HomeMy WebLinkAbout2011-092 Contract - Specialty Engineering Inc
,
CITY OF CONTRACTOR: Specialty Engineering
ASHLAND CONTACT: Doug Rotella, Senior Engineer
20 East Main Street
Ashland, Oregon 97520 ADDRESS: PO Box 5828, Vancouver, WA 98668
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 360-693-0588
DATE AGREEMENT PREPARED: 05/18/2011 FAX: 360-693-0592
BEGINNING DATE: Mav 25, 2011 COMPLETION DATE: June 24, 2011
COMPENSATION: $4.476,00 - Per attached oroposal attached as Exhibit C,
GOODS AND SERVICES TO BE PROVIDED: Contractor to replace the visible break window gaskets on four
(4) Cooper VFI switches, All repairs performed will be in compliance with Cooper Power Systems maintenance
orocedures, Per attached Droposal attached as Exhibit C,
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 900dS 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 re9istered, 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 2798.220, 279B.225, 2798.230, 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 $18,703 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 perfonms 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 (includin9 but not limited
to, Contracto~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 ne9ligence of City.
9. Termination:
a. Mutual Consent. This contract may be tenminated at any time by mutual consent of both parties,
b. Citv's Convenience. This contract may be tenminated 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:
i. If Citv fundina from federal, state, countv or other sources is not obtained and continued at levels
Contract for Contractor Services
Contract for Contractor Services, Page 1 0.l2'"6
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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. Oblication/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 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 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 Comoensation 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 singte 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,
including coverage for owned, hired or non-owned vehicles, as applicable.
d, Notice of cancellation or chance. There shall be no cancellation, material chance, reduction of limits or
Contract for Contractor Services, Page 2 0l-Y'6
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intent not to renew the insurance coverage(s) without 30 days' written notice from the Contractor or its insurer(s) to
the City,
e, AdditionallnsuredlCertificates of Insurance, Contractor shall name The City of Ashland, Oregon, and
its elected officials, officers and employees as Additional Insureds on any insurance policies required herein
but only with respect to Contractor's services to be provided under this Contract. As evidence of the insurance
coverages required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to
commencing work under this contract. The 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 andlor
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 conftict 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 any work may begin under this contract.
21, Certification, Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by
reference,
:;n~or: ~
~ignature
Lb~ ~~;t~eQ
City of Ashland
L#.. -'art~e~ Hea~
By
t)L
J lA. tl/ t€-A~
Print Name
::Je,rJior E/'I'jiI'fQ<;!r
Title
6:;/ / Za 1/
Date
W-g One copy of a W-g is to be submitted with
the signed contract._
Purchase Order No.
/ c?/9?
Contract for Contractor Services, Page 3 Of~
EXHIBIT A
CERTIFICATlONSIREPRESENTATlONS: 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:
(1) I carry out the labor or services at a location separate from my residence or is in a
specific portion of my residence, set aside as the location of the business.
(2) Commercial advertising or business cards or a trade association membership are
purchased for the business.
(3) Telephone listing is used for the business separate from the personal residence listing.
(4) Labor or services are performed only pursuant to written contracts.
(5) Labor or services are performed for two or more different persons within a period of one
year,
(6) I assume financial responsibility for defective workmanship or for service not provided
as evidenced by the ownership of performance bonds, warranties, errors and omission
insurance or liability insurance relating to the labor or services to be provided.
./
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Contracto
Contract for Contractor Services, Page 4 of,Z €;
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S1100111
, (Date')
CITY OF ASHLAND, OREGON
EXHIBIT B
City of Ashland
, LIVING
WAGE
ALL employers described
below must comply with City
r.l'
Employees must be paid a
living wage:
)>> For all hours worked under
a service contract between
their employer and the City
of Ashland if the contract
exceeds $18,703 or more,
)>> For all hours worked in a
month if the employee
spends 50% or more of the
employee's time in that
month working on a project
or portion of
business of their
employer, if the
employer has ten or
more employees, and has
received financial assistance
" _~e.t ~'ollr ef1ec.ti~e Juri~3Q,201 ci "
....- " ~ ';. ,j, ',.:- ,'. ~
. """ . . -~ ! ,-;
,(!ricr~,a,ses ann~ally~ve~ June'~~by t"e
'P9nsi.jmi!,r Price IndEf~l ,,' ",' , :
, """,~,,{",. ,.';.,..,. .,....\.~.'r;:"..'.. "j.:;;~'> '. .,~.. .~,
for the project or business
from the City of Ashland in
excess of $18,703.
twelve-month period. For
more details on applicability
of this policy, please see
Ashland Municipal Code
Section 3,12,020,
)>> If their employer is the City of
Ashland inciuding the Parks
and Recreation Department.
