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Portable Divers - 8-1075 , IN I TIGARD CITY OF TIGARD, OREGON Cleaning and Inspection of Potable Water Storage Facilities PERSONAL SERVICES AGREEMENT THIS AGREEMENT made and entered into this 27th of September, 2007, by and between the CITY OF TIGARD, a municipal corporation of the State of Oregon, hereinafter called City, and Potable Divers, Inc., hereinafter called Contractor. RECITALS City has need for the services of a company with a particular training, ability, knowledge, and experience possessed by Contractor, and City has determined that Contractor is qualified and capable of performing the professional services as City does hereinafter require, under those terms and conditions set forth: Therefore, the parties agree as follows: SCOPE OF WORK Contractor shall initiate services on upon receipt of City's notice to proceed, together with an executed copy of this Agreement. Contractor agrees to complete work that is detailed in Exhibit A — Scope of Work and by this reference made a part hereof EFFECTIVE DATE AND DURATION This Agreement shall become effective upon execution and shall expire, unless otherwise terminated, or extended,. on 30th of September, 2008. The term of the contract shall be one (1) year with the option to renew two (2) additional one (1) year periods. The total term of the contract cannot exceed three (3) years. All work under this Agreement shall be completed prior to the expiration of this Agreement. COMPENSATION City agrees to pay Contractor an amount not to exceed Eleven Thousand and 00 /100 dollars ($11,000.00) over the life of the contract for performance of those services described in this Agreement. Payment will be made based on Contractor's invoice, subject to the approval of John Goodrich, Water Supervisor, and not more frequently than monthly. Payment shall be payable within thirty (30) days from the date of receipt by the City. CONTACT INFORMATION All notices, bills, and payments shall be made in writing and may be given by personal delivery, mail, or fax. Payments may be delivered by personal delivery, mail, or electronic transfer. The following addresses and contacts shall be used to transmit notices, bills, payments, and other information: Contact Manager for City: Contact. Manager for Contractor: City of Tigard Company: Potable Divers, Inc. Attn: John Goodrich, Water Supervisor , Attn: David Harvey 13125 SW Hall Blvd., Tigard, O regon 97223 Address: PO Box 474 Vernal, UT 84078 Phone: 503- 639 -4171 ext. 2609 Phone: 866- 789 -3483 Fax: 503-684-8840 . Fax: 866-913-4905 • Email Address: johng @tigard - or.gov Email Address: david@potabledivers.com CONTRACTOR AS INDEPENDENT CONTRACTOR Contractor acknowledges that for all purposes related to this Agreement, Contractor is and shall be deemed to be an independent contractor as defined by ORS 670.600 and not an employee of City, shall not be entitled to benefits of any kind to which an employee of City is entitled and shall be solely responsible for all payments and taxes required by law. Furthermore, in the event that Contractor is found by a court of law or any administrative agency to be an employee of City for any purpose, City shall be entitled to offset compensation due, or to demand repayment of any amounts paid to Contractor under the terms of this Agreement, to the full extent of any benefits or other remuneration Contractor receives (from City or third party) as a result of said finding and to the full extent of any payments that City is required to make (to Contractor or to a third party) as a result of said finding. Contractor acknowledges that for all purposes related to this Agreement, Contractor is not an officer, employee, or agent of the City as those terms are used in ORS 30.265. INDEMNIFICATION City has relied upon the professional ability and training of Contractor as a material inducement to enter into this Agreement. Contractor warrants that all its work will be performed in accordance with generally accepted professional practices and standards as well as the requirements of applicable federal, state and local laws, it being understood that acceptance of a contractor's work by City shall not operate as a waiver or release. Contractor and City agree indemnify and defend the other, and the other's officers, agents and employees and hold them harmless from any and all liability, causes of action, claims, losses, damages, judgments or other costs or expenses including attorney's fees and witness costs and (at both trial and appeal level, whether or not a trial or appeal ever takes place) incurred by the party being indemnified resulting from the indemnifying party's acts (or failure to act when action is appropriate) that may be asserted by any person or entity which in any way arise from or relate to this Agreement or the performance of obligations under this agreement, except liability arising out of the sole negligence of the party being indemnified. The indemnification by Contractor of the City shall also cover claims brought against the City under state or federal worker's compensation laws. If any aspect of this indemnity shall be found to be illegal or invalid for any reason whatsoever, such illegality or invalidity shall not affect the validity of the remainder of this indemnification. INSURANCE Contractor shall maintain insurance acceptable to City in full force and effect throughout the term of this contract. Such insurance shall cover all risks arising directly or indirectly out of Contractor's activities or work hereunder. The policy or policies of insurance maintained by the Contractor shall provide at least the following limits and coverages: a. Commercial General Liability Insurance Contractor shall obtain, at contractor's expense, and keep in effect