HomeMy WebLinkAbout2009-008 Contract - Pacific Paving Inc
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: 01/13/2009 FAX: 541-830-4612
BEGINNING DATE: 01/15/2009 COMPLETION DATE: 01/16/2009
COMPENSATION: $4,920.00, Per proposal dated 01/09/2009.
GOODS AND SERVICES TO BE PROVIDED: Furnish and install 4" of asphalt over trench patch
approximately 1,315sf. Location: Holly Street, Idaho to Taylor Street
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 500/0 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. 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
------WT
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.710, 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 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 coveraoe 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
--- ----~---11T 1
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.
CITY OF ASHLAND:
BY
TITLE
Print Name
~~~ frrU.SWU-IL
DATE
/
DATE
I . \ ~ · 04
CONTRACT AWARD AND INDINGS DETERMINED BY:
By: ~ '-:J
City Department Head
Date: , \ \ t. 161
6' 7~ 6J8 (B' tJ}07&~'1' CJO
(For City purposes only)
C/@760
FederallD#
l\~ ~ 't)lD4\.9~~
ACCOUNT #
*Completed W9 form must be submitted with contract
PURCHASE ORDER #
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 3 of 9
~._,._- ..Ilr.. T
EXHIBIT A
CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the
number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be
issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from
backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is
subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS
has notified it that it is no longer subject to backup withholding. Contractor further represents and
warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the
Contract, when executed and delivered, shall be a valid and binding obligation of Contractor
enforceable in accordance with its terms, (c) the work under the Contract shall be performed in
accordance with the highest professional standards, and (d) Contractor is qualified, professionally
competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury
that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on
behalf of the entity designated above and authorized to do business in Oregon or is an independent
Contractor as defined in the contract documents, and has checked four or more of the following
criteria:
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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.
\ t t3~O~
(Date)
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 4 of 9
--nr-r--
Form W-g
(Rev. October 2007)
Department of the Treasury
Internal Revenue Service
Name (as shown on your income tax return)
Request for Taxpayer
Identification Number and Certification
Give fonn to the
rvquester. Do 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 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 ce~ify 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
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. aoquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
arrangement (IRA), and generally. payments other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. See the i at page 4.
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Taxpayer Identification Number (TIN)
o Exempt
payee
Requester's name and address (optional)
I Social eecurity number
, ,
or
~p1py.r ide?tific,tion n
~ -::>: \O~%9.
Sign
Here
Date ~
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 for a number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claimexemption 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.
Deftnmon 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
following 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
III T--
01/13/2009 08:20
.5418304612
PACIFICPAVINGINC
PAGE 02
City of Asbland Water Department
N Mountain
January 9, 2009
Attn: Terry Oldfield
PROPOSAL SUBMlTI'ED TO:
97520
Idaho.to Taylor
Ashland
Commercial Patching
ITY-
STA TB
We hereby submit specifications and estimates for:
1. Furnish and install 4" of asphalt over trench patch approximately 1,315sf.
~o ACCEPT srG'N &
~,!CJTlJ r~N 7"OP cO'PY
We hereby 1lftIIIOIC to furnillb tbc: .bove k\bar and fltldrlriaIa in accord81Klc . t~ ltbcwe ~CIIicm, for tbC IRmJ of.
....Four Thousand Nine Hundred Twenty and 00/100*** .
doIlm (5 ***$4..92Q.OO***)
TERMS: C. an COID1tlelion of job.. unl_ <JdK:r ~ are made m writius. A 1% pet"monIh FINANCE CHARGB will be lidded on IIn past chic accDur1b,.
lltI ANNUAL PERCENTAGE RA't6 ()1l' 249'. 1ft 1M event .my bBlemc is __ (nret' ~ IIlI1t1Dmey fbr coIleetkm. otif .1a\wldt is filed 1IJ coIlCct ~ balance.
