HomeMy WebLinkAbout2009-010 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: 01/21/2009 FAX: 541-535-8588
BEGINNING DATE: January 26,2009 COMPLETION DATE: January 30,2009
COMPENSATION: Not to exceed $1,531.00, per attached estimate dated 01/13/2009
GOODS AND SERVICES TO BE PROVIDED: Contractor to install new 3" conduit from transformer to house
service at 473 Euclid Street. Equipment, labor, and sand supplied by DNA Excavation. Conduit and fittings
supplied by the City of Ashland.
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 followinQ
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 1 of 9
---------~-~~~-~-..ITr,
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. Gbliaation/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 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 obligat.iqns under the Contract; or attempts to assign rig?fs in,
or delegate duties under, the Contract. ~ ~ v~ - ~ ~ p ~ 7"c.LS Jt}-V
16. Insurance. C~aetor shall ~ ~ ense provide the following insurance:
a. Worker's Com ensatio . urance in compliance with GRS 656.017, which requires subject employers to
provide Grego s compensation coverage for all their subject workers
b. General Liab'" ce with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,00 $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 . ... ance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, 1,000,000 r Not Applicable for each accident for Bodily Injury and Property Damage,
includin covera e for owne , ired or non-owned vehicles, as a licable.
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 2 of 9
d. Notice of cancellation or chance. There shall be no cancellation, material change, reduction of limits or
intent not to renew the insurance coverage(s) without 30 days' written notice from the Contractor or its insurer(s) to
the City.
e. Additional Insured/Certificates of Insurance. Contractor shall name The City of Ashland, Oregon, and its
elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only
with respect to Contractor's services to be provided under this Contract. As evidence of the insurance coverages
required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to commencing work
under this contract. The certificate will specify all of the parties who are Additional Insureds. Insuring companies
or entities are subject to the City's acceptance. If requested, complete copies of insurance policies, trust
agreements, etc. shall be provided to the City. The Contractor shall be financially responsible for all pertinent
deductibles, self-insured retentions and/or self-insurance.
17. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws
of the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or
proceeding (collectively, 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 im'munity, 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.
CONTRACT CITY OF ASHLAND:
BY
BY
TITLE
L'/l'U /f/ tl' P
DATE
DATE
/-~<-CJ?'
FederallD#
.~~:z -<:' ~--~bC-//
ACCOUNT #
I
~ 9~ I( ~.~ t?-~ 7t!J~rCJCJ
(For City purposes only)
*Completed W9 form must be submitted with contract
PURCHASE ORDER #
0e3'i7':?
Contract for Goods ~nd 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:
,/'
L
(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 ;P ~~~ -
ntractor
)-n-69
(Date)
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 4 of 9
Fo~ W-g
Request for Taxpayer
Identification Number and Certification
Give form to the
requester. Po not
send to the IRS.
Enter your TIN in the appropriate box. The TIN provided must match the name given on Une 1 to avoid
backup withholding. For individuals, this is your social security number (SSN). However, for a resident
alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is
your employer identification number (EIN). If YOll do not have a number, see How to get 8 TIN on page 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter.
C$rtificatiQn
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 isslIed 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 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. acquisition or abandonment of secured property, cancellation of debt. contributions to an individual retirement
arrangement (IRA), and generally. p entsother than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. See the' ructions on page .
Taxpayer Identification Number (TIN)
D Exempt
payee
I so,,~..~ ~ - ,J
"'5~, , roo
or
Employer identification number
Sign
Here
General Instructions
Section references are to the Internal Revenue Code unless
otherwise noted.
Purpose of Form
A person who is required to file an information return with the
IRS must obtain your correct taxpayer identification number (TIN)
to report, for example, income paid to you, real' estate
transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or
contributions you made to an IRA
Use Form W~9 only if you area 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.
&x&mpt 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 FormW-9 to
request your TIN, you must use the requester's form if it is
substantially similar to this Form W-9.
Deftnltlon 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 busin~ss in the United States,
provide Form W-9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership
income.
