HomeMy WebLinkAbout2008-178 Contract - Versatile Concrete
Contract for GOODS AND SERVICES Less than $25,000
CITY OF
ASHLAND
20 East Main Street
Ashland, Oregon 97520
Telephone: 541/488-6002
Fax: 541/488-5311
CONTRACTOR: Versatile Concrete Construction Inc.
CONTACT: Patrick Harney
ADDRESS: PO Box 507, Talent, OR 97540
TELEPHONE: 541-512-1064, Cell 541-601-1261
DATE AGREEMENT PREPARED: 08/28/2008 FAX:
BEGINNING DATE: 09/08/2008 COMPLETION DATE: 11/30/2008
COMPENSATION: $32,200.00 - Per the attached proposal, including BOll prevailing wages, dated 08/01/2008
GOODS AND SERVICES TO BE PROVIDED: Contractor to engineer, layout, and construct concrete foundations at
Mountain Avenue Substation to adequately support the steel structure erection, assembly and equipment mounting. The
contractor will comply with current building codes and standards, including BOll prevailing wage requirements.
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 $18,088 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 500/0 or more of the work under this contract. Contractor is also required to post the notice attached
hereto as Exhibit B predominantly in areas where it will be seen by all employees.
8. Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless
from any and all losses, claims, actions, costs, expenses, judgments, subrogations, or other damages resulting from
injury to any person (including injury resulting in death), or damage (including loss or destruction) to property, of
whatsoever nature arising out of or incident to the performance of this contract by Contractor (including but not limited
to, Contractor's employees, agents, and others designated by Contractor to perform work or services attendant to this
contract). Contractor shall not be held responsible for any losses, expenses, claims, subrogations, actions, costs,
judgments, or other damages, directly, solely, and proximately caused by the negligence of City.
9. Termination:
a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties.
b. Citv's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing
and delivered by certified mail or in person.
c. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 1 of 9
written notice to Contractor, or at such later date as may be established by City under any of the following
conditions:
i. If City funding from federal, state, county or other sources is not obtained and continued at levels
sufficient to allow for the purchase of the indicated quantity of services;
ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way
that the services are no longer allowable or appropriate for purchase under this contract or are
no longer eligible for the funding proposed for payments authorized by this contract; or
iii. If any license or certificate required by law or regulation to be held by Contractor to provide the
services required by this contract is for any reason denied, revoked, suspended, or not renewed.
d. For Default or Breach.
i. Either City or Contractor may terminate this contract in the event of a breach of the contract by
the other. Prior to such termination the party seeking termination shall give to the other party
written notice of the breach and intent to terminate. If the party committing the breach has not
entirely cured the breach within 15 days of the date of the notice, or within such other period as
the party giving the notice may authorize or require, then the contract may be terminated at any
time thereafter by a written notice of termination by the party giving notice.
ii. Time is of the essence for Contractor's performance of each and every obligation and duty under
this contract. City by written notice to Contractor of default or breach, may at any time terminate
the whole or any part of this contract if Contractor fails to provide services called for by this
contract within the time specified herein or in any extension thereof.
iii. The rights and remedies of City provided in this subsection (d) are not exclusive and are in
addition to any other rights and remedies provided by law or under this contraet.
e. Obliaation/Liabilitvof Parties. Termination or modification of this contract pursuant to subsections a, b, or
c above shall be without prejudice to any obligations or liabilities of either party already accrued prior to such
termination or modification. However, upon receiving a notice of termination (regardless whether such notice is
given pursuant to subsections a, b, c or d of this section, Contractor shall immediately cease all activities under
this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination,
Contractor shall deliver to City all contract documents, information, works-in-progress and other property that are
or would be deliverables had the contract been completed. City shall pay Contractor for work performed prior to
the termination date if such work was performed in accordance with the Contract.
10. Independent Contractor Status: Contractor is an independent Contractor and not an employee of the City.
Contractor shall have the complete responsibility for the performance of this contract.
