HomeMy WebLinkAbout2008-215 Contract - Pacific Paving
10/28/2008 10:08
5418304612
PACIFICPAVINGINC
PAGE 02
PROPOSAL SUBMI1TED TO:
ent
NA
aterD
STkEET
t
Between Idaho &:. Harrison
STATE
c
90 N MountaiD.
Ashland
STATE
OR 97520
ITY
We hereby submit spec:i.fic8tions and estimaIEs fur:
Ashland
Commercial patchina
1. Fumish and instal14" of asphalt over trench patch approximately 2)90sf.
~TO AOCJ.tI..'lIl' SIO'N" &
RETn Rl"i '1'01-" OO~y
We 1lereby1ftpole to ~ !he atKm WIor aIldlllltcMl$ in ~..nth the IIbcm; spedi1c:ationl. to, the !IlIIII of:
...Eight Thousand Five Hundred Sixty Five and 00/100...
. *..$8,565.00..*
dolhn ($ )
TERMS; CIsh Oft ~ Qfjab~ anIcss oCbet ~..~ lie..... in writiIJI. A 2% 1* mooIh FINANCE CHARGE witl be 8dcIed on an past clue ~,
... ANNUAL PERCENTAGE RATE Of 1""- In tile ~ II1Y baI80cC iR 1Urned o.ert() lID lIttOrT1C1 foe coIla(lO. or if allWSUlt is filed to dleet any bfdaN:e.
inclodin& It'PC*1&ft'Om uW. the: 1)mIIlq pMty sblll be c:ndtIed to lib AWOnIbIo ~ fees _1'eIIOIIIbk: expenses of~ such ... invcsdption.
~ provilicul ~ tnd od1Cflib~. All __ is ~1IIleed to be. spcdfic4. All wm:.. be c~ in a ~lib IIIiP1CI' 8CCOl'ding
to!ltmdlrd ~ Arrt iItt:ttdon or devittian ttom II\w;M specmc.tioal in.voMbgldclitiOnlt wvdt IIIClcma c:QSt!; will bcalme III ~ c:bIrgc over end above
1bc estiIIB. 1f!lUbblle"or bMe is ~ by odIas.1beft ~ is limad liy ....urlan_ldp. The ROI1'IJII soil ttaiJ~ 1)I'OCCSS win not kill. tMXlS of
~on Iltd we will aot be n:spot1Sibk fbr -r dfImatpI ~ due to the ~ ofV~"~' All ~~mtI\tS comiJtF1t 1ipOD. stn" accickrd5 or clellys
beYond our ~t. Ifthis,Q;lIIbad ~ $1.000, the owner ~ RC:eipt aftbe "InbmItion Nodocto H~ Uout ~on Uc;ns." This
propoul maybe ~ by us if~ ~ withbt 30 days. CC8 f.SO&15
Eslim8IorfJ/1h- r.J. 4~f TcrryWSimcoe ..
1/o::L~ ... 7J Acceptance of Proposal
The above pri<<:s. 6Pecificalions and conditions arc: s.nmdory aftd are hereby acceptc;d. You art authorized to ,do all of the work as specified.
Payment will be made as outlined above.
Sipatunt
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: 10/30/2008 FAX: 541-830-4612
BEGINNING DATE: 10/31/2008 COMPLETION DATE: 11/21/2008
COMPENSATION: Not to exceed $8,565.00 per attached proposal dated 10-28-2008
GOODS AND SERVICES TO BE PROVIDED: Furnish and install 4" of asphalt over trench patch,
approximatelv 2,290sf. Location: Holly Street, Between Idaho & Harrison
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
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, 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 ~hall be in default of this agreement if Contractor: commits any material breach or default of
any covenant, warranty, certification, or obligation it owes under the Contract; if it loses its QRF status pursuant to
the QRF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a
QRF if Contractor has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has
instituted against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing
business on a regular basis of the type identified in its obligations under the Contract; or attempts to assign rights in,
or delegate duties under, the Contract.
16. Insurance. Contractor shall at its own expense provide the following insurance:
a. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to
provide Oregon workers' compensation coverage for all their subject workers
b. General 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,
includino coveraae 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. AdditionallnsuredlCertificates 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 Council or 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.