during the term of this contract, Comprehensive General Liability Insurance covering Bodily Injury and Property Damage on an "occurrence" form (1996 ISO or equivalent). This coverage shall include Contractual Liability insurance for the indemnity provided under this contract. The following insurance will be carried: Coverage Limit General Aggregate 1,000,000 Products - Completed Operations Aggregate 1,000,000 Personal & Advertising Injury 1,000,000 Each Occurrence 1,000,000 Fire Damage (any one fire) 50,000 Medical Expense (any one person) 5,000 b. Business Automobile Liability Insurance If Contractor will be delivering the goods, Contractor shall provide City a certificate indicating that Contractor has business automobile liability coverage for all owned, hired, and non -owned vehicles. The Combined Single Limit per occurrence shall not be less than $1,000,000. Said insurance shall name City as an additional insured and shall require written notice to City thirty (30) days in advance of cancellation. If Contractor hires a carrier to make delivery, Contractor shall ensure that said carrier complies with this paragraph. c. Workers' Compensation Insurance The Contractor and all employers providing work, labor or materials under this Contract that are either subject employers under the Oregon Workers' Compensation Law and shall comply with ORS 656.017, which requires them to provide workers' compensation coverage that satisfies Oregon law for all their subject workers or employers that are exempt under ORS 656.126. Out -of -state employers must provide Oregon workers' compensation coverage for their workers who work at a single location within Oregon for more than 30 days in a calendar year. Contractors who perform work without the assistance or labor of any employee need not obtain such coverage. This shall include Employer's Liability Insurance with coverage limits of not less than $500,000 each accident. d. Insurance Carrier Rating Coverages provided by the Contractor must be underwritten by an insurance company deemed acceptable by the City. The City reserves the right to reject all or any insurance carrier(s) with an unacceptable financial rating. e. Certificates of Insurance As evidence of the insurance coverage required by the contract, the Contractor shall furnish a Certificate of Insurance to the City. No contract shall be effected until the required certificates have been received and approved by the City. The procuring of such required insurance shall not be construed to limit contractor's liability hereunder. Notwithstanding said insurance, Contractor shall be obligated for the total amount of any damage, injury, or loss caused by negligence or neglect connected with this contract. TERMINATION The parties agree that any decision by either party to terminate this Agreement before 30th of September, 2008 shall be accompanied by sixty (60) days written notice to the other party prior to the date termination would take effect. There shall be no penalty for early termination. If City terminates the contract pursuant to this paragraph, it shall pay Contractor for services rendered prorated to the date of termination. AGREEMENT MODIFICATIONS Modifications to this Agreement are valid only if made in writing and signed by all parties. OWNERSHIP OF WORK PRODUCT City shall be the owner of and shall be entitled to possession of any and all work products of Contractor which result from this Agreement, including any computations, plans, correspondence or pertinent data and information gathered by or computed by Contractor prior to termination of this Agreement by Contractor or upon completion of the work pursuant to this Agreement. GOVERNING LAW Contractor shall comply with all applicable federal, state and local laws; and rules and regulations on non- discrimination in employment because of race, color, ancestry, national origin, religion, sex, marital status, age, medical condition or disability. The provisions of this Agreement shall be construed in accordance with the provisions of the laws of the State of Oregon. All provisions required by ORS Chapter 279 to be included in a contract of this type are incorporated into this Agreement as though fully set forth herein. Any action or suits involving any question arising under this Agreement must be brought in the appropriate court of the State of Oregon. CONDITIONS OF SUPPLYING A PUBLIC AGENI;Y Where applicable, Contractor must make payment promptly as due to persons supplying Contractor labor or materials for the execution of the work provided by this order. Contractor must pay all contributions or amounts due from Contractor to the Industrial Accident Fund incurred in the performance of this order. Contractor shall not permit any lien or claim to be filed or prosecuted against Buyer or any subdivision of City on account of any labor or material to be furnished. Contractor further agrees to pay to the Department of Revenue all sums withheld from employees pursuant to ORS 316.167. COMPLETE AGREEMENT This Agreement and attached exhibit constitutes the entire Agreement between the parties. No waiver, consent, modification, or change of terms of this Agreement 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 specific instances and for the specific purpose given. There are no understandings, agreements, or representations, oral or written, not specified herein regarding this Agreement. Contractor, by the signature of its authorized representative, hereby acknowledges that he /she has read this Agreement, understands it and agrees to be bound by its terms and conditions. IN WITNESS WHEREOF, City has caused this Agreement to be executed by its duly authorized undersigned officer and Contractor has executed this Agreement on the date hereinabove first written. CIT 4 TIG��' C