11. Non-discrimination Certification: The undersigned certifies that the undersigned Contractor has not discriminated
against minority, women or emerging small businesses enterprises in obtaining any required subcontracts.
Contractor further certifies that it shall not discriminate in the award of such subcontracts, if any. The Contractor
understands and acknowledges that it may be disqualified from bidding on this contract, including but not limited to
City discovery of a misrepresentation or sham regarding a subcontract or that the Bidder has violated any
requirement of ORS 279A.11 0 or the administrative rules implementing the Statute.
12. Asbestos Abatement License: If required under ORS 468A.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 ORF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a
ORF if Contractor has qualified as a ORF for this agreement; institutes an action for relief in bankruptcy or has
instituted against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing
business on a regular basis of the type identified in its obligations under 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 Comoensation insurance in compliance with ORS 656.017, which requires subject employers to
provide Oregon workers' compensation coverage for all their subject workers
b. General Liabil' ,.' 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 inclu n ractualliability coverage for the indemnity provided under this contract.
c. Automobile Li .... . nce with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, 1,000,000, Not A Iicable for each accident for Bodil In'u and Pro ert Dama e,
,000, Revised 06/30/2008, Page 2 of 9
Contract for Goods and Services Less tha
, including coverage for owned, hired or non-owned vehicles, as applicable.
d. Notice of cancellation or chance. There shall be no cancellation, material change, reduction of limits or
intent not to renew the insurance coverage(s) without 30 days' written notice from the Contractor or its insurer(s) to
the City.
e. Additional Insured/Certificates of Insurance. Contractor shall name The City of Ashland, Oregon, and its
elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only
with respect to Contractor's services to be provided under this Contract. As evidence of the insurance coverages
required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to commencing work
under this contract. The certificate will specify all of the parties who are Additional Insureds. Insuring companies
or entities are subject to the City's acceptance. If requested, complete copies of insurance policies, trust
agreements, etc. shall be provided to the City. The Contractor shall be financially responsible for all pertinent
deductibles, self-insured retentions and/or self-insurance.
17. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws
of the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or
proceeding (collectively, "the claim") between the City (and/or any other or department of the State of Oregon) and
the Contractor that arises from or relates to this contract shall be brought and conducted solely and exclusively within
the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal
forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the
District of Oregon filed in Jackson County, Oregon. Contractor, by the signature herein of its authorized
representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this section be
construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United
States Constitution, or otherwise, from any claim or from the jurisdiction.
18. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE
PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL
BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT,
MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR
THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR
REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT.
CONTRACTOR, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT
HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND
CONDITIONS.
19. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and
authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Contractor
understands and agrees that City's payment of amounts under this contract attributable to work performed after the
last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow
City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In
the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this
contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further
liability to Contractor.
20. Prior Approval Required Provision. Approval by the City of Ashland Councilor the Public Contracting Officer is
required before any work may begin under this contract.
21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by
reference.
CONTRACTOR CITY OF ASHLAND:
BY
BY
TITLE
0(1 )V'\ ~V
DATE
Date: 't-lq-
DATE
?-z-(2-0~
<13 - J12~-/ 6 ~
ACCOUNT #
FederallD#
(For City purposes only)
*Completed W9 form must be submitted with contract
PURCHASE ORDER #
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, 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:
.
~
(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.
ikAd
Contractor ' ~
q -('::J--O%
(Date)
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 4 of 9
Fa"" W-9
Request for Taxpayer
Identification Number and Certification
Give form to the
re.quester. Do not
send to the IRS.
(Rev, October 2007)
DepaJtrnent of tile Treasury
InternE!! Revenue Service
C\i
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15
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EnleryourTINin the appropriate box. The TIN provided must match the name given on Une 1 to avoid I Social ..~:. num~:
backupwithholQing. 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. or
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter.
· Certification
Liataccount nunber(s) hert(optionaQ
Taxpayer Identification Number (TIN)
c
o Exempt
payee
Requester's name and address (optionaQ
Under penalties of perjury, I certify that:
1. The nl.llllbershown 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 notsUbje6t to backup withholding because: (8) 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 subje6tto backup withholding, 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 currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.
