HomeMy WebLinkAbout2008-192 Contract - Pacific Paving
u~/25/2008 16:12
5418304612
PACIFICPAVING1NC
'H\,AL.. ........
I\.B
September 25, 2008
S1(1RB97520
CITY
stATE
We hereby submit specifications and estimate..1I; for~
Commercial Patching
1. Furnish and install 4" of asphalt over Trench Patch approxim,ately 2,602sf.
-TO ACCEPT 810.1'1 &
RETURl"l 'T. O:f~ OOP'V
We b~\)Y fll'<lPO!IC to fiDni9h the ftbove labor and matl:ria1~ in aoooroancc with the !\how ~pccifiQ8tiool. for the mm of:
***Nine Thousand Seven Hundted Thirty Five and 00/100*..
dotlaB ($ ...$9..735.00... )
TERMS: Cash on CQTl1pletion of job. \101e~ ather OJT8Dgerncnts IU'C made in writing. A 2% per montb '-'lNANCE C1IARG8 wilt be added 00 II' pa.'lt d~ SCeo\lots.
IIJ'l ANNUAL PERCENTAGE RATE OF 24%.. In the fNeJ\t SJry balance is turned (i.x:r to 1m aunmey for collection, or if _lawlillait is filc4 to oollcct any bl1an~.
iftcluding appeals from trial, tM pnNailing par\)' shIll be cntitIfld to hil EeaSonabtc ILtOmey tees me! rcasono.ble expeuscs oflitiglli~ sudl ~ itwelltigation.
depofIiIion. pn>ViSitmDlproom .... other Uko _co. "11_ i. ~ 10 be II spocifiool. An _11> be oompleIe<I in · ..._Iiko ...........,..!ms
to SlIDdto\l ~ Arty ~ or dev_liom ~ ~ _.ill& Iddi\iQllll1.......... Olltt&'" wlII_'" - dwgc.... .... o\JcM:
1he osti.....lf _ andI<1< 11?001. ~ by o\ben. .... &IJIllIIIW is limilod by~. The 1101111111 soli otr.ri\izBtioD JIl1II'Cl" will not till oI1lyp<$ or
..g<\lIlioD.... ..e wIR not be tcIPO"llble lbr IIIIj' dasJ1lI&l:<I ~ due 11> the pill of~ An IglO<IIIORb -.g.nt...... strikes, ""';- vi ao1sys
beyond 01U" _I !flbis """"""'..- $1,000, theowne< ~ _pt ofdle "IMom&tlM NoticC \0 - about (;omdludIon L1.....11dt
proposal m~ be withdrawn. by us ifnot accepted Within gO days. CCB #S0835
Eslim&t<l' c1J~ W. d~ _ Tc~ W Simcoe ~ .
U . Acceptance of Proposal
The abo.. prices. speclfications....o oonoitions "'" satishctmy one! ore \IetOhy ""'"'JlIed. you.... authorized 10 do all of the wor1c os sp<Cificd.
Payment will be made $lS outlined above.
SignalUf6 Date
\
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: Pacific Paving
CONTACT: Terry Simcoe
ADDRESS: PO Box 2370, White City, OR 97503
TELEPHONE: 541-772-4616
DATE AGREEMENT PREPARED: 10/01/2008 FAX: 541-830-4612
BEGINNING DATE: 10/01/2008 COMPLETION DATE: 11/01/2008
COMPENSATION: Not to exceed $9,735.00 per attached proposal dated September 25,2008
GOODS AND SERVICES TO BE PROVIDED: Pave trench (580' x 4') on Faith Avenue. Contractor to furnish
and install 4" of asphalt over trench patch approximately 2,602 sf.
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, 2798.230, 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 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 06/30/2008, Page 1 of 9
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. 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, cor 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 ORF status pursuant to
the ORF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a
ORF if Contractor has qualified as a ORF for this agreement; institutes an action for relief in bankruptcy or has
instituted against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing
business on a regular basis of the type identified in its obligations under 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 Liabilitv insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000,000, $2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property
Damage. It shall include contractual liability coverage for the indemnity provided under this contract.
c. Automobile Liabilitv insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000,000, or Not Applicable for each accident for Bodily Injury and Property Damage,
including coverage for owned, hired or non-owned vehicles, as applicable.
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 2 of 9
d. Notice of cancellation or chanae. 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.
