HomeMy WebLinkAbout2011-088 Contract - Pacific Paving
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CITY OF CONTRACTOR: Pacific Paving, Inc.
ASHLAND
20 East Main Street CONTACT: Terry w. Simcoe
Ashland, Oregon 97520 ADDRESS: PO Box 2370, White City, OR 97503
Telephone: 541/488-6002
Fax: 541/488-5311
TELEPHONE: (541) 772-4616
DATE AGREEMENT PREPARED: 5/17/2011 FAX: (541) 830-4612
BEGINNING DATE: 5/20/2011 COMPLETION DATE: 6/30/2011
COMPENSATION: $7,800.00 (see attached auote)
GOODS AND SERVICES TO BE PROVIDED: Resurface the "Beaver Slide' between Lithia Wav and Water Sl.
ADDITIONAL TERMS: Contractor shall grind off and dispose of 4 inches of asphalt surfacing and replace
with 4 inches of hot mixed asphalt concrete pavement conforming to the Oregon Standard Specifications for
Construction, 2008 edition, section 00744 which is attached as Exhibit C. Contractor to provide all necessary
temDorarv traffic control.
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. 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
rnade part of this contract.
7. Living Wage Requirements: If contractor is providing services under this contract and the amount of this contract
is $18,703 or more, Contractor is required to comply with chapter 3.12 of the Ashland Municipal Code by paying a
living wage, as defined in this chapter. to all employees performing work under this contract and to any subcontractor
who performs 50% or more of the work under this contract. Contractor is also required to post the notice attached
hereto as Exhibit B predominantly in areas where it will be seen by all employees.
8. Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless
from any and all losses, claims, actions, costs, expenses, judgments, subrogations, or other damages resulting from
injury to any person (including injury resulting in death), or damage (including loss or destruction) to property, of
whatsoever nature arising out of or incident to the performance of this contract by Contractor (including but not
limited to, Contractor's employees, agents, and others designated by Contractor to perform work or services
attendant to this contract). Contractor shall not be held responsible for any losses, expenses, claims, subrogations,
actions, costs, judgments, or other damages, directly, solely, and proximately caused by the negligence of City.
9. Termination:
a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties.
b. Citv's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing
and delivered by certified mail or in person.
c. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of
written notice to Contractor, or at such later date as may be established by City under any of the following
conditions:
. Contract for GOODS AND SERVICES Less than $25,000
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conditioQs:
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
ili. 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/Liabilitv of 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 dellverables 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 subcpntractor 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 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 $1,000,000,
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
$1,000,000, for each accident for Bodilv Iniurv and Propertv Damaoe, includin!J coveraae for owned, hired or non-
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owned v€!hicles, as applicable. .
d. Notice of cancellation or chanQe. There shall be no cancellation, material change, reduction of limits or
inient 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 contractor's insurance is primary and non-contributory. 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 Councilor the Public Contracting Officer is
required before an ork may begin under this contract. .
21. Certification. ractor shall sign the certification attached hereto as Exhibit A and herein incorporated by
ref
Contr - c
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IfA',.W
l Print Name t#trL-
'JIB Title
City of ASh~~nd \.
By ~'K ~
Departme~
't'f\.\.dAlIIFi...\ ~ j~
Print Name
.s/31/ (;J.O If
Date
W-9 One copy of a W-9 is to be submitted with
the signed contract.
Purchase Order No.
( tf;2--1 C;;
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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 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 (Hi) th~ 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:
1-
L-
y
~
-F2-
*
(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.
7.
Contractor
(Date)
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-
, ,
EXHIBIT C
SECTION 00744 - MINOR HOT MIXED ASPHALT CONCRETE (MHMAC) PAVEMENT
Comply with Section 00744 of the Standard Specifications modified as follows:
00744.16 MHMAC Acceptance - Replace this subsection with the following subsection:
00744.16 MHMAC Acceptance - A CAT-1 shall perform a minimum of one asphalt content,
gradation, mix moisture, and Maximum Specific Gravity (AASHTO T 209) test per day and
provide results to the Engineer by the middle of the following work shift. The Contractor shall
also provide split samples to the Engineer when requested. Testing may be waived upon
written notice and accepted visually by the Engineer according to Section 4(8) of the MFTP.
