HomeMy WebLinkAbout2011-223 Contract - Pacific Paving Inc Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: Pacific Paving
ASHLAND CONTACT: Terry Simcoe
20 East Main Street
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:September 1,2011 FAX: 541-830-4612
BEGINNING DATE: September 2, 2011 COMPLETION DATE: September 16, 2011
COMPENSATION: $3,590.00 - Per quote dated August 30, 2011 and attached as Exhibit C.
GOODS AND SERVICES TO BE PROVIDED: Commercial Asphalt Patching, Approximately 1,128 sq ft of 4"
asphalt, Location: Holly Street between Harrison & Morton
ADDITIONAL TERMS:
NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the
CITY AND CONTRACTOR AGREE as follows:
1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and
expense, perform any work described above and, unless otherwise specified, furnish all labor, equipment and
materials required for the proper performance of such work.
2. Qualified Work: Contractor has represented, and by entering into this contract now represents, that any personnel
assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned
in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are
so registered, licensed and bonded. Contractor must also maintain a current City business license.
3. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no later
than the date indicated above and start performing the work under this contract by the beginning date indicated
above and complete the work by the completion date indicated above.
4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and
expenses, the sum specified above. 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, 279B.225, 279B.230, 2796.235, 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:
i. If Cirty funding from federal, state, county or other sources is not obtained and continued at levels
Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 1 of 5
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 Liability 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 Liability 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
intent not to renew the insurance oovera e s without 30 days'written notice from the Contractor or its insurers to
Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 2 of 5
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 Council or the Public Contracting Officer is
required before any work may begin under this contract.
21. Cert' n. ctor shall sign the certification attached hereto as Exhibit A and herein incorporated by
r en
Co c City of Ashland
y By a DAB.
Signature Department Head
Print Name Print Name
j Title Date
W-9 One copy of a W-9 is to be submitted with
the signed contract. Purchase Order No. '1
Contract for Goods and Services Less than$25,000, Revised 06/30/2011, 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.
Con racto (Date)
Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 4 of 5
OS/31 0(3:: 5 5418304612 PACIFICPAVINGINC PAGE 02
PAVING, INC.
P.O. Box 2370 ■ White City, Oregon 97503-0370
Office 541-77211616 as Fax 541-8304-612
FROPO£ kLSURMCCTED TO: PHONE 541-552-2335 ugust—3012011
NXYT
of Ash) tmd Waste Water Dept.. JOB N` fiolly St.
I. Moun ain Avc. STRT�'Holly St.between Harrison&MOMU
T 1.md 6 97520 CITY Ashland STb 9�s2o
N%'c he vbmit spec fications and esifnlales for: Commercial Patching
1. h trend line,approximately 1,128 sq. ft.,with 411 of asphalt.
R'ehrn .wewfumisl N,c ahe,e labor and mstelinlx in aeeadanecwiMtba ol,m qu6eaCOVa fo.nn wm oC
** Thous; ad Five Hundred Ninety Dollars and No/100"* dnnarsis 3,590.00 l
TERN 1 nn compl, ion ofjob,Mess other mrmrporeets are made in writing.A2%per motdt FINANCE CHARGE will be"Von all pas[doe accomas,
W1,W "ERCFNf QE RATE OF 24%.In the ppean cry balmoc is fumed over to an aMermy for 0011(n mm,or if a lawsuit is filed to collect any balance,
hmladi a ads from tr d,the provaEbi party shed be albticd to his raasonable aaamry flea and raaonahk expea�of litigstkm,such as investiganon,
dcposi (.visional la e and other htn:repensrs.All main,al is gueradocd to be as specified.All work to be compldW m a workmanhla:manna according
I stn! �ctices.Aar eltmNioa or deviation from above specifications involving additional work and extra costa will became an extra chmp over and above
tin cm :.'subbase a Nor base is prepmcd by others,then iwerenae is limited by wodonanship•The normal soil SMIO�on pracass.will not kill all types of
vegota :we will w he responsible for any damaged pavemmt due to the gtowth ofvegefation.All agreements contingent upon stnkL%accidents or delays
b ryon, i nml.Ifthi contact axoxds$1,000,die owner acimowledgw receipt of the"lufamatinn Notice to Homoowners about Construction Liens."This
pn w )c withdrr n by us if not accepted within 30 days.CCa#50f135
1�
t c-d-G..� Terry W Simcoe
Acceptance of Proposal
vices,spa $cations and conditions arc satisfactory and are hereby accepted.You arc auftrized to do all of the work as specified.
Paym 11 be made is outlined above.