For mortgage interestpaid,aOquisition or abandonment of secured property,.cancellation of debt, contributions to an individual retirement
arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN, S$e the instructions on page 4.
~~:;, 1~~~::O:f ~
General Instructions
Section references are to the Internal Revenue Code unless
otherwise noted.
Purpo.se of Form
A pers()n who is required to fUe an inf9fmation return with the
IRS must obtain your correct taxpayer identification number (TIN)
to report. for example, income paid to you, real ~ate
transactions. mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or
contributions you made to>an IRA.
Use FormW-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. C~rtify 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 w~hholding if you are a U.S.
ex&mpt payee. If applicable, you are alsocliJrtifying that as a
U.S. person, your allocableshar& of any p;artnership income from
a U.S. trade 9fbusiness 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
reqoost your TIN, YOll must use the requester's form if it is
SUbstantially similar to this Form W-9.
Oat$ ~
DeftnWon 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 United
States,
· An estate (other than a foreign estate), or
· A domestic trust (as defined in Regulations section
301.7701-7).
SpecIal ruiesfor ~nershlps. 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 isa foreign person, and pay the Withholding tax.
Therefore, if you are a U.S. person that is a partner ina
partnership conducting a trade or busin~ss 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,
Cat, No. 10231X Form W-9 (Rev. 10-2007)
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 5 of 9
--..~-----.-r-- ......------.. - ...---..--..-.. .-.---.-. -.-- -..-..-..-
PROPOSAL
V.flltlte Concrete Const. Inc.
. PlOt Box 507
Talent, OR 97540
CC.B 10 <is C(f;Jf
o k- C,i{
,ct 601-1')...(QI
PROPOSAL NO.
SHEET NO.
DATE
~- 1- f)~
PROPOSAL SUBMITTED TO:
NAME
WORK TO BE PERFORMED AT:
ADDRESS
DATE OF PLANS
PHONE NO.
ARCHITECT
We hereby propose to furnish the materials and perform the labor necessary for the completion of
~~ - V( LX A-t== ',8ClJ Go...oL,.. 5-'1
--------rP!~ e lV">O"l~;r~ U)SF: __________~______~__
. ._----------~ . ..-------------------------.-
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/boo &<h
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-----------...---------.---..----
All material is guaranteed to be as specified, and the above work to be performed ill accordance with the drawings and specifications
submitted for above work, and completed in a substantial workmanlike manner for the sum of ____
Dollars ($ ~5/1:J/YJ .)
with payments to be made as follows:
Respectfully submitted
~ ,1a17
\/~^~~ C~
Any alteration or deviation from above specifications involving extra costs
will be executed only upon written order, and will become an extra charge Per
over and above the estimate. All agreements contingent upon strikes, ac-
cidents, or delays beyond our control.
Note - This proposal may be withdrawn
by us if not accepted within _ days,
".
..
AQC;.PTANCE OF P.ROPOSAL
The ailove pri(;~,SPeci~f~'Xl~~d conditions are satisfactory and are hereby accepted. You are authorized to do the work
as specified. PaymE!ots WilrbE.J made as outlined above.
Signature
Date
Signature
at 08118
....... MADE IN MEXICO
PROPOSAL
. '. . V~satlle Concrete Canst. Inc.
, ., 'P.O. Box 507
, Talent, OR 97540
TO THE CITY OF ASHLAND ELECTRIC DEPT.
IN REFERENCE TO THE PROPOSAL FROM VERSATILE CONCRETE CONST. INC.
DATED AUG. 4th 2008. FOR THE MNT. AVE. POWER SUB STATION.
THE PROPOSED BID FOR CONCRETE FOOTINGS AND Pll.ASTERS , IN THE
AMOUNT OF 32,200 DOLLARS, WILL BE ADEQUATE FOR BOLl WAGES.
Your truly.