When three or more tests are performed on a project, a price adjustment will be calculated
according to 00744.95.
Add the following subsection:
00744.17 Small. Quantity Acceptance - When less than three test results are obtained on a
, project and testing has not been waived by the Engineer, the MHMAC will be accepted
according to the following:
(a) Within Specification Limits - If all sublot sample test results are within specification
limits for all constituents (including compaction) the material will be accepted and the full bid
price will be paid for the material represented by that test.
(b) Outside Specification Limits - If a sublot sample test result for any constituent is
outside the specification limit the Engineer will have the backup sample tested.
(1) Backup Within Specifications -If the backup sample test results for all constituents
are within specification, the material will be accepted and the full bid price will be paid for
the material represented by that test.
(2) Backup Out of Specifications - If the backup sample test results are out of
specification, the Contractor may choose to accept the price adjustment calculated
according to 00744.95 or may choose to sample the in-place material for further testing.
The price adjustments will be computed using all original test results as well as all backup
test results. (If there are less than three tests, average the two tests you have and use the
average as the third test result). In no case will the composite pay factor (CPF) be greater
than 1.0.
(3) In-Place Samples -If the in-place material is sampled, the Engineer will select and
sample from three random locations from the area represented by the lot in question.
Those samples will be tested and if found to be within specification the material will be
accepted and paid for at the full bid price. If the material proves to be outside of the
specification limits, the material will be accepted and paid for at an adjusted price
according to 00744.95. In no case will the CPF be above 1.0.
00744.49 Compaction - Replace this subsection with the following subsection:
00744.49 Compaction - Immediately after the MHMAC has been spread, struck off, and
surface irregularities and other defects remedied, roll it uniformly with rollers meeting the
~
" ,
requirements of 00744.24 until compacted to a minimum of 91% of MAMD. Perform finish
rolling and continue until all roller marks are eliminated. Determine the density of each sublot by
averaging five QC tests performed at random locations by a CDT with the 'nuclear gauge
operated in the backscatter mode according to WAQTC TM 8. Calculate MAMD according to
ODOT TM 305. When less than three sublot test results are obtained on a project, the MHMAC
will be accepted according to 00744.17. Perform a minimum of one sublot density test per day.
The Engineer may waive compaction testing upon written notice.
00744.80 Measurement - Delete the paragraph thai begins "No separate measurement will be
made...".
00744.90 Payment - Delete the paragraph that begins "No separate or additional payment will
be made for the asphalt tack.. . ".
Add the following subsection:
00744.95 MHMAC Price Adjustments - The Composite Pay Factor (CPF), calculated
according to 00165.40 will be applied to the Contract unit price for the pay items of 00744.90
and to the applicable lot quantities. The CPF will be made available to the Contractor within 24
hours of receipt of the required quality control test results. If less than three samples are tested,
the CPF )!IIill be computed as outlined in 00744.17. The maximum CPF for any case will be 1.0.
.
Use the following table to determine price adjustments in the CPF for constituents of MHMAC.
Gradation Constituents
All Aggregate Passing
1"
3/4"
1/2"
3/8"
NO.4
No.8
No. 30
No. 200
Other Constituents
Asphalt Content
Moisture Content
Compaction
Dense Graded MHMAC Type
Weighting Factor (f)
3/4" 1/2"
1
1 1
1 1
5 5
5 6
3 3
10 10
26 26
8 8
40 40
3/8"
1
1
5
6
3
10
26
8
40
Those MHMAC constituents statistically evaluated will be eligible for a maximum PF of 1.00
(see 00165.50(b-1)), unless othervvise specified.
If these specifications do not require measurement of a constituent, its individual PF will be
considered 1.00 in calculating the CPF according to 00165.40.
