HomeMy WebLinkAbout2008-055 Contract - Rocky Mountain Construction
Contract for GOODS AND SERVICES Less than $25,000
CITY OF
ASHLAND
20 East Main Street
Ashland, Oregon 97520
Telephone: 541/488-6002
Fax: 541/488-531"1
CONTRACTOR: Rocky Mountain Construction LLC
CONTACT: Jamie Jackson, General Manager
ADDRESS: PO Box 7489, Klamath Falls, OR 97602
TELEPHONE: (541) 882-8377
DATE AGREEMENT PREPARED: 04/02/2008 FAX:
BEGINNING DATE: 04/14/2008 COMPLETION DATE: 06/27/2008
COMPENSATION: $5.00 per ton, Not to exceed 4,500 tons and $22,500.00
GOODS AND SERVICES TO BE PROVIDED: Asphalt Crushing - Asphalt is located at Glenview Street
asphalt pit. Finished product is reauired to be a diameter of 1 inch or smaller (similar to 1" minus rock).
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
written notice to Contractor, or at such later date as may be established by City under any of the following
Contract for Goods and Services Less than $25,000, Revised by Legal 06/30/2007, Page 1 of 9
-r I
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 Liabilit J ance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, 1 000 00 ,$2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property
Damage. It shall include con ractualliability coverage for the indemnity provided under this contract.
c. Automobile Liabili ~rance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, 1 000 000'_ r Not Applicable for each accident for Bodily Injury and Property Damage,
includin covera e for owne ,hired or non-owned vehicles, as a licable.
Contract for Goods and Services Less than $25,000, Revised by Legal 06/30/2007, Page 2 of 9
"r I
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, lithe claim ") between the City (and/or any other or department of the State of Oregon) and
the Contractor that arises from or relates to this contract shall be brought and conducted solely and exclusively within
the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal
forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the
District of Oregon filed in Jackson County, Oregon. Contractor, by the signature herein of its authorized
representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this section be
construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United
States Constitution, or otherwise, from any claim or from the jurisdiction.
18. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE
PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL
BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT,
MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR
THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR
REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT.
CONTRACTOR, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT
HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND
CONDITIONS.
19. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and
authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Contractor
understands and agrees that City's payment of amounts under this contract attributable to work performed after the
last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow
City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In
the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this
contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further
liability to Contractor.
20. Prior Approval Required Provision. Approval by the City of Ashland Councilor the Public Contracting Officer is
required before any work may begin under this contract.
21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by
reference.
CONTRACTOR CITY OF ASHLAND:
BY
BY
TITLE C:~ C (\~ 1,1\ M'MYE\j(LV
DATE L{ - y og
DATE
CONTRA J AWARD AND FINDINGS DETERMINED BY:
By:
FederallD#
Cj \ - I ~\5S1
Date:
P / c [' f3 /cf2 ?f c if; /? /;//t:9 C/
(For City purposes only)
'Completed W9 form must be submitted with contract
PURCHASE ORDER #
c:/(5.:213
Contract for Goods and Services Less than $25,000, Revised by Legal 06/30/2007, Page 3 of 9
"1" I
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:
.,\J.J
JJ
,~D
,,~)
,~)
~\l)
(1) I carry out the labor or services at a location separate from my residence or is in a
specific portion of my residence, set aside as the location of the business.
(2) Commercial advertising or business cards or a trade association membership are
purchased for the business.
(3) Telephone listing is used for the business separate from the personal residence listing.
(4) Labor or services are performed only pursuant to written contracts.
(5) Labor or services are performed for two or more different persons within a period of one
year.
(6) I assume financial responsibility for defective workmanship or for service not provided
as evidenced by the ownership of performance bonds, warranties, errors and omission
insurance or liability insurance relating to the labor or services to be provided.
~~D)\)\lMn\ n Cn(\SkuJil5tJ 1= I-C(Dat8)LJ - O'-i - m
Contract for Goods and Services Less than $25,000, Revised by Legal 06/30/2007, Page 4 of 9
or I
Form W-g
ttw TreaslJlV
Revenue Sen/IC'E"
Request for Taxpayer
Identification Number and Certification
Give form to the
requester. Do not
send to the IRS.
(Rev. October 2007)
. I Name (as shown on your income tax retLij'n) .
~ I' R DC-Ku m Q UJ\JALtJ..CQJJSI&LllcalD.b,L_LL.Y~__..._.._
g> Business name, i\ different from above
0.
c
o _... .__.__....._.__._._..__.........__~.__............_..._._____...._._...........__.________~._._.._._..~_
Q) ~ ,Ch.,eck appropriate box: D Individual/Sole proprietor D Corporation D Partnership
~ 0 {1 " Exempt
_ U ......! Limited liability company. Enter the tax classification (D=disregarded entity. C=corporation, P=partnership) ~ i~ payee
5 2 . Other (S66 'nstruct,ons) ~
.~ ~ r, street, and apt. or suite no.) Requester's name and address (optional)
0..:2 ,
:t::
1 ~-i\k)
Q)
Q)
(f)
.~..
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match tile name given on Line 1 to avoid
backtlp witllllolding. 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 Ilave 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.
Ecia' seCUrity numb;,"~ .-. ___ -j
or
Certification
Under penalties of perjury, I certify that:
1 The number shoVln 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 withllolding, and
3. I am a U.S. citizen or other U.S. person (defined below)
Certification instructions, You must cross out item 2 above if you have been notified by the IRS that you are currentiy subject to backup
withholding because you Ilave 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: contribLltions 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
Signatu.... of
U.S. person ~
;Wv
Section references are to the Internal Revenue Code unless
otherwise noted.
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.