CONTR CITY OF ASHLAND:
BY
ignature
Terry Sehoenleber
Print Name
TITLE
See/Trease
DATE
DATE
October 1, 2008
CONTRACT AWARD AND FINDINGS DETERMINED BY:
By:
FederallD#
93-1064699
ACCOUNT #
Date: 10 '> 08
k~t? tJg 17 67& 6?J:2~t1-CJ
(For City purposes only)
PURCHASE ORDER # (/ g ~8
*Completed W9 form must be submitted with contract
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 ql:Jalified, professionally
competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury
that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on
behalf of the entity designated above and authorized to do business in Oregon or is an independent
Contractor as defined in the contract documents, and has checked four or more of the following
criteria:
x
x
X
X
x
(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.
Pacific Paving Inc. by: T. Schoenleber
contractoy\!~
October 1, 2008
(Date)
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 4 of 9
Form W-g
Request for Taxpayer
Identificat.ion Number and Certificat.ion
Give fonn to the
requester. Do not
send to the IRS.
Check appropriate boX: 0 Individual/Sole proprietor KJ Corporation 0 Partnership
o Limited liability company. Enter the tax classification (D=disregarded entity, C=corporation, P=partnership) ~ _ _ _ _
o Other (666 instructions) ~
Addres.s (number, street, and apt. or suite no.)
P.O. Box 2370
Enter your TIN in the appropriate box. The TIN provided must match the name given on Une 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 I"lumber (EIN)_ If you do not have a number, see How to get a TIN on page 3,
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter,
Certification
Under penalties of perjury, I certify that:
1, The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2, I am notsllbject 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 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 interest paid, acquisition 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, See the instructions on page 4.
(Rev. October 2007)
Department of the Treasury
Internal Revenue Service
Name (eu; shown on your income tax return)
Pacific Pavin Inc.
Bu6ine&s name, if different from above
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City, state, and ZIP code
List account number(s) here (optional)
Taxpayer Identification Number (TIN)
Sign
Here
General Instructions
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 fora 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 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,
o Exempt
payee
Requester's name and address (optional)
I Social security number
, ,
or
64699
Date ~ October 1, 2008
Deftnnlon 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 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 ina
partnership conducting a trade or business in the United States,
provide Form W-9to 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
followi ng cases:
. The U.S. 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 06/30/2008, Page 5 of 9
ACORD.. CERTIFICATE OF LIABILITY INSURANCE OP ID SU I DATE (MMlDD/YYYY)
PACI05W 09/30/08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
KPD Insurance, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO Box 784 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Springfield OR 97477
Phone: 541-741-0550 Fax:541-741-1674 INSURERS AFFORDING COVERAGE NAlC.
INSURED INSURER A: SAIF Corporation - Salem
INSURER B:
Pacific Paving, Inc. INSURER C:
PO Box 2370 INSURER D:
White City OR 97503
INSURER E:
COVERAGES
THE POliCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF Am CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSRJ: TYPE OF INSURANCE POLICY NUMBER ~';'~lriMtDIiYYf I ~kfE"'MMI6Drffl" LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
- UAMAuc
COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) $
- o CLAIMS MADE D OCCUR
- MED EXP (Anyone person) $
PERSONAL & ADV INJURY $
-
GENERAL AGGREGATE $
f--
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
h POUCY n ~~8;: nLOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
I-- $
ANY AUTO (Ea accident)
I--
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 $
==i iW'f AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
o OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND - xITORY LIMITS I IOJH-
ER
A EMPLOYERS' LIABILITY 812919 10/01/08 10/01/09 E.L EACH ACCIDENT $ 500,000
ANY PROPRIETORIPARTNERlEXECUTlVE
OFFICERlMEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $ 500,000
~~~cl~~~JlS1~s below E.L. DISEASE - POLICY LIMIT $ 500,000
OTHER
DESCRlPnON OF OPERA nONS I LOCAnONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
