HomeMy WebLinkAbout2012-009 Contract - Green Meadows Building Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: Green Meadows Building Co.
ASHLAND CONTACT: Jim Green
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 5313 Highway 66, Ashland OR 97520
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-201-0095, Cell 541-840-5848
DATE AGREEMENT PREPARED: January 20, 2012 FAX: 541-482-8914
i
BEGINNING DATE: January 23, 2012 COMPLETION DATE: February 29, 2012
COMPENSATION: $2,389.00 — Per proposal attached as Exhibit C.
GOODS AND SERVICES TO BE PROVIDED: Contractor to tear out walls, build new walls and install doors
per proposal attached as Exhibit C. Location: Mountain View Cemetery
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 279B.220, 2798.225, 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
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 dude ontract.
16. Insurance ontractor shall at its o expense provide the following insurance:
a. ' Worker's Comoensation i urance in compliance with ORS 656.017, which requires subject employers to
provide nsation coverage for all their subject workers
b. General Liabilit i urance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, 000,000, 000,000 or Not Applicable for each occurrence for Bodily Injury and Property
Dama . al liability coverage for the indemnity provided under this contract.
C. Automobile Liabilitv in rance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, 1 1 , 0, 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 Contractors services to be provided under this Contract. As evidence of the insurance coverages
required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to commencing work
under this contract. The contractor's insurance is primary and non-contributory. The certificate will specify all of the
parties who are Additional Insureds. Insuring companies or entities are subject to the City's acceptance. If
requested, complete copies of insurance policies, trust agreements, etc. shall be provided to the City. The
Contractor shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self-
insurance.
17. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws
of the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or
proceeding (collectively, "the claim") between the City (and/or any other or department of the State of Oregon) and
the Contractor that arises from or relates to this contract shall be brought and conducted solely and exclusively within
the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal
forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the
District of Oregon filed in Jackson County, Oregon. Contractor, by the signature herein of its authorized
representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this section be
construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United
States Constitution, or otherwise, from any claim or from the jurisdiction.
18. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE
PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL
BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT,
MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR
THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR
REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT.
CONTRACTOR, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT
HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND
CONDITIONS.
19. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and
authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Contractor
understands and agrees that City's payment of amounts under this contract attributable to work performed after the
last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow
City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In
the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this
contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further
liability to Contractor.
20. Prior Approval Required Provision. Approval by the City of Ashland Council or the Public Contracting Officer is
required before any work may begin under this contract.
21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by
reference.
Contracto : 1 City of Ashland
By By dc-__
Signat Department Head
�1 t'"t '%NAkc,l ,V-ii Pte. (-3 `1 V,—
�p Print Name Print Name
RESIDFnr? t ( ' 3/f�
Title Date
W-9 One copy of a W-9 is to be submitted with BCD
the signed contract. Purchase Order No.
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.
Contractor (Date)
Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 4 of 5
Green Meadows Building Co.
5313 Highway 66 Estimate
Ashland,OR
97520
Office:541-201-009 1-0095 Ce11:541-840-5848
Fax:541-482-8914 Date Estimate#
en...Head—..0 Email:greenmeadows@q%%estoffice.net
CCB# 132551 1/13/2012 88
Name/Address
City of Ashland-
20 E.Main Street
Ashland,OR 97520
Project
Description Qty Rate Total
Permits to be obtained by City of Ashland 0.00 0.00
Carpenter and carpenter helper to remove existing walls and doors between proposed living area and 7 86.40 604.80
dining area and between living area and garage.Remove walls at existing bathroom in garage.
Dump fees for material removed from building.(Asbestos testing to be provided by City of Ashland for 180.00 180.00
materials removed)
Provide materials and labor to rough frame new walls and doorways per print(4 doors). Install four 990.00 990.00
doors.3.3-0 X 6-8 solid core fire doors and 12-8 X 6-8 pocket door(doors to be purchased by City).
Jim Green,labor and project management 4 55.00 220.00
20%Contractor fee for overhead and profit. 395.00 395.00
NOTE:Green Meadows will perform work as described for this set bid amount or if desired,we will do 0.00 0.00
job on a cost plus basis at cost of materials and labor plus 20%for overhead and profit.
Total $2,389.80
12:27 JAN 25, 2012 FAX NO: 772-8235 #76817 PAGE: 2/2
CERTIFICATE OF LIABILITY INSURANCE OP ID DR DATE(MMD/
IDYYYY)
O1/2S/12
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; it I certificate holderis an ADDITIONAL INSUKLU.me po Icy les must be endorsed. ,subject o
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 Ilan of such andorsement(s).
PRODUCER NAME:
PHONE �A'
Insurance Marketplace, Inc. E-MAIL
C.Na,Ext) (n/c'N.):
1998 Skypark Dr suite 100 ADDRESS:
Medford OR 97504 cusroMERIDe: GREEN-7
Phone:541-779-0177 Fax:FAX 7728235 INSURERS)AFFORDING COVERAGE NAICS
INSURED INSURER A: CHIC
Green Meadows Building CO INSURER O:
Jim Green
5313 Hwy 66 INSURER C:
Ashland OR 97520 INSURER D:
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFYTHAT 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.