C~NTR~CTOR ~
BY \. ~l
, C' ignatur
0(.: E.-/l--
Print Name
~ ITY2..bIf\'? ·
CITY OF ASHLAND:
BY
~
TITLE
DATE
DATE
\ \. ~. Oi
CONTRACT AWARD AND FINDINGS DETERMINED BY:
By: c... ~
artment Head
Date:
*Completed W9 form must be submitted with contract
PURCHASE ORDER #
?/l (I Rg;f@ tfJ{fJ~tJ;Z
(For City purposes only)
tl ~ ~ t:;-6
....,
1t:L--&
FederallD#
~A \ObLt-to~\
ACCOUNT #
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 10 (or is waiting for the number to be
issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from
backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is
subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS
has notified it that it is no longer subject to backup withholding. Contractor further represents and
warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the
Contract, when executed and delivered, shall be a valid and binding obligation of Contractor
enforceable in accordance with its terms, (c) the work under the Contract shall be performed in
accordance with the highest professional standards, and (d) Contractor is qualified, professionally
competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury
that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on
behalf of the entity designated above and authorized to do business in Oregon or is an independent
Contractor as defined in the contract documents, and has checked four or more of the following
criteria:
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.
tl- 3-o&'
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 4 of 9
Form W-9
Request for Taxpayer
Identification Number and Certification
Give fonn to the
~.quester. 00 not
send to the IRS.
Enter your TIN in the appropriate box. The TIN provided must match the name given on Une 1 to avoid
backup withholding. For individuals, this is your social security number (SSN). However, for a resident
alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is
your employer identification number (EIN). If you do hot have a number, see How to get 8 TIN on page 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter.
C$rtification
(Rev. October 2007)
Department of the Treasury
Interned Revenue $ervice
Name (~ shown on your income tax return)
to '\1~ 3
Taxpayer Identification Number (TIN)
o Exempt
payee
Requester's name and address (optionaO
I Social aecuity number
, ,
or
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 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
notifiecl me that I am .no longer subject to backup withholding, and
3. I ama 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,aoquisition or abahdonment of secured property, cancellation of debt, contributions to an individual retirement
arrangemeht (IRA), ahd generally, payments other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. See the instructi<>ns on page 4.
~~~ I~~":::f.. (:&~
Gen.eralln.struction.s
Section references are to the Internal Revenue Code unless
otherwise noted .
Purpo.se of Form
A person who is reqUired to file an information return with the
IRS must obtain your correct taxpayer identification number (TIN)
t~ report, for example, income paid to you, real estate
transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or
contributions you made to an IRA
Use Form W-9 only if you are a U.S. person (including a
resident alien), to provide your correct TIN to the person
requesting it (the requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you are
waiting for a number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S.
exempt payee. If applicable, you are also Certifying that as a
U.S. person, your allocable share of any partnership income from
a U.S. trade or business is not subject to the 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.
Oat$~ \\.3.0~
"
DennlUon 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 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 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,
Cat. No. 10231X Form W-9 (Rev. 10-2007)
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 5 of 9
10/28/2008 10:08
5418304612
PACIFICPAVINGINC
PAGE 02
PROPOSAL SUBMITTED TO:
JOB NAME
Ho
t
NA
bland Water De artment
STREET
Ashland
STATE
OR 97520
CITY
Between .Idaho & Hamson
STATE
CITY
We hereby submit spccifiC8tions and estimatES fur:
Ashland
Commercial Patchina
1. Furnish and install 4" of asphalt over tren.ch patch approximately 2~290sf.
".to .AOOF,;.l:"T SI>":f,lt.T 11_
~'. f . "A P( '1."'<1
.1:a!J .l'{J ..t~- '1'0 I-~ oO:P.'Y
We hereby lffilPOllC to tuTni'!:h Ihe aboV': l(lbot' 3I'Id m8tcri~l$ in acccmlanQC with tllC above SJ)eClflcatiOllB, rOf tho !rom of:
***Eight Thousand Five Hundred Sixty Five and 00/100...
***$8,565.00."'*
dolhlrs ($ )
TERMS; Cash (In completioJl of job~ unless other ommgrnnents are made in writing. A 2% per moo1h FINANCB CHARGE will be added on all past d\lc IlCCOunts..