Si{v€ .. Date
ACORD_. CERTIFICATE OF LIABILITY INSURANCE OP ID DA O9 3�0 0)
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
RPD Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
PO Box 784 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Springfield OR 97477
Phone: 541-741-0550 Fax:541-741-1674 INSURERS AFFORDING COVERAGE NAICA
INSURED INSURERA SAIF Co oration - Salem 36196
INSURERS
Pacific Paving, Inc. INSURER C:
PO Box 2370 INSURER O:
White City OR 97503
INSURER f'
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS.
LTR TYPE OF INSURANCE POLICY lNBUR DATE YWDD. ATE BMNDJYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE S
COMMERCIAL GENERAL UASILfTY PREMISES(a a a le $
CLAIMS MADE ❑OCCUR NED EXP(Any OM IIBISCII) $
PERSONAL B ADV INAJRY S
GENERAL AGGREGATE $
GENt AGGREGATE LIMIT APPLIES PET, PRODUCTS-COMP/OP AGG S
POLICY ,MT LOC
AUTOMOBILE LIABILITY COMBINED SINGLE UNIT
ANY AUTO (Ea accMe,X) $
ALL OWNED AUTOS BODILY IFUURY
SCHEDULED AUTOS (P°PaDg11 $
HIREDAUTOS SODILYINIURY
S
NON-OWNED AUTOS (Pera¢itlenl)
PROPERTY DAMAGE f
(Pa eoWentl
GARAGE LIABILITY AUTO ONLY-EAACCIDENT S
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGO S
EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR FD CLAIMS MADE AGGREGATE S
S
DEDUCTIBLE S
RETENTION $ S
WORKERS COMPENSATION AND B TORY LIMITS ER
'A EMPLOYERS LIABILITY 812919 10/01/10 10/01/11 E.L.EACH ACCIDENT $ 500,000
ANY PROPRIETORIPARTNER/ ECUTIVE
OFFICEWMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ 500,000
IIyyee+e��C =10=1O
SPECIAL PROVISIONS Ee1PIV EL DISEASE-POLICY LIMIT $SOO,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS J VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROWSNINS
RE: All Operations
CERTIFICATE HOLDER CANCELLATION
CITASO2 SHOULD AMY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City Of Ashland DATE THEREOF,THE ISSUING INSURER WILL ENOEAVORTO MALL 30 DAYS WRITTEN
Finance Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO$O SHALL
Attn: RariAnn Olson IMPOSE NO OBLIGATION OR W&LRY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
90 N Mountain Ave.
Ashland OR 97520 REPRESENTATIVES.
ALIT RES
ACORD 25(2001108) ®ACORD CORPORATION 1988
Beecher Carlson 9/6/2011 10 : 44 : 58 AM PAGE 3/007 Fax Server
ACOR& TI G I T� C 1 1 1 1 DATE(MMMDIYYYY)
� CER . CA . E O. ABILITY eNSURANCE 5/26/2011
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(SI, AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may requlro an endorsement. A statement on lids cortlficate does not confer rights to the
certificate holder in lieu of%uch endorsement(s).
PROMJC.FR NAME: Susan Nilson, AAI, AIC
Beecher Carlson Insurance Agency LLC AICtNO EIII: (541)772-1111 FAC N0:15411912-3785
707 Murphy lid ADDRESS susan.vilson8beechercarl son.com
PRODUCER 00005034
CUSTOMER 10 1.