incJudiN gppaIs 10m vial.lhc ~ling pMy 8IIa1l be entitled 10 his ~fllltOmey fees ancllaSOD8b1c ~ ofJitiplioo, svda IS investi~
~ ~iomd pnxlCIS IOd othct lib~. All mataiII is ~.ltted to be.. sptCitied. All WOJt; 11) he camplcted tD I WorkmIlhJ~ IIt8mCI' llCCOfdiDg
to ~ ~ces. Any IIltvnIticm or devi8&m 10m abcm specitialdOrJs br.dYins Idclitional work aod ... Q)StS 'friO become an CXb ~ on::r and 8IJove
the c:stimIIe. If subbase lSldfor b8SO is ~ by Cltbcrs, 1bIn gulnll80 .s1hnitt:d by wodauDsIfip. The ~ so.1 _liZllliao process' wilt not IdII all typeS or
1~ and we willllOt be rcspousiblo i1r ~ damIged ,.mnI!Dt due to the ~ of .4. 1.100. All ~ CClGtkngenl upclIl stribs. ~ or delays
~ QIIf control. Jfdlis eontnld ~ $1.000. tile owner acI!:notrJafF,9 rcc:eipt oftbe "Information ~ to JbhtoM'lel'lJ about C~ 1..icns." This
~ may be wilhdrawn by \II if not ~ within 30 days. CCB #50835
~ ~tJ. ~G4-e' TmyWSimeoe ..
-'-' . - - ACceptance of Proposal
Dc above prices, specifications and condmons are satisfadory and are hereby acc:epted. You arc authori2'led to do all of the work Q specified.
payment will be ~ade IS outlined above.
Signatur; .
Date
-fiT
ACqRD", CERTIFICATE OF L.IABILITY INSURANCE OP 10 SU I DATE (MMlDDIYYYV)
PACI05W 09/30/08
PROOUCER 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: SAIFCorporation - 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 INDI~ATED. 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 'D~~~lriMfJif~ve- I Pgi TE" 'MMib'IDYY~N LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
- LJ1\MI\\:lt: I U_l1I:N II:U
COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) $
- o CLAIMS MADE 0 OCCUR
MED EXP (Anyone person) $ .----
-
PERSONAL & ADV INJURY $
-
GENERAL AGGREGATE $
-
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.COM~OPAGG $
I POLICY n ~~g: nLOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
- (Ea accident) $
ANY AUTO
-
ALL OWNED AUTOS BODILY INJURY
- (Per person) $
SCHEDULED AUTOS
-
HIRED AUTOS BODILY INJURY
- (Per accident) $
NON-OWNED AUTOS
-
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
=i ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
~ OCCUR o CLAIMS MADE AGGREGATE $
-.---.
$
=i OEQUCllBlE $
RETENTION $ $
WORKERS COMPENSATION AND X IrORY LIMITS I IO~H'
ER
A EMPLOYERS' LIABILITY 812919 10/01/08 10/01/09 E.L. EACH ACCIDENT $ 500,000
ANY PROPRIETORlPARTNERlEXECUTIVE
OFFICERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $500,000
'. '~~~~I~Ls~~~J:S~~NS b~l~ . -'-. ..._~..- &. . . -..." .- ". ., . . . - -....... -.... $ 500,0'00 -
E.L. DISEASE - POLICY LIMIT
OTHER
DESCRIPTION OF OPERA nONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENpoRSEMENT / SPECIAL PROVISIONS
RE : All Operations
CERTIFICATE HOLDER
City of Ashland
90 N Mountain Ave.
Ashland OR 97520
CANCELLATION
CITAS02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITTEN
NonCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUT IZEQ.REPRES
ACORD 25 (2001/08)
@ACORD CORPORATION 1988
---m-T
A CORD.., CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDNYYY)
10/3/2008
PROC1IJCER (54~)772-~111 ~AX: (541)772-3785 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAll0N
Beecher Carlson Insurance Agency LLC ONL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERllFICATE DOES NOT AMEND EXTEND OR
707 Murphy Rei AL TER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Medford. OR 97504 INSURERS AFFORDING COVERAGE NAICff.
INSURED INf,l'REFi A. Travelers
Pacific Paving Inc IN;,.I!h:l:k h Developers Surety &
PO Box 2370 INSURER C
IN:;;I.RFI1f'l
White city OR 97503 INSURER E..