INSR TYPE OF INSURANCE ADD SUB POLICY EFF POLICY EXP LIMITS
LTR INSR vw POLICY NUMBER (MMIDDIYVYY) (MMIDDM )
GENERAL LIABILITY hAl�H OL_;L1HI2tWGt 4 1,000,000
- n/wn.r n:.R'rNTrn
A X rnMMFRi:IN RFNI-RN I WIII ITY D11PGO629 01/06/12 01/06/13 1'PtML $ 300,000
ra AIM,:MA-,r UOI:(:I IP MFO-X F'(N I.onu Pm $5,000
Phlesow;L.5, LoV UNARY ( 1,000,000
GrNrRN AasgFGATr 61,000,000
�aIJ'L HUGI?tC'HIt LIMIT HI'I'LItB PhRl PIBJULIG I'0-CVMPIIJI'AL:c' �f 1,000,000
F'OI Ir;'i ""Y, I or (
AUTOMOBILE LIABILITY COMbINLDI NOLtLIMII t.
1ta accm]ertl
PJ�IY PJJ U _ non V INA TRY(P!r
p0i..nQ 5
NI )VMl7OAI7,-A rtOr,ll'i IN.IRe(Pci nc A.h J) 5
Ria IFFIHI 75 NI TOG F'F'OPfRTY nANARr 5
HULL,AUI I.". IF I)
nIDN oYnarn Al ITrx; 1'
5
UMBRELLA LIAR iIt;CUI? tgr',H U_s ip11?tWGt P
EXCESS LAB !':I
AIM MMir A!:GRR?ATr 5
nFr,l 1"Tlril r
RhILUI10N L `
WORKERS COMPENSATION !�
IOItY LIMIT tl?
AND EMPLOYERS'LIABILITY Y I N
Afurl'N11PHItIrR-Kcijrrr,( 41Vt rl rAfIINYIr,rMT IF
M.md. ,I.NA)rKCa IOfM I A
(Mandatory in NH) r I ❑IArAr.r FA rMF'1 OVr $
li vw:.Jn'.'n lLn uuJrn
11r1;FRIFTIi,N Or i!PfRATIOM'.Li9uw h .UIUtHFJE_PiJLIOY LIMIT fl
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attdch ACORD 101,Additional RBmama Schedule,II more space le remdI
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CITYOFA THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Ashland
541-488-5320 AUTHORIZED REPRESENTATIVE
20 E Main St
Ashland OR 86520 R. Scott Weaver, CIC
OO 1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2008109) The ACORD name and logo are registered marks of ACORD -
State rarmw •�......� ... . .-.....�... __— _
ACCOUNTNUMBER 0215-1653-15
Pp Box 2746 Monthly A000unt
Jackeomilla FL 32232-2746
AT1 0215-1653-15 2155-F472 37 DATE DUE - - PLEASE.PAY THIS AMOUNT
005M 0006 .JAN 10, 012 $150.61
GREEN, JIM 8 DONNA
5313 HIGHWAY 66 " BILLING SUMMARY••
ASHLAND OR 97520-9780
Last Amount Billed $147.60
Last Amount Paid -147.60
$ DEC 12,2011
Y
"e Difference 0.00
Current Installment 146.09
Policy Changes 1 .52
•'POLICIES ON ACCOUNT'* Service Charge 3.00
2006 MITSUBISHI
115 8219-A20-37B 59.16 Total Amount Due
By JAN 10,2012 $150.61
2001 HONDA
139'7347-C07-37A 34.19
Changes completed after 12-22-11 will appear on
2003 CHEVROLET the next notice.
293"1'846=E0937K 42.74
We appreciate the way you consistently pay your
PERSONAL UMBRELLA account.
37-BB-B398-0 10.00
Want to save money?Consider switching
to our Recurring Monthly payment option.
CURRENT INSTALLMENT $146.69 Accounts in good standing carrying a
sufficient balance may be eligible to use the
CURRENT CHANGES" balance and skip a monthly payment upon
converting to a Recurring Monthly payment
2006 MITSUBISHI plan. Contact your agent for more details.
115 8219-A20-37B 1 .52
Change in vehicle rating group for
comprehensive coverage.
Rates have been changed.
_ Change of lability,tating.grouP.__ -
Difference in premium from the effective
date of the change to the current due date
is included in the total amount due
on this bill only-
Please refer to your policy documents
or contact your State Farm agent for
additional information about this change.
