HomeMy WebLinkAbout2009-007 Contract - DNA Excavation
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: DNA Excavation
CONTACT: Don Anderson
ADDRESS: PO Box 1087, Phoenix, OR 97535
TELEPHONE: 541-210-2104
DATE AGREEMENT PREPARED: 12/26/2008 FAX: 541-535-8588
BEGINNING DATE: January 5,2009 COMPLETION DATE: January 19, 2009
COMPENSATION: Not to exceed $4,050.00, per attached estimate 00/129, dated 12/23/2008'"
GOODS AND SERVICES TO BE PROVIDED: Contractor to install four 4" conduits. Two conduits from vault
90' to back of building and two conduits to small vault in middle of alley. Conduits will be bedded in sand and
trench will be back filled with 3/<( minus and paved back. Paving back trench $1,400 and Equipment, labor and
materials $2,650
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 2798.220, 2798.225, 2798.230, 2798.235, 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 8 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
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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 contract.
e. Gbliqation/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 GRS 279A.11 0 or the administrative rules implementing the Statute.
12. Asbestos Abatement License: If required under GRS 468A.71 0, Contractor or Subcontractor shall possess an
asbestos abatement license.
13. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work
without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be
void. Contractor shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all
persons employed by them, and the approval by City of any assignment or subcontract shall not create any
contractual relation between the assignee or subcontractor and City.
14. Use of Recyclable Products: Contractor shall use recyclable products to the maximum extent economically feasible
in the performance of the contract work set forth in this document.
15. Default. The Contractor shall be in default of this agreement if Contractor: commits any material breach or default of
any covenant, warranty, certification, or obligation it owes under the Contract; if it loses its QRF status pursuant to
the QRF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a
QRF if Contractor has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has
instituted against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing
business on a regular basis of the type identified j,t1 its oqligations under the Contract; or attempts to ~s"n rights in,
or delegate duties under, the Contract. ~~i/~ - /t/o ~~ j""-S v;:7
16. Insurance. tjts expense provide the following insurance: "V'
a. Worker's Com ensation" rance in compliance with GRS 656.017, which requires subject employers to
provide Grego mpensation coverage for all their subject workers
b. General Liabili~ [n~HJL~_e with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000($'1-;-000,006, Se,ooo,OOO or Not Applicable for each occurrence for Bodily Injury and Property
Damage. It shall inc~alliability coverage for the indemnity provided under this contract.
c. Automobile . .. ~ance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000,000, (:}r Not A licable for each accident for Bodil In" r and Pro ert Dama e,
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 2 of 9 ?1 t
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including coverage for owned, hired or non-owned vehicles, as applicable.
d. Notice of cancellation or chanqe. There shall be no cancellation, material change, reduction of limits or
intent not to renew the insurance coverage(s) without 30 days' written notice from the Contractor or its insurer(s) to
the City.
e. Additional Insured/Certificates of Insurance. Contractor shall name The City of Ashland, Oregon, and its
elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only
with respect to Contractor's services to be provided under this Contract. As evidence of the insurance coverages
required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to commencing work
under this contract. The certificate will specify all of the parties who are Additional Insureds. Insuring companies
or entities are subject to the City's acceptance. If requested, complete copies of insurance policies, trust
agreements, etc. shall be provided to the City. The Contractor shall be financially responsible for all pertinent
deductibles, self-insured retentions and/or self-insurance.
17. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws
of the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or
proceeding (collectively, "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 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.
CONTRACTOR, %/.? .
BY ;J~ L~
, \ Signqture
CITY OF ASHLAND:
BY
ECTOR
TITLE
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DATE
/
DATE
A,RD AND FIN9fNGS" D D~E R,,~M~D BY:
.~vv1A4t/t4'tl' I
City Department Head Date'
*Completed W9 form must be submitted with contract
PURCHASE ORDER #
Mt?// /gtPC/7t!/~/~
(For City purposes only)
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SL\J - \ ~)r -O(lC) l
ACCOUNT #
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 3 of 9
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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:
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(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.
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Con ractor ( ate)
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 4 of 9
, r
Form W-g
(Rev, October 2007)
Request for Taxpayer
Identification Number and Certification
Give form to the
requester. Do not
send to the IRS.