TRACTOR : y ut prized City staff By ut � �rized Age Contractor MA o7 0 Irl Date Date Exhibit A Scope of Work Specifications for Diving Contractors Cleaning and Inspecting Potable Water Storage Facilities City of Tigard Drinking Water Division is anticipating a three (3) year contract with work to be completed between October 1St and December 31" of each year beginning in 2007 and completing before 2010. The following schedule is supplied with the type and size of each reservoir to be inspected and cleaned: FY07 /08 Name Type Size Volume 1. High Tor Reservoir Concrete 48 ft diameter x 15 ft height 0.5 MG hatch access — medium shoe -box style — 15' above ground access via ladder 2. Menlor Reservoir Concrete 142 ft diameter x 30 ft height 3.5 MG hatch access — large bilco style — 30' above ground access via ladder FY08 /09 Name Type Size Volume 1. High Tor Reservoir `A' Concrete 89 ft diameter x 25 ft height 1.1 MG hatch access — medium Bilco style — below - ground reservoir /above ground access 2. High Tor Reservoir B' Concrete 84 ft diameter x 25 ft height 1.0 MG hatch access — medium Bilco style — below - ground reservoir /above ground access FY09 /10 Name Type Size Volume 1. Canterbury Reservoir #1 Concrete 83 ft diameter x 24 ft height 1.0 MG hatch access — medium Bilco style — below - ground reservoir/ 14 ft above ground access 2. Canterbury Reservoir #2 Concrete 83 ft diameter x 24 ft height 1.0 MG hatch access — medium Bilco style — below - ground reservoir/ 14 ft above ground access Note: All reservoirs have good ingress access; off street parking, and electricity. Introduction To comply with the Oregon Department of Health Services requirements for cleaning and inspections of potable water storage facilities, the City of Tigard utilizes commercial diver inspection contractors to clean and inspect these facilities. Scope of Work City of Tigard requires the successful contractor to provide cleaning and inspection services of potable water storage reservoirs according to this scope of work. • Cleaning procedures will combine vigorous brushing of surfaces cleaned, in addition to removing material from reservoir by vacuum or water suction. The potable water reservoir will be in service during cleaning, the cleaning procedures shall not create any visible turbidity in the water column. In addition to cleaning all sediment or other material from the floor of the reservoir the divers will ensure that all sediment is removed from the floor to wall seams, support column bases, plumbing fixtures and supports, man entries, or any other areas where the vacuum does not reach during normal floor cleaning. - If brushing is not done in conjunction with vacuuming, potentially hazardous bio -film may be left ,behind. Use of a stationary or fixed brush inside or outside the vacuum head is inadequate for this purpose. The brushing has to be vigorous enough to remove biofilm. This can only be accomplished by a rapidly rotating brush inside a vacuum head or by vigorous hand brushing in order to agitate the surface enough to remove biofilm. Regardless of the technique used the brushing must be done in such a manner that does not create turbidity inside the reservoir. Divers must use external or surface supplied air source, with hardhat. Hardhat is defined as a helmet that keeps divers head dry (no SCUBA or full face mask gear). External air supply must be sufficient to support divers for the duration of the planned dives and must be accompanied by an adequate diver carried reserve breathing air source. A second external air supply will be available for back up in the event the primary air source fails, in addition to the diver reserve. For preventing contamination of the water supply by the diver, full-face masks are specifically prohibited. • Divers will have full time, hard wired (wireless devices are prohibited) voice communication with • surface personnel. - Divers will use vulcanized rubber dry suit, in good repair, which are dedicated for use in potable water. Neoprene or shell dry suits are not suitable for disinfection. All equipment and diver (external gear) must be disinfected with 200+ mg /L chlorine solution immediately prior to entering potable water. Dry suit must be variable volume with push button air inflation and must have automatic over inflation / exhaust valve. Dive team will consist of a minimum of three persons. If two divers are submerged at the same time a minimum of a five - person dive team is required. All dive team members must have ANSI /ACDE 01 -1993 minimum commercial diver training. This requires a certificate of graduation from an ACDE certified commercial diving school or equivalent military or other training (minimum 600 hr.). • Dive team must have OSHA approved Standards, Procedures, and Safe Practices Manual present and available for review at each dive location. Diver will have a helmet - mounted video camera with adequate lighting capable of supplying live video feed to surface. The live video will be set up so that surface personnel can view underwater procedures as they are performed and so that procedures can be recorded on video tape along with live voice narration. This also provides the City of Tigard staff with a method of monitoring quality control, to ensure job is done and that the diver does not create turbidity. The video camera must have infinite focal range. Cameras with a limited short focal range are not acceptable. Hand held cameras and hand held video cameras if used will be used for still or detail images only. - All water discharged from reservoir during cleaning procedures will be de- chlorinated using sodium - meta- bisulfate or an equivalent approved by City of Tigard water quality staff at no additional charge. If the City of Tigard or local water quality boards require