an ANNUAl.. PERCENTAGE. RATE Of ~~%. In the cvc:nt ony balaocc iR turned over to an attorney fot ooJlection. or jf alftWSUit is filed to collem: any balance,
ineluding appcallt ftom tri~l. the prevailing party shall be entitled to Ms reasonable Jttomey fees .d 1'e8.wna'bJe expenses ofliti,,"ion, such Jill investigation,
deposition, provisional proocs~ and other like e?tPenscs. All materilll is gtJAtDDteed to be as specified. All work W he completed In a workmanlike matlncr according
to 5tm1dBrd pTllctices. Any 81~lon or devililtinn ftoom llbove specificatiQM involving additional work and mra costs will be~ame BR extra charge over and above
the tstimatt. If !lubbase and/Qr ballc is prepltlCd by others. then guaramcc i~ limited bY worlcmlUlShip. The normal soil stmliz$ion process mil not kill all ~es of
vcsttation aod we wil1 not be re!il)ons1ble for any damaged pavement dut to the growth of vegctBtion. All agreemertts eontingcnt I1pon strike!l., ac:t;ideni5 01' delays
beyond our IXlnt1'Ol. [fthis oontract exoeedtl $1.000~ the owner acknowlcd~ l'e(1eipt of the "Informmion Notiec to Homeovro~ about ~tlon U~rr.i. II This
proposal may be withdrmvo hy us ifnot ft~oepted within 30 days. CC8 1#50&35
~~ocikv 0. 4~.
Acceptance of Proposal
Terry W Simcoe
-.
The above prices. specifications BJld conditions are satisfactlJI)' $nd are hereby accepted. you arC authorized to do all of the work as specJficd.
Paymont will be made as outlined above.
SignatUJ'6
Date.-
ACORD", CERTIFICATE OF LIABILITY INSURANCE OP ID SU I DATE (MMIDD/YVYY)
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 NAIC#
INSURED INSURER A: SAIF Corporation - Salem
INSURER B:
.--
Pacific Paving, Inc. INSURER C:
-
I 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 ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSRC TYPE OF INSURANCE POLICY NUMBER '~IjN~TriMrlfrl',w)t: I P8H~YI~tAib~IN LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
f-- UAMA\jt: I U Ht:N Il:U --
COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) $
f-- ~ CLAIMS MADE D OCCUR --
MED EXP (Anyone person) $ ---
I-- -----~.-
PERSONAL & ADV INJURY $ --
I--
GENERAL AGGREGATE $
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $
n n PRO- nLOC
POLICY JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
I-- $
ANY AUTO (Ea accident)
-
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
-
HIRED AUTOS BODILY INJURY
f-- $
NON-OWNED AUTOS (Per accident)
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
R ANY AUTO --
OTHER THAN EA ACC $
.--
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
~ OCCUR D CLAIMS MADE AGGREGATE $
---- ------.- - - ----...-----
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND X IT~~l~~Ws I IOJ~-
A EMPLOYERS' LIABILITY 812919 10/01/08 10/01/09 $ 500,000
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT
OFFICERlMEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $ 500,000
~~~~I~tS~~~~~?~~s~elow --
E.L. DISEASE - POLICY LIMIT $ 500,000
OTHER
DESCRIPTION OF OPERA TIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
RE : All Operations
CERTIFICATE HOLDER CANCELLATION
CITAS 02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
City of Ashland
90 N Mountain Ave.
Ashland OR 97520
@ACORD CORPORATION 1988
ACORD 25 (2001/08)
Date:
To:
Company:
Phone:
Fax:
BEE C HE, R"""",'ii(!AR LSON
. Insurance Agency, LtC
f'1)n1H.'rly J B ~K 1~1~;K sr'HVICT". LLC
I:f\ 6_~~r RA ~~~; 1V11!=I AJ~
AMB48E61 E0050C2
10/3/2008 1 :28:28 PM Num of Pages:
(including
cover)
The City of Ashland From:
Direct Phone:
Direct Fax:
5414885320 Email Address:
___._.._....________.._...___._n___.._._~_____.~_._.____ ._____
5
Am ber L. Slattery
5414942655
5414942755
_ ~.m ber.s_@ttery@be~ch~~carlson ,c~~__
707 Murphy Rd, Medford, OR 97504 (541)772-1111 Main (541)772-3785 Fax
CA License #OF09618 OR License #816307 WA License lt252204
::U '''i rn I., i ,.