)>> In calculating the living wage,
employers may add the value
of health care, retirement,
401 K and IRS eligible
cafeteria plans (including
childcare) benefits to the
amount of wages received by
the employee,
)>> Note: "Employee"
does not include
temporary or part-
time employees hired for less
than 1040 hours in any
For additional information:
Call the Ashland City Administrator's office at 541488-6002 or write to the City Administrator, City Hall,
Contract for Contractor Services, Pag~-of ~
(~
20 East Main Street, Ashland, OR 97520 or visit the city's website at www.ashland.or.us.
Notice to Employers: This notice must be posted predominantly in areas where it can be seen by all
employees,
CITY OF
ASHLAND
Contract for Contractor Services. Pag~ of '6
@
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.~.~'"'
"
"Speciillty
'Engineering
,"'-;--
P,O, Box 5626
Vancouver. WA
96666
PHONE::
360/693-0588
~
''''''
"3~0!693-0S92 '
May 9, 2011
Attn: Kari Olson
Purchasing Representative
City of Ashland
90 N, Mountain Avenue
Ashland, Oregon 97520
Subject: Visible Break Window Gasket Replacement
Dear Ms. Olson:
Specialty Engineering Inc. (SEI) is pleased to offer the following proposal for the scope of work
described herein:
\
SCOPE OF WORK
SEI will perform the replacement of visible break window gaskets on four (4) Cooper VFI
switches,
SEI anticipates this scope of work can be performed in two to three 8 hour days. All repairs
performed will be in compliance with Cooper Power Systems maintenance procedures, SEI
technicians are Cooper factory trained and certified, and SEI is an Authorized Cooper Service
Center.
Customer ResDonsibilities
. Make all electrical equipment under work scope available to SEI personnel during the
mutually agreed upon work schedule.
. Schedule and perform switching operations to de-energized equipment on which work
will be performed, .
. Install all protective grounding.
. Isolate all equipment which SEI is to perform maintenance and testing on prior to the
arrival of SEI,
The cost to perform the scope of work outiined in this proposal is based on a Firm Fixed Price of
$4,476.00. This amount is based on the work taking place on week days during normal business
hours.
Any deficiencies found within the switches shall be reported, but not corrected as part of this
scope of work. Work to be performed beyond the scope of work will be performed on a Time &
Materials basis only with the prior approval of the client. Any delays beyond the control of SEI
shall be billed in addition to the cost of this proposal.
SEI requires 7 days notice to proceed prior to the start of the work. The work is dependent on
dry weather. Work is not dependent on BOll prevailing wages. SEI's OR BIN: 1277113-7.
If you have any questions please do not hesitate to contact me,
Sincerely,
.'
Doug Rotella
Senior Engineer
D [201 el1o.. e E. P S TNC. CDfV)
,./
I
",
COOPER Power Systems
Wal1l'81lUD1lg
~mpOlrr1aD1lt Safety Notuce
Underground Distribution Switchgear with Visible Break Window
November 30th, 2010
City of Ashland ,
Attn: Scott Johnson
90 N Mountain Ave
Ashland OR 97520
Via: United Parcel Service
Re: Underground ,Distribution Switchgear with Visible Break Window,
Dear Valued Cooper Power Systems Customer:
Our records indicate your organization purchased one or more of the products referenced
above. We recently discovered that some of the visible break window gaskets supplied
to Cooper Power Systems for use on underground distribution switchgear may contain
materials not in compliance with our specifications, These gaskets may leak, If the
dielectric fluid level drops, energized components within the switchgear may no longer
be covered, and eventful failure may occur. Such a failure may result in internal
arcing, tank rupture and the emission of flame or hot oil, potentially
resulting in severe injury or death.
Cooper Power Systems isolated your potentially-affected units to the specific serial
numbers listed below. Only the units with the serial numbers listed are affected.
To minimize the possibility of an incident, immediately inspect all units with the listed
serial numbers, per the procedure detailed below.
1. If oil is not visible in the oil sight glass gauge, remove the unit from
service immediately and repair per the Gasket Replacement
. . Instructions, S285 ~ 10 - 8.