sediment containment, material filter bags will be used. Filter bag material will consist of ten -ounce non -woven geo- synthetic material. Width of the filter bag will be at least seven feet in diameter and length of the filter bag will be at least ninety feet in length. Diving contractor will have the ability to clean the vertical wall surfaces with similar equipment and procedures as used in cleaning the floor. Cleaning procedures will combine vigorous brushing of surfaces cleaned, in addition to removing material from reservoir by vacuum or water suction, and must be done in such a manner that does not create turbidity inside the reservoir. This procedure will or will not be requested after viewing the interior or the reservoir. Diving contractor will provide a separate line item quote for wall cleaning. Diving contractor must provide proof of commercial general liability insurance of at least $2 million and workman compensation insurance for all employees. Contractor must provide proof of bonding ability to demonstrate financial stability. This should be in the form of a bond obtained within the last 12 months or a letter from a bonding company indicating that the contractor is financially capable of obtaining a bond. Inspection Inspections will be performed according to NACE, ASNT standards. Inspection of the reservoir will be included as part of the cleaning process and cost. The inspection will be done as a continuous process by the diver and include a detailed final inspection. Contractor will submit a comprehensive inspection checklist detailing all areas of inspection. City of Tigard will approve the inspection list or amend the inspection list if necessary. Amendments will be sent to the approved contractor prior to bid acceptance. , Video and Written Inspection Reports Contractor will provide inspection reports that will include high- resolution color VCD or DVD with real time imprint and time log indicating where each feature or problem areas may be found. VCD or DVD will be narrated live by the divers, contractors on -site support personnel or. City of Tigard personnel at the time the video is recorded. One copy will be submitted to the City of Tigard Water Quality Supervisor. A bound computer generated printed report will be provided and shall include still color images of all problem areas along with a schematic diagram of each reservoir showing location of each image, with a time stamp showing where the image may be found on the inspection VCD or DVD disc. Repairs Repairs will be at the discretion of public works staff. Repairs to coatings in a steel reservoir will be made with a NSF 60 approved, two -part epoxy that chemically bonds to the steel substrate. All blisters, holidays and voids will be wire brushed with a pneumatic tool to bare metal according to SSPC- SP -11, special consideration will be given for underwater environments, and the surrounding intact coating will be feathered and abraded to provide an anchor profile for the epoxy. Epoxy will be prepared and applied according to the manufactures specifications, including but not limited to surface preparation, water temperature, mixing ratios, pot life, Wet Film Thickness and Dry Film Thickness. • • • Exhibit B Contractor's Proposal " • Dedicated to Potable Water Visit us on the Internet at http: / /www.potabledivers.com Send to: City of Tigard From: David Harvey John Goodrich Fax: 866 -913 -4905 At: 503 -684 -8840 Phone: (866)- 789 -Dive toll free # of Pages Including Cover 4 E -mail: davidApotabledivers.com Mailing adress: PoBox 474 Vernal, Ut 84078 8/13/2007 - Other Phone: 602- 920 -9438, 602 - 920 -9439 If you do not receive the correct number of pages please call (866)789 -3483 Message: Attn: John Following is the quote you requested. For the last few years Potable Divers has been developing state of the art equipment to better serve your needs. We have proven our methods and equipment are the absolute best in the Industry. With the biggest underwater system we save you more lime, money and water by cleaning a larger area and remove less water than any other service provider in the market. Our system is the only way to remove sediment as well as the bacteria biofilm that lives on our floors and walls. Ask about our free wall cleaning. Please sign the last page and FAX it back to us with the approximate time frame you would like the work done. Please give us a call If you have any questions or we can be of further assistance to you. David Harvey Operations Manager exsiDnrEitj 'ja_ Po Box 474 tS `vim "!� Vernal, UT 84078 Toll Free (868) -789 -DIVE (602) 920 -9438 www.00tabledivers.com e -mail pdi@potabledivers.com District Name City of Tigard Phone: 503 - 639 -4171 Address 1 13125 SW Hall Blvd FAX 503 - 684 -8840 Address 2 Tigard, OR 97223 Address 3 Date Aug 13,2007 The following is our firm quote and specifies our conditions of services. Our quote is based on the information you provided and the following assumptions: Reservoir Type Dia or Hgt. Max. Surface Cubic Price for LxW Feet Gallons area Yards Inspection (S.F) Sediment and Floor 1" deep Cleaning FY 07/08 1. High Tor Concrete 48 FT 15 FT 500 KG 1808 5.5 $1,200 2. Menlor Concrete 142 FT 30 FT 3.5 MG 15828 48.6 $2,700 FY 08/09 1. High Tor "A" Concrete 89 FT 25 FT 1.1 MG 6217 19.1 $1,900 2. High Tor "B" Concrete 84 FT 25 FT 1 MG 5538 17 $1,800 FY 09/10 1.Canterburyl Concrete 83 FT 24 FT 1 MG 5407 16.6 $1,700 2.Canterbury2 Concrete 83 FT 24 FT 1 MG 5407 16.6 $1,700 1. Cleaning service includes removal of all sediment up to one inch deep. Calculated as as an average depth over the reservoir floor. 2. Repairs are done on a basis of $280 per hour plus materials. Repairs are done only with your authorization and are guaranteed. 3. Filtration is is included in the cost of the cleaning Dechlorination is included in the cost of the cleaning. 