A price adjustment will be determined by the following formula:
(CPF -1) x MHMAC Unit Price x (LQ) =_
Where:LQ is the quantity of mixture in the lot
EXHIBIT 0
P.O. Box 2370. . White City, Oregon 97503-0370
Office 541-772-4616 . . Fax 541-830-4612
PROPOSAL SUBMITTED TO:
NAME City of Ashland Street Department
RE 90 N. Mountain Ave.
!TY Ashland S~E97520
PHONE
541-488-5313
JOB NAMBeaver Slide Rd.
STREET
April 27, 2011
CITY
Ashland
STti~ 97520
We hereby submit specifications and estimates for:
Commercial Paving
1. Grind 4" of existing asphalt, approximately 2,252 sq. ft.
2. Furnish and install 4" of asphalt over street, approximately 2,252 sq. ft.
We hereby propose to furnish the above labor and materials in accordance with the above specifications, for the sum of:
**Seven Thousand Eight Hundred and Noll 00**
dollars ($
7,800.00
TERMS: Cash on completion of job, unless other arrangements are made in writing. A 2% per month FINANCE CHARGE will be added on all past due accounts,
an ANNUAL PERCENTAGE RATE OF 24%.. In the event any balance is turned over to an attorney for coUeetioD, or if a lawsuit is filed to collect any balance,
including appeals from trial, the prevailing party shall be entitled to his reasonable attorney fees and reasonable expenses of litigation, such as investigation,
deposition, provisional process and other like expenses. All material is guaranteed to be as specified All work to be completed in a workmanlike manner according
to standard practices. Any alteration or deviation from above specifications involving additional work and extra costs will become an extra charge over and above
the estimate. If subbase and/or base is prepared by others, then guarantee is limited by workmanship. The normal soil sterilization process will not kill all types of
vegetation and we will not be responsible for any damaged pavement due to the growth of vegetation. All agreements contingent upon strikes, accidents or delays
beyond our control. If this contract exceeds $1,000, the owner acknowledges receipt of the "lnfonnation Notice to Homeowners about Construction Liens." This
proposal roay be withdrawn by us if not accepted within 30 days. CCB #50835
Ii) tJ .
EstimatorC.J~
~~
Terry W Simcoe
..
Acceptance of Proposal
The above prices, specifications and conditions are satisfactory Wld are hereby accepted. You are authorized to do all of the work as specified.
Payment will be made as outlined above.
Signaturp.
Datp.
~AIF Corporation
~
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www.saif.com
OREGON WORKERS COMPENSATION
CERTIFICATE OF INSURANCE
.!!'i!
CERTIFICATE HOLDER:
CITY OF ASHLAND
20 EAST MAIN ST.
ASHLAND, OR 97520
The policy of insurance listed below has been issued to the insured named below for the
policy period indicated. The insurance afforded by the policy described herein is subject to
all the terms, exclusions and conditions of such policy.
POLICY NO.
812919
POLICY PERIOD
10/01/2010 to 10/01/2011
ISSUE DATE
OS/26/2011
INSURED:
PACIFIC PAVING INC
PO BOX 2370
WHITE CITY, OR 97503-0370
BROKER OF RECORD:
KPD INSURANCE INC
PO BOX 29
SPRINGFIELD, OR 97477
LIMITS OF LIABILITY:
Bodily Injury by Accident
Bodily Injury by Disease
Body Injury by Disease
$500,000
$500,000
$500,000
each accident
each employee
poliCY limit
DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS:
IMPORTANT:
The coverage described above is in effect as of the issue date of this certificate. It is subject to change
at any time in the future.
This certificate is issued as a matter of information only and confers no rights to the certificate
holder. This certificate does not amend, extend or alter the coverage afforded by the policies above.
AUTHORIZED REPRESENTATIVE
PJr?~ jr RqiiJ-
-
President and CEO
40U High Street 51:
Salem. OR 97312
P,8OO.185.8515
F: 503.373.smo
Pollcy_Batch_CertlncateOOnSllrance
~reChe.