Medford OR 97504 INSURER(S)AFFORDING COVERAGE NAIC0
INSURED INSURERA:Travelems Prop Cas CO of AM 25674
NSURFRR:Charter Oak Fire Insurance Co 25615
Pacific Paving Inc INsuRERc:Indeainit C an of CA
Y P Y
PO BOX 2370 IMURERD:
INSURER E'
White City OR 97503 INSURERF'
COVERAGES CERTIFICATE NUMBER:CL11317g9660 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. N07Wi THSTANDNG 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.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE POLICYNUMB6R MMIW/YriY MMIMIYYW LIMITS
R
GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000
TCOLINIEPCIAL OENEPAL lV.B0.1TV PpcMISEc EaPw.ncncc T 300.DOO
cumms MME 1OCCUR TCO526D8417TIL11 /20/2011 /20/2012 MED EX (An)omPrwn) i 5,000
PFRAONfd R WN INA IS V S 1,000,000
r,ENERAI A CPEBATE $ 2,000,000
GFN" AGC,RF6ATF I FAIT APT IFS PFR' 'PODI ICTS-COMP.n�AC.G j 2,000,000
X POL CY PRO- LOG J
AUTOMOBILE LIABILITY ^OMBNEDSINCAE LNIR S 1,000,000
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B /1L OW [D AUTOS T810526DB417COF11 /20/2011 /20/2012 BODI_Y NJURY IP?r acrde . S
BOUI_Y 0lJUFY IF'sr acadeMf $
X SCHEDULEDAUTOS
PROPERTY D?MABE i
X HIREDNJIOS 'P=i xuid++nq
X NON OMED AUTOS 5,000
CPllsion
X UMBRELLA LIAR OCC'J P. ESCH OCCURRENCE § 1,000,000
EXCESS LIAR CLAINO-01ADE ASGREGATE $ 1,000,000
_ CEDUCTIELE 4
A X RCTCNToIII S 10,000 TSMCUPS26DS417TIL11 /20/2011 /20/2012 z
WORKERS COMPENSATION RC SIgIU- OIH-
AND EMPLOYERS'LIABILITY '
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,AdtlNenal R1msk1 Sceedd.,If...1pro 1.nquln4)
Cortificato holder included a0 additional insured per attachod ondocuornant BCCD2460005 where required by written
contract. Subject to policy terms, conditions and exclusions.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland, its elected officials, ACCORDANCE WITH THE POLICY PROVISIONS.'
officers 6 amployees -
20 East Main Street AUTHORIZEDREPRESENTATIVE
Ashland, OR 97520
S Wilson, AAI, AIC/SU ��jtrL�.-� �--�• l'f%�t+`�
ACORD 25(2009109) O 1988-2009 ACORD CORPORATION. All rights reserved.
INS025 p00000) The ACORD name and logo are registered marks of ACORD
Beecher Carlson 9/6/2011 10 : 44 : 58 AM PAGE 4/007 Fax Server
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
(CONTRACTORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. WHO IS AN INSURED— (Section II) is amended c) The insurance provided to the additional in-
to, include any person or organization that you sured does not apply to "bodily injury" or
agree in a "written contract requiring insurance" ."property damage" caused by "your work"
to include as an additional insured on this Cover- and included in the "products-completed op-
age Part, but: erations hazard" unless the "written contract
a) Only with respect to liability for"bodily injury", requiring insurance" specifically requires you
"property damage" or'personal injury"; and to provide such coverage for that additional
insured, and then the insurance provided to
b) If, and only to the extent that, the injury or the additional insured applies only to such
damage is caused by acts or omissions of "bodily injury" or "property damage" that oc-
you or your subcontractor in the performance curs before the end of the period of time for
of "your work" to which the "written contract which the "written contract requiring insur-
requiring insurance" applies. The person or ance" requires you to provide such coverage
organization does not qualify as an additional or the end of the policy period, whichever is
insured with respect to the independent acts earlier.
or omissions of such person or organization. 3. The insurance provided to the additional insured
2. The insurance provided to the additional insured by this endorsement is excess over any valid and
by this endorsement is limited as follows: collectible "other insurance", whether primary,
a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is
this Coverage Part shown in the Declarations available to the additional insured for a loss we
exceed the limits of liahility required by the cover under this endorsement. However, if the
"written contract requiring insurance", the in- "written contract requiring insurance" specifically
surance provided to the additional insured requires that this insurance apply on a primary
shall be limited to the limits of liability re- basis or a primary and non-contributory basis,
quired by that "written contract requiring in- this insurance is primary to "other insurance"
surance". This endorsement shall not in- available to the additional insured which covers
crease the limits of insurance described in that person or organization as a named insured
Section III—Limits Of Insurance. for such loss, and we will not share with that
b) The insurance provided to the additional in- "other insurance". But the insurance provided to
shred does not apply e "bodily fad the additional insured by this endorsement still is
Ppy y I ry", ,prop- excess over any valid and collectible "other In-
erty damage" or "personal injury" arising out surance", whether primary, excess, contingent or
of the rendering of, or failure to render, any on-any other basis, that is available to the addi-
professional architectural, engineering or sur- tional insured when that person or organization is
veying services, including: an additional insured under such "other insur-
I. The preparing, approving, or failing to ance".
prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the
ings, opinions, reports, surveys, field or- additional Insured by this endorsement:
ders or change orders, or the preparing,
approving, or failing to prepare or ap- a) The additional insured must give us written
prove, drawings and specifications; and notice as soon as practicable of an 'occur-
rence" or an offense which may result in a
II. Supervisory, inspection, architectural or claim. To the extent possible, such notice
engineering activities. should include:
CG D2 46 08 05 0 2005 The St. Paul Travelers Companies., Inc. Page 1 of 2
Beecher Carlson 9/6/2011 10 : 44 : 58 AM PAGE 5/007 Fax Server
COMMERCIAL GENERAL LIABILITY
f. How, when and where the "occurrence" any provider of"other insurance"which would
or offense took place; cover the additional insured for a loss we
If. The names and addresses of any injured cover under this endorsement. However, this
persons and witnesses; and condition does not affect whether the insur-
ance provided to the additional insured by
M. The nature and location of any injury or this endorsement is primary to "other insur-
damage arising out of the "occurrence" or ante" available to the additional insured -
offense, which covers that person or organization as a
b) If a claim is made or "suit" is brought against named insured as described in paragraph 3.
