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Home My WebLink About2011-287 CONT Addendum - Terrasurvey Inc ADDENDUM TO CITY OF ASHLAND CONTRACT FOR PERSONAL SERVICES LESS THAN $35,000 Addendum made this 26th day of September 2011, between the City of Ashland ("City") and Terrasurvey, Inc. ("Consultant"). Recitals: A. On (January 22, 2009) City and Consultant entered into a "City of Ashland Contract for Personal Services Less than $35,000" (further referred to in this addendum as "the agreement"). B. The parties desire to amend the agreement to extend the contract by one year as part of the two, one-year contract extensions as allowed for in the original contract. City and Consultant agree to amend the agreement in the following manner: 1. The date for completion as specified in Paragraph 3 of the agreement is extended to October 1, 201,1::�— 2. The maximum price as specified in Paragraph 4 of the agreement is changed to $9,000.00. 3. Except as modified above the terms of the agreement shall remain in full force and effect. CONSULT T: CITY OF ASHLAND: BY o�� BY VVQ k-c. Q Department Head Its \(IfJI8 Date ld tai, 10 DATE lOI I I Purchase Order# lose° Acct. No.: (For City purposes only) 1-CITY OF ASHLAND,ADDENDUM TO CONTRACT FOR PERSONAL SERVICES EXHIBIT C TERRASURVEY,INC. PROPOSED SURVEYING SERVICES FF,F, SCHEDULE FOR CITY OF ASHLAND SURVEY CREW: $120.00/HR (Two Person or One person w/Robotic) PROFESSIONAL: $80.00/HR SURVEY TECHNICIAN: $65.00/HR DRAFT PERSON: $65.00/HR CLERICAL: $45.00/HR THERE IS NO ADDITIONAL CHARGE FOR COMPUTER TIME, MILEAGE, IN-HOUSE PRINTS,MAIL, COPIES, FAXES, PHONE CALLS, OR NORMAL SURVEYING SUPPLIES SUCH AS LATH OR STAKES. THESE ITEMS ARE CONSIDERED TO BE INCLUDED IN THE HOURLY RATE. Form. W-9 Request for Taxpayer Give form to the (Rev.October 2007) Identification Number and Certification requester.Do not oepa.¢mew et ve Treamy send to the IRS. imam•Reve,ua Sernce Name I shorn on your incas reN e m) N m n Busin me,k differintirom above 0 o u m c Check appropriate box: ❑ tndividuoUSole propdatw Corporation ❑ Partnership Fxem ri �` ❑ Limited liability company.Enter the tax classification(0 disregarded entity,C=cwpomtion,pmpartnership)►------- ❑ payee o ❑ Other(see inetrucEma)► Address(number,Mr.9t,and St or sake noJ Requester's name and addraea(optional) m City,state,and ZIP Cade a y List account nvnber(s)here(op onatt , Ta ayer Identification Number(TIN) Ester your TIN In the appropriate box.The TIN provided must match the name given on Line 1 to avoid social security camber backup withholding.For individuals,this is your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other entities,It is , your employer identification number(EIN).If you do not have a number,see How to get a nN on page 3. or Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose E/mployer tdem ikertion numb number to enter. �.1�; lie 7�l to FOM Certification Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waking for a number to be issued to me),and 2. 1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest a dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding,and 3. 