4. This quote is valid on the tank(s) listed above 90 days. Once quote is signed the work shall be accomplished at a mutually accepted date within one year. 5. We guarantee your satisfaction if the sig ee of the quote is not satisfied, we will return until you are. 6. All cleaning and inspections are done with high quality color camera and sound, recorded on'DVI vcd, or svcd, along with full computer generated reports with digital photos. 7. PDI complies with all AWWA and OSHA standards and requirements. Insured, Licensed, and Bonded. Proposal Acceptance Signature Required PO # • . Sep 26 2007 16:13:17 10669134905 -> 5037102401 David r ley Page 002 Form V V - yrven to we ret uestury Identification Number and Certification department or the department you are currently doing business with. Name ( List legal name, if joint names, list first & circle the name of the person whose TIN you enter in Part I - See Specific Instruction on page 2) Potable Divers Inc Business name, if different from above (See Specific Instruction on page 2) Check the appropriate box: ❑ Individual /Sole proprietor X Corporation ❑ Partnership ❑ Other ► - - -- — — — Legal Address: number. street, and apt or suite no. Remittance Address: if different from legal address number. street, and apt. PO Box 474 or suite no. City, state and ZIP code City, state and ZIP code Vernal, UT 84078 Phone # ( 866 ( 789 -3483 Fax # ( 602) 445 -9913 Email address: david @potabledivers.com Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. For individuals, this is your Social security number social security number (SSN). However, for a resident alien, sole ❑ 0-0 ❑ _ ❑ CI proprietor, or disregarded entity, see the Part I instruction on page 2. For other entities, it is your employer identification number OR (EIN ). If you do not have a number, see How to get a TIN on page 2. Employer identification number Note: If the account is in more than one name, see the chart on page 2 for guidelines on whose number to enter. 20-0436894 'Part II Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2, I 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 Services ( IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am an U.S. person (including an U.S. resident alien). 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. Sign Here J� Purpose of Form conditions. This is called "backup withholding." 5. You do not certify to the requester that you are A person who is required to file an information Payments that may be subject to backup not subject to backup withholding under 4 above return with the IRS must get your correct withholding include interest, dividends, broker (for reportable interest and dividend accounts taxpayer identification number (TIN) to report, for and barter exchange transactions, rents, opened after 1983 only). example. income y to aid you, real estate royalties. nonemployee pay. and certain p payments from fishing boat operators. Real Certain payees and payments are exempt from tion or mortgage interest you paid, backup withholding. See the Part II instructions acquisition or debt, or contributions you made to estate transactions are not subject to backup page 2. an IRA. withholding. on Use Form W -9 only if you are a U.S. person If you give the requester your correct TIN, make Penalties (including a resident alien), to give your correct the proper certifications, and report all your interest and dividends on your tax return, Failure to furnish TIN. If your fail to furnish your TIN to the person requesting it (the requester) payments you receive will not be subject to correct TIN to a requester, you are subject to a and . when applicable, to: backup withholding. Payments you receive will penalty of $50 for each such failure unless your 1. Certify the TIN you are giving is correct (or be subject to backup withholding if: failure is due to reasonable cause and not to you are waiting for a number to be issued). willful neglect. 1. You do not furnish your TIN to the Civil penally for false information with respect 2. Certify you are not subject to backup requester, or to withholding. If you make a false statement withholding 2. You do not certify your TIN when required with no reasonable basis that results in no If you are a foreign person, use the (see the Part II instructions on page 2 for backup withholding, you are subject to a 5500 appropriate Form W - See Pub 515, details), or penalty. Withholding of Tar on Nonresident Aliens and Foreign Corporations 3. The IRS tells the requester that you furnished Criminal penalty for falsifying information. an incorrect TIN, or Willfully falsifying certifications or affirmations What is backup withholding? Persons making may subject you to criminal penalties induding certain payments to you must withhold a 4. The IRS tells you that you are subject to fines and /or imprisonment. designated percentage, currently 29% and pay to backup withholding because you did not the IRS of such payments under certain report all your interest and dividends only), or Misuse of TINs. If the requester discloses or uses TINS in violation of Federal law. the requester may be subject to civil and criminal penalties. ) Date: 5262007 02'55 PM Sender's Fax ID: 504 482 -1475 Page 1 of 1 . 