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. If applicable, you are also certifying that as a
U.S. person, your allocable share of any partnership income from
a U.S. trade or business is not subject to the wrthholdll1g tax on
foreign partners' share of effectively connected income.
Note. If a requester gives you a form other than Form W-9 to
request your TIN, you must use the requester's form if it is
substantially similar to this Form W-9.
Oate ~
-OB
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
. An individual who is a U.S, citizen or U.S. resident alien,
. A partnership, corporation, company, or association created or
organized in the United States or under the laws of the Unrted
States,
. An estate (other than a foreign estate), or
. A domestic trust (as defined in Regulations section
3017701-7).
Special rules for partnerships. Partnerships that conduct a
trade or business in the United States are generally required to
pay a withholding tax on any foreign partners' share of income
from such business. Further, in certain cases where a Form W-9
has not been received, a partnership is required to presume that
a partner is a foreign person, and pay the withholding tax.
Therefore, if you are a US person that is a partner in a
partnership conducting a trade or business in the United States,
provide Form W-9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership
income.
The person who gives Form W-9 to the partnership for
purposes of establishing its U.S. status and avoiding withholding
on its allocable share of net income from the partnership
conducting a trade or business in the United States is in the
following cases:
. The US, owner of a disregarded entity and not the entity,
Cat. No. 10231 X
Form W-9 (Rev. 10-2007)
Contract for Goods and Services Less than $25,000, Revised by Legal 06/30/2007, Page 5 of 9
"r I
Form W-9 (Rev. 10-2007)
Page 2
. The U.S. grantor or other owner of a grantor trust and not the
trust, and
. The U.S. trust (other than a grantor trust) and not the
beneficiaries of the trust.
Foreign person. If you are a foreign person, do not use Form
W-9. Instead, use the appropriate Form W-8 (see Publication
515, Withholding of Tax on Nonresident Aliens and Foreign
Entities).
Nonresident alien who becomes a resident alien. Generally,
only a nonresident alien individual may use the terms of a tax
treaty to reduce or eliminate U.S. tax on certain types of income.
However, most tax treaties contain a provision known as a
"saving clause." Exceptions specified in the saving clause may
permit an exemption from tax to continue for certain types of
income even after the payee 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 ciaim an
exemption from U.S. tax on certain types of income, you must
attach a statement to Form W-9 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.
Example. Article 20 of the U.S.-China income tax treaty allows
an exemption from tax for scholarship income received by a
Chinese student temporarily present in the United States. Under
U.S. law, this student will become a resident alien for tax
purposes if his or her stay in the United States exceeds 5
calendar years. However, paragraph 2 of the first Protocol to the
U.S.-China treaty (dated April 30, 1984) allows the provisions of
Article 20 to continue to apply even after the Chinese student
becomes a resident alien of the United States. A Chinese
student who qualifies for this exception (under paragraph 2 of
the first protocol) and is relying on this exception to claim an
exemption from tax on his or her scholarship or fellowship
income would attach to Form W-9 a statement that includes the
information described above to support that exemption.
If you are a nonresident alien or a foreign entity not subject to
backup withholding, give the requester the appropriate
completed Form W-8.
What is backup withholding? Persons making certain payments
to you must under certain conditions withhold and pay to the
IRS 28% of such payments. This is called "backup withholding."
Payments that may be subject to backup withholding include
interest, tax-exempt interest, dividends, broker and barter
exchange transactions, rents, royalties, nonemployee pay, and
certain payments from fishing boat operators. Real estate
transactions are not subject to backup withholding.
You will not be subject to backup withholding on payments
you receive if you give the requester your correct TIN, make the
proper certifications, and report all your taxable interest and
dividends on your tax return.
Payments you receive will be subject to backup
withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the Part II
instructions on page 3 for details),
3. The IRS tells the requester that you furnished an incorrect
TIN,
4. The IRS tells you that you are subject to backup
withholding because you did not report all your interest and
dividends on your tax return (for reportable interest and
dividends only), or
5. You do not certify to the requester that you are not subject
to backup withholding under 4 above (for reportable interest and
dividend accounts opened after 1983 only).
Certain payees and payments are exempt from backup
withholding. See the instructions below and the separate
Instructions for the Requester of Form W-9.
Also see Special rules for partnerships on page 1.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a
requester, you are subject to a penaity of $50 for each such
failure unless your failure is due to reasonable cause and not to
willful neglect.
Civil penalty for false Information with respect to
withholding. If you make a false statement with no reasonable
basis that results in no backup withholding, you are subject to a
$500 penalty.
Criminal penalty for falsifying information. Willfully falsifying
certifications or affirmations may subject you to criminal
penalties including fines and/or imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in
violation of federal law, the requester may be subject to civil and
criminal penalties.
Specific Instructions
Name
If you are an individual, you must generally enter the name
shown on your income tax return. However, if you have changed
your last name, for instance, due to marriage without informing
the Social Security Administration of the name change, enter
your first name, the last name shown on your social security
card, and your new last name.
If the account is in joint names, list first, and then circle, the
name of the person or entity whose number you entered in Part I
of the form.
Sole proprietor. Enter your individual name as shown on your
income tax return on the "Name" line. You may enter your
business, trade, or "doing business as (DBA)" name on the
"Business name" line.
Limited liability company (LLC). Check the "Limited liability
company" box only and enter the appropriate code for the tax
classification ("D" for disregarded entity, "C" for corporation, "P"
for partnership) in the space provided.
For a single-member LLC (including a foreign LLC with a
domestic owner) that is disregarded as an entity separate from
its owner under Regulations section 301.7701-3, enter the
owner's name on the "Name" line. Enter the LLC's name on the
"Business name" line.
