HomeMy WebLinkAbout2011-282 Contract - Gridley Painting Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: Gridley Painting
ASHLAND CONTACT: Clinton Gridley, Owner
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 734 Haskell Street, Central Point, OR 97502
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-821-9974
DATE AGREEMENT PREPARED: October 18, 2011 FAX:
BEGINNING DATE: October 27, 2011 COMPLETION DATE: November 18, 2011
COMPENSATION: $165.00
GOODS AND SERVICES TO BE PROVIDED: Contractor to pressure wash exterior of Pioneer Hall.
Location: Pioneer Hall
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 27913.220, 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 $18,890 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 City 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
l 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 coverage(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. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by
reference.
Contractor- City of Ashland
BY BY
Signatur Department Head
2 E
Prin Name Print Name-
4,
Titre Date
W-9 One copy of a W-9 is to be submitted with
the signed contract. Purchase Order No. G
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:
SCI (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) 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.
ZA - (4 Z
Contractor (Date)
Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 4 of 5
Sep. 29. 2011 2 : 3 1 P M Drake " s Paint and Supply No. 0526 P. 1
Gridley Painting Clinton Gridley
734 Haskell St. Owner
Central Point, Or. (541) 821-9974
97502 CCB€t 170445
PROPOSAL
09/29/2011
Proposal Submitted To: Kart Olson—Pi rchaslou Rep.
Address: 90N. Mountain Ave.Ashland Or.97520
Phone: 541488-5354
Job Location: City Of Ashland— Plonger Hell
We hereby submit specifications fur:
Exterior-
- Pressure washing or exterior to remove dirt,cobwebs,loose point,etc.
Masking of all non stained surfaces.
Application of exterior stain to structure.
Application shall be one coat-Sprayed and back rolled.
Above application shall be two coals.
Complete clean up of fob site.We propose propose hereby to finish material and labor—co e n accordance with the above ®�—e
specifications for t rs,
Pressure weshin 1$ 65.00 dollars.,
Painting of structu s- T9Z5.00 dollars.Labor- 2 ,0 dollars.
If 3'coat is needed: Materials- SIJ40.00 dollars, Labor- $2.9¢5.00 dollars.
Any allemtion or deviation from the above specifications Involving extra costs will be executed only upon wrinen
order,and will become an extra charge over and above the estimate.NOTE—This proposal may be withdrawn by us
If not accepted within 30 days.
Respectfully Submitted: Clinton Gridley
Sep. 29. 2011 2 : 30PA Drake ' s Paint and Supply No. 0526 P. 2F(MM/DD11m)
�-� tam i IF[k,fa I r- yr LIAOILi i Y INSURANCE OPID DS 09/28/11
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: the certificate holder Is an ADDITIONAL INSURED,the po Icy 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 INS certificate does not confer rights to the
certificate holder In Ilan of such endorsemenl(s).
PRODUCER NAME:
one
Insurance Marketplace, Inc, al SRO ESt: aa,No:
1998 Skypark Dr Suite 100 ADDRESS:
Medford OR 97504 CUSTOMERIOI; GRICL-1
Phonet541-779-0177 Pax;PAX 772-8235 INSURER(S)AFFORDING COVERAGE NAIC0
INSURED INSURER A: Austin Mutual Ins 412
Cl}nton Robert Gridley INSURER B:
Gridleyy Painting
734 S Haakell St INSURERC:
Central Point OR 91502 INSURER O:
INSVPER E;
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED RAMER ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION Of ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS
CEHZTIFICATE MAY BE ISSUED OR NAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALLTHE TERMS.
EXCLUSIONS MHO CONDITIONS OF SUCH POLICIES.LIMITS SHOWN mAY HAVE BEEN REouceo BY PAID CLAIMS.