COVERAGES
I HE: 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 PCRTAIN,
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AG ,REGATE LIMITS SHOWN MAY HAVF BEEN REDUCED BY PAID CLAIMS
I~{: ~~~~ TYPE OF "~SURANCE POLICY NUMBER P~i~~~~~~A.~r p~~J(~~b~~~N LIMITS
GENERAl LIABILITY
f--
~Ml:h'CIAI. <3tl\cl<AL lIAl:1l1l 'r
X ~I--J CLl...IMSMADE ~ 0CCUR DTC0526DS41 '7TILOS
I
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A
A
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loENl AGi,F1[::,I\TE i.lM1T ,'>PPLlES PER
!Xl FOLIC'\' ~t-~~f Z~~- n LaC
AUTOMOBILE LIABILITY
c--
~ flN'r AUTO
f-- I'LL ()VllNCDAIJ~03
~:;CHl:()1 )LEu AlJT-::,~;
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~ - r; ED AUT ,)'~
~ I\ON-O\\1\E[) AUTOS
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DT910526D841'7TIL08
EACH OC::URREN::E !J. 1,000,000
~~t~H?E~~:~~~{lr.~' $ 100,000
3/20/2008 3/20/2009 ""ED FiVO (....'w 'JI~ rti'!rs..:n\ $ 5,000
PERsmJ/.t. P..flDV I~U..R'( $ 1,000,000
GENE~AI.. A(;m~EGATE $ 2,000,000
00..,....' II"T~ _ crM:'/I)p AC;(; $ 2,000,000
COM[lINFD -jINGLE lIMIl $ 1,000,000
lc;:; :f(Y~fdp.ntl
3/20/2008 3/20/2009 5=.)[)lt.. !',".Uf~'1
r'r.r [...,.....on) $
EilXII_ y IN.A!RY $
it>llr aCmlP.fl( I
PR:lPERTY DiW^GE $
F'F.r Rr.rirl"nl)
GARAGE LIABILITY
R ~NV AI.lTo)
FXCF5S/UMARFI I A I IAf.\II.ITY
o 1),-(:I.lP 0 ,-:LAIMS MI>DE
AUTO ON'_ '( . ::A ACCIDE\lT $
OT -jEll HIM..J EA Ace 1$
Ao.ITIJ (,'N'.'(
AG(, $
R [lEDUC T16LE
RETE~.JT 0"1 'J
WORKERS COMPENSATION AND
EMPI.OYERS'LlABILlTY
.IW Y .DP',)PP.IETOR,PART.'IIER:EXECI.fTlIfE
OFFIr.=R/MFlilAFR F)l1.I1 inFO?
II \'I'l!; llA~("rt".F lJocl;\r
:;PFC:It.1 :'P.OV 'SIONS hAlON
BOTHER Contraotor' s Lioense 7B601BC
Bond
I=ACH 0C::URRFN"':F $
t.m;r?F(~AT:: $',
$
$
$
7/1/2008
7/1/2011
IT~~[~~~ I IOrW
E,L EACt-. ACC[)E.\IT $
E L ()I::'EA.-x:. EA =-MF1.lJ fEE $
=.LDISEASE- POLlC'{LIMlT $
I
Limit
$20,000
DESCRIPTION OF OPERATIONSIlOCATIONSNEHICLES/EXCLUSIONS ADOED BY ENDORSEMENTISPECIAL PROVISIONS
The City of Ashland, it's officers. agents and employees are included as additional insured as respects to genera~
l~~hility per CG 0246 09/05 where required by written contract. This form is subject to policy terms; conditions,
and exclusions.
CERTIFICATE HOLDER
1(54:1.) 488-5320
The City of ASh1and, its officers, agents
and e:mp~oyees
90 North MOuntain Avenue
Ashl~d, OR 97520
CANCELLA TION
I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CA,,!CELLEO BEFORE THE
EXPlRAll0N DATE THEREOF. THE ISSUING INSURER 'MLL ENDEAVOR TO MAIL
:1.0 DAYS VVRIITEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUl
FAILURE TO 00 SO SHALL IMPose NO OBUGA nON OR LIABILITY OF ANY KIND UPON THF.