For an LLC classified as a partnership or a corporation, enter
the LLC's name on the "Name" line and any business, trade, or
DBA name on the "Business name" line.
Other entitles. Enter your business name as shown on required
federal tax documents on the "Name" line. This name should
match the name shown on the charter or other legal document
creating the entity. You may enter any business, trade, or DBA
name on the "Business name" line.
Note. You are requested to check the appropriate box for your
status (individuaVsole proprietor, corporation, etc.).
Exempt Payee
If you are exempt from backup withholding, enter your name as
described above and check the appropriate box for your status,
then check the "Exempt payee" box in the line following the
business name, sign and date the form.
Contract for Goods and Services Less than $25,000, Revised by Legal 06/30/2007, Page 6 of 9
.r I
Form W-9 (Rev. 10-2007)
Page 3
Generally, individuals (including sole proprietors) are not exempt
from backup withholding. Corporations are exempt from backup
withholding for certain payments, such as interest and dividends.
Note. If you are exempt from backup withholding, you should
still complete this form to avoid possible erroneous backup
withholding.
The following payees are exempt from backup withholding:
1. An organization exempt from tax under section 501 (a), any
IRA. or a custodial account under section 403(b)(7) if the account
satisfies the requirements of section 401 (f)(2),
2. The United States or any of its agencies or
instrumentaiities,
3. A state, the District of Columbia, a possession of the United
States, or any of their poiitical subdivisions or instrumentaiities,
4. A foreign government or any of its political subdivisions,
agencies, or instrumentaiities, or
5. An international organization or any of its agencies or
instrumentaiities.
Other payees that may be exempt from backup withholding
include:
6. A corporation,
7. A foreign central bank of issue,
8. A dealer in securities or commodities required to register in
the United States, the District of Columbia, or a possession of
the United States,
9. A futures commission merchant registered with the
Commodity Futures Trading Commission,
10. A real estate investment trust,
11. An entity registered at all times during the tax year under
the Investment Company Act of 1940,
12. A common trust fund operated by a bank under section
584(a),
13. A financial institution,
14. A middleman known in the investment community as a
nominee or custodian, or
15. A trust exempt from tax under section 664 or described in
section 4947.
The chart below shows types of payments that may be
exempt from backup withholding. The chart applies to the
exempt payees listed above, 1 through 15.
IF the payment Is for, . .
THEN the payment is exempt
for. , ,
All exempt payees excepl
for 9
Exempl payees 1 lhrough 13.
Also, a person registered under
tl,e Investment Advisers Acl of
1940 who regularly acts as a
broker
Exempt payees 1 througl, 5
Interest and dividend payments
Broker transactions
Barter excl,ange transactions
and patronage dividends
Payments over $600 required
to be reported and direct
sales over $5,000 '
Generally, exempt payees
1 through 72
'See Form 1099-MISC, Miscellaneous Income, and its instructions.
'However, the following payments made to a corporation (including gross
proceeds paid to an attorney under section 6045(1), even if the attorney is a
corporation) and reportable on Form 1099-MISC are not exempt from
backup withholding: medical and health care payments, attorneys' fees, and
payments for services paid by a federal executive agency.
Part I. Taxpayer Identification
Number (TIN)
Enter your TIN in the appropriate box. If you are a resident
alien and you do not have and are not eiigible to get an SSN,
your TIN is your IRS individual taxpayer identification number
(ITIN). Enter it in the social security number box. If you do not
have an ITIN, see How to get a TIN below.
If you are a sole proprietor and you have an EIN, you may
enter either your SSN or EIN. However, the IRS prefers that you
use your SSN.
If you are a single-member LLC that is disregarded as an
entity separate from its owner (see Limited liability company
(LLC) on page 2), enter the owner's SSN (or EIN, if the owner
has one). Do not enter the disregarded entity's EIN. If the LLC is
classified as a corporation or partnership, enter the entity's EIN.
Note. See the chart on page 4 for further clarification of name
and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one
immediately. To apply for an SSN, get Form SS-5, Appiication
for a Social Security Card, from your local Social Security
Administration office or get this form online at www.ssa.gov. You
may also get this form by calling 1-800-772-1213. Use Form
W-7, Application for IRS Individual Taxpayer Identification
Number, to apply for an ITIN, or Form SS-4, Appiication for
Employer Identification Number, to apply for an EIN. You can
apply for an EIN oniine by accessing the IRS website at
www.irs.gov/businesses and ciicking on Employer Identification
Number (EIN) under Starting a Business You can get Forms W-7
and SS-4 from the IRS by visiting www.irs.gov or by caliing
1-800-TAX-FORM (1-800-829-3676).
If you are asked to complete Form W-9 but do not have a TIN,
write "Applied For" in the space for the TIN, sign and date the
form, and give it to the requester. For interest and dividend
payments, and certain payments made with respect to readily
tradable instruments, generally you will have 60 days to get a
TIN and give it to the requester before you are subject to backup
withholding on payments. The 60-day rule does not apply to
other types of payments. You will be subject to backup
withholding on all such payments until you provide your TIN to
the requester.
Note. Entering "Applied For" means that you have already
appiied for a TIN or that you intend to apply for one soon.
Caution: A disregarded domestic entity that has a foreign owner
must use the appropriate Form W-8.
Part II. Certification
To estabiish to the withholding agent that you are a U.S. person,
or resident alien, sign Form W-9. You may be requested to sign
by the withholding agent even if items 1, 4, and 5 below indicate
otherwise.
For a joint account, only the person whose TIN is shown in
Part I should sign (when required). Exempt payees, see Exempt
Payee on page 2.
Signature requirements. Complete the certification as indicated
in 1 through 5 below.