A CORD", CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYYY)
10/3/2008
PRonur.ER (541)772-1111 FAX: (541)'7'72-3785 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Beecher Car1.son In.surance Agency LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERllFICATE DOES NOT AMENDl: EXTEND OR
707 Murphy Rei AL TER THE COVERAGE AFFORDED BV THE pOLlcr S BELOW_
---
Medford OR 97504 INSURERS AFFORDING COVERAGE NAIC ff
INSURED IN;;'l'RER A Travelers
-
Pacific Paving Inc IN,c.''iith ~j Developers Surety &
PO Box 2370 INSlJf;'ER C
IN::;lRFf; f)
White City OR 97503 IN~,lJRER E,
COVERAGES
I HI:: POLICIES O~ INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY
REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PCR'AIN,
THE It-JSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM S, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES
AGGREGATE liMITS SHOWN M,n.y HAVE BEEN REDUCED BY PAID CLAJMS.
INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION
I.TR INSRO TYPE OF It~SURANCE f>OllCY NUMBER DATE IMMIDDIYY) DATE IMMIDDIYY\ LIMITS
GENERAl. LIABILITY EACH \'C :~URR[N ::E 'f. -- 1,000,000
~ 04.111\;:;[' 10 !:':t:h'TED
X U)MMl:h:L1f\1. i;t"t:k".Al. 1I/\H LilY P?.FMISE~ / ECl ou:urrf:pr.,,' $ 100,000
~ :=J CL.'^JM3 MADE ~ "CCUR 3/20/2009
A X DTC0526DS417TILOS 3/20/2008 ME.D F ,ZF (.'\r.~ '.I""" l'i8rs,':l1 \ ,t 5,000
~
PERSOI.J/,L & N.N IN-un $ 1,000,000
---~_.- --.. -..-
- I;ENE~Al AC,(;RE(;AT[ $ 2,000,000
,-,on ...,c,,~~?E:,/ITE l.iMIT N::'PLlE" PER DO'\r\II('T<C; _ CCM"/Ol" At;!; $ 2,000 000
~. n PR()- r"f
X FOLlCY J::CI Lac:
AUTOMOBILE LIABILITY C(;MUINFD .,INGLE LIMII 1,000,000
- ,IE,,=; :f(Y'/(lpntl $
~ f\J'U ill no
A I'lL OlfvNI:D AI.IT0:3 DTR10526D8417TIL08 3/20/2008 1/20/200Q ~L.'I["l\i_ \ (\L{E~'t
I-- ':'r.r r.1(~rr.Ofi) $
- ,~,HI::()I ILh) ^LJH',~;
X ,., r.E'(.A"T,Y.: r;1)[Ji_,' 1~I.A!r,y
- -.- \"'8r ilCCldfJil{ I $
X r,ON-O\Y1\r::rJ I\UTD~.
-
- PR:JPERTY D,W^GE $
(:>H"r.rirl.>nl)
GARAGE LIABILITY "UTO ON_Y - '~j\ACCIDE\lT $
==l ,\NY '\I.IT,) 01 -IErl THAN b\ACC .~
A,.!1;.) n:..J' '( N;C, j;
..-
FXC:FSS/UMRRFI I A I IARIIITY E^CH ':'C ~~URr~E~L:1:. $
~ 'KCI.IP o '-:LAIM~; MPDE /,(;(',111 '(,A 1- :f,
!f:
==l DEDUCTIBLE $
-..--- PETF~JT ('hi 1 $
WORI<ERS COMPENSA TION AND '~~n~'4s I 10TH
rFi -.-
EMPI OVERS' LIABILITY
ANY C\P',)!~P.IET0R/PAP.T'~ERiEXECI./TII/E EL Ej\n: ^CClDI=\JT $ --
OFFIC "J.;:/MFMFlFR n<\.11 Inn)? r-_ L DI~E^"'>l: . E/\ ':'.MF'l.() n:J:: ~,
11\11"" (It:Y~crltlr- IJncl:;r
SF1' elf,1 "P()V I::;IONS h~lmv "L DISeASE - POLil: Y LIMIT $
B OTHER Contractor's License 7B 6010C 7/1/2008 7/1/2011 Limit $20,000
Bond
DESCRIPTION 010 OPERA TIONs/LOCATIONSNI:HICLE:S/EXCLUSIONS ADDED BV ENDORSEMENTISPECIAL PROVISIONS
The City of Ashland, it's officers, agents and employees: are included as additional insured as respects to general
1.: <'<.hility per CG D246 08/05 where required by written contract. This Eorm is subject to policy terms, r.oncl.it~ons,
and E!xc'lusions,
_n_.