, t/~~~
-.............................. ""'_.. .A.V''''~~, uu.....n 01 " 'UUO ,,: ~ I ; ~t:) tlM
1-'AUJ:; 001/004
Fax server
BEECHERJ2ARLSON
, ._.// Insurance Agency, LLC
Fonnerfy J B ~K RISK SERVICES. llC
FAX TRANSMITTAL
Date: 9/2/20083:46:28 PM
Num of Pages:
(including
cover)
From:
Direct Phone:
Direct Fax:
Email Address:
LAR48BD5FDEEF7F
4
To: City of Ashland
Company:
Phone:
Fax: 5414886006
Larry Thompson
(541 )494-2657
(541) 772-3785
larry. thompson@beechercarlson.com
Additional insured certificate from Versatile Concrete Construction, Inc.
707 Murphy Rd. Medford, OR 97504 (541)772-1111 Main (541)772-3785 Fax
CA Ucense #OF09618 OR Ucense #816307 WA License ~52204
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A CORD. CERTIFICATE OF LIABILITY INSURANCE I rrJe(~~YYY)
9 13 2007
PItODUC~ (541)772-1111 FAX: (541)772-3785 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
JBL~I( Insurance Agency ONLY AND CONFERS NO RlGtfTS UPON 'THE CERTIFICATE
HOlDER. THIS CERTFJCATE DOES NOT AMEND. EXTEND OR
707 Muxpby ReI AL TEA THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Ifadf OM OR 97504 INSURERS AFFORDING COVERAGE NAIC #
INIURI!D It4SURER 1\. American Hallmark 1:na Co 43494
VeraaUl. Concrete Const Inc INSJRER B:
PO Box 507 IN9JRER c:
IN9JRER 0:
TaJ..nt OR 97540-0507 INaJRER E:
TIE POliCIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED 1'0 ntE INSURED NAMED ABOVE F~ '11-E POliCY PERIOD INDICATED. NOTVVITHSTANDlNG ANY
REQUIREMENT. TERM OR CONDITION C* ANY CONTRACT OR OTHER DOCl.MENT IMTH RESPECT TO WHCH lHlS 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 SUCHPQ.ICIES.
'I aMT~ "'UI'\lA"~ U.&V I RV ........ _. .......
I~:: ~~~ ...... I """ ~RA-TION
TYPE OF INSURANCE POLICY NUMBER LIMITS
~IIW. LIABlLrrY E-'CH OCCURRENCE S 1,00O,OOC
~ OMERCIAl GeERAl LIABILITY ~ID9..RENTEC $ 100,000
A i-- CLAIMS MADE ~ OCCUR 44CL4400902 9/14/2007 9/14/2008 MEO EXP (Arw one '*'01\\ S 5,000
~ PERSONAL & N:JV IN.JI..mY $ 1,000,00a
GENER~L AGGREGATE $ 2,OOO,OOC
- 2,000,000
~m. AGGf<lnE LIMIT "'~s PER: PRODllCTS - COMPIOP AGG $
X POUCY !:8i n LOC
~TOMOIIILE i.!AIIILrTY COMBIl-leo SlNGI.E LIMIT $ 1,000,000
~ N-iY.lUTO (Eo oocide~
A /ilL O'I.t.lEO AUTOS 44CL4400902 9/14/2007 9/14/2008 BOOIL Y INJURY
- (Per PMOn) $
- SCHEDULED AlJTOS
- HIRED .~UTOS eootL Y INJURY $
NON-OVvl'ED AUTOS (PfIf accident)
I--
PROPERTY DAMtlGE $
(Per accident)
GARAGE LIAIIILITY AlJTO 01... Y - EA ACCIDENT S
R ANY AUTO CTfoER TH.t.N EA. M"".- S
.lUTO ONlY: M""..t; $
DCDSlUMMI!LLA LJAlSLrrY ~Ar.J.I $
tJ OCCUR D CUIMSMADE ..r.c.~~ATj: s
S
==i I:JE[)UCTleLE $
RE'J1;NTION S $
WORKl!fltS CClMllNSA TIaiI AND lll\C STATU.c:.1 IOl~
I!MPLOVPS' LIABlUTY
"NY PROPRIETORJPAATNERlEXECUTIVE E.L, EACH ACCIDENT $
OFFICERHEMBER EXCLUDED? U. CISEASE. Ell. EMPLOYEE $
~~~~~\ ~cJer I: I nlc:l:4CI: _ POU."::V , IUTT 5
OTHl!lt
D!!SCRPTlON Of OPI!ftATIONM.OCATIONSlV!HlCLI!SI!XCLUSIONS ADDI!D I5Y !NDOR~TISPI!CIAl PROVISIONS
C.rti~ioate holder inoluded as a~tional insured as respects general liability where required by written contract.