1. Interest, dividend, and barter exchange accounts
opened before 1984 and broker accounts considered active
during 1983. You must give your correct TIN, but you do not
have to sign the certification.
2. Interest, dividend, broker, and barter exchange
accounts opened after 1983 and broker accounts considered
Inactive during 1983. You must sign the certification or backup
withholding will apply. If you are subject to backup withholding
and you are merely providing your correct TIN to the requester,
you must cross out item 2 in the certification before signing the
form.
Contract for Goods and Services Less than $25,000, Revised by Legal 06/30/2007, Page 7 of 9
'1 I
Form W-9 (Rev. 10-2007)
3. Real estate transactions. You must sign the certification.
You may cross out item 2 of the certification.
4. Other payments. You must give your correct TIN, but you
do not have to sign the certification unless you have been
notified that you have previously given an incorrect TIN. "Other
payments" include payments made in the course of the
requester's trade or business for rents, royalties, goods (other
than bills for merchandise), medical and health care services
(including payments to corporations), payments to a
nonemployee for services, payments to certain fishing boat crew
members and fishermen, and gross proceeds paid to attorneys
(including payments to corporations).
5. Mortgage Interest paid by you, acquisition or
abandonment 01 secured property, cancellation 01 debt,
quall11ed tuition program payments (under section 529), IRA,
Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give your
correct TIN, but you do not have to sign the certification
What Name and Number To Give the Requester
For this type of account:
Give name and SSN ot
1. Individual
2. Two or more individuels Goint
account)
The individuai
The actual owner of the account or,
if combined funds, the first
individual on the account I
The minor 2
3. Custodian account of a minor
(Uniform Gift to Minors Act)
4. a. The usual revocable savings
trust (grantor is also trustee)
b. So-called trust account that is
not a legai or valid trust under
state law
5. Sole proprietorship or disregarded
entity owned by an individual
The grantor-trustee'
The actual owner
The owner '
Give name and EIN ot
For this type of account:
6. Disregarded entity not owned by an The owner
individual
7. A valid trust, estate, or pension trust Legal entity'
8. Corporate or LLC electing The corporation
corporate status on Form 8832
9. Association, club, religious,
charitable, educational, or other
tax-exempt organization
10. PartnElfship or mu~i-member LLC
11. A broker or registered nominee
12. Account with the Department of
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricu~ural
program payments
I list first a'"ld Circle the neroe of the person whose number you furnish If only one person
on a jont account has an SSr-J, that person's number must be furnished
2
Circle the minor's name and furnish the minor's SSN
3
You must show your individual name and yoo may also enter your bUSiness Qr "DBA"
name Cf1 the second name line You may use either your SSN or Ett'>! (if you have one),
rut the IRS encClJrages you to use your SSN
4 Ust first and circle the name of the trust, estate, or pension trust (Do not furnish the TIN
of the personal representative C1 trllstee unless tl-le legal entity Itself is not cieSJgnated in
the accoont tl tie) Also see SfJeclal rules lor partnerships on page 1
The organization
The partnership
The broker or nominee
The public entity
Note. If no name is circled when more than one name is listed,
the number will be considered to be that of the first name listed.
Page 4
Secure Your Tax Records from Identity Theft
Identity theft occurs when someone uses your personal
information such as your name, social security number (SSN), or
other identifying information, without your permission, to commit
fraud or other crimes. An identity thief may use your SSN to get
a job or may file a tax return using your SSN to receive a refund.
To reduce your risk:
. Protect your SSN,
. Ensure your employer is protecting your SSN, and
. Be careful when choosing a tax preparer.
Call the IRS at 1-800-829-1040 if you think your identity has
been used inappropriately for tax purposes.
Victims of identity theft who are experiencing economic harm
or a system problem, or are seeking help in resolving tax
problems that have not been resolved through normal channels,
may be eligible for Taxpayer Advocate Service (TAS) assistance.
You can reach TAS by calling the TAS toll-free case intake line
at 1-877-777-4778 or TTYfTDD 1-800-829-4059.
Protect yoursel11rom suspicious emails or phishlng
schemes. Phishing is the creation and use of email and
websites designed to mimic legitimate business emails and
websites. The most common act is sending an email to a user
falsely claiming to be an established legitimate enterprise in an
attempt to scam the user into surrendering private information
that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via emails.
Also, the IRS does not request personal detailed information
through amail or ask taxpayers for the PIN numbers, passwords,
or similar secret access information for their credit card, bank, or
other financial accounts.
If you receive an unsolicited email claiming to be from the IRS,
forward this message to phishing@irs.gov. You may also report
misuse of the IRS name, logo, or other IRS personal property to
the Treasury Inspector General for Tax Administration at
1-800-366-4484. You can forward suspicious emails to the
Federal Trade Commission at: spam@uce.gov or contact them at
www.consumer.gov/idtheft or 1-877 -IDTHEFT(438-4338).
Visit the IRS websita at www.irs,gov to learn more about
identity theft and how to reduce your risk.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who must file information returns with the IRS to report intElfesl.
dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, or
contributions you made to an IRA, or Archer MSA or HSA. The IRS uses the numbElfs for identification p"poses and to help verify the accuracy of your tax return.
The IRS may also provide this information to the Department of Justice for civil and criminal litiga1ion, and to cities, states, the District of Columbia, and U.S.
possessions to carry out their tax laws. We may also disclose this information to other countries under a tax. treaty, to federal and state agencies to enforce federal
nontax criminal laws, or to fedElfallaw enforcement and intelligence agencies to combat terrorism.
You must provide YOll TIN whether or not you are required to file a tax return. Payers must generally 'Nithhold 28% of taxable interest, dividend, and certain other
payments to a payee who does not give a TIN to a payer. Certain penalties may also apply.