4 • , ACORD CERTIFICATE OF LIABILITY INSURANCE CSR GB DATE (MMIDD/YY1Y) POTAB -1 09/26/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE John W. Fisk Company HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR 4833 Conti Street Suite 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. New Orleans LA 70119 Phone:504- 486 -5411 Fax:504- 482 -1475 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A' Great American Ins. Co. INSURER 8: Potable Divers, Inc. INSURER C: David Harvey P.O. 474 INSURER D: Vernal UT 84078 INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSW Awl. POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE (MM/DONY) DATE (MMIDDIW) GENERAL LIABILITY EACH OCCURRENCE $ 1000000 uww Iv A X COMMERCIAL GENERAL LIABILITY OM 4631364-01 02/17/07 02/17/08 PREM ISES(Eeoccu rence) $ 50000 CLAIMS MADE X OCCUR MED EXP (Any ono person) $ 5000 PERSONAL & ADV INJURY $ 10 00 0 0 0 GENERAL AGGREGATE s 2000000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 1000000 1 POLICY n jECT n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO _ ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) — PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 8 ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ — 1 OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WC SIAM- UIH- WORKERS COMPENSATION AND TORY LIMOS ER EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ It yes. descnbe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate holder shown as additional insured with waiver of subrogation in their favor, as required by written contract in respect of insured' operations. CERTIFICATE HOLDER CANCELLATION TIGARDI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR City of Tigard 13125 SW Hall Blvd. REPRESENTATIVES. Tigard OR 97223 A RE ATIVE ACORD 25 (2001108) © ACORD CORPORATION 1988 6 , 5 \svniti o ,(3:4 Dedicated to Potable Water Visit us on the Internet at http: / /www.potabledivers.com Send to: City of Tigard From: David Harvey John Goodrich Fax: 866 - 913 -4905 At: 503 - 684 -8840 Phone: (866)- 789 -Dive toll free # of Pages Including Cover 4 E -mail: david(a�potabledivers.com Mailing adress: PoBox 474 Vernal, Ut 84078 8/13/2007 Other Phone: 602 - 920 -9438, 602 - 920 -9439 If you do not receive the correct number of pages please call (866)789 -3483 Message: Attn: John Following is the quote you requested. For the last few years Potable Divers has been developing state of the art equipment to better serve your needs. We have proven our methods and equipment are the absolute best in the industry. With the biggest underwater system we save you more time, money and water by cleaning a larger area and remove less water than any other service provider in the market. Our system is the only way to remove sediment as well as the bacteria biofilm that lives on our floors and walls. Ask about our free wall cleaning. Please sign the last page and FAX it back to us with the approximate time frame you would like the work done. Please give us a call if you have any questions or we can be of further assistance to you. David Harvey Operations Manager e x. � lirC1 4 PoBox 474 = Vernal, UT 84078 Toll Free (866)- 789 -DIVE a (602) 920 -9438 www.potabledivers.com e -mail pdi @potabledivers.com District Name City of Tigard Phone: 503 - 639 -4171 Address 1 13125 SW Hall Blvd FAX 503 - 684 -8840 Address 2 Tigard, OR 97223 Address 3 Date Aug 13,2007 The following is our firm quote and specifies our conditions of services. Our quote is based on the information you provided and the following assumptions: Reservoir Type Dia or Hgt. Max. Surface Cubic Price for LxW Feet Gallons area Yards Inspection (S.F) Sediment and Floor 1" deep Cleaning FY 07/08 1. High Tor Concrete 48 FT 15 FT 500 KG 1808 5.5 $1,200 2. Menlor Concrete 142 FT 30 FT 3.5 MG 15828 48.6 $2,700 FY 08/09 1. High Tor "A" Concrete 89 FT 25 FT 1.1 MG 6217 19.1 $1,900 2. High Tor "B" Concrete 84 FT 25 FT 1 MG 5538 17 $1,800 FY 09/10 1.Canterburyl Concrete 83 FT 24 FT 1 MG 5407 16.6 $1,700 2.Canterbury2 Concrete 83 FT 24 FT 1 MG 5407 16.6 $1,700 1. Cleaning service includes removal of all sediment up to one inch deep. Calculated as as an average depth over the reservoir floor. 2. Repairs are done on a basis of $280 per hour plus materials. Repairs are done only with your authorization and are guaranteed. 3. Filtration is is included in the cost of the cleaning Dechlorination is included in the cost of the cleaning. 4. This quote is valid on the tank(s) listed above for 90 days. Once quote is signed the work shall be accomplished at a mutually accepted date within one year. 5. We guarantee your satisfaction if the signee of the quote is not satisfied, we will return until you are. 6. All cleaning and inspections are done with high quality color camera and sound, recorded on DVI vcd, or svcd, along with full computer generated reports with digital photos. 7. PDI complies with all AWWA and OSHA standards and requirements. Insured, Licensed, and Bonded. Proposal Acceptance Signature Required PO # REQUEST FOR PROPOSAL City of Tigard Public Works Department Drinking Water Division Bid Specifications for Diving Contractors Cleaning and Inspecting Potable Water Storage Facilities City of Tigard Drinking Water Division is requesting bid submittals for a three (3) year contract with work to be completed between October 1st and December 31St of each year beginning in 2007 and completing before 2010. The following schedule is supplied with the type and size of each reservoir to be inspected and cleaned: FY07 /08 Name Type Size Volume 1. High Tor Reservoir Concrete 48 ft diameter x 15 ft height 0.5 MG hatch access — medium shoe -box style — 15' above ground access via ladder 2. Mentor Reservoir Concrete 142 ft diameter x 30 ft height 3.5 MG hatch access — large bilco style — 30' above ground access via ladder FY08 /09 Name Type Size Volume 1. High Tor Reservoir `A' Concrete 89 ft diameter x 25 ft height 1.1 MG hatch access — medium Bilco style — below- ground reservoir /above ground access 2. High Tor Reservoir B' Concrete 84 ft diameter x 25 ft height 1.0 MG hatch access — medium Bilco style — below - ground reservoir /above ground access FY09 /10 Name Type Size Volume 1. Canterbury Reservoir #1 Concrete 83 ft diameter x 24 ft height 1.0 MG hatch access — medium Bilco