This form 1& &ub~ect to policy terms, conditions, and exclu&1ons.
CERTFICATE HOlDER
CANCELLATION
(541)488-6006 SHOULD ANY Of THE ABOve Dl!SCRIISI!D POLICIES BE CNtCI!IJ.B) 81!P0ftE THE
Ci~y o~ Ahland EXPIRATION D.t.TE THEREOF, THE rssultG INSURER WILL ENDEAVOR TO MAIL
20 East: Main 81:.. 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOlDER NAtoED TO THE LEFT. BUT
Ashland, OR 97520 -
'AILURe TO DO so SHAllIiIPOse NO OBLIGAnON OR UA8LJTY 0' At('( KlND UPON THE
- INSUR~. rrs AGI!NTS OR RI!PRI!S!HTA TIVB, .
AUTHORIZeD ItI!PltI!SlNT A TM! ~,.~
~arry Thompson/LAP.RY
ACORD 25 (2001108)
INS025 (&tU8),U6a
. ACORD CORPORA nON 1988
Page , d 2
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POLICY NUMBER:
tlAUJ:. UU':I:/UUl!
t"ax berVer
COMMERCIAL GENERAL UABI.JTY
CO 32 8110 05
THIS ENDORSEMENT CHANGES 11iE POLICY. PLEASE READ IT CAREFULLY.
OREGON ADDITIONAL INSURED - OWNERS.
LESSEES OR CONTRACTORS - SCHEDULED PERSON
OR ORGANIZATION
This endorsement modifies insurance provided under the folowil1):
COMMERCiAl GENERAl UABILlTY COVERAGE PART
SCHEDULE
Name Of Addition. lnaur.ca Person(a) Or Drga.uZdon(&):
The City of Ashland, Oregon
20 East Main St.
Ashland, OR. 97520
Locdon(s) Of Covered Operations:
Ashland, Oregon 97520
tnformation required to complete this Schedule, jr not ~ above. will be SOO\W1 in the Dectarations.
A. Section II - Who .. An Insured is amended to
include as an additional insured the person(.) or
organfzatfon(s) sf'KMn in the Schedure, but only
IAitII'ftpect to liability for "bodily injury", "property
d.-nage" or "personal and advertising injury'"
caused by your ongoing aperatkn; for the ~i-
tional ..~ed(l) at Ihe location(.) desVtIUd
above and only to the eJdenl that such "boOty in-
jury" I "property damage" or "penonal and advertis-
ing injury'" is c.sld by yowo negrigence or the neg_
ligence of those performing operations on your
behalf.
CG 32611005
B. With respect k:I the ineurance afforded to these
addJtlonal insureds, the follo\M~ additional e)(clu-
lion appl"':
This Insurance does not apply to '-oodiIV injury" or
"property damaga'1 occurq after.
1. All work, including materials, paI1s Of equip-
ment furnished in connection with auch work,
on the project (oIher than service, maintenance
or repairs) to be pet10rmed by or on bettar of
the additi~ insured(s) 3t the location of the
covered operations nas been comPleted; Of
2. That portion of "your wor1t" out of 'Ahlctt the
injury or damage arises has been pLA to its in-
tended U88 by any person or organization oIher
than anmher contractor or subcontractor en-
gaged In performi1g operations for 8 p'~1
as a part of the same project.