Contract for Goods and Services Less than $25,000, Revised by Legal 06/30/2007, Page 8 of 9
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.
r~'
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 9 of 9
"r I
ACORD", CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDD/YYYY)
4/4/2008
PRODUCER (541)770-2000 FAX: (541) 772-6861 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Mission Insurance Agencies Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Mission of OR CA Lic#OB27900 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
2770 Biddle Road
Medford OR 97504-4113 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA:American States Insurance 19704
ROCKY MOUNTAIN CONSTRUCTION, LLC INSURERB: Safeco Insurance Company 24740
SUPERIOR LAND DEVELOPMENT, LLC INSURER c:
PO BOX 7489 INSURER D:
KLAMATH FALLS OR 97602 INSURER E:
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.
An'-:;REnATE LIMITS SHOWN MAY HAVE BE" N REDU"ED BY PAID r.LAIMS.
INSR ADD'L Pgk+~~~~~6g;W1' Pg~!flt~~~t~N LIMITS
TYPE OF INSURANCE POLICY NUMBER
~NERAL LIABILITY EACH OCCURRENCE $ 1,000,000
~ 3MMERCIAL GENERAL LIABILITY ~~~~~H9E~~~J~~nce \ $ 200,000
A X ~ CLAIMS MADE [i] OCCUR 01CH13243120 7/26/2007 7/26/2008 MED EXP IAnv one cersonl $ 10,000
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
-il'L AGG~EnE LIMIT AAES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
X POLICY j~8;: LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
~ ANY AUTO (Ea accident)
A - ALL OWNED AUTOS 01CH13523920 7/26/2007 7/26/2008 BODILY INJURY
$
SCHEDULED AUTOS (Per person)
-
~ HIRED AUTOS BODILY INJURY $
~ NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident)
==rAGE LIABILITY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
~ESS/UMBRELLA LIABILITY EArH rlrrURRENrr: $ 4,000,000
X OCCUR D CLAIMS MADE AGGREGATE $ 4,000,000
$
B ~ DEDUCTIBLE 01SU38232620 7/26/2007 7/26/2008 $
X RETENTION ~ 10,000 ~
WORKERS COMPENSATION AND I T~~n~rJl~S I IOTH-
ER
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE EL. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYE" $
If yes, describe under
SPECIAL PROVISIONS below EL. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
The City of Ashland is named Additional Insured as respects operations of the Named Insured subject to policy terms,
condi tions, limitations and exclusions.
*Except 10 day written notice of cancellation for nonpayment of the premium to apply.
CERTIFICATE HOLDER
(541)488-5320
City of Ashland
90 N. Mountain Avenue
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
30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Patty Shealy/PATTY
ACORD 25 (2001/08)
IN<:n?J;. rn-1'HI\ no",
@ACORD CORPORATION 1988
0::...,,,,, 1 ,..,f?
ACORDTN CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDD/YYYY)
4/4/2008
PRODUCER (541) 770-2000 FAX: (541)772-6861 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Mission Insurance Agencies Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Mission of OR CA Lic#OB27900 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
2770 Biddle Road
Medford OR 97504-4113 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: SAI F Corporation
Rocky Mountain Construction, LLC INSURER B:
INSURER C:
P.O. Box 7489 INSURER D:
Klamath Falls OR 97603 INSURER E:
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.
AD. RED.ATE L1MIT~ ~W)WN MAY HAVE BEEN REnllrED BY PAID CLAIMS.
I~~~ ~~~~ TYPE OF INSURANCE POLICY NUMBER P~.k+~~~~~6g~~ Pg~!fl(~~tt~N LIMITS
~NERAL LIABILITY EACH OCCURRENCE $
f-- nMMERCIAL GENERAL LIABILITY S~~~gM?E~~J~~nce ) $
CLAIMS MADE D OCCUR MED EXP (Anv one oerson) $
f-- PERSONAL & ADV INJURY $
f-- GENERAL AGGREGATE $
n'L AGGREnE LIMIT AAES PER: PRODUCTS - COMP/OP AGG $
PRO-
POLICY JECT LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
f--
f-- ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS (Per person)
-
- HIRED AUTOS BODILY INJURY $
NON-OWNED AUTOS (Per accident)
-
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
~ ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESs/UMBRELLA LIABILITY EACH OCCURRENCE $
o OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ .$
A WORKERS COMPENSATION AND I WC STATU-I 10TH-
TORY LIMITS ER
EMPLOYERS' LIABILITY 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? 901084 3/1/2008 3/1/2009 E.L. DISEASE - EA EMPLOYE" $ 1,000,000
If yes, describe under 1,000,000
SPECIAL PROVISIONS below EL. DISEASE - POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
The City of Ashland is named Additional Insured as respects operations of the Named Insured subject to policy terms,
conditions, limitations and exclusions.
*Except 10 day written notice of cancellation for nonpayment of the premium to apply.
CERTIFICATE HOLDER
(541)488-5320
City of Ashland
90 N. Mountain Avenue
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
30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENT A TlVE
Patty Shealy/PATTY
ACORD 25 (2001/08)
It\lc::.n?~ tt11f"lQ\ no"
@ACORD CORPORATION 1988
D~nQ 1 nf?
~
COMMERCIAL GENERAL LIABILITY
CG 76 35 02 07
".