1 am a U.S. citizen or other U.S.person(defined below). Certification Instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply. For mortgage Interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the Certification,but you must provide your correct TIN.See the In ctione on page 4 Sign s.s.Pars or i _' p�q► I 1 t / I Here us.parses► F✓�,`�—r'^°'�� General Instructi S Definition of a U.S. person. For federal t purposes, you are : Section references are to the Internal Revenue Cade unless considered a U.S.person k you are otherwise noted. •An individual who is a U.S.citizen or U.S.resident alien, • A partnership,corporation, company,or association created or Purpose of Form organized in the United States or under the laws of the United A person who Is required to file an Information return with the States, IRS must obtain your correct taxpayer identification number(TIN) • An estate(other than a foreign estate),or to report,for example. income paid to you,real estate e A domestic trust(as defined in Regulations section transactions,mortgage Interest you paid, acquisition or 301.7701-7). abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Special rules for partnerships.Partnerships that conduct a Use Form W-9 only if you are a U.S.person(including a trade a business in the United States are generally required to resident alien),to provide your correct TIN to the person' pay a withholding tax on any foreign partners'share of income requesting k(the requester)and, when applicable,to: from such business. Further,in certain cases where a Form W-9 has not been received,a partnership is required to presume that 1.Certify that the TIN you are giving is correct(a you are a partner is a foreign person, and pay the withholding tax. waking for a number to be issued), Therefore, it you are a U.S. person that is a partner in a 2.Certify that you are not subject to backup withholding,or partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. 3.Claim exemption from backup withholding if you are a U.S. status and avoid withholding on your share of partnership exempt payee.If applicable,you are also certifying that as a income. U.S. person,your allocable share of any partnership income from The person who gives Form W-9 to the partnership for a U.S.trade a business is not subject to the withholding tax on purposes of establishing its U.S. status and avoiding withholding foreign partners' share of effectively connected income. on its allocable share of net income from the partnership Note. If a requester gives you a form other than Form W-9 to conducting a trade or business in the United States Is in the request your TIN, you must use the requester's form if it Is following cases: substantially similar to this Form W-9. •The U.S.owner of a disregarded entity and not the entity, Cat.N.10231X Form W-9 (Rev.10-2007) G:\pub-wrks\eng\dept-admin\SURVEYOR\Terra 2009\Terra Survey Contract Jan 09.doc Page 5 of 9 q°® CERTIFICATE OF LIABILITY INSURANCE to/ /toll OATS(u/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(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(tes)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 WNTpCT Julie Asher NAME: Ashland Insurance Inc PHONE ($41)4BZ-O831 FAX (5411488-5851 c a: JC_SBS A Street Suite 1 Eo aESS•]asher@ ashlandinsurance-com P. O. Box 880 INSURERS AFFORDING COVERAGE NAICd Ashland OR 97520 INSURER AAssurance Company of America 19305 INSURED INSUREReNorth Pacific Ins. Co. 23892 TERRASOAVEY, INC INSURER C: 274 4TH STREET INSURER O: INSURER E: ASHLAND OR 97520-2044 INSURER F: COVERAGES CERTIFICATE NUMBER:CI.11101103260 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL 1N7q TYPEOFINSURANCE a POQDYEFF POLICYEXP POLICY NUMBER MWDO MMmOIYYYY UNITS GENERAL LIABILITY EACH OCCURRENCE b 1,000,000 X COMMERCIAL GENERAL LoBXnY PREMISES Ea omnenoe S 1,000,000 A CLAIMS-MADE 1z OCCUR X PAS043357319 /10/2011 /10/2012 MIND EXP(AM one poeon) 5 10,000 PERSONAL S ADV INJURY 5 1,000,000 GENERAL AGGREGATE