Taxpayer Identification Number (TIN)
D Exempt
, payee
Requester's name and address (optional)
Enter YOLlr TIN in the appropriate box, The TIN provided must matcll tile name given on Line 1 to avoid
backup withholding, For individuals, this is your social secLlrity number (SSN), However, for a resident
alien, sole proprietor, or disregarded entity, see tile Part I instructions on page 3, For otller entities, it is
your employer identification number (EIN), If you do not have a nUlilber, 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,
I s~al"~ "'!"~'. ~J
~')<fJ: l~)r: om
or
Certification
Employer identification number
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) tllat I am subject to backup witllholding as a result of a failure to report all interest or dividends, or (c) tile IRS l,as
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, ments otller than interest and dividends, you are not required to sign the Certification, bLlt you must
provide your correct TIN, See th ~ structions on page 4,
Sign
Here
Section references are to the Internal Revenue Code unless
otherwise noted,
Purpose of Form
A person who is required to file an information return with the
IRS must obtain your correct taxpayer identification number (TIN)
to report, for example, income paid to you, real estate
transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt. or
contributions you made to an IRA.
Use Form W-9 only if you are a U,S, person (including a
resident alien), to provide your correct TIN to the person
requesting it (the requester) and, when applicable. to:
1, Certify that the TIN you are giving is correct (or you are
waiting for a number to be issued),
2, Certify that you are not subject to backup withholding, or
3, Claim exemption from backup withholding if you are aU,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,
Definition of a U.S. person. For federal tax purposes, you are
considered a U,S, person if you are:
. An individual who is a U,S, citizen or U,S, resident alien,
. A partnership, corporation, company, or association created or
organized in the United States or under the laws of the 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 in a
partnership conducting a trade or business in the United States,
provide Form W-9 to the partnership to establish your U,S,
status and avoid withholding on your share of partnership
income.
The person who gives Form W-9 to the partnership for
purposes of establishing its U,S, status and avoiding withholding
on its allocable share of net income from the partnership
conducting a trade or business in the United States is in the
followi ng 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
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ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY)
TM 01/13/2009
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Ag Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Petrik Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
2119 7th Street
Baker City OR 97814 INSURERS AFFORDING COVERAGE NAIC#
INSURED Donald Anderson INSURER A: The Ohio Casualtv Insurance Company
DNA Excavation INSURER B:
P.O. Box 1087 INSURER C:
Phoenix OR 97535-1087 INSURER D:
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.
I~~: ~~~~ -.-- POLICY NUMBER POLICY EFFECTIVE I POLICY EXPIRATION LIMITS
~NERAL LIABILITY EACH OCCURRENCE $ 1,000,000
A X COMMERCIAL GENERAL LIABILITY BLO 53527681 08/22/2008 08/22/2009 DAMAGE T9,..RENTED S 100,000
I CLAIMS MADE D OCCUR MED EXP (Anv one oerson) $ 10,000
- PERSONAL & ADV INJURY S 1,000,000
I-- GENERAL AGGREGATE $ 1,000,000
n'L AGGREnE LIMIT APnS PER: PRODUCTS-COM~OPAGG S 1,000,000
POLICY ~~T LOC
I
~TOMOBILE LIABILITY I COMBINED SINGLE LIMIT
(Ea accident) $
- ANY AUTO
- ALL OWNED AUTOS BODILY INJURY
(Per person) $
- SCHEDULED AUTOS
- HIRED AUTOS BODILY INJURY
(Per accident) $
I-- NON-OWNED AUTOS
~ PROPERTY DAMAGE $
(Per accident)
~RAGE LIABilITY AUTO ONLY - EA ACCIDENT S
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG S
OESSIUMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR D CLAIMS MADE AGGREGATE S
$
R DEDUCTIBLE S
RETENTION S $
WORKERS COMPENSATION AND I ~gJJ~T.~~ I ! OJ61-
EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $
ANY PROPRIETOR/PARTNERIEXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE S
If yes, describe under E,L. DISEASE - POLICY LIMIT $
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER
CANCELLATION
Kari Olsen
City of Ashland
90 N. Mountain Ave
Ashland, OR 97520
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAil .J.L DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINO UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
~
ACORD 25 (2001/08)
@ACORDCORPORATION 1988
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ACORD CERTIFICA TE OF LIABILITY INSURANCE I OA TE lh\h\/OOTYY'N)
. rlJ 01115/2009
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
AS Ini\,Jranc~ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA TE
HOL.DER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Petrik Agency AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
2119 7th Street
~ake~ City OR 97814 INSURERS AFFORDING COVERAGE NAIC#
, .