Elm LTR TYPE OF INSURANCE INS. MD FOLICYKUMMR (NWDDlYYYM (MMWO LIMITS
GENERAL LIABILITY EACH OCCURRENCE $1000000
A COMMERCIAL GENEML LIABILITY BP 170709204 05/26/11 05/26/13 PREMISES Eaomrtence $ 50000
CLAIMS-MADE F—]OCCUR MED EXP(MY WIT Per,yn) S5000
X Business Owners PERSONALILADVINJURY $1000000
GENERAL AGGREGATE $2000000
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPrOP AGG $2000000
POLICY j� LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
(Ea amldenl)
ANY AUTO BODILY INJURY(Parpa=rI) $
ALLOWNEOAUTOS BODILY INJURY(Parxddcn) S
SCHEDULED AUTOS PROPERTY DAMAGE
HIREDAUTOS (Peeaccldenl) $
NON-OWNEO AUTOS $ -
$
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION E $
WORKER COMPENSATION '
AND EMPL OTERS'LIABIUTT YIN TORY LIMITS I I ER
ANY pROR/MIETQR/PA.RTUOEO ECVT IA EL.EACH ACCIDENT $
Imandamry In HH) Lf EL.DISEASE-FA EMPLOYEE S
IT Yav describe under
DESCRIPTION OF OPERATIONS del. 1 5.DISEASE-POLICY LIMIT $
PROPERTY 5000
DG$CRIPToq OF OPERATIONS I LOCATIONS I VEHI JEi IANach ACORD 101,Ad4hignal RAmo*s Schedule,If more space is required)
Certificate holder is additional insured per the attached.
CERTIFICATE HOLDER CANCELLATION
SHOULO ANY OF THE ABOVE DESCRIBED POLICIES RE CANCELLED BEFORE
ASHLAND THE EXPIRATION DATE THEREOF,NOTICE WRL BE DELIVERED DI
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Ashland its Officers
and Zmployees AUTHORIZED REPRESENTATIVE
20 E Main Ave
.Ashland OR 97520 R. Scott Weaver, CIC
11900.2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009109) The ACORD name and logo are regls(ored marks of ACORD
PROGRESSIVE PROGREI 111
P.O.BOX 31260
TAMPA,FL 33631 DIRECT
Policy Number. 712198941
Underwritten by:
Progressive Universal Insurance Co
JULIE RICHARDS September 23,2011
189 VASHTI WAY Policy Period: Oct 19,2011 -Apr 19,2012
MEDFORD,OR 97501 Page 1 of 2
progressive.com
Online Service
Make payments,check billing activity,update
policy information or check status of a claim.
Auto Insurance 1-800-PROGRESSIVE (1-800.776.4737)
For Coverage Summary 24hours a dyrviceys calms service,
24 hours a day,7 days a week.
This is your Renewal
Declarations Page
The coverages, limits and policy period shown apply only if you pay for this policy to renew.
Your coverage begins on October 19,2011 at 12:01 a.m. This policy expires on April 19,2012 at 12:01 a.m.
Your insurance policy and any policy endorsements contain a full explanation of your coverage. The policy contract is
form 9610D OR(06/06). The contract is modified by forms Z357(01/07),4884(10/08),Z538(10/08)and Z616 OR(08/09)
Drivers and household residents Additional information
..................................................Na...med....... ....insured......................................................................................
..
JULIE RICHARDS
Outline of coverage
2003 Ford F750
VIN 2FfRX17283CA37648
Primary use of the vehicle: Commute
Limits Deductible Premium
.............................................................................................................................................................................
Liability To Others $238
Bodily Injury Liability $100,000 each persoN$300,000 each accident
Property Damage Liability $100,000 each accident
..............................................................................................................................................$' ..............................
Personal Injury Protection $25,000 $0 29
.............................................................................................................................................................................
Uninsure UU: "**..sured Motorist $100,000 each persoN$300,000 each accident 8
.............................................................................................................................................................................
Comprehensive Actual Cash Value $500 8
.....................................................................................-......................................................................................:
Collision Actual Cash Value $500 69
....................................................................................................x'i'm" ............'s....................................................
Rental Reimbursement up to$30 each day/maximum 30 days 13
.............................................................................................................................................................................
Roadside Assistance 8
.............................................................................................................................................................................
Total 6 month policy premium $373.00
.............................................................................................................................................................................
Discount if paid in full -53.00
............................................................................................................................................................I................
Total 6 month policy premium if paid in full $320.00
Premium discounts
Policy
......................................................................................................t'ln"u.......perl' 'ss',' ..............................................
71219894-1 Continuous Insurance:Platinum,Paperless,Home Owner,Multi-Policy and
Online Quote
Farm 6489AA OR(02/10) Corm Ind
Late: 10/2H/2011 lime: 11:2`1 HM lo: 15415522304 D 2/2
�R CERTIFICATE OF LIABILITY INSURANCE 10/ 2e o 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 CERTI FICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)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 endorsement(s).