S 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPMP AGO S 2,000,000 X POLICY PRO- LOD S JFCT AUTOMOULELIAMUTY COMBINED SING LIMB 1 000 000 ANY AUTO BODILY INJURY(Pa'penew) S B ALL OWNED T( SCHEDULED 10151749 0/30/2010 O/3D/2011 BODILY INJURY(Per accdanl) S AUTOS AUTOS X NON-0 WNE0 11151749 0/30/2011 0/30/2012 PROP DAMAGE 5 HIRED AUTOS AUTOS a aclderd UnHSUmtl mpledslmmlinea S 1 000,000 UMBRELLA LIAR HOCCUR EACHOCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE S DEO I I RETENTION S WORKERS COMPENS ATION WC ITATII- OTH- ' AND EMPLOYERS'LIAHWTY ANY PROPRIETORIPARTNERIf.%ECURVE� NIA EL EACH ACCIDENT S OFFICERIMEMSER E%CLUDW7 (Mandalory in NH) EL DISEASE-EA EMPLOY 5 If Vas,dasoba under DESCRIPTION OF OPERATIONS balm EL DISEASE-POLICY LIMIT I S DESCRIPTION OF OPERATIONS[LOCATIONS I VEHICLES(ANach ACORD 101,Addidonal Roanoke Schedule,It mom spurn Is required) The City of Ashland, OR and its elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only with respect to Consultants service to be provided under this Contract. CERTIFICATE HOLDER CANCELLATION (541)488-5320 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED.BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 E. Main St. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE Julie Asher ACORD 26(2010106) c -2010 ACORD CORPORATION. All rights reserved. INS026I2olowfal The ACORD name and logo are registered marks of ACORD NMI NA 0187 0 1 PAS 43397318 NONE BRANCH Z2 SOUTHERN CALIFO RENEWAL EFF 05/I0/2011 ZURICH PRECISION PORTFOLIO POLICY SUPPLEMENTAL DECLARATIONS PRECISION AMERICA (CONTINUED) ITP r -PA Pa" m;I 10K 94 Xi@ R5:11"T _§VA 10 09 r,530t ADDITIONAL INSURED-DESIGNATED PERSON OR LIABI LITY ORGANIZATION HAVE OF ADDITIONAL INSUREDS PERS90(8 ) OR GRUNIZATION(S) CO2Qz6 0704 DOE I CITY OF ASHLAND NAME 2 ADDRESS 1 20 E. MAIN STREET ADDRESS 2 CITY ASHLAND STATE OR ZIP 97520 COMMERCIAL GENERAL LJABUJTY MEMO Ed. 3-00 AGENT'S COPY 04/0512011 7 A 7 ACIC) OO' ' CERTIFICATE OF LIABILITY INSURANCE DA E ,mwporcrr 10111/2011 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(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be Endorsed. B 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 endomemem(s). PRODUCER Phone: (360)5983700 Fax: (360)5963703 LINSURERS :MICHAEL J.HALL&COMPANY MICHAEL J.HALL&COMPANY (360)598-3700 F (360)598-3703 Ax HALL&COMPANY 19660 10TH AVENUE N.E. 1073 POULSSO WA 98370 m. INSURERS)AFFORDING COVERAGE NAICe INSURED LIO d's Of London Terri survey Inc : y 274 Fourth Street : Ashland OR 97520 INSURER INSURER D. INSURER INSURERF COVERAGES CERTIFICATE NUMBER: 146811 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, INSR TYPE OF INSURANCE ADO1 SUBR POUCYEFF PODCY Ew LTR INSR two POLICYNUMBER ream MMN LIMITS GENERAL UABILr1Y EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY OAMAGETORENTED $ PREMISES A° Dw CLAIMS-MADE FIOCCUR MED.UP(Any one person) $ PERSONAL S ADV INJURY $ GENERAL AGGREGATE $ ' GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $ POLICY El PRO- LOC E AUTOMOBILE LU BIUTY COMBINED SINGLE LIMIT ANY AUTO (Ea aoaderd) $ ALL OWNED AUTOS BODILY INJURY(Per person) $ SCHEDULEDAUTOS - BODILY INJURY(Par acdden) $ PROPERTY DAMAGE HIREDAUTOS (Perarddent) E NON-OWNEDAUTOS $ E FuRmE87R.