RE: All Operations
CERTIFICATE HOLDER
Ci ty of Ashland
90 N Mountain Ave.
Ashland OR 97520
CANCELLATION
C ITAS 0 2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPlRAnON
DATE THEREOF, THE ISSUING INSURER W1U ENDEAVOR TO MAIL ~ DAYS WRITTEN
NonCE TO THE CERnFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLlGAnON OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUT E~PRES
@ ACORD CORPORATION 1988
ACORD 25 (2001108)
.L t..Ao~,., .........,.L. '-'.L
A CORD.M CERTIFICA TE OF LIABILITY INSURANCE 1 DATE (NMIDDNYYY)
10/3/2008
PRODUCER (541)772-1111 FAX: (541)772-3785 THIS CERllFICATE IS ISSUED AS A MATTER OF INFORMATlON
Beecher Carlson ~nsurance Agency LLC ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERllFICATE DOES NOT AMEND EXTEND OR
707 Mu:z:phy Rd AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Medford. OR. 9'7504 INSURERS AFFORDING COVERAGE NAIC #
INSURED INSl'RER A. Travelers
Pacific Pavinq ~nc IN:o-UI-it:K t! Developers Suretv &
PO Box 2370 INSUf;'.ER c
INSI.RFF; n
Whi te ci ty OR 97503 INSURER E.
COVERAGES
IHE: POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY
REClUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WiICH 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,
Ar.I~R~GAT~ liMITS SHOWN MAY ~AV~ R~EN REDlJCFD BY PAID CI AIMS.
I~~: ~~~~ TYPE OF INSURANCE POLICY NUMBER Pr?i+~~~~~8m~ P~!fJ,~':~J~N LIMITS
A
GENERAL UABIUTV EACH OC::URREN::E $ 1,000,000
>-- ~~~H?E~~~~r>ce'
~DMt:RCIAl (';I:I\I:K.AL L1A1:l Lit '( $ 100,000
X I-- CL".1MS MADE ~ :::lCCUR DTC0526DS417TILOS 3/20/2008 3/20/2009 MED Fxp (Anll 'JM "",r..en\ ,~ 5,000
I-- PERsml/"'-. & /lDV IN..l. R '( $ 1,000,000
- GENE<<PJ.. AGGREGATE $ 2,000,000
GENL AC,C,RE:'ATE LiMIT APPLIES PER. _ rrt.P/oP Ar=.(-" 1$ 2.000,000
~ n-PRO- n
X FOllCY :':'C'I LOC
AUTOMOBilE L1ABllITV COMBINED SINGLE LIMIT 1,000,000
- $
~ PNY AUTO (ca aocidenti
,ALL O'M'lCD AUT03 DTB10526D8417TIL08 3/20/2008 3/20/2009 S8DIL'( ('~LURY
- I :>u pmo-,on) $
- SCHEDULED AUTOS
~ HIRED AliTO;: BOCiL y 1~I,l)RY $
~ I\ON-CJ\\1\ED AUTOS (Ptlr acadent)
- PRJPERTY D/WAGE $
. (:> Fir R~(j o'ln1)
GARAGE LIABILITY AUTO ON-_Y - =AACCIDE\l1 $
R :'NY AUTO OT-lEn THAN EA ACC $
AdTO 01'1'_'( AGG $
FXCFSS/UMBRF.I I A I IABI!. ITV ~^rH nr-IIRR~N-E $
:=J O,-CUP D CLAIMS MADE AGGRFC.;AT= $
$
~ DEDUCTIBLE $
PETENT 0N 1 $
WORI<ERS COMPENSATION AND I T~~T~~!; I IOrW
EMPLOVERS'L1ABllITV
_ANY!='ROPRIETDR,PART'IlER/EXECUTIVE EL EACI-: ACCIDE'lT $
OFFIl.=R/MFMAFR F)l\.l I IOFO? EL DI~EA5E - EA "'MF1..01EE $
If yt=;'=;. riAScrhF IJnc1~r :::L DISEASE- POLICY LIMIT $
SPFr.IAI :>POVISIONS hFIOI'v
OTHER Contractor's License 786018C 7/1/2008 7/1/2011 Limit. $20,000
Bond
A
B
DESCRIPTION OF OPERATlONSA.OCATIONSNEHICLESIEXCLUSIONS ADOED BY ENDORSEMENTJ'SPEClAL PROVISIONS
The City of Ash~and, it's officers, agent~ and emp~oye&s are included as additiona~ insured as respects to general
liability per CG 0246 08/05 where required by written contract. This form is subject to po~icy terms, conditions,
and exclusions,
CERTIFICATE HOLDER
CANCELLATION
(541)488-5320 SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED BEFORE THE
The city of ~hland, its officers, agents EXPIRATION DATE THEREOF, TtE ISSUING INSURER WILL ENDEAVOR TO MAIL
and employees 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO lliE LEFT, BUT
90 North MOuntain Avenue -
FAILURE TO 00 SO SHALL IMPOSE NO OSLlGA nON OR LIABILITY OF ANY I<IND UPON THE
Ashland., OR 97520
INSURER, rrs AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE (JA^(f ,)b:z tt(f-
~ Slatte.::-y, CI3R/AMBE
ACORD 25 (2001/08)
INS025Io1oe)oo~
@ACORDCORPORATION 1988
Pagw 1 0' '.1
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POUCy, PLEASE READ IT CAREFULl. Y
BLANKET ADDITIONAL INSURED
(CONTRACTORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1, WHO IS AN INSURED - (Section II) is amended c)
to include any person or organization that you
agree in a "written contract requiring insuranceu
to Include as an additional insured on this Cover-
age Part, but
a) Only with respect to liability for "bodily injury",
"property damage" or "personallnJury"; and
b) If, and only to the extent that, the injury or
damage is caused by acts or omissions of
you or your subcontractor In the performance
of "your work" to which the "written contract
requiring insurance" applies, The person or
organization doe!; not qualify as an additional
insured with respect to the Independent acts
or omissions of such person or organization.