The person who gives Form W-9 to the partnership for
purposes of establishing its U.S. status and avoiding withholding
on its allocable share of net income from the partnership
conducting a trade or businesS in the United States is in the
following cases:
. The U.S. owner of a disregarded entity and not the entity,
Cat. No. 10231X Form W-9 (Rev. 10-2007)
Contract for Goods and Services Less than $25,000, Revised 06/30/2008, Page 5 of 9
-m---r---
DNA Excavation
CCB# 55306
PO Box 1087
Phoenix~ OR 97535
NAME I ADDRESS
Ashland Electrical Dept.
90 North MOUJltain A V.
Ashland OR_ 97520
Estimate
DATE
ESTIMATE NO.
1/13;2009
00/130
PROJECT
473 Euclid Ave.
DESCRIPTION TOTAL
Install new conduit from lrdIlsforrncr to 473 Euclid Ave.
Equipment, Labor, and sand supplied by DNA ex.cavation. 1,531.00
Conduit and fittings supplied by City of Ashland.
This is only an Estimate TOTAL
$1,531.00
Thi~ is only an estimate. Estimates are subject to change asjob description
changes or as more work is included in the job. Estimates are Void after 30
Days from date above.
Phone #
Fax #
541-210-2104
541-535-8588 call f...
SIGNATURE
~
III-T
ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY)
TM 01/13/2009
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Ag Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Petrik Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
2119 7th Street
Baker City OR 97814 INSURERS AFFORDING COVERAGE NAIC #
INSURED Donald Anderson INSURER A: The Ohio Casualty Insurance Company
DNA Excavation INSURER B:
P.O. Box 1087 INSURER c:
Phoenix OR 97535-1087 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ~~?;~ ---- POLICY NUMBER POLICY EFFECTIVE I PRil$l EXPIRATION
ITD LIMITS
~NERAL LIABIUTY I 08/22/2009 EACH OCCURRENCE $ 1,000,000
A X COMMERCIAL GENERAL LIABILITY BLO 53527681 08/22/2008 DAMAGE TO RENTED S 100,000
I CLAIMS MADE D OCCUR I
I MED EXP tAnv one oerson\ $ 10,000
I S 1,000,000
- j PERSONAL & ADV INJURY
- I GENERAL AGGREGATE $ 1,000,000
n'L AGGRnE LIMIT APnS PER: PRODUCTS-OOMP~PAGG S 1,000,000
POLICY ~~9T LOC
I
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
-
- ALL OWNED AUTOS BODILY INJURY
(Per person) $
- SCHEDULED AUTOS
- HIRED AUTOS BODILY INJURY
(Per accident) $
- NON-OW NED AUTOS
f-- PROPERTY DAMAGE $
(Per accident)
RGEL-= AUTO ONLY - EA ACCIDENT S
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG S
~ESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR D CLAIMS MADE AGGREGATE $
$
~ DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I #.g9J~I~~ I I OJb'-
EMPLOYERS' LIABILITY E.L EACH ACCIDENT $
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.l. DISEASE - EA EMPLOYEE $
~~E~I~~spr~~V:~16NS below E.L DISEASE - POLICY LIMIT $
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 ~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ~
@ ACORD CORPORATION 1988
ACORD 25 (2001/08)
----nr,
JRN-19-2009 12:24 From:TOM_STANALAND
5417790570
To: 4885320
Page:2/3
i ACORD CERTIFICA TE OF LIABILITY INSURANCE I tlA T~ lMMIDDNYY"f'}
. r" 01115/2009
ipRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Ag InS\,Irance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Petrik Agency ALTER THE COVERAGE AFFORDEO BY THE POLICIES BEL.OW.
2119 7th Street
l!ake~ City OR 97814 INSURERS AFFORDING COVERAGE NAle #
.. . .,
INSURED Ocnald Anderson INSUReR P\. Uberty.~~.rthwe8t
... ..
DNA Excav,tion INSURER B. ." ... ..
...
.P.O.60x1087 INSURF..R c:
-. ..
Phoenix OR 97535-1087 INSURER D
....
INSURER c:
COVERAGES
THe POLICIES OF INSURANCE LISTED BELOW HAVE; BEEN ISSUED TO THE INSURED NAMEO AElOVE FOR THE: POLICY PERIOD INDICATED. NOT\MTHSTANDING
ANY REQUIREMI:NT, TERM OR CONDITION OF ANY CONTR^CT OR OTH~R DOCUMENT WITH RESpeCT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE; INSURANCE: AFFORDED BY THE POLlCIE:S OESCRIBED HE.R~IN IS SUBJE:CT TO ALL THt:: TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ~~~~ -.. - ~ .. .... P.9J.J.~'Y EfFECTIVE POLICY I:)(PlRATION . .