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
LIABILITY PLUS ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
CITY OF ASHLAND, OREGON
ADDITIONAL INSURED BY WRITTEN
CONTRACT, AGREEMENT OR PERMIT, OR
SCHEDULE
The following paragraph is added to WHO IS AN
INSURED (Section II):
(b) This insurance does not apply to any
structural alterations, new
construction or demolition operations
performed by or on behalf of the
person or organization added as an
insured;
4. Any person or organization shown in the
Schedule or for whom you are required by
written contract, agreement or permit to provide
insurance is an insured, subject to the following
additional provisions:
(2) Your ongoing operations for that insured,
whether the work is performed by you or
for you;
a. The contract, agreement or permit must be
in effect during the policy period shown in
the Declarations, and must have been
executed prior to the "bodily injury,"
"property damage," or "personal and
advertising injury."
(3) The maintenance, operation or use by
you of equipment leased to you by such
person or organization, subject to the
following additional provisions:
(a) This insurance does not apply to any
"occurrence" which takes place after
the equipment lease expires;
b. The person or organization added as an
insured by this endorsement is an insured
only to the extent you are held liable due to:
(b) This insurance does not apply to
"bodily injury" or "property damage"
arising out of the sole negligence of
such person or organization;
(1) The ownership, maintenance or use of
that part of premises you own, rent,
lease or occupy, subject to the following
additional provisions:
(a) This insurance does not apply to
any "occurrence" which takes place
after you cease to be a tenant in
any premises leased to or rented to
you;
(4) Permits issued by any state or political
subdivision with respect to operations
performed by you or on your behalf,
subject to the following additional
provision:
This insurance does not apply to "bodily
injury," "property damage," or "personal
and advertising injury" arising out of
operations performed for the state or
municipality.
Includes Copyrighted Material of Insurance Services Office, Inc., with its permission.
Copyright, Insurance Services, 2001
CG 76 35 02 07
Page 1 of 1
Saleco and the Saleco logo are registered trademarks of Safeco Corporation
EP
C-AG-13-PRINT001-2439-0041-N
C. The insurance with respect to any architect,
engineer, or surveyor added as an insured
by this endorsement does not apply to
"bodily injury," "property damage," or
"personal and advertising injury" arising out
of the rendering of or the failure to render
any professional services by or for you,
including:
(1) The preparing, approving, or failing to
prepare or approve maps, drawings,
opinions, reports, surveys, change
orders, designs or specifications; and
(2) Supervisory, inspection or engineering
services.
d. This insurance does not apply to "bodily
injury" or "property damage" included within
the "products-completed operations hazard".
A person's or organization's status as an insured
under this endorsement ends when your operations
for that insured are completed.
No coverage will be provided if, in the absence of this
endorsement, no liability would be imposed by law on
you. Coverage shall be limited to the extent of your
negligence or fault according to the applicable
principles of comparative fault.
NON-OWNED WATER CRAFT AND NON-OWNED
AIRCRAFT LIABILITY
Exclusion g. of COVERAGE A (Section I) is replaced
by the following:
g. "Bodily injury" or "property damage" arising
out of the ownership, maintenance, use or
entrustment to others of any aircraft, "auto"
or watercraft owned or operated by or
rented or loaned to any insured. Use
includes operation and "loading or
unloading" .
This exclusion applies even if the claims
against any insured allege negligence or
other wrongdoing in the supervision, hiring,
employment, training or monitoring of others
by that insured, if the "occurrence" which
caused the "bodily injury" or "property
damage" involved the ownership,
maintenance, use or entrustment to others
of any aircraft, "auto" or watercraft that is
owned or operated by or rented or loaned to
any insured.
This exclusion does not apply to:
(1) A watercraft while ashore on premises
you own or rent;
(2) A watercraft you do not own that is:
(a) Less than 52 feet long; and
(b) Not being used to carry persons or
property for a charge;
(3) Parking an "auto" on, or on the ways next
to, premises you own or rent, provided
the "auto" is not owned by or rented or
loaned to you or the insured;
(4) Liability assumed under any "insured
contract" for the ownership, maintenance
or use of aircraft or watercraft; or
(5) "Bodily injury" or "property damage'
arising out of:
(a) the operation of machinery or
equipment that is attached to, or part
of, a land vehicle that would qualify
under the definition of "mobile
equipment" if it were not subject to a
compulsory or financial responsibility
law or other motor vehicle insurance
law in the state where it is licensed or
principally garaged; or
(b) the operation of any of the machinery
or equipment listed in Paragraph f.(2)
or f.(3) of the definition of "mobile
equipment" .
(6) An aircraft you do not own provided it is
not operated by any insured.
TENANTS' PROPERTY DAMAGE LIABILITY
When a Damage To Premises Rented To You Limit is
shown in the Declarations, Exclusion j. of Coverage A,
Section I is replaced by the following:
j. Damage To Property
"Property damage" to:
(1) Property you own, rent, or occupy,
including any costs or expenses incurred
by you, or any other person, organization
or entity, for repair, replacement,
enhancement, restoration or maintenance
of such property for any reason, including
prevention of injury to a person or damage
to another's property;
Page 2 of 2
C-AG-13-PRINT001-2439-0042-N
(2) Premises you sell, give away or
abandon, if the "property damage" arises
out of any part of those premises;
(3) Property loaned to you;
(4) Personal property in the care, custody or
control of the insured;
(5) That particular part of real property on
which you or any contractors or
subcontractors working directly or
indirectly on your behalf are performing
operations, if the "property damage"
arises out of those operations, or
(6) That particular part of any property that
must be restored, repaired or replaced
because "your work" was incorrectly
performed on it.
Paragraphs (1), (3) and (4) of this exclusion
do not apply to "property damage" (other
than damage by fire) to premises, including
the contents of such premises, rented to you.
A separate limit of insurance applies to
Damage To Premises Rented To You as
described in Section III - Limits Of Insurance.
Paragraph (2) of this exclusion does not
apply if the premises are "your work" and
were never occupied, rented or held for
rental by you.