INSURED Oonald A.nderson INSURER A: UbertY..~~.r1hwe$t
,-
DNA Excavation INSUHER 8, ...
.', ,.. ..,
P.O. Box 1087 INSJ.LR~R c:
-,
Phoenl~ OR 97535.1087 INSURER D
, ..
IN~URE.R 1::.:
COVERAGES
rH~ POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEO ABOVE FOR THE POLICy PERIOD INDICATED. NOT\MTHSTANDING
P.NY REQUIREMENT. TERM OR CONDITION OF ANY CONTR^CT OR OTHc'R DOCUMEN'r WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED O~
MAY PERTAIN, TH~ INSURANCE AFFORDED Elv THF:: POLICIES DESCRIBEO HE:R~IN IS SUBJECT TO ALL THt: TERMS, EXCLUSIONS AND CONDITIONS UF SUCH
POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
~~~~ .. .- pm~y f:FFECnVE P~~~j' E)I;PIRATION
INSR - POLICY NUMBER LIMITS
ITIt 'T'Y'P~ O~
GENERAL UA81UTY FACH OCCURRENC[;: S
- DAMAG~ TO RENT!=;D
- COMMI::.RCIAl G!;,Nf'=AAL LIABILITY 'c;; lE,B C,"',r.u"-n,.,,.,1 .$ ..
~" CLAIMS MAl)f D OCCUR Mr;D E:XP (An\! O!"tl ~~"'~n) ~
- PeRSONAL & ADV IN.Il.l~'I" ~- -
GCNCRALAGUREGATE ,.... ~ "--
CEN'L AGGRr~.!r LIMIT ^Y1!~t PER PRODUCTS. COMPIOP AGG $
~ "OLlC'r' ~fPj IOC
~TOMOBIL~ lIA8ILI'l'Y COMBINED SINGLC LIMIT $ 1,0001000
A ANY AUTO BAW 53527681 8/22/2008 8/22/20Q9 (E~ :!CI:lic1~nt)
- f--- -
- ALL OWNED AUTOS 60DIL y INJu~y
$
x ~CHEDULED AUTOS (PI:lI person)
,- 1---' - ..
:l HIRE:D AUTOS BOLlIL Y INJURY
r--- $
II NUN-DWNED AUTOS (POI ~t;t;jd[:nt)
-, -.-
- ....- PROPeRTY DAMAC,I= $
(Per ..c;<;idanl)
GARAGE LlABIUrr AU II) UNL Y . EA ACCIDENT $ ...
n ANYAUTO OT11E:R THAN ~~cr. $
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EXCESSJI)/..lBRELLA UAC31LITY -St\CI'1 QCCURKtNCE $
J OCC:I JR o CLA.IMS MAUE:: AG\:RECATE $ .,-
~-
--- $
R UtUUCT'BLE ~
I1ETCNTION :jI :Ii
WORlCl!RS COMPENSAllON AND I ~~,,~r~m~ I IO!~.
EM PLOYE;RS' LIA61LIlY ...E.:.hF:Ar.H AC;:.CIDI::N r ~
AN'!' f'RUI-'RIETOR/PARTNERlEXEqmvE
O~FICErlJM[MBER tJl\~LUDED? f.:1 .nlSEASE - EA EMPLOYE!:' $ - --
~~EC It(p~bo~;~1o~~ hnlQW c,L. DISEASE. POliCY LIMIT $
OTHER
I
DESCRIPTION OF OPERA nONS I LOCA "ONt) f VEHICLES I EXCI.USIONS ACCt!.O BY ENDORSEME.Nll SPECIAL PROVISION5
1983 Ford F2S0 vln#1FTHF2612DPA40803
CERTIFICATE HOLDER
Karl Olsen
City of Ashl:md
90 N. Mountain Ave
Ashland, OR 97520
CANCELLA TION
SHOULD A.NY OF THE ABOVE DESCRIBED POUCIES Be CANCELLED BI!!!OR~ Tl-tE UPIRA TlON
DATI! TH2REOF. THE ISSUING INSURER WILL ENO[;AVOR TO MAlL -!L DAYS WJlI1T!:N
NOTICe. TO 'J"HE CERllF1CATE HOLDER NAMED TO THE LEH, BUT ~All.URE TO DQ $0 SHAl.L
IMPO~E NO OBLlGAllO~ OR L1ABILlT't' OF ANY KINO UPON TK!. IN6URER, ITS AGE;NT9 OR
ACORD 25 (2001/08)
~c 23 08 08:48a
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. DNA Excavation
b41-oj~o~~
CCB# 55306
PO Box 1087
Phoenix:! OR 97535
NAME' ADDRESS
Ashland Electrical Dept
90 North Mountain A V.
Ashland OR. 97520
DESCRIPTION
This estimate is for installing four 4" conduits. Two conduits from vault 90' to back of building and lWO
conduits to small vault in middle of alley. Conduits will be bedded in sand and trench wilt be back filled
with 3/4" minus and paved back.