INSURER. ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE /)
A S latt e.::'y, CI.3R./l..MBE tJ/-otAa /;htt,cJ---
@ ACORD CORPORATION 1988
ACORD 25 (2001/08)
INS025 {01061 O!i.~
~1ag" 1 O' J
----~--- --- TTr T
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDiTIONAL INSURED
(CONTRACTORS)
This endorsemenl 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 IIwritten contract requiring insurancell
to Include as an additional insured on this Cover-
age Part, but: '
a) Only with respect to liability for "bodily injury",
"property damage" or "personal InJury"; 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 Nwritten contract
requiring insurance" applies, Tile 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 that the Limits of Insurance of
Ihi~ ~OVRr;:l!JR Pmt ~hown in thA ()p.r:I~r~tionR
exceed the limits of liability req.uired by the
"written conlract requiring insurance''. the in-
surance provided to the additional insured
st:all be limited to the limits of liability re-
quired by Chat "written contracl requiring in-
surance". This endorsement shall not in-
crease the limits of insurance dee::cribad in
Section 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 oul
of the rendering of, or failure 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, rsports, surveys, field or-
ders or change orders, or the preparing,
approving, or failing to prepare or ap-
provo. drawings andspocifications; and
ii. Supervisory, inspection, architectural or
engineering activities.
CG 02 46 08 0 ~
The Insuranc6rProvided to the additional in-
sured does not apply to "bodily injury" or
"property damagel~ caused by "your work"
and inoluded' in the "products-completed op-
erations hazard" unless the "written conlract
reqUiring insurance" spe'cifically requires you
to provide fluch covcrngc for that additional
insured, end then the insurance provided to
the additional insured applies only to such
"bodily injury" or "property damage" lhat oc-
curs before the end of the period of time for
which the "written contracl requiring insur-
ance" requiJ ~~ you to provide such coverage
or the end of the policy period. whichever is
earlier.
3. The insurance provided to the additional insured
by this endor5em'ent is exce85 over any valid end
COllectible "other insurance", whether primary,
excess, contingent or on any other basis, that is
avaflable to the additional Insured for a loss we
cover under this endorsement. Howeve~, if the
"written contract requiring insurance" specifically
requires that this insurance apply o,n a primary
Ul::/sls or ~ prirm~ry anu IlUfI-UJfI(rluu(ury uasls,
this insurance is primary to. "other Insurance"
available to the additional insurM 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 10
the additIonal insured by this endorsement sUII ;s
excess over any valid and collectible "other in-
surance", whether primary, excess, contingent or
on any other basis, that is available to the addi-
tional insured when that person or organlz.atlon is
an additional insured under such "other insur-
ance",
4. A~ ri r.onrlition of r.nVf~r::lgA (1rnvlrlArl to thp.
additIonal insured by this endorsement:
a) The additional insured must give us written
notice as soon 8!'> rm:tcticable of an I'occur-
rence" or an offense which mc.lY resul~ in a .
claim. To the extent possible, such notice
should Include:
@ 2005 Th~ 51. Pi:ful TrC:.'Jvt1lt:m:i COll1p(:Ir1i~s, IrIG.
Pi:f!:lt:: 1 ur 2
COMMERCIAL GENERAL UABILI fY
i.. How, when Elnd where the "occurrence"
or offense took place;
ii. The names and addresses of any injured
persons and witnesses; and
iii. 'The nature and localion of any. injury or
damage arisi ng out of the "occurrence" or
offcnsc.
b) If a claim Is made or "suIt" Is brought against
the additional insured, the additional insured
must:
i. Immediately record the specifics of [he
claim or "suit" and the dale received; and
II. Notify us as 800n as practicable.
The additional insured must see to it that we
receive written notice of the claim or "suit" as
~uu" i:::IS pri:iclicl::llJIH,
c) The additional insured must immediately
send us copies of aU legal papers received in
conneclion with the clair:, or "suit", cooperate
with us in the investigation or settlement of
the claim or defense against the "sui I", and
otherwise comply with all policy cDnditions.
d) The additional insured must tender the de-
fense and indemnity of any claim or "suit" to
PC1~e 2 ur 2
any provider of "blher insurance" which would
cover the Eldditional insured for a loss we
cover under this endorsement. However. this
condition does not affect whether the insur-
ance provided 10 the additional insured by
thIs endorsement is prima.ry to "oiher insur-
ance" available to the additional insured
which covers lllat person or organization as a
named insured as described in paragraph 3.
abov~.