2. Visually inspect for gasket swelling (See Picture: 1)
oj eve m ez. B(tJ{
pC{uL ~eed
1-800- '(q7- 59S 3
Y JLf- 76(3- 8"3! 0
L{IL{- 21B- Z-7bo
Ge//'W-
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ACOR '" I
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DONYYY)
~ 5/20/2011
PRODUCER (907)561-1250 FAX: (907) 561-4315 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Alaska USA Insurance Brokers ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. Box 196530 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
Anchorage AI{ 99519-6530 INSURERS AFFORDING COVERAGE NAIC#
INSUR~ INSURERA:.Evanston Insurance Company
Specialty Engineering Inc. INSURERB:West American Insurance
PO Box 5828 INSURERC:Navigators Insurance Company 42307
INSURERD:Alaska National Ins. Company 38733
VancouvElr WA 98668 INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLlCY 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 OfSUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
!I~~~ ::i:.'?:~ POUCYNUMBER POUCY EFFECTIVE POUCY EXP~N UMITS
~NERAL UABlUTY lM Best;' XIII EACH OCCURRENCE $ 2,000,000
~=~~, 0
X COMMERCIAl GENERAL UABlUTY Ea"",,~ $ 50,000
A X I CLAIMS MADE [X] OCCUR lOPKG0184l . 12/1/2010 12/1/2011 MED EX? (Anyone person) , 5;000
~ WA Stop Gap PERSONAL & ADV INJURY $ 2,000,'000
~ Surplus Lines Policy orl<\wide Facilities GENERAL AGGREGATE $ 2,000~000
-il'LAGG:nE L!MIT APnSI PER: PRODUCTS. COMPIOP AGG , 2 000,000
X POLICY ~~RT LOC Deductible, ~ 10 000
~TOMOBILE UABIUTY ~ Best: AXV COMBINED SINGLE LIMIT
~ (Eaaccident) $ 1,000,000
ANY AUTO
B X - AlL OWNED AUTOS AW1l54282005 12/1/2010 12/1/2011 BODILY INJURY
(PerpefSOO) $
- SCHEDULED AUTOS
~ HIRED AUTOS BODILY INJURY
$
~ NON-oWNED AUTOS (Peracx::ldent)
- PROPERTY DAMAGE $
(Per accident)
~RAG' UABIUTY AUTO ONLY - EA ACCIDENT $
ANY AUTO OTHER THAN EAACC $
AUTO ONLY: AGG $
EXCESSI UMBRELlA UABIUTY xcess ofl Gen Liab, EACH OCCURRENCE $ 3,000,000
0.OCCUR [!] CLAIMS MADE uto, Employers Liab, AGGREGATE $ 3,000,000
ollution & Professional Prod/ComDl-Otls Aaa $ 3,000,000
C R DEDUCTIBLE ~lOBXC7l9908IC .. 12/1/2010 12/1/2011 Poll, Clams-Made $
RETENTION $ I\M' Best; A X Prof, Claims~Made $
D WORKERS COMPENSATION lM Best: A IX X we STATU. IOJ~
AND EMPLOYERS' UABIUTY Y I N
ANY PROPRIETORlPARTNER/EXECUTIVE [!!] E.L. EACH ACCIDENT $ 1 000,000
OFFlCERlMEMBER EXCLUDED? N E.L DISEASE. EA EMPlOYE!
(Mandatory in NH) DLWS596D1 12/1/2010 12/1/2011 $ 1,000,000
~~I~~~NS below E.L DISEASE - POLICY UMIT $ 1 000 000
A OTHERCLAIMS_MADB COVERAGE OPKG0184l . 12/1/2010 12/1/2011 Limits. Deducti;b1e:
pollution Liability urplus Lines Policy $J,DDD,DDD $25,000
Professional Liab orldwide pacilties .. ~25 000
DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLESI EXCLUSIONSAODEO BY ENDORSEMENT I SPECIAL PROVISIONS
Re: Contract for Contractor Services
The Certificate Holder is an Additional Insured on the General Liability & Automobile policies, but only with respect
to work done by or on behalf of the named insured for the project referenced. Subject to pOlicy te~, conditions &
exclusions.
CERTIFICATE HOLDER
CANCELLATION
(541) 488-5320 olson@ashland.or.us SHOULDANYOFTHE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION
City of Ashland DATE THEREOF, THE ISSUING INSURER WILL ENOEAVOR TO MAIL ~ DAYS WRITTEN
Kariann Olson, Purchasing Representative NOTICE TO THE CERTlACATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL
90 N. Mountain Avenue
Ashland, OR 97520 IMPOSE NO OBUGATlON OR LlABIUTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES,
AUTHORIZED REPRESENTAllVE ~A,
Brenda Nolin, fLo,~
ACORD 25 (2009/01)
INS025 (200001)
@1988-2009ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
COMMENTS/REMARKS
ALASKA SURPLUS LINES WORDING,
"This is evidence of insurance procured and developed under the Alaska Surplus Lines Law
AS21.34. It is not covered by the Alaska Insurance Guarantee Association Act, AS21.80.