Carlson
5/26/2011 12:10:45 PM PAGE
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1/006
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BEEC H ER::.~.'~;cARLSON
_._...,--' Insurance Agency, LLC
FAX TRANSMITTAL
Date: 5/26/201112:10:22 PM
6
To: City of Ashland
Company:
Phone:
Fax: 541-488-5311
SUS400E4334836E
Num of Pages:
(including
cover)
Frorn:
Direct Phone:
Direct Fax:
Email Address:
Susan Wilson
(541) 494-2691
(541) 772-3785
susan.wilson@beechercarlson.com
FOllowing is certificate of insurance requested for Pacific Paving Inc. I have also
included 2 additional documents that explain why we (or any other agency) can no
longer legally issue certificates with a 30 day notice of cancellation according to the
provisions of the insurance contract.
Please contact me if you have any questions or concerns.
Thank you.
707 Murphy Rd. Medlord. OR 97504 (541)772"1111 Main (541)772"3785 Fax
CA License #QF09618 OR UCAnso #816307 WA License #252204
Ti1i"';::'I:::~';.irn"(' !?1n;.:!:~~'II;:I() i;:; ,':(1:'11 donl:::;1 ::HI:j is inlnll(:('(:~ ;:;okl>' fer It~c 1,1:;(') ul "[:'1('1 in::!;',iic'u;;\11'8;tHI::1 i',t.b::i',i0. il'loll
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~~~.! ~:~;;j: ~ , ;'~~i;~~l~~ I:;' ;~'iX~:; :~;~ l~~<~~:~~:j ~~.::
imlll(}(1iGlf.'ly by t(\lni)t~l)n() Glnd'f()turn It,\,:, ()ri:JiilGli ;.::l,-~~inl:!(; tran~llli$~i('il (G tt,(; $()tKklr by lj._C,. iflail
Beecher Carlson
5/26/2011 12:10:45 PM
PAGE
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Fax Server
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ACORD" CERTIF!CA TE OF LIABILITY !NSURANCE I DArE (MM!OOIYYYYj
I......----' 5/26/203.1
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER TliE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certlDcate holder 13 an AOOIllONAL INSURED, the pollcy(les} must be endorsed. If SUBROGATION IS WAIVED, subject 10
the terms and condltlons of the policy, certain pollchu. may require an endorsem9f1t. A statement on this certificate does nol confer rlght6 to tho
certlflcate holder In lieu of !l:llch enrtor~ement(~I.
PRODUCER E2~~CT Susan Wilson, AAl, AlC
Beecher Car1son Insurance Agency LLC ~gt:fo Elltl: (541) 772 1111 I rtr~ No}: (541) 772-3795
. --AIL-L- ,
707 Murphy Rd At'DRESS; susan. wilson(Jbeechercarlson. com
~~~~~~:'oIPOOO5034
Medford OR 97504 ,
INSURERIS) AFFORDING COVERAGE NAICIII
INSURED lNSURERA ;'rravel~.s Prop Cas Co of Al1 5674
INSuRERB:Charter Oak Fire Insurance Co 5615
Pacific Paving Inc INSURER c :Indemni tv Companv of CA
PO Box 2370 INSURER 0 :
INSURER e :
Wbi te ci ty OR 97503 INSURER F :
COVERAGES
CERTIFICATE NUMBER.r.I.1:l 31799660
REVISION NUMBER'
THIS IS TO CERTlFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOlWlTHSTANDNG ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO ,^,,",ICH 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 LIMITS SHOVVN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
"'" TYPE OF INSURANCE POI...ICYEFF POLlCYEXP LIMITS
n" POI...ICY NUMBER MMIDDJYYYY MII4/00IYYYY
GENERAL LrAGILITY EACH Q(.CJRREN':E , 1,000,000
I- :;;<~'(A~E~ 'r'E:~:;'_~~Anr." 300,000
X <.mAMFRr:1A1 GFNFRAJ I IARIIITY ,
~ /20/2011 /20/2012 5,000
A _I ClA\MG-MA(JE ~lo'=":JP, TC052608417TILll MED EX;:' (My one person) ,
I- 1,000,000
f- I'EI~SONAL '" ,....lJV INJ.JI,( ,
, GENERI>,I... ,l>GGREGhTE , 2,000,000
I- 2,000,000
~'~ AGG~ErflllI;1IT Ai~S, PER: :>ROOUCTS -COMP,'O:> AGG I
X pal Ci P.f.9- Loe I
AUTOMOBILE LIABILITY COlv'Bl/'IIF.D SIW;IE Ll)"-IIT I 1,000,000
I- li:Oaaccidentl
.ANY Aurc BOOL Y IN,JUF;Y (PJrpn~on) S