the additional insured, the additional insured above.
must: 5. The following definition is added to SECTION V.
I.- Immediately record the specifics of the —DEFINITIONS:
claim or"suit" and the date received; and 'Whitten contract requiring insurance" means
if. Notify us as soon as practicable, that pan of any written contract or agreement
The additional insured must see to it that we under which you are required to include a
receive written notice of the claim or"suit" as person or organization as an additional in-
sured on this Coverage Part, provided that
the "bodily injury' and "property damage" oc-
c) The additional insured must immediately curs and the"personal injury" Is caused by an.
send us copies of all legal papers received in offense committed:
connection with the claim or "suit", cooperate a. After the signing and execution of the
with us In the investigation or settlement of contract or agreement by you;
the claim or defense against the "suit", and
otherwise comply with all policy conditions. b. While that part of the contract or
d) The additional insured must tender the de- agreement is in effect; and
fense and indemnity of any claim or "suit" to c. Before the end of the policy period.
Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05
Beecher Carlson 9/6/2011 10 : 44 : 58 AM PAGE 6/007 Fax Server
r9 �
Department of Consumer and Business services
regor� p Insurance Division
350 Winter St.NP,
k.,z ,t-'k,c-,.,.,. PO Box 24480,Sateen,OR 97309-0405
503-947-7980
Fax:503-378-4351
www.insurance-oregon.gov
CERTIFICATE OF INSURANCE ARTICLE
April 22,2010
Oregon insurance producers and industry representatives have advised the Insurance Division
that they are concerted about continuing pressure to modify certificates of insurance to satisfy
contracts that require a much broader extension of coverage than the policy will provide.
Certificates of insurance slate that they are issued as a mallet'of information only, and confer no
rights upon the certificate holder. A certificate does not amend,extend or alter the coverage
afforded by the policies represented.
Oregon Revised Statute (ORS)742.003 addresses the filing and approval of policy lomts.
Certificates of insurance are not considered part of the policy contract and are not required to be
filed. If a document is issued that alters the contract agreement in any way, an admitted
company would be required to have filed the change in the contract acid have it approved prior to
changing the policy language and issuing a certificate.
The information on a certificate should represent the contract of insurance. There should be no
variation in the information presented on the certificate from the coverage or conditions that are
a part of that contract.
Art insurance producer who issues a certificate of insurance that is not a representation of the
policy contract could be in violation of ORS 744.074(I)(e). 'fhe director has the authority to
place a producer On probation, Or to suspend or revoke 112e license of a producer who
intentionally misrepresents the terms of an actual or proposed contract of insurance.
Beecher Carlson 8/6/2011 10 : 44 : 58 AM PAGE 7/007 Fax Server
~ ^
Why We-Are Using the Latest ACORD 25 Certificate 8fInsurance
In SeptembeF2009, ACORD revised the ACORD 25 Certificate of Insuranceform. One ofthe majorchangeswas
the removal ofthe 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 approved for use in our state When a new form is approved, prior
versions can no longer be used. Therefore, it is illegal for us to issue anything other than the currently approved
ACORD form.
• Notice of cancellation isa policy right, not uo unregulated service. Nu insurer shown on this nertifiooteis 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 grants the insurer the
right to cancel for reasons such as nonpayment with less notice than you require.
• For the reason just cited, i[our agency was 10 issue acertifivote 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 certificate infraudulent.
• Under (lie ACORD Corporation's Huerising agieernent, 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
caonntuoeannNereditinoofthe8C0RD25DoinOsowwu|dv|o|a(ekC0RCro|ioenainga8»remeoiand, oso
copyrighted document, federal Copyright law.