., ISO Properties, (nc.. 2005
P8g111 d 1 C
~ VV 'I VV,-
ACORD... CERTIFICATE OF LIABILITY INSURANCE I OATE (MM/COlYnr)
9/24/2008
PRODUCEIil (541)857-0679 FAX: (541)857-9883 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Ashland InsuranCQ Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
801 O'Hare Parkway, Ste 101 AL TER THE COVE:RAGE AF~ORDED BY THE POL.ICIES BELOW.
Medford OR 97504 INSUReRS AFFORDING COVERAGE NAIC.
INSURED INSURER-A' SA!F Corporation
V8rsatile Concrete Construction, Inc. INSURER. B.
PO Box 507 INSUReR C,
2106 S. Pacific Hwy INSURER 0
Talent OR 97540 INSURe~ E
....1"\",.,.M......e~
THE POLICIES OF INSURANCE LISTED BELOW HAVe BeEN ISSUED TO THE INSURED NAMED ABOVE FOF( iHe POLICY PERIOD INDICATED, NOTWITHSTANDING ANY
REQUIREMENT, TeRM OR CONOITION OF ANY CONTRACT OR OTHE~ DOCUMENT WITH RESPECT TO WHICH THIS ceRTIFICATe MAY BE ISSUED OR MAY PERTAIN,
THE iNSURANCE AFFORDEO BY THe PO~ICIES DESCRIBED HEREIN IS SUBJECT TO Al,l. THe TeRMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES
AGG~!:GATe LIMITS ~~()WN tolAV HAVE BEE:N ~eDuceD BV PAID CI AIMS
Iti: AOO'L. TYPE 01= INSURANCE:. POLICY NUMBER P~AL+i~j~f8g;W~ Pg~lflt~~~t~~1II '-lMITS
IN5R:J
GEIlIERAL LIABILITY EACH QCCUf:lRkNCE ~ .~,
,.-- B~~~~~ I9F=~~~J.,~nll4l
COMMERCIAL GENERAL L/AeILlTY !
I CLAIMS MADE D OCCUR ME;O EXP r~'w one oerionl s
i - PER>:ONAL & ,),nv INll j~v 3
I ""-- GF.Ni=RAI ~GG~EGATE a
SE ~.'~ AGGREG.. TE 1.'MIT "PPuE:S PER "'ROl")l H'TS . ~nMP/nD AGe: II
I n "'OLley (1- ~~T I~-r LOC
AUTOMOBILE LIABILITY COMBINED SINGL& LIMIT
----, :Ell aCCldbnl) 8
! ANY AUTO
-
- "LL OWNED AUTOS 60DIL V INJURY
(Piir person) !.
- SCHEDULED AUTOS
f-- ,.,IRE~ AUTOS BODILY INJURY
(Per IIccldenl) 9
. f-- NON-QWNED AUTOS
~ PROPERT'!' OAMAGE ;
(Pef Iccidll"'~)
GARAGE LIABILITY AUTO ONLY. EA ACCIOE;Nr ~
I q ANY AUTO OTHeF\ THAN EA A":C i
I AUTO Or4L Y; AGG .il
I EXCESS/UMBRELLA LIABILITY I ~
~ r-'1
")Ccuq L-J CL",M3 MACE i ~GGAEO~Te $
-
I &
~ DEDUCT,"L' $
i
RETENTION ! .s
A WORKERS COMPENSATION AND I ~~C;.JH~T,~~ I IO~.
EMPLOyeRS'L1ABILlTV 500,000
ANY PROPRIETOR/PARTNER/ExECUTIVE E lEACH ACCIOE/IIT $
OFJ!ICERJMEMBER EXCLUDED'i 929007 4/1/2009 4/1/2009 e L DISEASE. EA EMPLOYEE .; 500,000
if yQS, OeSCrlD& unOer E L DISEASE. POLICY LIMIT 500,000
speCIAL flFl.OI/ISION5 be1o- a
OTHE.R
!