- TBI0526D8417cOF11 ~/20/201l /20/2012
B Ix ALL O\fI/\JED AUIOS BODLY INJUFY (p.,( ll",<.:id"'l~) S
SCHEOULEDAUTOS
Ix PR:)PERTY D~MAGE ,
Hlf<~UAUIU::; :P~r"wdenl)
Ix NON-O\o\NED AUTOS MAr.lml p;j'fffiArl~ , 5,000
I-
Co\l~I"n ,
2'.. UMBRELLA lIAB H~CCUp. ~"CH OCC.JGRE"lCE. , 1,000,000
exCESS LIAS ClAI'o1S-Mf'DE A.:;GREG,II.TE . 1,000,000
X CEDUCTIEI...E" ,
A nETEHTlO~1 , 10 000 T~OP526D8417TILl1 /20/2011 /20/2012 ,
WORKERS COMPENSATlON T~.jT~J.~~ I IOJ~-
AND EMPLOYERS' LJA61LITY Y I tJ
ANY PROPP',C;-ORI?<\R';"NE'<:/E)(EC)TIYE D <=_L EJlCh ACCIDENT ,
OFFIr:FRIMFWAFR Fxn llrrm NJA
(Mandatory in NH) :::.L. JISEASE- EJI.EMPl:J"F $
1f~3.describeund3r
DFSCRIPTIO" CF OPFRATIONS 1J..I"w -.L.DISEASE_ POll:YlllllrT ,
C BOLl Bond (Statutory) 8S448C /14/2011 -/14/'012 _imil: $30,000
DESCRIPTION OF OPERATlONS I LOCATlONS IVEl-lIClES (Attach ACORO 101, Addltlonal Remwkr Schedule, Irmore rpace Ir required)
Cgrtific4l.tg holder includgd .. additiona~ in~ured per attached endor~~nt ltCGD2460S05 where roquired by written
contract. Subject to po~icy terms , conditions and exclusioriS".
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
TH. EXPIRATION DATE THEREOF, NOnCE WILL .. DELIVERED IN
City of Ashland, its elected officials, ACCORDANCE WITH THE POLICY PROVISIONS.
officers & employees
20 East Main Street AUTHORIZED REPRESENfA TlVE
Ashland, OR 97520
S T-Tilson I MI, AIC/Sa ~ 0. J.<G-!:.Ii--.
ACORD 25 (2009/09)
INS025 (~UUUUll)
@ 1988-2009 ACORD CORPORATION. All riyhts reserved.
The ACORD name and logo are registered marks of ACORD
Beecher Carlson
5/26/2011 12:10:45 PM PAGE
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COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
(CONTRACTORS)
This endorsement modifies insurance provided under ttle following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. WHO IS AN INSURED - (Section II) is amended
to include any person or organization that you
agree in a "written contract requiring insurance"
to include as an additional insured on this Cover-
age Part, but:
a) Only with respect to liability for "bodily injury",
"property damage" or '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 subcontmctor in the performance
of "your work" to which the "written contract
requiring insurance" applies. The person or
organization does not qualify as an additional
insured with respect to the independent acts
or omissions of such person or organization.
2. The insurance provided 10 the additional insured
by this endorsement is I imited as follows:
a) In the event that the Limits of Insurance of
this Coverage Part shown in the Declarations
exceed the limits of liability required by the
"written contract requiring insurance", tile in-
surance provided to the additional insured
shall be limited to the limits of liability re"
quired by that "written contract requiring In"
sLlrance". This endorsement shall not in-
crease the limits of Insurance described in
Secllon 111- Limits Of Insurance.
b) The insurance provided to the addillonai in-
sured does not apply to "bodily injury". "prop-
erty damage" or "personal injury" arising out
of the rendering of, or failure to render. any
professional architectural, engineering or sur-
veying services, including:
i. The preparing, approving, or failing to
prcpare or approvc, maps. shop draw-
ings, opinions, reports, surveys, field or-
ders or change orders, or the preparing,
approving, or failing to prepare or ap-
prove, drawings and specifications; and
II. Supervisory, inspection, archilcctural or
engineering activities.
