: Speciallnst: Req. No.: Dept.: PUBLIC WORKS Contact: Jim Olson Confirming? No Quantitv Unit Description Unit Price Ext. Price Geotechnical Exploration for Hosler Dam 12,000.00 Stability, Compensation: Not to exceed $12,000 in accordance with the attached rate schedules from Western States Soil Conservation and AGEGC RFP Date of aqreement: 03/12/2008 Beqinninq date: 03/12/2008 Completion date: 04/12/2008 Insurance required/On file Project #2008.14 SUBTOTAL 12000.00 BILL TO: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2028 TOTAL 12,000.00 ASHLAND, OR 97520 Account Number Project Number Amount Account Number Project Number Amount I E 670.08.19.00. 70420( E 200814.120 6,000.00 1 I E 690.11.18.00.7041 O( E 200814.120 6,000.00 I I 1 I I / ~ ~ 3/, , ,"/A/ - . ~~~ Authori Signature if VENDOR COPY CITY OF ASHLAND REQUISITION No. PW - FY 2008 Department PUBLIC WORKS Vendor AGEGC* 1314-B Cemter Dr. #452 Medford OR 97501 Account No. 670.08.19.00.702400 690.11.18.00.704200 Date March 12,2008 Requested Delivery Date Deliver To Jim Olson Via Pieter Smeenk PE ASAP 50% (* Note: Please allow approximately two(2) weeks for delivery on items not 50% generally caried in stored, and approximately two (2) months on printing jobs.) * indicates Aoolied Geotechnical EnQineerinQ And GeoloQic ConsultinQ, LLC Item No. Quantity Unit Description Use of Purchasing Office Only Unit Price Total Price PO No. 1 Geotechnical Exploration for Darn Stability T &M NTE $ 12,000.00 for K.ari: BID /RFP lEXEMPT: RFP Contract Start. Date: 12-Mar-OS ContractCompletiQn Date:12-A~-OS Insurance on file: rYES . INO Project No: . 200S:1i... \4 Job No. Unit No. I hereby certify that the above items are necessary for the operation of this department and are budgeted ~~~-,- Issued By Date Received By r.l' G:\pub-wrks\eng\08-12\requisition general form.xls CITY OF ASHLAND PROJECT ACCOUNTING WORKSHEET PROJECT NUMBER (YEAR XX) PROJECT TITLE 2007211 IHOSLER DAM FERC PART 12 SAFETY INSPECTION & ASSOCIATED BASE SHEAR ANAL YSISI PROJECT DESCRIPTION Engineering evaluation and report on the condition of Hosler Dam in accordance with Federal Energy Regulatory Commission (FERC) Part 12 Safety Inspection Guidelines Department Project Manager Department Head Public Works - Engineering Pieter Smeenk James H. Olson BUDGET INFORMATION Identify fiscal year I potential splits I FY08 Identify Funding Codes Water Suoolv Electric Deoartment 670.08.19.00.702400 50% 690.11.18.00.704200 50% and Funding Code names DESIGN .100 Engineer Name PO COST Change Orders 1 2 3 4 Hatch Energy Pending $ 100,660.00 $ 100.660.00 CONSTRUCTION .120 (~, PRar Jp Or>-/2J) contractor name AGEGC PO Pending budget estimate $ 12,000.00 bid I contract total $ 12,000.00 changes total $ 12,000.00 CONSTRUCTION .120 contractor name PO budget estimate bid I contract total changes total $ PERMIT COSTS (Building Dept) .170 budget estimate final costs Miscellaneous Costs: ~A' Dally Journal of Commerce $ 418.25 Medford Mail Tribune $ 239.42 G:Pub-wrksleng/dept-adminlengineer/projectl07-21 Proj Acct Worksheet NS.xls