CERTIFICATE HOLDER
1(541) 488-5320
The city of Ashland, its officers, agents
and employees
90 North Mountain Avenue
Ashland, OR 97520
CANCELLATION
I SHOULD ANV OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF. THE ISSUING INSURER 'MLL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTlflCArE HOLDER NAMt::D TO THE LEfT. ClUI
FAILURE TO 00 SO SHALL IMPOSE NO OBUGA TION OR LIABILITY OF ANY KINO UPON THF
INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
^ Slatta=y, CI3R!AMBE
/) Ii /)-.
(A.4 1 (T SI'7 tt..cJ"-
@ACORD CORPORATION 1908
ACORD 25 (2001/08)
INS025 ifl10f) ('0"
1-';:1(.1(' ~ f")
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADD~TIONAL 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)
\0 include any person or organization that you
agree in a "written contract requiring insurance"
to Include as an additional insured on this Cover-
age Part, but
a) Only with respect to liability for "bodily injury",
"property damage" or "personallnJLJry"; and
b) If, and only te 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 does 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 thai the limits of Insurance of
'hi~ r.nv~r;:l!Jp. P::trt ~hnwn in thp. ()p.r:I~r:l.tinn~
exceed the limits of liability required by the
"written contract requiring insurance", the in-
surance provided to the additional insured
sr.alf be limited to the limits of riabHity re-
quired by that "written contract requiring in-
surance" This endorsement shall not in-
crease the Ii mits of inGurance de~crjbed in
Section III - Limits Of Insurance.
b) The insurance provided to the additional in-
E;urAd d('JAS nol apply to "bodily injury", "prop-
erty damage" or "personal injury" ansing out
of the rendering of, or failure to render, any
professional architectural, engineering Dr sur.
veying services, including:
i. The preparing, approving, or failing to
prepare or approve, maps, shop draw-
ings, opinions, reports, SUN9YS, field or-
ders or change orders, or the preparing,
approving, or faili ng to prepare or ap-
provc, drawings and specifications; and
ii. Supervisory, inspection, architectural Dr
engineering activities.
CG 02 46 08 O~
The insurance provided to the additional in-
sured does not apply 10 "bodily injury" or
"property damage" caused by "your work"
and included in the "products-completed op-
erations hazard" unless the "written conlract
requiring insurance" specifically requires you
to providc euch covcrngc for thnt additional
insured, c;nd then 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 ti me for
which the "written contracl requiring insur-
ance" requir ~~ you to I-llOvide such coverage
or the end of the policy period, whichever is
earlier,
3. The insurance provided to the additional insured
by this. endorsement is ex.ce5S over any valid and
collectible "other insurance", whether primary,
excess, contingent or on any other basis, that IS
available to the additional insured for a loss we
cover under this endorsement Howev8~, jf the
"written conlroct requiring insurance" specifically
requires thai this insurance apply on a primary
uasls or <:I primary awl IIUlH."(J(llriuulury l.Jasi~,
this insurance is primary to "other Insurance"
available to the additional insured which covers
that person or organization 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 still is
excess over any valid and cOllectlb,e'otner Ir\-
surance", whether primary, excess, contingent or
on any other basis, that is available to the addi-
tional insured when that person or organlz.ation is
an additional Insured under such "other Insur-
ance",
4. A~ r:l r,onrlition of r.OW:m.1QP. rrnvlrlArl tn thp.
addItional Insured by thIS endorsement
a) The additional insured musf give us wriflen
notice as soon 8~ I'r~cticable of an /loccur,-
rence" or an offense which mC1Y result in a
claim. To the extent possible, such notice
should Include:
@ 2005 TtJ~ SI. Pi::lU1 TrCivt:l~n:i CUIIl~C1nitl::i, Irlt,;,
Pi:1!:1t: 1 u( 2
COMMERCIAL GENERAL UABILI rv
i. How, wtlen Elnd where the "oocurrence"
or offense took place;
ii. The names and addresses of any injured
persons Elnd witnesses; and
iii. The nature and location of any injury or
damage arisi ng out of the "occurrence" or
offense.