PRODUCER COMA Leesa Martindale
E:
Wilson-Heirgood Associates PHONE (800)852-6140 FAX No:I5421392-3786
2930 Chad Drive L .lmartindaleBNhainsurance.com
PO BOX 1421 INSURERS)AFFORDING COVERAGE NAICI
Eugene OR 97440-1421 INSURERA:SA31r Corporation
INSURED INSURERB:
Selectem Corp INSURERC:
PO Box 71250 INSURERD:
INSURER E:
Eugene OR 97440 INSURERF:
COVERAGES CERTIFICATENUMBER:11/12 WC 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. 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.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSlRl1NCE POLICY NUMBER MAm,,YF YYI POLICY EXP LIMITS
GENERAL LIABILITY EACH OCCURRENCE F
COMMERCIAL GENERAL LIABILITY EMI u en 4
CLAIMSMADE ❑OCCUR MEDEP(A weparsen) S
PERSONAL L ADV INJURY S
GENERAL AGGREGATE $
GENL AGGREGATE UNIT APPLIES PER: PRODUCTS-COMPIOP AGG S
POLICY PRO- LIM S
AUTOMOBILEUABILRV
CaO I
s 'dent
ANY AUTO 60DS.YINJURY(Per Parson) $
ALL OWNED SCHEDULED
AUTOS S AUTOS BODILY INJURY IPM NON OWNED ectidml) $
HIRED AUTOS AUTOS PROPERTY DAMAGE S
er ecciden
5
UMBRELLA LIAR HOCCUR EACH OCCURRENCE f
EXCESS LUIS CLAIMSMAIDE AGGREGATE S
IDED1 IRETENTIONS S
A WORKERS COMPENSATION WC A LL
ANDEMPLOYERSJUABILITY YIN X
ANY PROPRIETOR/PARTNER/EXEQRIVE
If'FICER EMEIEER Ex U0m4 O NIA 16338 0/1/2033 0/1/2012 EL.EACH ACCIDENT S 500,00
IIge ,1,escdbeuar EL.DISEASE-EA EMPLOYE S 500 000
DESCRIPTION OF nd OPERAT)ONShdm EL.DISEASE-POLICY LIMIT S 500,00
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(Attach ACORD 101,AddAlO'w Rem d,SdwdWq amore space Ie required)
CERTIFICATE HOLDER CANCELLATION
(541)552-2304 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Gridley Painting ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Clint Gridley
743 Haskell Street AUTHORIZED REPRESENTATIVE
Central Point, OR 97502
Leesa Martindale/LJM
ACORD 25(2010105) 0 1988-2010ACORD CORPORATION. All rights reserved.
INS025oflinn,51m - Tho ACr1RD nanoand Itvtn Orn rani¢}arod mar4¢of Ar.nRII
5417 3.57733
797504
SE L E(TEMP) 05
E MDLOYM ENT SERVI ( ES www.selec-temp.com
Staffing Service Agreement for Gridley Painting
Position and Rates
As a multi-service staffing company, Selectemp is dedicated to providing skilled and reliable employees as detailed below:
Ali Commercial Painting labor positions to be billed at 54%
(Example:$10.00 pay rate/$15.40 bill rate)
The above rate includes wage, Workers' Compensation, state and federal payroll taxes, 1-9 verification, W-2&W-4
administration, screening, advertising and interviewing costs.
Personnel Placement
Selectemp will recruit and screen personnel as requested, at the skill level needed. All temporary employees must
successfully pass an in-depth interview that also includes reference checks prior to placement on any assignment with our
clients.
In addition, SHOULD THE CLIENT REQUEST-all employees will have successfully passed a pre-employment drug
screen and/or criminal background check prior to placement. The$15.00 cost of the drug screen and the$25.00 cost of
the background check will be billed to the client on the first invoice for the employee. If neither is requested, then neither
will be billed.
Our Staffing Managers provide expedient, experienced, and efficient placement of employees as needed. Our
customized industry software allows us to immediately identify the most qualified candidates for requested positions. We
offer a 24-hour dedicated"On-call"system that ensures an immediate call back in the event of an emergency,for order
placements and employee status updates.
Hiring Options
If you would like to hire a Selectemp employee, the employee shall remain on Selectemp's payroll for a minimum period of
480 hours. After that time, you may hire the employee at no additional cost If you should wish to hire a Selectemp
employee prior to the completion of 480 hours, a buy-out option can be negotiated.