!). The following definition is added to SECTION V.
- DEFINITIONS:
"Written contract requiring insurance'.' means
lhat part of any wrillen contract 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 damage" oc-
curs and the "personal injury" is 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 Tln:= 51. PCiul TrC:1vt:th:::r~ Cur"pc::HIIt:t~, lllu.
CG 02 46 08 O~
~---------- -'----..r--y
CITY RECORDER
r.,
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:
Asphalt PavinQ - Furnish and install 411
asphalt over trench, approximately
1,315sf
Location: Holly Street, Idaho to
Taylor St
Contract for Services
Date of aQreement: 01/13/2009
BeQinninQ date: 01/15/2009
Completion date: 01/16/2009
Insurance required/On file
BILL TO: Account Payable
20 EAST MAIN ST
541-552-2028
ASHLAND, OR 97520
~ ..L-.,,~ /'%<?
Auth . ed Signature /
DATE
1/13/2009
.. pQjNlJMBER
08760
SHIP TO: Ashland Water Department
(541) 488-5354
90 N MOUNTAIN
ASHLAND, OR 97520
Req. No.:
Dept.: PUBLIC WORKS
Contact: Terry Oldfield
Confirming? No
4920.00
VENDOR COPY
Unj!: Price:
SUBTOTAL
TAX
FREIGHT
TOTAL
- - ~-~TTI T
Page 1 / 1
EXt. Rrice
4,920.00
4 920.00
0.00
0.00
4,920.00
CITY OF
ASHLAND
REQUISITION FORM
Date of Request: / - /3" o?
THIS REQUEST IS A:
D Change Order(existing PO #
..
Required Date of Delivery/Service:
Vendor Name
Address
City, State, Zip
Telephone N~mber
Fax Number
Contact Name
P f.\o c. I ~ l c.. PAv I A.J GO
P'O,. (joy: ~3-?O
(,J If I 'fP ,et 1'"7 oR..,€. '0 N
S'll- '>.')'2-'('/(,
~'11 - &'3 () - Iff. 1:2
~?S"o 3
SOLICITATION PROCESS
Small Procurement o Sole Source 0 Invitation to Bid
~ Less than $5,000 o Written findings attached (Copies on file)
JgJ Quotes (Optional) o Quote or Proposal attached
Coooerative Procurement 0 Reauest for Prooosal
o State of ORI'NA contract (Copies on file)
Intermediate Procurement o Other government agency contract 0 Soeciall Exemot
o (3) Written Quotes 0 Copy of contract attached 0 Written findings attached
(Copies attached) 0 Quote or Proposal attached
0 Contract # 0 Emeraencv
0 Written findings attached
0 Quote or Proposal attached
Description of SERVICES
f'"u~ l S fI- f I AJ$ nt<--l. 'I " t-r ~ PHI4l.,1 0 v [It.. -r1t.(..AJ c....
It f~1t. 0 ~ .. 1315- s>-P
JlOl-c..1 SF. CIJ/J,/,fO ro rAYt4&!t, sr.
o Per attached PROPOSAL
Item # Quantity
Unit
Description of MATERIALS
Unit Price
Total Cost
Project Number ______ - ---
o Per attached QUOTE
Account Number 'j~- _of-lt- JJS!- _/to!lj~g
* Items and services must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately.
By signing this requisition form, I certify that the information provided above meets the City of Ashland public contracting requirements,
and the documentation can be provided upon request.
Employee Signature: .~ ()~ Supervisor/Dept. Head Signature: ::::::7 d ~ I--
G: Finance\Procedure\AP\Forms\8_Requisition form revised.doc
Updated on: 1/13/2009
HrT