CG 02 46 08 05
eJ The insurance provided to the additional in-
sured does not apply to "bodily injury" or
"property damage" caused by "your work"
and included in ti,e "products-completed op-
erations hazard" unless the "written contract
requiring insurance" specifically requires you
to provide such coverage for that additional
insured, and then the Insurance provided ro
the additional insured applies only to such
"bodily injury" or "proper1y damage" that oc-
curs before the end of lhe period of lime for
which the "written contract requiring insur-
ance" requires 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 endorsement is excess over any valid and
collectible "other insurance", whether primary.
excess, contingent or on any other basis, that is
available to the additional insured for a loss we
cover under this endorsement. However. if the
"written contract requiring insurance" specifically
requires that this insurance apply on a primary
basis or a primary and non"contributory basis,
this insurance is primary to "other insurance"
availabie to the additional insured which covers
that person or organization as a named insured
for such loss, and we will not share with that
"other insurance". But the insurance provided to
the addillonal insured by this endorsement still is
excess over any valid and collectible "other in-
surance", whether primary, excess, contingent or
on any other basis, that is avaliable to the addi-
tional insured when thaI person or organization is
an additiDnal insured under such "Dther insur-
ance".
4. As a condition of coverage provided to the
additional insured by this endorsement:
a) The additional insured must give us writlen
nolice as soon as practicable of an 'occur-
rence" or an offense which may result in a
claim. To the extent possible, such notice
should include:
@ 2005 The St. Paul Travelers Companies, Inc.
Page 1 of2
4/006
Fax Server
Beecher Carlson
5/26/2011 12:10:45 PM PAGE
COMMERCIAL GENERAL LIABILITY
I. How, when and where the "occurrence"
or offense took place; .
II. The names and addresses of any injured
persons and witnesses; and
iii. The nature and location of any injury or
damage arising out of the "occurrence" or
offense.
b) If a claim is made or "suit" is brought against
the additional insured, the additional insured
must:
I. immediately record the specifics of the
claim or "suit" and the date received; and
iI. Notify us as soon as practicable.
The additional insured must see to it that we
receive written notice of the claim or "suit" as
soon as practicable.
c) The additional insured must immediately
send us copies of ali legai papers received in
connection with the r:laim or "suit", cooperate
with us in the investigation or settlement of
the claim or defense against the "suit", and
othelWise compiy with ali policy conditions.
d) The additional Insured must tender the de"
tense and indemnity of any claim or "suit" to
Page 2 of 2
any provider of "other insurance" which would
cover the additional insured for a loss we
cover under this endorsement. However, this
condition does not affect whether the insur"
ance provided to the additional insured by
Ihis endorsement is primary to "other insur-
ance" available to the additional insured
which covers that person or organizailon as a
named insured as described in paragraph 3.
above.
5. The following definition is added to SECTION V.
- DEFINITIONS:
"Written contract requiring insurance" means
that part of any written 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. Aller lhe signing and execution of Ihe
contract or agreement by you;
b. While that part of the contract or
agreement is in effect; and
c. Before the end of the P?licy period.
@2005 The St. Paul Travelers Companies, Inc.
CG D2 46 08 05
Beecher Carlson
5/26/2011 12:10:45 PM PAGE
5/006
Fax Server
({\i~
regon
Department of Consumer and Business Services
lmmmnC'c nivi~ion
350 Winter 51'. NB
PO Box 14480, S,lem, OR 97309-0405
503-947-7980
Fo" 503.378.4351
www.insurancc.oregon.gov
Th'llUllre R. KuIOllifU-~kj. C(lVl'rn..>r
CERTII'ICATE OF INSURANCE ARTICLE
Apli122,201O
Oregon insurance producers and industry representatives have advised the Insurance Diyision
that they are concerned about continuing pressure to modify cel1ificates of insurance to satisfy
contracts that re'lllire a much broader extension of coverage than the policy wil1 provide.