style — below - ground reservoir/ 14 ft above ground access 2. Canterbury Reservoir #2 Concrete 83 ft diameter x 24 ft height 1.0 MG hatch access — medium Bilco style — below - ground reservoir/ 14 ft above ground access Note: All reservoirs have good ingress access; off street parking, and electricity. Introduction To comply with the Oregon Department of Health Services requirements for cleaning and inspections of potable water storage facilities, the City of Tigard utilizes commercial diver inspection contractors to clean and inspect these facilities. Scope of Work City of Tigard requires the successful contractor to provide cleaning and inspection services of potable water storage reservoirs according to this scope of work. Cleaning procedures will combine vigorous brushing of surfaces cleaned, in addition to removing material from reservoir by vacuum or water suction. The potable water reservoir will be in service during cleaning, the cleaning procedures shall not create any visible turbidity in the water column. In addition to cleaning all sediment or other material from the floor of the reservoir the divers will ensure that all sediment is removed from the floor to wall seams, support column bases, plumbing fixtures and supports, man entries, or any other areas where the vacuum does not reach during normal floor cleaning. If brushing is not done in conjunction with vacuuming, potentially hazardous bio -film may be left behind. Use of a stationary or fixed brush inside or outside the vacuum head is inadequate for this purpose. The brushing has to be vigorous enough to remove biofilm. This can only be accomplished by a rapidly rotating brush inside a vacuum head or by vigorous hand brushing in order to agitate the surface enough to remove biofiln.. Regardless of the technique used the brushing must be done in such a manner that does not create turbidity inside the reservoir. Divers must use external or surface supplied air source with hardhat. Hardhat is defined as a helmet that keeps divers head dry (no SCUBA or full face mask gear). External air supply must be sufficient to support divers for the duration of the planned dives and must be accompanied by an adequate diver carried reserve breathing air source. A second external air supply will be available for back up in the event the primary air source fails, in addition to the diver reserve. For preventing contamination of the water supply by the diver, full-face masks are specifically prohibited. Divers will have full time, hard wired (wireless devices are prohibited) voice communication with surface personnel. Divers will use vulcanized rubber dry suit, in good repair, which are dedicated for use in potable water. Neoprene or shell dry suits are not suitable for disinfection. All equipment and diver (external gear) must be disinfected with 200+ mg /L chlorine solution immediately prior to entering potable water. Dry suit must be variable volume with push button air inflation and must have automatic over inflation / exhaust valve. Dive team will consist of a minimum of three persons. If two divers are submerged at the same time a minimum of a five - person dive team is required. All dive team members must have ANSI /ACDE 01 -1993 minimum commercial diver training. This requires a certificate of graduation from an ACDE certified commercial diving school or equivalent military or other training (minimum 600 hr.). Dive team must have OSHA approved Standards, Procedures, and Safe Practices Manual present and available for review at each dive location. Diver will have a helmet - mounted video camera with adequate lighting capable of supplying live video feed to surface. The live video will be set up so that surface personnel can view underwater procedures as they are performed and so that procedures can be recorded on video tape along with live voice narration. This also provides the City of Tigard staff with a method of monitoring quality control, to ensure job is done and that the diver does not create turbidity. The video camera must have infinite focal range. Cameras with a limited short focal range are not acceptable. Hand held cameras and hand held video cameras if used will be used for still or detail images only. All water discharged from reservoir during cleaning procedures will be de- chlorinated using sodium - meta - bisulfate or an equivalent approved by City of Tigard water quality staff at no additional charge. If the City of Tigard or local water quality boards require sediment containment, material filter bags will be used. Filter bag material will consist of ten -ounce non -woven geo- synthetic material. Width of the filter bag will be at least seven feet in diameter and length of the filter bag will be at least ninety feet in length. Diving contractor will have the ability to clean the vertical wall surfaces with similar equipment and procedures as used in cleaning the floor. Cleaning procedures will combine vigorous brushing of surfaces cleaned, in addition to removing material from reservoir by vacuum or water suction, and must be done in such a manner that does not create turbidity inside the reservoir. This procedure will or will not be requested after viewing the interior or the reservoir. Diving contractor will provide a separate line item quote for wall cleaning. Diving contractor must provide proof of commercial general liability insurance of at least $2 million and workman compensation insurance for all employees. Contractor must provide proof of bonding ability to demonstrate financial stability. This should be in the form of a bond obtained within the last 12 months or a letter from a bonding company indicating that the contractor is financially capable of obtaining a bond. Inspection A , Inspections will be performed according to NACE, ASNT