This insurer does not hold a certificate of authority with Alaska, and is not subject to
supervision by the Alaska Department of InsuranceU
Worldwide Facilities, Inc. - License #9718
OFREMARK
COPYRIGHT 2000, AMS SERVICES INC.
~..
...~
CITY OF
ASHLAND
20 E MAIN ST,
ASHLAND, OR 97520
(541) 488-5300
C!TY RECORDER
Page 1/1
lX., 'uXDATE' """,',
5/31/2011
,f!olNiJMBERSk: .,
10195
VENDOR: 015919
SPECIALTY ENGINEERING INC, ELECTRIC POW!
3305 ARCTIC BLVD, SUITE 201
ANCHORAGE, AK 99503
SHIP TO: Ashland Electric Department
(541) 488-5354
90 N MOUNTAIN
ASHLAND, OR 97520
FOB Point:
Terms: Net
Req. Del. Date:
Speclallnst:
Req. No.:
Dept.:
Contact: Dave Tygerson
Confirming? No
ijiitQllanil~. IltuiliilJ!
Contractor to replace visible break
window gaskets on (4) Cooper VFI
switches, Work to be performed in
compliance with Cooper Power Systems
maintenance procedures.
4,476.00
Contract for Goods & Services
Beginning date: May 25, 2011
Completion date: June 24, 2011
Insurance required/On file
BILL TO: Account Payable
20 EAST MAIN ST
541-552-2028
ASHLAND, OR 97520
SUBTOTAL
TAX
FREIGHT
TOTAL
4476,00
0.00
0,00
4,476,00
1~~c_c.O_Ul)t~~umDer~} e&!'I~Je:ctlijum6i;~~]n::r:j ~ " , ;~~ollnHNt.imbe"rS~;'~ ~;~;'3!:F~~oJe~tTN.umb'<"e~~;g~~ ~~.A~~~Q
E 690, 1 1 1 8,00,7041 0 E 000245,999 4 476.00
,
4'(~ ~ '"~/(
Authorl d Signature
VENDOR COPY
I FORM#3 I
A request for a Purchase Order
REQUISITION
CITY OF
ASHLAND
r?~/tJ 4/ I
Date of req uest:
Required date for delivery:
Vendor Name
Address, City, State, Zip
Contact Name & Telephone Number
Fax Number
SOLICITATION PROCESS
o Exempt from Competitive Biddina
o Written Findings (Form attached)
o Quote or Pro osal attached
o Small Procurement
Less than $5.000
Note: Total contract amount, including any
amendments may not exceed $6.000
Intermediate Procurement
GOODS & SERVICES
$5.000 to $100.000
o (3) Written quotes attached
PERSONAL SERVICES
$5,000 to $75,000
o Less than $35,000, by direct appointment
o 3 Written ro osals attached
Description of SERVICES
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Description of MATERIALS
o Invitation to Bid (Copies on file)
Date a roved b Council:
o Reauest for Proposal (Copies on file)
Date approved by Council:
o Sole Source
o Written Findings (Form attached)
o Quote or Proposal attached
o Special Procurement
o Written Findings (Form attached)
o Quote or Proposal attached
Date a roved b Council:
Item #
Quantity
Unit
D Per attached QUOTE
Emeraencv
~ritten finding3 .:.tt.:.G1,.:.d ..
[9-QUote or Pro osal attached
CooDerative Procurement
o State at Oregon
Contract #
o State of Washington
Contract #
o Other government agency contract
Agency
Contract #
o Intergovernmental Agreement
Agency
Contract #
Date approved by Council:
$
Unit Price
Total Cost
Project NumberQQQZY5. 9J9' Account Number6.'?.Q. JL .1?. QQ. ZQ.'l.LIPP Account Number u_' __' u' u' ____h
Account Number ___' __' __' __' ______ Account Number ___' __' __' __' ______
'Expenditure must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately. Affach extra pages if needed.
By signing this requisition form, I ceriify that the information provided above meets the City's public contracting requirements, and the documentation can be provided
upon requesl.
Employee Signature: 'JL~O :7~~QJ(D.J0\... Department Head Signature: ~ ~ G' d---
Additional signatures (if applicable):
Funds appropriated for current fiscal year: fi$ / NO
,d.. -tfi' ~
Finance Director
Comments:
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Dale'
G: Finance\Procedure\AP\Forms\Form #3 - Requisition.doc
Updated on: 511812011