Ilh! POLICY NUMBER LIMITS
~EAAL UABILI'IY I:ACH OCCURRENce s
COMMt::RCIAL. GI:NF.AAL LIABILITY ~~ TO RENTF.r:l . .$
~ CLAIMS MAnE 0 OCCUR 'l:::i lE.A ' ..
~ Ml:D E:XP (Anv 0'-'''' ~~~~n) $
- PE.HSONAL. & ADV IN.J~IRY $.. -
.. G[N~RALAOUREGATE -. .'-
~'L AGGRnC LIMIT N'f~S PER: PRODUCTS ~ COMP/Of' AGO 5 -.
pOlle y ~EP- I.OC
~OMOBIU! L1A8Ill'l'Y COMBINED SINGLE LIMIT $ 1,000,000
A ANY AUTO BAW 53527681 8/22/2008 8122/20Q9 (E~ :scc.idr.nl)
- - -
- ^l.l OWNED AUTOS eODIL Y INJuRy
(P~I I-Icrson) .$
X 5CHEDULED AUTOS
,- --. - ..
J. HIRED AUTOS BOlJlL Y INJURY
- $
x NON.oWNED AUTOS (PlOl ~c[;idcnt)
-,' --
- .. ....- PROI-'I:::RTY DAMAGI= $
(Per .,c;<:idenl)
n'" U'B'Un AU' 0 UNL Y . EA ACCIDENT $, .. ...
_ ANY AUTO OTI tl:R THAN _~~J\Cr. $
AUTO ONL V: AUG S
EXCeSSJUMBRELUl UAOILtl1 .E.t\.CI'1 OC~URKl::NCE s ..
W aCel JR 0 CU\IMS MAUE AG~~ECATE 91 ,..-
-- .- s
R ".""enOl' ~
RETCNTION 91 s
WQliU(!RS COMPENSATION AND I ~9:.Jr~I.~;. I I O!tt. ..
EMPLOYERS' LIABILITY ....D::.f,M:H A9C1Ol:N.. $
ANT PfotOI"RIETORlPARTNER/EXEqmvE
OFFICEI1/MCM[lER l::Jll.l:LUDED? f. I .nJSEASE - EA [;:MPLQyEt $
- -~
~~~~ 1~1:;~~~J:~~~.c; hnlnw l:.L. DISEASE. POIICV LIMIT $
OTHER
DESCRIP110N OF OPERA nONS I LOCA "nON5 / VEHICLES I EXCLUSIONS ACD~D BY ENDORSEMENt I SPECIAL PROVISION5
1983 Ford F250 vln#1FTHF26120PA408D3
Karl Olsen
City of .Ashland
90 N. Mountain Ave
Ashland, OR 97520
CANCELLA TION
SHOULD ~NY OF THE ABOVE DEseR,lBED POLICIES oe CANCELLED BI!f!ORE"..e EX PI RA TlON
DAT! THe~EOf. THE ISSUING INSURER WILL ENDEAVOR TO MAIL -.:!L. gAYS W"I~N
NOTIC! TO 'Oie CERl1FICATE HOLDER. NAMED TO THE LEFT, gUT FAll.URE 10 DO $0 8HAI.L
IMPO~E NO OBLlGAT\ON OR LIABILITY OF ANY KIND UPON TH! IN6URER. ITS A('i~"T9 OR
R.EPRESENTATIVes.
AUTHORIZED RI!PAE6ENTATlV~ ~~~> :..- ,.... ....
'( .r"",?/.. ;;. ........ ~ "
CERTIFICA TE HOLDER
ACORD 25 (2001/08)
~ -""Tr -y
DNA Excavation
CCB# 55306
PO Box 1087
Phoenix, OR 97535
Estimate-
NAME I ADDRESS
DATE
ESTIMATE NO.
Ashland Electrical Dept.
90 North MOWltain A V.
Ashland OR. 97520
1/] 3i2009
00/130
PROJECT
473 Euclid Ave.
DESCRIPTION TOTAL
Install new conduit from transformer to 473 Euclid Ave.