Paving back trench.
Equipmen~Labor, and materials
This is only an Estimate
This is only an estimate. Estimates are subject to change as job description
changes or as more work is included in the job. Estimates are Void after 30
Days from date above.
SIGNATURE
Phone #
Fax #
54]-210-2104
541-535-8588 call f...
p. I
Estimate
DATE ESTIMATE NO.
12/23/2008 00/129
PROJECT
A lIeyway beside US B...
TOTAL
1,400.00
2,650_00
TOTAL
$4,050.00
Page 1 / 1
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CITY OF G~
ASHLAND
20 E MAIN ST.
ASHLAND1 OR 97520
(541) 488-5300
1"""; ~"~CO~~ r-R
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I 'i- . I .. \- 1I::~~09
PO NUMBER
08762
VENDOR: 011484
DNA EXCAVATION
PO BOX 1087
PHOENIX, OR 97535
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
Quantity Unit Description Unit Price Ext. Price
Contractor to install four 4" conduits. 4,050.00
Two conduits from vault 90' to back of
buildinq and two conduits to small
vault in middle of alley. Conduits will
be bedded in sand and trench will be
back filled with 3/411 minus and paved
back. Location: Alley next to US Bank
Pavinq back trench $1,400.00
Equipment, labor and materials $2,650.00
,
Contract for Services
Beqinninq date: January 5, 2009
Completion date: January 19, 2009
Insurance required/On file
SUBTOTAL 4 050.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 4,050.00
ASHLAND, OR 97520
Account Number
E 690.11.18.00.70410
Project Number
E 000143.999
Amount
4,050.00
Account Number
Project Number
Amount
~ :Is 0/
VENDOR COpy
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CITY OF
ASHLAND
REQUISITION FORM
THIS REQUEST IS A:
D Change Order(existing PO #
Date of Request: I /.;2-2 ~~
Required Date of Delivery/Service: \ \
Vendor Name
Address
City, State, Zip
Telephone Number
Fax Number
Contact Name
I)N 14 I3A'c/1VaC-/ON
~ C). ~ J()87
''hO~~ " .rc . q Z')ZO
."5 L/ 1- - '. /~ '()L( ,
.5 ~ / - {5~~ ,I:) - 'F? 5 PES
~/-'1'L/
, d A1Jf~'f?'~~~
SOLICITATION PROCESS
Small Procurement D Sole Source D Invitation to Bid
D Less than $5,000 D Written findings attached (Copies on file)
D Quotes (Optional) D Quote or Proposal attached
Cooperative Procurement D Reauest for Proposal
D State of OR/W A contract (Copies on file)
Intermediate Procurement D Other government agency contract D Special I Exempt
lld' (3) Written Quotes D Copy of contract attached D Written findings attached
(Copies attached) D Quote or Proposal attached
D Contract # D Emeraencv
D Written findings attached
D Quote or Proposal attached
Description of SERVICES
Total Cost
~~--r?- ~~_yf..Z;" ,f - -5 c 'I' '
o Per attached PROPOSAL ~&-?n-,: (~<-.'1~'.:5~, <tal.? f~ 1"/9 '" 0 9
050,
o
Item #
Quantity
Unit
Description of MATERIALS
Unit Price
Total Cost
TOTAL ,COST
0 Per attached QUOTE
---._-~~--~~--.~
Proje t NumberQf'Pl~~- ~~~) $
--
Account Number(?9t2-11 - L6- QQ-]g!:.{lP.1)
* Items and services must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately.
By signing this requisition form, I certify that the information provided above meet~J!!g.CityorAshJandPliblic-(J()ntractil19re9uyements,
and the documentation can be provided upon request. . ~ ~
Employee Signature: Wflk.l:J) ,-1~. Supe isor/Dept. Head Signa ure:.. ~ \ ~. /~'-'
-~--------- --~-- ~ -~~--
G: Finance\Procedure\AP\Forms\8_Requisition form revised.doc
Updated on: 12/23/2008
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