2. The insurance provided to the additional insured
by this endorsement is limited as follows:
a) In the event that the limits of Insurance of
this COVAr::l!J&:l PRrt ~hown in thp. np.r.k:lmtion~
exceed the limits of liability required by the
"written contract requiring insuranceA, the in-
surance provided to the additional insured
srall be limited to the limits of liability re-
quired by that "written contracl requiring in-
surance", This endorsement shall not in-
crease the limits of insurance described in
Sectlon III - Limits Of Insurance.
b) The insurance provided to the additional in-
sured does not apply to "bodily injury.. "prop_
erty damage" or "personal injury" arising out
of the rendering of, or fail ure to render, any
professional architectural, engineering or sur-
veying services, including:
i. The preparing, approving, or failing to
prepare or approve, maps, shop draw-
ings, opinions, reports, surveys, field or-
ders or change orders, or the preparing.
approving, or failing to prepare or ap-
prove, drawings and specifications; and
it Supervisory, inspection, architectural or
engineering activities.
CG 0248 OB O~
The insurance provided to the additional in~
sured does not apply to "bodily injury" . or
"property damage" caused by "your work"
and included in the "products-completed op-
erations hazard" unless the "written contract
requiring insurance" speCifically requires you
to provide fluch covcmgc for that additionol
insured, GOO than the insurance provided to
the additional insured applies only to such
"bodily injury" or "property damage" that oc-
curs before the end of the period of time for
which the "written contrad requiring insur-
ance" requh ~~ you to provide such coverage
or the end of the policy period, whichever 15
earlier.
3. The insurance provided to the additional insured
by lh\s endorsement is excess over any valid end
collectible "other insurance", whether primary,
excess, contingent or on any other basis, that IS
avarlable to the additional insured for a loss we
cover under this endorsement Howeve:, jf the
"written contract requiring insurance" specifically
requires that this insurance apply on a primary
UC:ls/s or i:f primary amI Ilorl-wlllriLJu(ury Oasis,
this insurance is primary to, "other insurance"
available to the additional insured which covers
that person or oroanization as a named insured
for such loss, and we will not share with that
"other insurance-, But the insurance provided to
the additional insured by this endorsement stilt is
excess over any valld and collectibie "other in-
surance", whether primary, excess, contingent or
on any other basis, that is available to the addi-
tional insured when that person or or9anlzation is
an additional insured under such "other insur-
ance" ,
4. A~ A r.nnriition of r.nvArAop. prnvlrtAci to thp.
additional insured by this endorsement:
a) The additional insured must give us written
notice as soon R~ pr::tcticable of an "occur-
rence" or an offense which mc:lY result in a
claim. To the extent possible, such notice
should ;nclude:
@ 2005 Tht:: 51. Pi::Iul TrdVtflt:m:i Compi::lnit:::i, Ifltj,
PC:t~t: 1 ur 2
1.J\J'-'\..I.l.l.,",~ "''''-.A. .....""""..."" VA....#............