Paragraphs (3), (4), (5) and (6) of this
exclusion do not apply to liability assumed
under a sidetrack agreement.
Paragraph (6) of this exclusion does not
apply to "property damage" included in the
"products-completed operations hazard".
Paragraph 6. of LIMITS OF INSURANCE (Section III)
is replaced by the following:
6. Subject to 5. above, the Damage To
Premises Rented To You Limit is the most
we will pay under Coverage A for damages
because of "property damage" to anyone
premises, while rented to you, or in the case
of damage by fire, while rented to you or
temporarily occupied by you with permission
of the owner.
The Damage To Premises Rented To You limit is the
higher of the Each Occurrence Limit shown in the
Declarations or the amount shown in the Declarations
as Damage To Premises Rented To You Limit.
CG 76 35 02 07
WHO IS AN INSURED - MANAGERS
The following is added to Paragraph 2.a. of WHO IS
AN INSURED (Section II):
Paragraph (1) does not apply to executive officers, or
to managers at the supervisory level or above.
SUPPLEMENTARY PAYMENTS - COVERAGES A
AND B - BAIL BONDS - TIME OFF FROM WORK
Paragraph 1.b. of SUPPLEMENTARY PAYMENTS -
COVERAGES A AND B is replaced by the following:
b. Up to $3,000 for cost of bail bonds required
because of accidents or traffic law violations
arising out of the use of any vehicle to which
the Bodily Injury Liability Coverage applies. We
do not have to furnish these bonds.
Paragraph 1.d. of SUPPLEMENTARY PAYMENTS -
COVERAGES A AND B is replaced by the following:
d. All reasonable expenses incurred by the
insured at our request to assist us in the
investigation or defense of the claim or "suite",
including actual loss of earnings up to $500 a
day because of time off from work.
EMPLOYEES AS INSUREDS - HEALTH CARE
SERVICES
Provision 2.a.(1)(d) of WHO IS AN INSURED (Section
II) is deleted, unless excluded by separate
endorsement.
EXTENDED COVERAGE FOR NEWLY ACQUIRED
ORGANIZATIONS
Provision 3.a. of WHO IS AN INSURED (Section II) is
replaced by the following:
a. Coverage under this provision is afforded only
until the end of the policy period.
EXTENDED "PROPERTY DAMAGE"
Exclusion a. of COVERAGE A. (Section I) is replaced
by the following:
a. "Bodily injury" or "property damage" expected
or intended from the standpoint of the insured.
This exclusion does not apply to "bodily injury"
or "property damage" resulting from the use of
reasonable force to protect persons or
property.
EXTENDED DEFINITION OF BODILY INJURY
Page 3 of 3
EP
C-AG-13-PRINTOOl-2439-0043-N
"r I
Paragraph 3. of DEFINITIONS (Section V) is
replaced by the following:
3. "Bodily injury" means bodily injury, sickness
or disease sustained by a person, including
mental anguish or death resulting from any of
these at any time.
TRANSFER OF RIGHTS OF RECOVERY
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of
COMMERCIAL GENERAL LIABILITY CONDITIONS
(Section IV):
We waive any rights of recovery we may have
against any person or organization because of
payments we make for injury or damage arising out
of your ongoing operations or "your work" done under
a contract with that person or organization and
included in the "products-completed operations
hazard". This waiver applies only to a person or
organization for whom you are required by written
contract, agreement or permit to waive these rights of
recovery.
AGGREGATE LIMITS OF INSURANCE - PER
LOCATION
For all sums which the insured becomes legally
obligated to pay as damages caused by
"occurrences" under COVERAGE A (Section I),
which can be attributed only to operations at a single
"location":
Paragraphs 2.a. and 2.b. of Limits of Insurance
(Section III) apply separately to each of your
"locations" owned by or rented to you.
"Location" means premises involving the same or
connecting lots, or premises whose connections is
interrupted only by a street, roadway, waterway, or
right-of-way of a railroad.
10.
INCREASED MEDICAL EXPENSE LIMIT
The medical expense limit is amended to $10,000.
KNOWLEDGE OF OCCURRENCE
The following is added to Paragraph 2. Duties In The
Event Of Occurrence, Offense, Claim Or Suit of
COMMERCIAL GENERAL LIABILITY CONDITIONS
(Section IV):
Knowledge of an "occurrence," claim or "suit" by your
agent, servant or employee shall not in itself constitute
knowledge of the named insured unless an officer of
the named insured has received such notice from the
agent, servant or employee.
UNINTENTIONAL FAILURE TO DISCLOSE ALL
HAZARDS
The following is added to Paragraph 6.
Representations of COMMERCIAL GENERAL
LIABILITY CONDITIONS (Section IV):
If you unintentionally fail to disclose any hazards
existing at the inception date of your policy, we will not
deny coverage under this Coverage Form because of
such failure. However, this provision does not affect
our right to collect additional premium or exercise our
right of cancellation or non-renewal.
LIBERALIZATION CLAUSE
The following paragraph is added to COMMERCIAL
GENERAL LIABILITY CONDITIONS (Section IV):
10. If a revision to this Coverage Part, which would
provide more coverage with no additional
premium, becomes effective during the policy
period in the state shown in the Declarations,
your policy will automatically provide this
additional coverage on the effective date of the
revision.
Page 4 of 4
C-AG-13-PRINT001-2439-0044-N
Gi I '( HECORDER
Page 1 / 1
r~'
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
DATE
4/8/2008
PO NUMBER
08213
VENDOR: 013128
ROCKY MOUNTAIN CONSTRUCTION
PO BOX 7489
KLAMATH FALLS, OR 97602
SHIP TO: Ashland Street Department
(541) 488-5313
90 N. MOUNTAIN
ASHLAND, OR 97520
FOB Point:
Terms: Net
Req. Del. Date:
Speciallnst:
Req. No.:
Dept.: PUBLIC WORKS
Contact: John Peterson
Confirming? No
Quantity Unit Description Unit Price Ext. Price
THIS IS A REVISED PURCHASE ORDER
Asphalt CrushinQ - Asphalt is located 22,500.00
at Glenview Street asphalt pit.
Finished product is required to be a
diameter of 1 inch or smaller (similar
to 1" minus rock).
$5.00 per ton
Not to exceed 4500 tons @ $5.00 per ton
for a total of $22,500.00
Contract for Goods and Services
Date of aQreement 04/0212008
BeQinninQ date 04/14/2008
Completion date 06/27/2008
Insurance required/On file
SUBTOTAL 22.500.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL I 22,500.00
ASHLAND, OR 97520
Account Number Project Number Amount Account Number Project Number Amount
E 260.08.12.00.60240< 22 500.00
I
"
~ ~~ed:g~~
VENDOR COPY
CITY OF
ASHLAND
REQUISITION FORM
Date of Request:
04/01/2008
THIS REQUEST IS A:
o Change Order(existing PO #
Required Date of Delivery/Service:
Before June 27
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
Ro~ky MOllnti~n,r.on~trlldion I I r.
POBox 74R9, KI;:Jmath F;:JII~J OrAgon, 97R02
541-882-8377
Jamie Jackson
SOLICITATION PROCESS
Small Procurement
o Less than $5,000
o 9.L!9~l["-
.."~/~
/
o Sole Source
o Written findings attached
o Quote or Pro sal attached
Cooperative Procurement
o State of OR/WA contract
o Other govemment agency contract
o Copy of contract attached
o Contract #
181
Inter diate Procurement
(3) Written Quotes
(Copies attached) I
~~0-'&~) /<-r f?
ad'i/...Lrk~L
c2 ~.<" < ~
Description of SERVICES
c2~r t:; ~/ ~ cZr//( ~ A -c A~)
,8L~~" RI/~/v8, ~~; t'c. ~ ;r7?1-
e ~ (c_c/ ,'",,'').. 6../:2 '7/c 6 ( r:
~ Per attached PROPOSAL
o Reauest for ProDOsal
(Copies on file)
o Special I Exempt
o Written findings attached
o Quote or Pro sal attached
o Emeraencv
o Written findings attached
o Quote or Pro sal attached
Total Cost
)
$
~9-f
Item # Quantity
Unit
Description of MATERIALS
Unit Price
Total Cost
~ Per attached QUOTE ...~,~
Project Number - - $
- - - - - - - -
Account Number 260 -08 -12 -00 - 602400
* 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 documentation c~n_ be provided upon ~
Employee Signature: ~~~ SupervlsorlDept. Head Si9natu~ c.. t.QQ,..:,.
G: FinanceIProcedure\APIFormsl040108 AC Crushing,doc
Updated on: 412/2008
"r I
CITY OF
ASHLAND
REQUEST FOR QUOTATIONS
Asphalt located at the Glenview Street asphalt pit. Finished product should be crushed
to a diameter of 1 inch or smaller. Water will be supplied by the City of Ashland Street
Department.
Please indicate your quotation for each of the following items as indicated below.
Item Deseri tion
Unit
Unit Price
Amount
No. 1 As halt Crush in
4,500
Tons
0<>
PLEASE RETURN QUOTE BY: 9:00 AM Fridav. March 28. 2008
Date:
3-j()-D8
~~~
S gnature
J tn., e. -Ja..cKSc::-.,y,,\ Address: -P.Q.Boy- '1Y3Q
~nntecl Name k \8 yY\:J-H.-.. '""F""o.-\ b) (~ 0[1/p()2-
Cf;ee n e-I( a \ M-c\..Y\::lJ ~
'~C.K't l'1\()\lr1falt1 CfY\~tnJ[~ ,
pany I ?-L\-115 Phone: Q3\ .~7- '~311
By:
Street Division Tel; 541/488-5313 _ ~
AshIa20 E'ndMainOrStreet Fax: 541/552.2329 C"A
. egon 97520 TTY: 8OOn35-2900 ..'
www.ashlancLor.us
G;\pub-wI1(s\eng\dept-admin\ENGlNEER\PROJECn2008\2008 Asphalt Crushing RFQ for Street Dept 2 OS,doc
'I' I
CITY OF
ASHLAND
REQUEST FOR QUOTATIONS
Asphalt located at the Glenview Street asphalt pit. Finished product should be crusl.ed
to a diameter of 1 inch or smaller. Water will be supplied by the City of Ashland Street
Department.
Please indicate your quotation for each of the followins items as indicated below.
Item Descri tion
Quantity
Unit
Unit Price
Amount
NO.1 As halt Crushin
PLEASE RETURN QUOTE BY: 9:00 AM Friday. r/1arch 28. 2008
Date:
;I:::#U~~
19 ature
1J:~:d:/J1 a lAMs Address
Ie
~f fAcv? 5 i'/iu: 5"A /~J) 7;J~.
ompany Phone:
~;'~rfM:trm,
975CJ:;L
By:
f!J 4/) ~~ 4- L./.:j ~ tJ
Street Division
20 E. Main Street
Ashland. Oregon 97520
www.ashland.or.us
G:\pub-wrks\engldept-admin\ENGINEER\PROJECT\2008\2008 Asphalt Crushing RFQ for Street Dept 2 08.doc
Tel: 541/488-5313
Fax: 541/552-2329
TTY: 800/735-2900
r~'