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HomeMy WebLinkAbout2011-205 Contract - Hays Oil Company Contract for Fuel — Ashland Parks & Recreation CITY OF CONTRACTOR: Hays Oil Company ASHLAND CONTACT: Steven Hays 20 East Main Street Ashland, Oregon 97520 ADDRESS: 1890 So. Pacific Hwy, Medford, OR 97501 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: 541-772-2053 DATE AGREEMENT PREPARED: 07/22/2011 FAX: 541-779-2602 BEGINNING DATE: 07/22/2011 COMPLETION DATE: 06-30-2012 COMPENSATION: Fuel to be priced using the "Eugene AM OPIS (Oil Price Index Service) rack average', plus applicable taxes and markup as follows: Regular Unleaded 10% Ethanol $0.181, Dyed B5 Biodiesel $0.181 GOODS AND SERVICES TO BE PROVIDED: Fuel to be delivered bi-weekly and/or as needed to the fuel tank located at the Ashland Park Shop (Next to Oak Knoll Course) 3070 Hwy 66, Ashland, OR, 97520. Per proposal attached as Exhibit C. ADDITIONAL TERMS: Types of fuel: Regular Unleaded 10% Ethanol and Dyed B-5 Biodiesel; Fuel tank: 1,500 Gallons — 500 Gallons/Bio-Diesel, 1,000 Gallons/Unleaded 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 2796.220, 27913.225, 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$18,890 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. City's Convenience. This contract may be terminated at any time by City upon 30 days',notice in writing and delivered by certified mail or in person. C. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of written notice to Contractor, or at such later date as may be established by City under any of the following conditions: Contract,for Goods and Services Less than $25,000, Revised 07/22/2011, Page 1 of 5 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. Obligation/Liability 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, 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 ORS 279A.110 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 Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide Oregon workers' compensation coverage for all their subject workers b. General Liabilitv insurance with a combined single limit, or the equivalent, of not less than Enter one: $200,000, $500,000, $1,000,000, $2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property Damage. It shall include contractual liability coverage for the indemnity provided under this contract. C. Automobile Liabilitv insurance with a combined single limit, or the equivalent, of not less than Enter one: $200,000, $500,000, $1,000,000, or Not Applicable for each accident for Bodily Injury and Property Damage, including coverage for owned, hired or non-owned vehicles, as applicable. d. Notice of cancellation or change. There shall be no cancellation, material change, reduction of limits or Contract for Goods and Services Less than $25,000, Revised 07/22/2011, Page 2 of 5 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 Contractors 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 Council or the Public Contracting Officer is required before any work may begin under this contract. 21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by refere Contract o : City of Ashl By By Signature epartment Head �81-�'-walwPvL5 ^ �Pr�int�N-a—me� Print Name t�f�U>�ESt{P A Title Date W-9 to be submitted with the signed contract. Purchase Order No. Contract for Goods and Services Less than $25,000, Revised 07/22/2011, Page 3 of 5 EXHIBIT A CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified it that it is no longer subject to backup withholding. Contractor further represents and warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms, (c) the work under the Contract shall be performed in accordance with the highest professional standards, and (d) Contractor is qualified, professionally competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on behalf of the entity designated above and authorized to do business in Oregon or is an independent Contractor as defined in the contract documents, and has checked four or more of the following criteria: (1) 1 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) 1 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. Contractor (Date) Contract for Goods and Services Less than $25,000, Revised 07/22/2011, Page 4 of 5 FROM CWEO>JUL MO 2011 10:04/ST. 10:03 1NO.33OOMS4184 P 2 INS illli � iii PO BOX 1220 Medford OR 97501 (800)-452-6555 July 19, 2011 City of Ashland 90 N. Mountain Avenue Ashland OR 97520 Fax: 541-488-5320 Attn: Purchasing Representative, Kari Olson Re: Fuel Bid for Ashland Parks Shop The pricing for this bid offering will be based on the following. The prices are quoted without any tax for bid purposes only. The applicable taxes will be applied at the time of delivery/invoice: • Eugene Oregon OPIS Average 09:OOAM EDT report. • Deliveries to Ashland are made on a weekly basis. • The fuels available for delivery are those that are provided at the Eugene Oregon fuel terminal. • Regular Unlead 10%Ethanol • B5 biodiesel Dyed • Price of fuel and markup. o Regular Unlead OPIS Price 3.0658, Markup .181, Total ex tax 3.2468 o Dyed B5 Biodiesel OPIS Price 3.1096, Markup .181, Total ex tax 3.2906 If you have any questions,contact Steven Hays,541-772-2053 ex 1009 or email shays @haysoil.com. Thanks you for the opportunity to bid on your fuel needs. Sincerely, Steven Hays 1890 So. Pacific Hwy. 529 NE F Street 191 Bateman Drive 829014"Street Medford OR 97501 Grants Pass OR 97526 Central Point OR 97502 White Citv OR 97503 541-772-2053 541-476-2218 541-664-6640 541-826.5550 Fax 541-779-2602 Fax 541-476-9936 Fax 541-664-1364 Fax 541-826-3864 www.salf.com OREGON WORKERS COMPENSATION 4. 11h sai F CERTIFICATE OF INSURANCE ,corporation CERTIFICATE HOLDER: CITY OF ASHLAND 90 N. MOUNTAIN AVENUE 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. POLICY PERIOD ISSUE DATE 480084 07/01/2011 to 07/01/2012 06/30/2011 INSURED: BROKER OF RECORD: R W HAYS CO PO BOX 1220 MEDFORD, OR 97501-0091 LIMITS OF LIABILITY: Bodily Injury by Accident $500,000 each accident Bodily Injury by Disease $500,000 each employee Body Injury by Disease $500,000 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. CANCELLATION: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL MAIL 30 DAYS'WRITTEN NOTICE TO THE ABOVE NAMED CERTIFICATE HOLDER. AUTHORIZED REPRESENTATIVE !Ng7c )f> President and CEO 400 High Street SE Salem,OR 97312 P:800.285.8525 F:503.373.8020 Pollcy_Batch_Cerifl ateORnsurance JUN-20-2011 13:29 LLLIUII I'UWLLL HHDLN HHKL 5.52'(4'1644 1'.01 I 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 THE 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 certificate holder Is an ADDITIONAL INSURED,the pblicy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,Certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemant(s). PRODUCER NAME: pace wimmer Elliott Powell Haden and Baker Inc. ONNNa.EZt. (503)227-1771 �. soSJ 2]_6-]6894 1521 S.W. Salmon Street pypEgg;pwimmaz @epbb.eem PRObbl7-c`OR 00004902 _ Portland OR 97205-1783 INSURERS AFFORDING COVERAGE Nwlca INSURED INSURMAContinental t9eatern Insurance INSURER®: RW Hays Cc Inc, D)BA: Hays Oil Companhr INSURER C BiMor Stations Inc INSURER OI PO Box 1220 INSURERS; Medford OR 97501 INSURER': COVERAGES CERTIFICATENUMBER;11-12 GL, Auto, Vatb REVISIONNUMBER: THIS IS TO CERTIFY THAT THE PCUCIES 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.LIMIT$SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ITRN TYPE QFIN$URANLE d POLICY NUMBER MM/O MMbQlYyYP LIMITS GENERAL11AMLITY EACH OCCURRENQE S 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMI F 100,000 A CLAIM"ADMExil OCCUR =2930039 7/1/2011 11/2012 MEDE Fw onepenm $ 5,000 PERSONAL&ADV INJURY 5 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: - PRODVCTS•COMPIOPAGG 5 2,000,000 X POLICY 0 PRO• LOO S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1,000,000 (ES Accident) X FWY AUTO BODILY INJURY(PefpArAOn) 5 A ALL OWNED AUTOS DP2938039 11/2011 /1/2012 BODILY INJURY Li deM) 5 eCHEDULEDAWOS PROPERTY DAMAGE HIREDAUTOS (Peracddeni) g NON-0WNED AUTOS - UnituUM m.Wat oc l hod s T PIP-Basic $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 R EXCESS me CLAIMS-MADE AGGREGATE_ $ 10,000,000 DEDUCIBLE --.-.._.-..... _ 5 A RETENTION a NIL PUZ938040 /1/2011 /1/2012 $ wORKER3 COMPENSATION WC STATU• OTH• AND EMPLOYERS'LIABILITY YIN 199X11 ANY O FlOERMREMBER FARTIN1DE L EtY1 ECUTIVE a NIA - E. EACH ACCIDENT $ --,�-,�-- IMAndALPrYInNH, E.L DISEASE-FA EMPLOYE S I/yyw desalae undef E.L. N%A%. �S 0E AIPTION OF OPERATIONS beloW POOCY LIMIT DESCRIPTION OF OPERATONS I LOCATIONS IVEaICLE$ (gnACh 0.QORD tOd,gddlNonAl RemAda GChCd4Ic,.I/mple apecc la rcqulRdl Re: pgiivgry of Fuel, The City of AshIA-d, Oregon and its Elected Officials, Officers and Employee. ere included as Additional inaureda per forms ON 3130 (09 06) .nd CR' 1054L (01 90) attached, Th$.a Insurance is Primary and Mon-Contributory. Subject to policy terms, conditions and exclusions- CERTIFICATE HOLDER CANCELLATION (541)488-5320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED W City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. Issued by Federated. AUTHORIZED REPRESENTATIVE 90 N Mountain Ave Ashland, OR 97520 Pam Wimmer/Pti ACORD 26(2009109 ®1988.2009ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD JUN—GIB—e011 13;3U CLL1U1 I rUWCLL 0HUCIY JoHItC POLICY NUMB$R: THIS ENDORSEMENT CHANGES THE POLICY- PLEASE READ IT CAREFULLY MANUSCRIPT ENDORSEMENT ) This endorsement modifies insurance provided under the gollowingc COMMERCIAL PROPERTY COVERAGE PART Q SUSINESSOWNERS Q INLAND MARINE ' Q CRIME COVERAGL' PART © COMMERCIAL AUTO COVERAGE PART ® COMMERCIAL GEN&P.AL LIABILITY COVERAGE PART PRODUCTS COMPLETED OPERATIONS LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART 0 COMMERCIAL UMBRELLA POLICY Q WOMERS'COMPENSATION POLICY ADDITIONAL INSURED - PRIMARY COVERAGE - SCHEDULED PERSON OR ORGANIZATION (continued) ww++w+=wxw:vwwww+o-++.xxxw+,t++sx+xxawwww�#txx+awwwrw+w+wxxxnwaww++++xwwe Name of additional Iutored Persons) Or Organization(s) r Any person or organization whom you are required to name as an additional insured on this policy under a written contract or agreement. Such written contract or agreement must be executed prior to the bodily injury" or "property damage"_ No such person or organization is an insured with respect to any occurence that takes place after expiration of the written contract or agreement between you and such person or organization, i 1 f { 'CA 10 54 01 90 TOTAL P.03 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CW 31 30 09 06 ADDITIONAL INSURED - PRIMARY COVERAGE - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Or aniYation s Blanket Additional Insured perform CW3130 and CW1054L cCo RW Hays Go Inc PO BOX 1220 Medford, OR 97501 Location(s)Of Covered Operatfons: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II—Who Is An Insured is amended to include as an additional insured the person(s) or organizations) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage"or"personal and advertising injury"caused, in whole or in part,by: 1. Your acts or omisslons;or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the Iooation(s)designated above. 8. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury"or 'property damage"occurring after: 1, All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed;or 2. That portion of "your work' out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds,the fallowing applies: . The insurance provided by this endorsement is primary insurance and we will not seek contribution under any insurance policy under which such additional insured. is a named insured, if such policy was procured and paid for by such additional insured, or a parent or related entity of such additonal insured. CITY PECOMER Page 1 1 Ashland Park Commission 1! DATE I P.O NUMBER',- 1 20 E MAIN ST. 8/17/20::1 00059 ASHLAND, OR 97520 (541)488-5300 VENDOR: 000414 SHIP TO: HAYS OIL COMPANY, RW HAYS OIL COMPANY D PO BOX 1220 MEDFORD, OR 97501 FOB Point: Req.No.: Terms: net Dept.: Req.Del.Date: Contact: Bruce Dickens Special Inst: Confirming? No Zu M. -M.r ltp�lce -fi_,=Ext Prlce.`,, Annual Fuel Contract FY 2011-2012 12,000.00 UNLEADED FUEL 10% Ethanol Estimate$1,000 per month DYED B5 BIO-DIESEL FUEL 12,000.00 Estimate $1,000 per month Fuel to be delivered bi-weekly and/or as needed to the fuel tank located at the Ashland Park Shop(Next to Oak Knoll Golf Course) 3070 Hwy 66. Fuel tank: 1,500 Gallons 500 Gallons/BioDiesel 1,000 Gallons/Unleaded Fuel to be priced using the"Eugene AM OPIS (Oil Price Index Service) rack average", plus applicable taxes and markup as follows: Regular Unleaded 10% Ethanol$0.181, Dyed B5 BioDiesel $0.181 Contract for Fuel (Ashland Parks & Rec) Beginning date: July 22, 2011 Completion date: June 30, 2012 Insurance required/On file SUBTOTAL 24.000 00 BILL TO: TAX 0.00 FREIGHT 0.00 TOTAL 24,000.00 ',,j,1A—cc3—u-ntTN—umb—erj[V�N�JMWWMMMW� KqWrcM�—UmI5—,rjJA WIM5-z Nu—m6MLM AmountQM E 211.12.04.00.602120 24,000.00 Authorize d'Signature VENDOR COPY FORM #3 CITY OF A request for a Purchase Order ASHLAND REQUISITION Date of request: Required date for delivery: Vendor Name Address,City,State,Zip Contact Name&Telephone Number Fax Number SOLICITATION PROCESS ❑ Exemot from Competitive Bidding ❑ Emergency ❑ Written Findings(Form attached) ❑ Invitation to Bid (Copies on file) ❑ Written findings attached ❑ Quote or Proposal attached Date approved by Council: ❑ Quote or Proposal attached ❑ Small Procurement Cooperative Procurement Less than$5.000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon Note:Total contract amount,including any Date approved by Council: Contract# amendments may not exceed$6,000 ❑ State of Washington Intermediate Procurements, ❑ Sole Source Contract# GOODS&SERVICES Z�?e a_e Written Findings(Form attached) ❑ Other government agency contract 5 0(0 100 000 ,(� ❑ Quote or Proposal attached Agency (3)Written quotes a achecj �� r Contract# PERSONAL SERVICES (x�y� `/ ❑ Special Procurement ❑ Intergovernmental Agreement $5.000 to$75.000 �� u,�p Written Findings(Form attached) Agency ❑ Less than$35,000,by direct appbin Ouote or Proposal attached Contract# ❑ 3 Written p ro osals attached Ste approved by Council: Date approved by Council: Description of SERVICES Total Cost Item # Quantity Unit Description of MATERIALS Unit Price Total Cost eR-���y Lt-v T07 AL COST ❑ Per attached quotelproposal - — -- ------ a°2W� ' Project Number-----_- °��Account Number--- / -- 6n�O�-�� 1 f Account Number-------_ - --_---- Account Number 'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expendi rer IT Director in collaboration with department to approve all hardware and software purlhases: 'TT Director Date By signing this requisition form,I certify that the information provided above satisfies the City's public contracting require a ts,and the documentation can be provided upon request. Employee Signature: Department Head Signature: Additional signatures(if applicable): Funds appropriated for current fiscal year YE / NO dLQ9C lam/ �� Finance Director Date Comments: G:FinanceTrocedurel4PTormsTorm#3-Requisibon.doc Updated on:811612011