Equipment, Labor, and sand supplied by DNA excavation. 1,531.00
Conduit and fittings supplied by City of Ashland.
This is only an Estimate
TOTAL $1,531.00
This is only an estimate. Estimates are subject to change as job description
changes or as more work is included in thejob. Estimates are Void after 30
Days from date above.
SIGNATURE
Phone #
Fax #
541-210-2104
541-535-8588 call f...
I 'n
ooco~C'c- I +'C
P.N"\' f'\ I ~f'\ C' I
,I
~.,
CITY RE:CORDER
CITY OF
ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300 '
VENDOR: 011484
DNA EXCAVATION
PO BOX 1087
PHOEN IX, OR 97535
FOB Point:
Terms: Net
Req. Del. Date:
Speciallnst:
.,,/;.'5;;.,[,'.;5('\ .,.'5( .5... ."'(Description
Contractor to install new 3" conduit
from transformer to house service at
473 Euclid Street. Equipment, labor,
and sand supplied by DNA Excavation.
Conduit and fittinQs supplied by the
City of Ashland.
Contract for Services
Date of aQreement: 01/21/2009
BeQinninQ date: 01/26/2009
Completion date: 01/30/2009
Insurance required/On file
BILL TO: Account Payable
20 EAST MAIN ST
541-552-2028
ASHLAND, OR 97520
I
Page 1 / 1
P0*N l:JI\IIBER
08775
SHIP TO: Ashland Electric Department
(541) 488-5354
90 N MOUNTAIN
ASHLAND, OR 97520
Unit Price
; Exf:FPrice
1,531.00
DA"FE
1/21/2009
Req. No.:
Dept.: ELECTRIC
Contact: Scott Johnson
Confirming? No
.
SUBTOTAL
TAX
FREIGHT
TOTAL
1.531.00
0.00
0.00
1,531.00
0:5: .:'t:t;".......,,".; ,.ad .... .5Account(NumPer \4' :d, "".'::f.: 'j(d d. . ... .....
..... I...'.'.'. ..
E 690.1 1 .18.00.70410C E 000021.999 1 531 .00
...
H ~
~gnatuY~
VENDOR COpy
a
REQUISITION FORM
CITY OF
ASHLAND
THIS REQUEST IS A:
D Change Order( existing PO #
Date of Request: I~ - / /.., -D91
Required Date of Delivery/Service: I I
Vendor Name
Address
City, State, Zip
. Telephone Number
Fax Number
Contact Name
DN A E~CQVaTI!JN
'P. O. BCJX /087
ProeNIJc ~ OR 9752:-t!J ~~
.'5L// - 2. /0 - '.2104 CiFLL ~
S*LfI- 535 - BS8B
SOLICITATION PROCESS
Small Procurement D Sole Source D Invitation to Bid
D Less than $5,000 D Written findings attached (Copies on file)
D Quotes (Not required)
Coooerative Procurement D Reauest for Prooosal
D State of ORfWA contract (Copies on file)
Intermediate Procurement D Other government agency contract D Soeciall Exemot
lM13) Written Quotes D Copy of contract attached D Written findings attached
(Copies attached) D Emeraencv
D Contract # D Written findings attached
Description of SERVICES
. //NSTH-tL. NEW t!..ONdur/- 3" F~OA1
T/2J9.NS"'ftoR.H15-,e TO HOUSE SE/<v/c$ e
/. ~73 EUCLID::Sr, ALL. C/cC4V~T/~/\I/ .t..14.6012..
~ Per attached PROPOSAL 8~c:.K-~L.t. By .lJ''Y.A., EXCo. Va..TIOA/
o ~~L~O
Item # Quantity Unit Description of MATERIALS
Total Cost
Unit Price
Total Cost
"'
D Per attached QUOTE
~ ~GL'6 1-26-09
c?~ h'<pf~/A ~'L ~ 1-3(}- 09
/ Project NumberQO.o.oZl-'f9.9
V' Account Number6.2t2. - J.1- LB- OQ-1Q~lg9
* 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 contractin
and the documentation can be provided upon request.
Employee Signature:J}r fl u1C) ~ rlOJU26fl Supervisor/Dept. Head Signat e:
. ~
G: Finance\Procedure\AP\Forms\8_Requisition form revised.doc
Updated on: 1/16/2009