• Likewise, we are unable io modify the new cert|fioaieto add u notice nf cancellation. ACORD forms are
designed to be completed, not altered ACORD's Forms Instruction Guide says that a certificate should not be
uxed "To waive /i8|/io... uquviewo/di//g front auoohocLJv quote any vvv/din8v,hid/anm/Vsapv|ioyon|fesu
the policy itself has been omonUoV."Also since our state requires ACCRID forms to be filed, any alteration to a
filed form would require its refiling. |n addition, our insurance company contracts only allow osto issue unaltered
ACORnho/mc
• We are often asked to issue proprietary certificates provided by the certificate requestor. Again, our insurance
company contracts only allow oolo issue unaltered ACCRDforms.
certificates of insurance and has very specific regulatory guidelines on certificate language. Many proprietary
certificates include broad, vague or ambiguous language that may or may not be incompliance with state laws,
regulations, and insurance department directives, Therefore, we cannot issue any proprietary certificates that
have not been reviewed ky our state insurance department.
�
Several states have voiced strong concern over ce��icotesas evidenced inhe|nwlinks:
• Oregon Insurance Dept.
• Atlanta, GeorUia� See detailed study they conducted in20V8h||��XU[��0'��I�Z08���0
• Click following link for current update bystate:
§.ma
We appreciate your understanding of the legal restrictions on our ability to fully comply with your request.
zzowvv 2nd Ave Ste 000 pvm^oonoy72oomo (503)222-1831 Main (503)274-0323 Fax
c^License*wFno61oon License*w1ozo7vvx License*ns/ow
U I i HECORDER Page 1 / 1
LA&I CITY O F
7�S H LA N D � . DATE' ` ' ;g0 NUMBER;, 20 E MAIN ST. 9/8/2011 10440
ASHLAND, OR 97520
(541)488-5300
VENDOR: 000903 SHIP To: Ashland WWTP
PACIFIC PAVING, INC .(541)488-5348
P O BOX 2370 1295 OAK STREET
WHITE CITY, OR 9750.3 ASHLAND, OR 97520
FOB Point: Req.No.:
Terms: Net Dept.:
Req.Del.Date: Contact: David Gies
Special Inst: Confirming? No
z..4uariti . .•,Unit Descr pti,cm ..' , Unit Price,:.', Ext..Okce.>:� ,.
Asphalt Patchinq 3,590.00
Approximately 1,128 sq ft Of 4" asphalt
Location: Holly Street between
Harrison and Morton
Contract for Goods & Services
Beginning date: September 2, 2011
Completion date: September 16, 2011
Insurance required/On file
SUBTOTAL 3 590.00
BILL TO:Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 3,590.00
ASHLAND, OR 97520
Y rte. <,..w._ _
Account Numberu s' �'ProJect Number Amoun6'. _AccountNumber _�, , s_';Pio)ect Number i,°> ;': .Amount,,,;,;,:=:
E 675.08.17.00.602400 3,590.00
lNl' Vr�GI. �tTG�.�III
Authorized Signature VENDOR COPY
FORM #3 CITY OF
A request for a Purchase Order ASHLAND
REQUISITION Date of request:
Required date for delivery:
Vendor Name O r r Ac o✓ion
Address,City,State,Zip '
Contact Name&Telephone Number
Fax Number
SOLICITATION PROCESS
❑ Exempt from Competitive Bidding ❑ Ememencv
❑ Written Findings(Form attached) ❑ Invitation to Bid (Copies on file) ❑ Written findings attached
❑ Quote or Pro sal 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 Procurement ❑ Sole Source Contract#
GOODS&SERVICES ❑ Written Findings(Form attached) ❑ Other government agency contract
$5.000 to$100.000 ❑ Quote or Proposal attached Agency
❑ (3)Written quotes attached . Contract#
PERSONAL SERVICES ❑ Special Procurement ❑ Intergovernmental Agreement
$5.000 to$75,000 ❑ Written Findings(Form attached) Agency
❑ Less than$35,000,by direct appointment ❑ Quote or Proposal attached Contract#
❑ 3 Written proposals attached Date approved by Council: Date approved by Council:
Description of SERVICES Total Cost
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
/'G fl.l. jr'o!/ 51- ze-try 3 590 .00
fli 1$ 0 le J
❑ Per attached QUOTE TOTAL:COST
3i_'9D _
Project Number---------- Account Number G75.OS- i?.00- L o:ry0O
Account Number
Account Number------------------- Account Number
'Expenditure must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately. Attach extra pages if needed.
By signing this requisition form,I certify that the information provided above meets the City's public contracting requirements,and the documentation.can be provided
upon request. (�
Employee Signature: &e Department Head Signature: I ch6aa IC .
Additional signatures(if applicable): /
Funds appropriated for current fiscal year: ES y NO 1d u 9 6 &,AtG Q 1 M I
Finance Director Date
Comments: