HomeMy WebLinkAbout2008-070 Contract - Siskiyou Appraisal
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: Siskiyou Appraisal
CONTACT: Christine M. Pellett MAl
ADDRESS: 972 Old Stage Road, Central Point, OR
97502 USA
TELEPHONE: 541.245.0503
DATE AGREEMENT PREPARED: 5-6-08 FAX: 541.245.0503
BEGINNING DATE: 5-6-08 COMPLETION DATE: 6-15-08
COMPENSATION: Estimated at $7800 but not to exceed $8500.00.
SERVICES TO BE PROVIDED: Complete appraisal to estimate the market value of a ten acre property
on Clay Street (Assessors Map # 391 E11 C taxlot 2500); Complete Appraisal to estimate the market value
of a City owned parkinq lot on Lithia Way (Assessors Map # 391 E09BA taxlot 10800).
ADDITIONAL TERMS: Conducting the Appraisal work shall be CONFIDENTIAL as it is undertaken to inform the potential sale or
trade of property pursuant to ORS Chapter 94, and Article X, Section 2(c), and Article XIX A, Section 2, of the Ashland City Charter
and Ashland Municipal Code.
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 / 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, subroqations,
Contract for Personal Services Less than $25,000, Revised by Legal 03/26/2007, Page 1 of 9
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, cor 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 Enter one:
$200,000, $500,000, $1.000,000, $2,000,000 or Not Applio3blo 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 Enter one:
$200,000, $500,000, $1 ,000,000, for each occurrence for Bodil In'u and Pro ert
Contract for Personal Services Less than $25,000, Revised by Legal 03/26/2007, Page 2 of 9
Damage. It shall include contractual liability coverage for the indemnity provided under this contract.
d. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000,000, or Not ^pplic:::lblo 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. Con ultant shall si n the certification attached hereto as Exhibit A and herein incor orated b reference.
CONSULTANT CITY OF ASHLAND:
lt1-1
BY
BY
TOR
TITLE
AFF(tLl--S 0,--
DATE
D t <- I") lL'(C.,
ae: J-'''''' .
(Fe .!'1q ?? 1'6 'lt1?4/ t"tfJO
~;2/ /;2. ?'.:2 CJ I 6> CJ ;y? 0
(For City purposes only)
DATE
J1 &to (,~
I I
z- Oc.;Jr..'1
FederallD#
./-/5[7 ~ 713 -d&~5
ACCOUNT #
'Completed W9 form must be submitted with contract
PURCHASE ORDER #
u8;2g0
Contract for Personal Services Less than $25,000, Revised by Legal 03/26/2007, Page 3 of 9
EXHIBIT A
CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the
number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be
issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from
backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is
subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS
has notified it that it is no longer subject to backup withholding. Contractor further represents and
warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the
Contract, when executed and delivered, shall be a valid and binding obligation of Contractor
enforceable in accordance with its terms, (c) the work under the Contract shall be performed in
accordance with the highest professional standards, and (d) Contractor is qualified, professionally
competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury
that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on
behalf of the entity designated above and authorized to do business in Oregon or is an independent
Contractor as defined in the contract documents, and has checked four or more of the following
criteria:
,
y
(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
. ~~Lliab:nsu~~;g to th;;:' ::~e provided
Contr or / (Date) I
/'
V'
\/
Contract for Personal Services Less than $25,000, Revised by Legal 03/26/2007, Page 4 of 9
Form W-9
Request for Taxpayer
Identification Number and Certification
Give form to the
requester. Do not
send to the IRS.
(Rev. Novem:::er 2005)
Decart;-'l";ent of ~l1e Treasury
1r',ter!'l.3:~evenl.;e ServIce
'" , Name (as shown on your income tax retum)
g, . Christine M Pellett, MAl
3. SL.:Sir.ess name. if d;tferent from above
<5
S; ~
- 0 . ~ IndlvlduaV 0
::'':; : Checl< appropriate box: ~ Sole propnetor Corporation
10.. 5::! I
o ;::
1: ;; Aadress (number. street. and apt. or sUite no.)
.;: -= 972 Old Stage Road
o..~
'0 i City. state. ana ZIP code
~ : Central Point OR 97502-1032
~ Ust account number(s) here (optional)
:J
(/)i
o Partnership 0 Other ~ ---.-----___p___ I
U Exempt from backup
Withholding
Requester's name .nM adcress (optional)
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
baCkup withholding. For individuals, this is your social security number (SSN). However, for a resident
alien. sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is
your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.
Note, If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter.
Social security number
415 81.9181.2161615
or
Employer identification number
~+
mmII
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from baCkup withholding, or (b) I have not been notified by the Intemal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends. or (c) the IRS has
notified me that I am no longer SUbject to backup withholding, and
3. I am a U.S. person (including a U.S. resident alien).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently SUbject to backup
withholding because you have failed to report all interest and dividends on your tax retum. For real estate transactions, item 2 does not apply.
For mortgage interest paid, acquisition or bandonment of secured property, cancellation of debt. contributions to an individual retirement
arrangement (IRA), and generally, pay me s other than interest a ividends, you are not required to sign the Certification, but you must
provide your correct TIN. (See the instnu ions on page 4.)
Sign II Signature of
Here . u.s. person ~
II-
Date ~
/ '
· An individual who is a citizen or resident of the United
States,
· A partnership, corporation, company, or association
created or organized in the United States or under the laws
of the United States. or
· Any estate (other than a foreign estate) or trust. See
Regulations sections 301.7701-6(a) and 7(a) for additional
information.
Purpose of Form
A oerson who is required to file an information return with the
IRS, must obtain your correct taxpayer identification number
(TIN) to report, for example. income paid to you, real estate
transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or
contributions you made to an IRA.
U.S. person. Use Form W-9 only if you are a U.S. person
(including a resident alien), to provide your correct TIN to the
person requesting it (the requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are
waiting for a number to be issued).
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a
U.S. exempt payee.
In 3 above, if applicable, you are also certifying that as a
U.S. person, your allocable share of any partnership income
from a U.S. trade or business is not subject to the
withholding tax on foreign partners' share of effectively
connected income.
Note. If a requester gives you a form other than Form W-9 to
request your TIN, you must use the requester's form if it is
substantially similar to this Form W-9.
For federal tax purposes, you are considered a person if you
are:
Special rules for partnerships. Partnerships that conduct a
trade or business in the United States are generally required
to pay a withholding tax on any foreign partners' share of
income from such bUSiness. Further, in certain cases where a
Form W-9 has not been received. a partnership is required to
presume that a partner is a foreign person, and pay the
withholding tax. Therefore. if you are a U.S. person that is a
partner in a partnership conducting a trade or business in the
United States, provide Form W-9 to the partnership to
establish your U.S. status and avoid withholding on your
share of partnership income.
The person who gives Form W-9 to the partnership for
purposes of establishing its U.S. status and avoiding
withholding on its allocable share of net income from the
partnership conducting a trade or business in the United
States is in the following cases:
· The U.S. owner of a disregarded entity and not the entity.
Cal. No. 10231 X
Form W-9 (Rev. 11-2005)
-1' I
JAN-31-2008 03:22
CCl.M"RY I~
541 '779 8894
P,02/05
~
Policy No. AUA5018363
County No. 015
COMPRE~NSIVE CATASTROPHE
EXCE UABIUTY POLICY
D CLARATlONS
!
F1RM AND RANCH
IlIUrlnce. FIIlllCllIIInIcII
Country Mutual Insurance Company
P.O. Boll 14151. &Mm. OR 17308-!5OOII
Item
1. Named lnand PELLETT GARY R & CHRISTINE M
972 OlD STAGE RD
2. P.O. Address CENTRAL POINT OR 97502
(Number, Street,
Towo & State)
3. Policy Term
Effective From 01/1512008
Effective To 01/1512009
12:01 A.M.. &tend.reI time *l the eddr.e. of the named muted, as slated herein. This poliCy is CONTIN
4. The named insured is: INDIVIDUAL
5. Retained Umit
$
1,000
UMrrs OF UABILITY
As the result of any one occurrence not covered by the
damages not covered by underlying Insurance but which r
uncleriying insuranoe. Iiated in the sd1edute attached hereto
ooIIectIIble by the Insured.
AE. the result of any 0,.. ~ on ~nt of personal
offense. or any combination thereof.
6. (8). Each Occurrence
$
1.000.000
(b). Aggregate
$
On account of aU occummces during each policy year 8' .
1.000.000 employee& of the Insured Of (2) out of the produCl$ haz<<d oom~ opera~ hazard. or both
combined. The limit under this Section applies separately to 1) and (2).
7. Premium Summery
Annual
Premium $
189.00
Included
PersonBl PremIum $
Professional Premium $
Tobit Premium $
189.00
In the event of canoelllltion by the named Insunld. the
Compeny shall receive and ret8ln not 18115 than $
170.00 As a Minim m Premium
8. During the past YMr no iMurw'" ~neelled any similar
Insurance Issued to the named insured. nor dedined to issue
such insurance unlll86 otherwIH at.at.ed herein: .
.ABSENCE OF AN EIIlTRY MEANS "NO EXCEPTION".
9.