b) If a claim is made or "suit" is broughl against
the additional insured, the additional insured
must:
i. Immediately record the specifics of lhe
claim or "sult" and the dale 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
~ourr CIS pr~clica\JIH,
c) The additional insured must immediate:.ly
send us copies of all legal papers receIved in
connection wI1h the clair':l or "SUIt", coop13rate
with us in the investigation or settlement of
the claim or defense against the "suit", and
otherwise cDmply with all policy conditions.
d) The additional insured must tender the de-
fense and indemnity of any claim or "suit" to
Pd8e 2 ur 2
any provider of "other insurance" which would
cover thc Ddditions) insured for a loss we
cover under this endorsement. However, this
condition does not affect whether the insur-
ance rrnvided to the additional insured by
this endorsement is primary to "other Insur-
ance" available to the additional insured
which COV13rs that person or organization as a
named insure<:! as described in paragraph 3.
above.
!), The following definition IS added to SECTION V.
- DEFINITIONS:
"Written contract requiring insurance" means
that port of any wrilten contred or agreement
under whIch you are required to include a
person or organization as an additional In-
sured on this Coverage Part, provided that
the "bodily Injury" and "property damClge" oc-
curs and the "personal injury" is caused by an
offense cDmmitted:
a. After the signing and execution of the
contract or agreement by you;
b. While lhat part of the contract or
agreement is in effect; and
c. Before the end of the policy period
@ 2005 Tilt:: 51. Pi::lul Tri:lVl:1ler~ Cur npclr lie::;, lIlt;,
CG D2 46 08 O~
Page 1 / 1
r~'
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
r -::--1
VENDOR: 000903
PACIFIC PAVING, INC
POBOX 2370
WHITE CITY, OR 97503
SHIP TO: Ashland Water Department
(541) 488-5354
90 N MOUNTAIN
ASHLAND, OR 97520
FOB Point:
Tenns: Net
Req. Del. Date:
Speciallnst:
Req. No.:
Depl: PUBLIC WORKS
Contact: Terry Oldfield
Confinning? No
Furnish and install 4" of asphalt over
trench patch approximately 2,290sf.
8,565.00
Contract for Services
Date of aareement: 10/30/2008
Beainnina date: 10/31/2008
Completion date: 11/21/2008
Insurance reQuired/On file
BILL TO: Account Payable
20 EAST MAIN ST
541-552-2028
ASHLAND, OR 97520
SUBTOTAL
TAX
FREIGHT
TOTAL
8 565.00
0.00
0.00
8,565.00
AP~
VENDOR COpy
A request for a Purchase Order
REQUISITION FORM
CI.TY OF
ASHLAND
Date of Request:
THIS REQUEST IS A:
D Change Order(existing PO #
Required Date of Delivery/Service:
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
f 4- c.. l F l. c..... {/4u I 'l1 C,
f~CJ,~o)C ~3'lO
LV /.t I rF c.. l r-y . a..e
541- '} '1 ~ .- tit!" (,
b'il - 1) 0 - W,L?-
9 ? )0 3
SOLICITATION PROCESS
Small Procurement
o less than $5,000
o Quotes (Optional)
mediate Procurement
(3) Written Quotes
(Copies attached)
o Sole SourCe
o Written findings attached
o Quote or Pro sal attached
Coooerative Procurement
o State of ORIWA contract
o Other government agency contract
o Copy of contract attached
o Contract #
o Invitation to Bid
(Copies on file)
o Reauest for ProDOsal
(Copies on file)
o Soeciall ExemDt
o Written findings attached
o Quote or Pro sal attached
o Emeraencv
o Written findings attached
o Quote or Pro sa attached
Description of SERVICES
~\~Cje) S'~ A--s-r~T' P~4<'o "Al l1-o'--{. sr
.>f?Ht..' d41L / o/fllcJi' r/I'JI.r~: 1J.4-~. /,; :z.'10f'
o Per attached PROPOSAL
Total Cost
Item # Quantity
Unit
Description of MATERIALS
Unit Price
Total Cost
Project Number ______ - ___
Account Number f,J,.f) df- J1-(J:2- _~Q~!tPO
.. Items and services must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately.
o Per attached QUOTE
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: ~ O..it.f.;:(/
SupervisorJDept. Head Signatu~ c.. ~
G: Finance\Procedure\AP\Forms\8_Requisition form revised.doc
Updated on: 10/30/2008