COMMERCIAL GENERAL LIABILITY
i. How, when end where the "occurrence"
or offense took place;
ii. The names and addresses of any injured
persons and witnesses; and
iii. The nature and location of any injury or
damage arising out of the "occurrence.' or
offense.
b) If a claim is made or "suit" is brought against
the additional insured, the additional insured
must:
i. Immediately record the specifics oflhe
claim or "suit" and the date received; and
II. Notify us as soon as practicable.
The additional insured must see to it that we
receive written notice of the claim or "suit" as
SOU" CiS praclicCiult:t.
c) The additional insured must immediately
send us copies of all legal papers received in
connection with the clair:, or "suit", cooperate
with us in the investigation or settlement of
the claim or defense against the "suit", and
otherwise comply with all policy conditions.
d) The additional insured must tender the de-
fense and indemnity of any claim or "suit" to
Pi:1~~ 2 ur 2
any provider of "other insurance" which would
cover the additional insured for a loss we
cover under this endorsement. However, this
condition does not affect whether the insur-
ance provided to the additional insured by
this endorsement is prima.ry to Itother insur-
ance" avallable to the additional insured
which covers (hat person or organization as a
named insured as described in paragraph 3.
above.
5. The following definition is added to 3ECT'ON V.
- DEFINITIONS:
"Written contract requiring insurance" means
lhat part of any wrillen contract or egreement
under whIch you a.re required to include a
person or organization as an additional In-
sured on this Coverage Part, provided that
the "bodily injury" and "property damage" oc-
curs and the "personal injury" ;s caused by an
offense committed:
a After the signing and execution of the
contract or agreement by you;
b. While that part of the contract or
agreement is in effect; and
c. Before the end of the policy period.
@ 2005 TIJ~ Sl. Paul Tr~vt:llt:!f~ CUll1pc:lr1i~~. Irlli.
CG D2 46 08 O~
r~'
CITY RECORDER
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 000903
PACIFIC PAVING, INC
POBOX 2370
WHITE CITY, OR 97503
FOB Point:
Terms: Net
Req. Del. Date:
Speciallnst:
Page 1 / 1
~~
SHIP TO: Ashland WWTP
(541) 488-5348
1295 OAK STREET
ASHLAND, OR 97520
Req. No.:
Dept.: PUBLIC WORKS
Contact: David Gies
Confirming? No
Pave trench on Faith Avenue
Trench 580' x 41
Contractor to furnish and install 4" of
asphalt over trench patch approximately
2,602sf
Contract for Services
Date of aQreement: 10/01/2008
BeQinninQ date: 10/01/2008
Completion date 11/01/2008
Insurance required/On file
BILL TO: Account Payable
20 EAST MAIN ST
541-552-2028
ASHLAND, OR 97520
SUBTOTAL
TAX
FREIGHT
TOTAL
735.00
0.00
0.00
9,735.00
N~i~:tf;ure
VENDOR COpy
----~-T -
request for a Purchase Order
REQUISITION FORM
CITY Of
ASHLAND
Date of Request: 9"~9..tJr
THIS REQUEST IS A:
o Change Order( existing PO #
Required Date of Delivery/Service:
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
Pa/!'-Ple "f{; vj .N'~
SOLICITATION PROCESS
Small Procurement o Sole Source 0 Invitation to Bid
o Less than $5,000 o Written findings attached (Copies on file)
o Quotes (Optional) o Quote or Proposal attached
Cooperative Procurement 0 Reauest for Proposal
o State of ORNJA contract (Copies on file)
Intennediate Procurement o Other government agency contract 0 Special I Exempt
~ (3) Written Quotes 0 Copy of contract attached 0 Written findings attached
(Copies attached) 0 Quote or Proposal attached
0 Contract # 0 Emeraencv
0 Written findings attached
0 Quote or Proposal attached
Description of SERVICES
f;:; lie ...;-;.~ jt/ clt ~,AI ;:;, fit Ill! ~ .
fl.f lid- .q;,. .5 to I X If (
~Per attached PROPOSAL
Item # Quantity Unit
Description of MATERIALS
Unit Price
Total Cost
Project Number _ _ _ _ _ _ - _ __
o Per attached QUOTE
Account Numbe~z[ -t2f. -L'l-I!.f!.-dfd.J.fP_O
* Items and services "-,ust be charged to the appropriate axount numbelS for the financials to reflect the actual expenditures accurately.
By signing this requisition form, I certify that the information provided above meets the City of Ashland public contracting requirements,
and the documentation can be provided upon request.
Employee Signature: lJ:ud L---- Supervisor/Dept Head Signature: I..:1J c.... ~
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