Certificates of insurance state that they arc issued as a matter of infonnation only, and confer no
rights upon the certificate holder. A certificate does not amend, extend or alter the coverage
afforded by thc policies represented.
Orcgon Reviscd Statutc (ORS) 742.003 addrcsscs thc filing and approval of policy forms.
Certificates of insurance are not considered part of the policy contract and ace not required to be
filed. If a document is issued that alters the contract agreetnent in any way, an adtnitted
company would be required to have filed the ch:U1ge in the contract and have it approved prior to
changing the policy language and issuing a certificate.
111e infUlmalion on a certificale should represenllhe conlrad of insurance. There should be no
variation in the in[onnation presented on the certificate from the coverage or conditions that are
a palt o!'that contract.
All insurance producer who issues a certificate of insurance that is not a representation ofthe
policy contract could be in violation ofORS 744.074 (1) (e). 'Jbe director has the authority to
place a producer 011 probation, or to suspend or revoke the licellse of a producer who
intentionally misrepresents the tellns of an actual or proposed contract of inSllrallce.
\
Beecher Carlson
5/26/2011 12:10:45 PM PAGE
6/006
Fax Server
BEECHER /(~ARISC)N
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Why We Are Using the Latest ACORD 25 Certificate of Insurance
In September 2009. ACORD revised the ACORD 25 Certificate of Insurance form. One of the major changes was
the removal of the cancellation notice provision. For the following reasons. we are unable to issue an older edition of
this form. modify the current form, or complete a proprietary form you provide:
ACORD certificate forms must be filed and aODroved for use in our state. When a new form is aooroved Driar
versions can no lonoer be used. Therefore it is illeoal for us to issue anvthino other than the currentlY approved
ACORD form.
Notice of cancellation is a policy right, not an unregulated service. No insurer shown on this certificate is able to
provide the cancellation notice you desire by endorsement. For example, the insured can cancel immediately, so
it would be impossible for the insurer to give you the notice you request. State law also giants the insurer the
right to cancel for reasons such as nonpayment with less notice than you require.
For the reason just cited, if our agency was to issue a certificate that provides the cancellation notice you
request. we would do so with the full knowledge that it would be impossible to actually give that amount of notice
under certain circumstances. As such, the certificate could be alleged to constitute a misrepresentation or fraud
which could subject our agency and staff to serious civil and criminal penalties.
If a certificate purports to provide a policy right different from that provided by the policy itself, then the certificate
effectively purports to be a policy form. Policy forms must be filed and approved by our state department of
insurance. Use of nonFiled policy forms is illegal and could result in legal sanctions distinct from the assertion
that the ocrtificatc is fraudulent
Under the ACORD Corporation's licensing agreement, the prior editions of superseded forms can be used for
one year from the time the new forms are introduced. Beginning in September 2010, this is another reason we
cannot use an older edition of the ACORD 25. Doing so would violate ACORD's iicensing agreement and. as a
copyrighted document, federal copyright law.
Likewise, we are ullable to modify the new celtificate to add a notice of cancel/ation. ACORD forms are
designed to be completed. not altered. ACORD's Forms Instruction Guide says that a certificate should not be
used "To waive rights...To quote wording from a contract... To quote any wording which amends a policy unless
the policy itself has been amended." Also. since our state requires ACORD forms to be filed any alteration to a
filed form would require its refilino, In addition, our insurance company contracts only allow us to issue unaltered
ACORD forms.