TOTAL POLICY CHANGES $1 .52
+= 57 4991 3520,
Agent Brian Conrad
Telephone 541-482-8470 Prepared Date DEC 22 2011
At 0W CERTIFICATE OF LIABILITY INSURANCE OP ID DR OATEtMMroonvrn
01/19/12
THIS CERTIFICATFV 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 e cartificate holder Is an AL INSURED, po c Ws must be endorsed. SUBROGATION 15 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
FAA
Insurance Marketplace, Inc. AC NP Ert:
1998 Skypark Dr Suite 100 ADDRESS:
Medford OR 97504 CUSTOMERIDk GRMW-7
Phone:541-779-0177 Fax:FA% 772-8235
RISIIRER(8)AFFORDING COVERAGE NAICO
ISLIFED INSURER A: Saif Corporation
O een Meadows Building Co INSURER 8,
Jim Green
5313 Hwy 66 INSURER C:
Ashland OR 97520
INSURER D:
INSURER 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 NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERIM 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 DE SCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TR TYPE OF INSURANCE INSR WVD POLICY NUMBER MNIOI (NIUDDIYYYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE S
COMMERCIAL GENERAL LIABILITY PREMISES Ea omm e s
CIAI194AADE ❑OCCUR MID IOIP(Ay m pm ) $
PERSONAL s Ace INJURY $
GENERAL AGGREGATE s
GENT AGGREGATE LIMIT APPLIES PE' PRODUCTS-COMPIOPAGO $
POLK,1' JECT LOC $
AUTOMOBILE LIABRRY COL®HfID SINGLE LDIT $
ANYAUTO ectlden!)
BODRYIHJURY(Pmpm m) s
ALL OWNED AUTOS BODILY INJURY p`a ecddwl) $
SCHEDULED AUTOS PROPERTY DAMAGE
HIiEDAUT05 (PW wdd&M $
NON-OWNED AUTOS $
$
ULMRELLA LIAS CUR EACH OCCURRENCE $
IXCE68 LWB CLAMS-MADE AGGREGATE $
DEDUCTIBLE $ .
RETENTION $ $
A
WORKERS COMPENSATION 947188 01101/12 01/01/11 -
AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER
ANY PROPMETORIPARTNERIE)tECUTNTO E.L EACH ACCIDENT $500000
OFFICEPJMEM13ER EXCLUDED? /A
(Mandatoq In H) EL DISEASE-EA EAPI.O s500000
DESCRIPTION OF OPERATIONS be(. EJ-DISEASE-POLICY LIMB $ 5500000 '
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Aflach ACORD 101,Addieoml RsmmYa Bebedlde,If nwro epee Is IpuMd) i
CERTIFICATE HOLDER CANCELLATION
CITYOFA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE M(PIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of Ashland AUTHORIZED REPRESENTATIVE
20 IS Main St
Ashland OR 86520 R. Scott Weaver, CIC
®1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD
Page 1 / 1
CITY OF td, i I RLVVI ® ..
�. -ASHLAND DATE .; I�:� �. P.O NUMBER�' :.
,A 20 E MAIN ST. 1/20/2012 ; 10640
ASHLAND, OR 97520
(541)488-5300
VENDOR: 005955 SHIP TO: Ashland Building Maintenance
_ GREEN MEADOWS BUILDING CO. (541)488-5358
5313 HIGHWAY 66 90 N MOUNTAIN AVENUE
ASHLAND, OR 97520 ASHLAND, OR 97520
FOB Point: Req.No.:
Terms: Net Dept:
Req.Del.Date: Contact: Dale Peters
Special Inst: Confirming? No
--.:Quanta :.Unit , _, :� . ,.Descrition .',`.: _'.' Unit Price 'Ext.Price .. :
Remodel project at Mountain View 2,389.00
Cemetery-Contractor to tear out
walls, build walls and install doors
per attached contract and proposal.,
Contract for Goods and Services
Beginning date: January 23, 2012
Completion date: February 29;2012
Insurance required/On file
a
SUBTOTAL 2,389.00
BILL TO:Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2028 TOTAL 2,389.00
ASHLAND, OR 97520
Account Number ._ ProjecfNuinber _Amount Account Number .. . ':;,;_Project Number ;.Amount
E 410.08.24.00.704200 E 000278.120 2,389.00
AutWized Signature VENDOR COPY
FORM #3 CITY OF
:7, r: rc�1. c:L.�i ASHLAND
REQUISITION Date of request: IBJpr , t Z-
Required date for delivery: ZC..S4n1 f Z
Vendor Name �a Ewcows ;. Co
Address,City,State,Zip S313 1-4 r gt<w
Contact Name&Telephone Number �Sw�wN or 81Z S�O
Fax Number
sy.t 98-2 $91y
SOLICITATION PROCESS
❑ Exempt from Competitive Bidding ❑ Emergency
❑ Written Findings(Form attached) ❑ Invitation to Bid (Copies on fde) ❑ 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 ❑ 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
s� �tio $
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
❑ Per attached QUOTE $TOTAL COST
�'��Y/,v �4-.per-[a✓'>L Q�IC-7'GL (/ c.G_SZ- i`—' ��
Project Number g_-� Account Number 04?_00AccountNumber___-__-__
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: Department Head Signature:' u
Additional signatures(if applicable):
Funds appropriated for current fiscal year / NO
Finance Director Dat
Comments:
G:FinanceTrocedurelA.PTormslForm#3-Requisition.doc Updated on:1118/2012