DESCRIPTION O~ OPERA'I'lQI\IS/I.OCATIONSIVEHICLES(EXCLUSIONS ADDED BV ENDORSEMeNT/SPECIAL PROVISIONS
CERTIFICATE HOLDER
(541)488-5320
City of Ashland
Electrical Department
Attn: Kari
20 E. Main St.
Ashland, OR 97520
CANCELLATION
SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION CATE THEREOF. THE 15SUING INSURER WILL ENDEAVOR TO MAIL
10 CAVS WRITl1i:N NOTICE TO THe. CERTIFICATe HOI.DER NAMED TO THE I.EFT, BUT
Fll.IL.U~E TO DO SO SHAL.1. IMPOSE NO OBLIGATION OR LIABIUTY OF ANY KIND UPON THE
YES.
A C 0 RD~'i5-'(20~o1708)-
@) ACORD CORPORA TION 1968
"II;:.... -." _.... _ .......
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r.,
CITY RECORDER
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
Page 1 1 1
~
VENDOR: 001079
VERSATILE CONCRETE, INC
POBOX 507
TALENT, OR 97540
SHIP TO: Ashland Electric Department
(541) 488-5354
90 N MOUNTAIN
ASHLAND, OR 97520
FOB Point:
Terms: Net
Req. Del. Date:
Speciallnst:
Req. No.:
Dept.: ELECTRIC
Contact: Scott Johnson
Confirming? No
Contractor to enaineer, layout, and
construct concrete foundations at
Mountain Avenue Substation to
adequately support the steel structure
erection, assembly and equipment
mountina. The contractor will comply
with current buildina codes and
standards, includina BOll prevailina
waae requirements.
32,200.00
Contract for Services
Date of aareement: 08/28/2008
Beainnina date: 09/08/2008
Completion date: 11/30/2008
Insurance required/On file
BILL TO: Account Payable
20 EAST MAIN ST
541-552-2028
ASHLAND, OR 97520
SUBTOTAL
TAX
FREIGHT
TOTAL
#,,( .A:.~ ~r-
Au zed Sig ure
VENDOR COpy
A request for a Purchase Order
REQUISITION FORM
CITY OF
ASHLAND
THIS REQUEST IS A:
o Change Order( existing PO #
Date of Request:
'r~~<r;'<?<~""i;::VV"'O<" r:<:t"'" ""'~ ~~=.-; "'11
~~t01:~4:;!;(~t~4J~~>~ ~ 1
it,t=tt~~~_ v ~ ~ ~ v. ~ d
Required Date of Delivery/Service:
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
Vp-~~tiIA C'.nnr.rAtA r.nn~tn Ir.tinn I nr.
P 0 Rny ~07
Talent Oregon 97540
541-601-1261
Patrick Harnev
SOLICITATION PROCESS
Small Procurement Sole Source
o Less than $5,000 0 Written findings attached
o Quotes (Not required)
CooDerative Procurement
o State of ORIWA contract
o Other government agency contract
o Copy of contract attached
o Contract #
Invitation to Bid
(Copies on file)
Reauest for Prooosal
(Copies on file)
Soeclall Exemot
o Written findings attached
Emeraencv
o Written findings attached
Description of SERVICES
~er attached PROPOSAL The concrete contractor will install foundations in Mountain Ave.
substation that will perform satisfactory for steel structure erection, assembly and equipment
mounting. The contractor will comply with current standards and codes in accordance with the
Contract Document requirements.
Total Cost
Item # Quantity Unit
DeSCription of MATERIALS
Unit Price
Total Cost
Project Number 000132.400
o Per attached QUOTE
Account Number 690.11.18.00.704100
* Items and services must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately.
By signing this requisition fonn, I certify that the i ation provided above meets the City of Ashland public contracting requirements,
onnqlreS. ~~J~ /
Employee Signatur · Supervisor/Dept. Head Signature: ~.
G: Finance\Procedure\AP\Forms\8_Requisition form revised.doc
Updated on: 8/27/2008