Employee Bonuses and Benefits
To help maintain a large pool of dependable and qualified employees, Selectemp offers incentive bonuses, short-term
medical insurance, and vacation pay. Attendance and safety awareness are key criteria in determining employee -
eligibility of bonuses.
— �Ferrnsa nd-Conditions
Employees are paid weekly; therefore, invoices are mailed weekly and are DUE UPON RECEIPT. A carrying charge of
1.5% (18% annual rate)will be charged on the balance past due. In most cases, a completed credit agreement and this
signed service agreement will be required before the placement of employees. The above service rate is effective
through October 31,2012.
Than ou for choosing Se% mp as your staffing partner/
42
Authorized Signature/Title Date
ild4e: lYJ/CO/CUll IAnle: 11;GJ MII lo: 1041ODee,)'J4 0 1/2
WILSON-HEIRGOORL4
I N S U R A N C
2930 Chad Drive, Eugene, Oregon 97408
(P).541-342-4441 I. (F)541-484-5434
www.WHAINSURANCE.com
Fax Transmittal Form
Date: Friday, October 28, 2011
Time: 11:29:35 AM
Subject:
Pages: 2
Send To: From: Leesa Martindale
Attn: Phone Number: 541-284-5838
Phone Number: Department:
Fax Number: 15415522304
Message:
Policy Disclaimer:
This fax,and any attachments thereto,is intended only for use by the addressee(s) named herein and may contain legally privileged andfor confidential information. If
you are not the intended recipient of this fax (or the person responsible for defivering this document to the intended recipieno ,you are hereby notified that any
dissemination,distribution,printing a copying of tins fa),and any attachment thereto,is strictly prohibited. If you have received this fax in error,please respond to the
individual sending the message,and permanenty,delete the original and any copy of any fax and printout thereof.
`ITY RECORDER Page 1 / 1
�.
ASHLAND C I T Y
., DATE ',:7 .:: -PO NUMBER.
20 E MAIN ST. 11/1/2011 10531
ASHLAND, OR 97520
(541)488-5300
VENDOR: 016542 SHIP TO: Ashland Building Maintenance
GRIDLEY PAINTING (541)488-5358
734 HASKEL STREET 90 N MOUNTAIN AVENUE
CENTRAL POINT, OR 97502 ASHLAND, OR 97520
FOB Point: Req.No.:
Terms: Net Dept.:
Req.Del. Date: Contact: Dale Peters
Special Inst: Confirming? NO
quanti "Unit" ' ' ` :+ . ,. • Description ;r - ! -Unit Price::-. ,•'Ext.Price
Pressure Wash -Pioneer Hall 165.00
Pressure wash $165.00
Contract for Goods and Services
Beginning date: October 27, 2011
Completion date: November 18, 2011
Insurance required/On file
SUBTOTAL 165.00
31LL TO:Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 165.00
ASHLAND, OR 97520
Account Numbei:, Project Numbei' ; Amount Account Number,- Project Number - ;Amount _
E 410.08.24.00.704100 E 000078.999 165.00
Adthorized Signature VENDOR COPY
FORM #3 CITY OF
A request for a Purchase Order ASHLAND
REQUISITION Date of request: 19 oe--[-(1
Required date for delivery: ( N I )
Vendor Name l RtaLt=V 7(4rNT1Nly
Address,City,State,Zip S-r
Contact Name&Telephone Number rNT 6 K "t Z
Fax Number
CLINTan� �c2�Ow^� 541 $�I 9ci�
SOLICITATION PROCESS
❑ Exempt 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 f le) ❑ State of Oregon
Note:Total contract amount,including any Date approved by Council: Contract#
amendments may not exceed$6,000 ❑ Stale 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 SER^VIIC-E-S_ Total Cost
r�Nr,HQ NaI) — T'r�sc..�2E t.,41614ISH
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL',COST.:°.
Per attached quotelproposal
Project Numbercoc Account Number
___-__-__-
------
Account Number°}1D-C-fi-s72Q-95-P-q??9 Account Number -__-_ -
'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures.
IT Director in collaboration with department to approve all hardware and software purchases:
IT Director Date
By signing this requisition form,I certify that the information provided above satisfies the City's public contracting requirements,and the documentation can be
provided upon request.
Employee Signature: Department Head Signature:
Additional signatures(if applicable):
Funds appropriated for current fiscal year: YES / NO
Finance Director Date
Comments:
G:FinanceNrocedure'APTormsTorm#3-Requisition.doc Updated on:10/18/2011