Endorsements at&ached hereto IInd mllde a part of thi5 policy
(dwigne-' by fonn number)
20132a(1211883) ~(1111812)
24617.(1111182) 24111a(1111812)
Z4e8311(1111H2) ~11111t2)
24703.(1111992) 2471311(11""192)
80176b(1212006)
Cota'll8rllgned at Selem. OR
1113012007
Date
I1'1rg~
Rep~tive
9101 "-{01-08I98)
A
Frum: LiIIbily 1-.-_ Admiislntors Page: 214 o.te: 1/31/200810:01:58 /1M
Date Issued:
01/24/2008
Poll Number:
LIU007274-006
Previous Poll Nwnber:
LlUOO7274-005
tJt REAL ESTATE APPRAISERS PROFESSIONAL LIABILITY
Libe!:tt.
Imurance
Undenvriter:'5lnc.v
55 Water Street. 18th Floor
New York, NY 10041
TIllS IS A CLAThIS MADE A.~ REPORTED POLICY.
PLEASE READ IT CAREFULLY.
LIBERTY INSURANCE UNDERWRITERS, INC. (herein called "the Company")
Item
DECLARATIONS
I. Customer 10: 110869
Named Insured:
SISKIYOU REAL ESTATE APPRAISAL
& CONSUL TING/ Christine M. Pellett
972 Old Stage Rd.
Central Point, OR 97502
2. Policy Period:
From: 02/18/2008 To: 02/18/2009
12:01 A.M. Standard Time at the address stated in
Item 1.
3. Deductible: $1,000.00 Each Claim
4. Retroactive Date: 02/18/2003
S. Inception Date: 02/1812003
6. Limits of liability: The Limit of Liability for Each Claim and in
A. $1,000,000.00 Each Claim tlte Aggregate is reduced by Damages aod
B. $1,000,000.00 Aggregate Claims Expenses as defmed in the Policy.
7. Mail All Notices to Agent:
Liability Insurance Administrators
1600 Anacapa Street
Santa Barbara, California 93101
(805) 963-6624; Fax: (805) 962-0652
8. Annual Premium: $961. 00
9. Number of Appraisers: 1
10. Forms attached at issue: LIA002 (O7/01) LlA009 (10/01) LlAOl2 (07/01) LlA013 (07/01)
LIAOlS (07101) LIA018 (07/01) LIA02S (07101)
ThIs Declarations Page together with the completed and signed Policy Appllcation Including all attachments and exhibits lherello, and the
Real Estate ' Professional Liabili Insurance Pol' shall constitute ct between !he Named Insured and !he
By
-J~
L1A001 (07/01)
Authorized Signature
~
AUTOINS~RANCEDECLARATIONS
,,/COUNTRY Mutual Insurance Company
P.o. Box 14151. Salem, Oregon 973C>>-5Oe9
Prefernd PI."
Insurance 8< Financia! Services
To report a claim or for roadside assistance any
time day or night, call 1-800-846-01 00.
POLICY NUMBER
I A36A4407255 I
POLICY TERM
6 MONTHS
PAYMENT PLAN
SEMI-ANNUAL
INS. OFFICE 1 AGENT
38003 SOREG /14751
ACCOUNT NUMBER 9401768-001-00001
INSURED
Policy period beginning Apr 30, 2008
12:01 a.m. standard time at your address
ending Oct 30, 2008 12:00 a.m.
PELLETT CHRISTINE M & GARY R
972 OLD Sf AGE RD
CENTRAL POINT OR 97502
Declarations reason:
POLICY RENEWAL
Effective Oct 30,2007 12:01 a.m. standard time
at your address.
Your policy consists of the policy booklet,
applications, declarations pages and any
endorsements. Please k_p them together.
0000 0000
PREMIUM CHANGE
NONE
TOTAL PREMIUM $686.11
DO NOT PAY THIS AMOUNT. ANY BALANCE DUE WILL BE LISTED ON A SEP"ARATE INVOICE.
VEHICLE
2002 TOYOT 024597
2006 TOYOT 156987
VEHICLE. USE AND DRIVER INFORMAT19N
TRUCK 1 TON AND UNDER, FARM, MALE, 30-&4
AUTOMOBILE, BUSINESS, FEMALE, 3Q-64
POLICY COVERAGE LIMITS
LIABILITY-BODILY INJURY
PROPERTY DAMAGE
UNINSURED MOTORISTS
UNDERINSURED MOTORISTS
EACH PERSON
250,000
,
2002 TOYOT 2006 TOYOT Intentionally Left Blank Intentionally Left Blank
A36A4407255 A36A4407255
VEHICLE COVERAGE LIMITS
PERSONAL INJURY PROTECT
EACH PERSON 15,000 15,000
COLLISION - ACTUAL CASH
VALUE LESS DED 500 500
COMPREHENSIVE - ACTUAL
CASH VALUE LESS OED 250 250
ROAD SERVICE YES YES
ENDORSEMENTS
AMENDATORY END-OR YES YES
PREMIUMS
LIABILITY-BODILY INJURY 97.95 165.45
PROPERTY DAMAGE included included
UNINSURED MOTORISTS 38.03 38.03
UNDERINSURED MOTORISTS included included
PERSONAL INJURY PROTECT 17.35 29.31
COLLISION 76.92 136.43
COMPREHENSIVE 32.38 48.26
ROAD SERVICE 3.00 3.00
250,000
250 000
EACH OCCURRENCE
500,000
100,000
500,000
500,000
AMENDATORY END-OR
included
included I
I 13020R (00-09/04)
FOR SERVICE CALL YOUR AGENT CLINT BERKEY CMA AT (541)779-8893.
INSURED'S COpy
Page 1
515
VEHICLE PREMIUM
The VEHICLE PREMIUM haa
a'ready been changed by
the following: .
DISCOUNTS
GOOD DRVRISELECT CUST
MUL nCAR
MULTI-POLICY DISCOUNT
TOTAL DISCOUNT
- Not applicable to this policy.
113020R (00-09,104)
2002 TOYOT
A36A4407255
$265.63
2006 TOYOT
A36A4407255
Intentionally Left Blank
$420.48
included
included
included
-309.19
included
included
included
-409.26
~~
Mar 26, 2008
AUTHOIIIIZED flmllllDlNTAnVE
Page 2
FOR SERVICE CALL YOUR AGENT CLINT BERKEY CMA AT (541 )779-8893.
INSURED'S COpy
DATE~NED
"'II
r~'
CITY RECORDER
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
Page 1 / 1
DATE
5/15/2008
PO NUMBER
08280
VENDOR: 013042
SISKIYOU APPRAISAL, CHRISTINE PELLETT, MAl
972 OLD STAGE ROAD
CENTRAL POINT, OR 97502
SHIP TO: Ashland Planning Department
(541) 488-5305
51 WINBURN WAY
ASHLAND, OR 97520
FOB Point:
Terms: Net
Req. Del. Date:
Speciallnst:
Req. No.:
Dept.: COMMUNITY DEVELOPMENT
Contact: Brandon Goldman
Confirming? No
QuantitY Unit Description Unit Price Ext. Price
Appraisal to estimate the market value 8,500.00
of the City owned L1THIA PARKING LOT;
Appraisal to estimate the market value
of the 10-ACRE PROPERTY ON CLAY STREET.
Estimate: $7,800
Not to exceed: $8,500
Cost to be shared between Community
Development $5,300, 110 09 27 16 704
100 -and- Parks Department $2,500,
221 120201 604160
SUBTOTAL 8 500.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 8,500.00
ASHLAND, OR 97520
Account Number Project Number Amount AccountNumber Project Number Amount
B 920.21100 3 000.00
E 110.09.27.16.704101 5 500.00
~SiZZ~
VENDOR COpy
"r" T
A request for a Purchase Order
REQUISITION FORM
CITY OF
ASHLAND
THIS REQUEST IS A:
o Change Order(existing PO #
Date of Request: I 5-9-2008
Required Date of Delivery/Service:
5-6-2008 to
6-15-2008
Siskiyou Appraisal
972 South Stage Rd.
Central Point. OR 97502
541-245-0503: FAX: 541-245-0503 (call first)
Cnnt;:d. ChristinA M PAIIAtt MAl
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
State of ORfWA contract
Other government agency contract
o Copy of contract attached
o Contract #
Invitation to Bid
(Copies on file)
Less than $5,000
Quotes (Optional)
ffrmediate Procurement
(3) Written Quotes
(Copies attached)
Reauest for PrQDosal
(Copies on file)
Soeciall ExlHllDt
Written findings attached
Quote or Pro sal attached
Emeraencv
Written findings attached
Quote or Pro al attached
Description of SERVICES
Total Cost
Appraisal to estimate the market value of the City owned Lithia Parking Lot;
Appraisal to estimate the market value a 10 Acre property on Clay Street
o Per attached PROPOSAL --'-
Estimate = $7800
Not to excaecf S8500
The cost of these services is to be shared by the Parks Department and the Community Development Department per the amounts
indicated below:
Community Development Department
Account Number 110-09-27-16-704100
Charge $5300
Parks Department
Account Number 221-12-02-01-604160
Charge $2,500
* 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 can be p i d upon requ
Employee Signature:
Community Development Dept. Head Signature:
G: FinanceIProcedurelAPlFonns\PellelRequisilion form
Updaled on: 51912008