�NT,ONUABS OCCUR EACH OCCURRENCE E EXCESS UAB CWMSMADE AGGREGATE $ DEDUCTIBLE $ WORKERS COMPENSATION TORY UMR9 GTH E AND EMPLOYERS• UABIUTY YIN FIR ANY PROPRIETO"ARTNERAE E=13VE E.L.EACH ACCIDENT $ OFRCERMEMBER EXCLUDED? I� N/A (NaadaWWM NHS ner E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS bean E.L DISEASE-POLICY LIMIT $ A Professional Ualmity CAmms Made Forms 11389953211011 02108117 02108112 $1,000,000 per claim Retro Date: $1,000,000 aggregate Feb 1 1999 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Aeach ACORD 101,Additional Remora Schedule,H more space IS required) Project:Miscellaneous Surveying services CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland,OR 97520 AumoRU® REPRESENrATNE . Attention: Jim Olson,City Surveyor n ` 9� Jo n Becker ACORD 25(200910-9) 0 1988-2009 ACORD CORPMTIUN. Ali rights reserved. The ACORD name and logo are registered marks of ACORD �'-s i Y RECOIRDER Page 1 / 1 �. C I T Y OF ASHLAND . . _ - �..•'� •DATE � � .. PO NUMBER 20 E MAIN ST. 10/31/2011 1 10534 ASHLAND, OR 97520 (541)488-5300 VENDOR: 003354 SHIP TO: Ashland Public Works TERRASURVEY INC (541)488-5587 274 FOURTH STREET 51 WINBURN WAY ASHLAND, OR 97520 ASHLAND, OR 97520 FOB Point: Req.No.: Terms: Net Dept.: Req.Del.Date: Contact: Jim Olson Special Inst: Confirming? NO .:Ouanti• P x rice -.Unit: nit. . •DeSCti lion - -" •-Urice '.Et'.P Contract for primary flexible general 9,000.00 surveying services to be provided on an as needed basis. Street 260 08 12 Street SDC 260 08 35 Street LID 260 08 41 Storm Drain 260 08 17 Storm Drain SDC 260 08 34 Airport 280 08 00 Water Dist 670 08 18 Water Supply 670 08 15 Water SDC 670 08 38 WW Collections 675 08 17 WW SDC 675 08 37 Engineering 710 08 11 Contract Amendment-September 26, 2011 Date of original contract: January 22, 2009 The date for completion is extended to October 1, 2012 and maximum price is changed to$9,000.00. Insurance required/On file SUBTOTAL 9,000.00 BILL TO:Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2028 TOTALI 9,000.00 ASHLAND, OR 97520 .: Account Number, 10 F ject Number , -- '" ;,Pro •'Amount. ' Account Number :, `Project Number ? ,:, ,...Amount�y,;Y, E 260.08.12.00.70420 1,000.00 E 670.08.18.00.7042 DO 500.00 E 260.08.17.00.70420 500.00 E 670.08.38.00.7042)0 200.00 E 260.08.34.00.70420 200.00 E 675.08.17.00.7042 DO 1,000.00 E 260.08.35.00.70420 200.00 E 675.08.37.00.7042 DO 200.00 E 260.08.41.00.70420 500.00 E 710.08.11.00.604130 3,000.00 E 280.08.00.00.70420 700.00 E 670.08.15.00.70420q 1,000.00 Authorized Si nature VENDOR COPY C I T Y OF ASHLAND REQUISITION No. PW FY 2011 Department PUBLIC WORKS Date September 26,2011 Vendor TERRASURVEY INC. Requested Delivery Date ASAP 274 FOURTH STREET Deliver To JIM OLSON ASHLAND OR 97520 Via Item No. Quantity Unit Description Use of Purchasing Office Only Unit Price Total Price PO No. Contract for primary flexible general surveying services to be provided on an as-needed basis. Street 260.08.12.00.704200 $ 1,000.00 Street SDC 260.08.35.00.704200 $ 200.00 Street LID 260.08.41.00.704200 $ 500.00 Storm Drain 260.08.17.00.704200 $ 500.00 Storm Drain SDC 260.08.34.00.704200 $ 200.00 Airport 280.08.00.00.704200 $ 700.00 Water Distribution 670.08.18.00.704200 $ 500.00 Water Supply 670.08.15.00.704200 $ 1,000.00 Water SDC 670.08.38.00.704200 $ 200.00 WW Collections 675.08.17.00.704200 $ 1,000.00 WW SDC 675.08.37.00.704200 $ 200.00 Engineering 710.08.0.604130 $ 3,000.00 1 f TOTAL $ 9,000.00 for Kari: BID /RFP/EXEMPT: - RFP - Contract Start Date: --Fehr=74,40 Contract Completion Date,,�_jun 11 Insurance on file: yes NO Pro'ecINo: N/A Job No. Unit No. 1 hereby certify that the above items are necessary,for the operation of this department and are budgeted wa Department Head or Authorized Person Issued By Date Received By G:\pub-wrks\eng\dept-admin\SURVEYOR\Terra 2011\2011 Terra Flexible Sery Req.xls