We are often asked to issue proprietary certificates provided by the certificate requestor. Again, our insurance
company contracts only allow us to issue unaltered ACORD forms. In addition. our state reauires the filinq of all
certificates of insurance and has very specific reoulatorv ouidelines on certificate lanauaae. Many proprietary
certificates include broad. vague or ambiguous language that mayor may not be incompliance with state laws.
regulations. and insurance department directives. Therefore. we cannot issue any proprietary certificates that
have not been reviewed by our state insurance department
Several states have voiced strong concern over certificates as evidenced in below links:
Oregon Insurance Dept: http://www.cbs.state.or.us/externallins/producer/topics/certificate-insurance article. pdf
Atlanta. Georgia: See detailed study they conducted in 2008 httg//tinyurl.com/26ouax8
Click following link for current update by state:
htt~:/ /"!![W. !l<l.~"ill't1epli~~!J:lX~lo!YYlNon M emberlVVilsonCertLawsReos. htm#Alabama
We appreciate your understanding oflhe legal restrictions on our abilITY to fully comply with your request.
220 NW 2nd Ave Ste BOO Portland. OR 97209-1831 (503)222-1831 Main (503)274-0323 Fax
CA license #OF09618 OR License #816307 WA License #252204 '
Page 1/1
~..
._~
C I T Y 0 F CITY RECORDER
ASHLAND I ~;:~TOE;1' .."
20E MAIN ST.
ASHLAND, OR 97520
(541) 488-5300
.P.O'NUMBER,r <";
10219
VENDOR: 000903
PACIFIC PAVING, INC
POBOX 2370
WHITE CITY, OR 97503
SHIP TO: Ashland Public Works
(541) 488-5587
51 WINBURN WAY
ASHLAND, OR 97520
FOB Point:
Terms: Net
Req. Del. Date:
Speclallnst:
Req. No.:
Dept.:
Contact: Jim Olson
Confirming? No
L~;QLJantit0;~j ~'rUm(~-7 ':;"'.",:,," ,. -.->~_: ':',:~:-:',,/,~~i~DescHDtion:".. . ., ':C' :.;'. ''''../ ':"": ;:H . -"'-",,';'~ .c.,........., :.' "J r<:'?)t(EXt.rP.rfCBt.~:
.. . ,Umt1prlce'"J':'-1i
Repave the "Beaver Slide" between 7,800.00
Lithia Way and Water Street
Contract for Goods and Services
Beginning date: OS/20/1011
Completion date: 06/30/2011
Insurance required/On file
,
. SUBTOTAL 7 800.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 7,800.00
ASHLAND, OR 97520
:~.-,: :'!A'ccounfiNLiinber.-~1;r4j) Ii' :-~ PfoJect~NiiiTiber.?-"'-:". ,/.- :.'.?;!Anio'iiiit;:;~:>'::,',.;; . ~A'ccoi"ntlNumDer,.c:C ~ '~:;F!rojEj"cflNLimbefc;~:~.(~:;~ K'i~?~AiTioun~
E 260.08.12.00.602401 E 200424.120 7 800.00
/
/h(J
. E ~ "1;0-
AuthQ:FIzed Signature
VENDOR COPY
CITY OF
ASHLAND
REQUISITION
No. PW_-FY2011
Department PW ENGINEERING
Vendor Pacific Paving, Inc.
PO Box 2370
White City, OR 97503
Account No. 260.08.12.00.602400
Date June 6, 2011
Requested Delivery Date
Deliver To Jim Otson
Via
(* Note: Please allow approximately two(2) weeks for delivery on items not
generally caned in stored. and approximately two (2) months on printingjobs.)
Item No. Quantity Unit Description Use of Purchasing Office Only
Unit Price Total Price PO No.
Repave the "Beaver Slide" $ 7,800.00 $ 7,800.00
for Kari:
BID IRFP / EXEMPT:
Contract Start Date: 6-Jun-ll
Contract Completion Date: 6/30/20 t 1
Insurance on file: IYES INO I
Pro;ect No: 2004-24
Job No.
Unit No.
I hereby certify thallhc above items are necessaJ)' for the operation
ofiliis department and are budgeted
~a...d~_{
Department Head or Authorized Person
Issued By
Date
Received By
~
(,/1/11
r.l'
G:\pub-wrks\eng\04-24 Beaver Slide\04-24 Pacific Paving Requisition.xls