standards. Inspection the reservoir will be included as part of the cleaning process and cost. The inspection will be done as a continuous process by the diver and include a detailed final inspection. Contractor will submit a comprehensive inspection checklist detailing all areas of inspection. City of Tigard will approve the inspection list or amend the inspection list if necessary. Amendments will be sent to the approved contractor prior to bid acceptance. Video and Written Inspection Reports Contractor will provide inspection reports that will include high- resolution color VCD or DVD with real time imprint and time log indicating where each feature or problem areas may be found. VCD or DVD will be narrated live by the divers, contractors on -site support personnel or City of Tigard personnel at the time the video is recorded. One copy will be submitted to the City of Tigard Water Quality Supervisor. A bound computer generated printed report will be provided and shall include still color images of all problem areas along with a schematic diagram of each reservoir showing location of each image, with a time stamp showing where the image may be found on the inspection VCD or DVD disc. Repairs Repairs will be at the discretion of public works staff. Repairs to coatings in a steel reservoir will be made with a NSF 60 approved, two -part epoxy that chemically bonds to the steel substrate. All blisters, holidays and voids will be wire brushed with a pneumatic tool to bare metal according to SSPC- SP -11, special consideration will be given for underwater environments, and the surrounding intact coating will be feathered and abraded to provide an anchor profile for the epoxy. Epoxy will be prepared and applied according to the manufactures specifications, including but not limited to surface preparation, water temperature, mixing ratios, pot life, Wet Film Thickness and Dry Film Thickness. Proposal Submittal Contractors will submit bid proposal outlining cleaning and inspection costs per reservoir based on sediment depth of one inch. Sediment depth is calculated as an average sediment depth across the reservoir floor. Bids will include costs of repairs, material used for repair and repair procedures will be included. Contractors will provide documentation that includes: a description of cleaning process, a detailed description of the vacuum cleaning head, a description of the divers equipment, description of video equipment and voice communication equipment, description of de- chlorination process, description of sediment filtration bags, description of wall cleaning equipment and wall cleaning procedures, inspection checklist and insurance and bonding documentation. A current reference list with contact names and phone numbers will be submitted. Contractor will submit VCD or DVD showing their cleaning process from a previous job. The videotape will show floor cleaning as well as wall cleaning. Please submit bids with all information as requested no later than September 15, 2007 to: John Goodrich Water Quality Supervisor City of Tigard Public Works Department 13125 SW Hall Blvd. Tigard, OR 97223 FAX: 503 684 -8840 johng @tigard - or.gov • Leavitt Group Vernal Fax :4357810001 Feb 10 2011 04:3flpm P001 /002 ACORN, CERTIFICATE OF LIABILITY INSURANCE I DATE(MMIDDIYYYY) 02/10/2011 PRODOC 435.78 1.0000 FAX 435.781.0001 THIS CERTIFICATE 18 ISSUED OR ON Leavitt Group of Vernal ONLY AND CONFERS NO • 205 N. Vernal Ave. HOLDER. THIS CERTIFICATE END OR ALTER THE COVERAGE AFFORDED BY THE - • ES BELOW. Vernal, UT 84078 RECEIVED INSURERS AFFORDING COVERAGE NAIC # IHSUReo Potable Divers, Inc INSURER A: Scottsdale Indemnity Company 15580 4 x✓ OBA: David Harvey FEB 16 2011 INSURERS: Colorado Casualty 41785 xi/ PO Box 474 INSURER C: Worker's Comp Fund of Utah 010033 Vernal, UT 84078 RISK MANAGEMEN1URER National Farmers Union 016217 x INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING MAY P HE IP Su AN AFFORDED BY TH PO CLIMES DESC HEREIN SUBJECT RESPECT ALLTHE TERMS, EXCLUSIONS & C Y NDIIT I IONS OF SUCK POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IH IN9q {{gqppD'L - - '�pIRATI LTR WaR� 'MEW 'MEW BURANCE POLICY NUMBER DA1 JE gA r {YYIOffrnr�j um GENERAL Luaturr CPS1112675 02/17/2011 02/17/2012 EACHOCCURRENCE s 1,000,00 X COMM ERG GENERAL K w a q ) 3 100,00 J CLAIMS MADE Et OCCUR MED EXP (My pea perm) S • 3,00C A PERSONAL a AOV NUJURY s 1,000,000 GENERAL AGGREGATE $ 2,000,00C GEN'L AGGREGATE LIMIT APPIJES PER PRODUCTS - COMP/OP AGO 5 2,000 000 7 POLICY ri pn LOC . AUTOMOBILE UABiurY BA2325120 02/05/2011 02/05/2012 COMBINED SINGLE LIMB I — A N"AUTO (EssIZAAAU $ 1,000,000 ALL OWNED AUTOS BODILY INJURY I X SCHEDULED AUTOS L B (Per poem) X HIRED AIf O$ X NON-OWNED AUTOS BODILY !M 5 (Per azddenl) U) PROPERTY DAMAGE S 1 (Per =Went) OARAGC LIABILITY AUTO ONLY • EA ACCIDENT S R ANY AUTO OTHER THAN EA ACC 6 AUTOONLYI AGG S EXCESS I IMBRELIA UABIUTY EACH OCCURRENCE 6 OCCUR a CLAIMS MADE AGGREGATE S 5 DEDUCTIBLE 8 RETENTION S $ AND u sunel 2490036 02/18/2011 02/18/2012 i�ilRS� ANY PROPRIEiORIPARTNERlFJfECIITiVE� E.L. EACH ACCIDENT 9 1,000,000 C (oyFF�ICERI)R EXCI UpEpr u If yep deee� l t fypr E.L DISEASE • EA EMPLOYEE S 1,000,000 SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT 5 1, 000. 000 OTHER 1510468792 06/10/2010 06/10 /2011 D . DESCRIPTION OF OPERATIONS I LOCATIONS I VETACL!B / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER — CANCELLATION SHOULD ANY OF THE ABOVE DESCRMED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL NA DAYS WRITTEN NOTICE TO THE CERTIRCATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL. City of Tigard IMPOSE No OBLIGATION OR LUwnU=Y OF ANY KIND UPON THE INSURER, RB AGENTS OR 13125 SW Hall Blvd. REPRESENTATIVES. Tigard, OR 97223 AUTHOAIiEDREPRIBCNTATNE �� , Sheridan Hatch/SH .j....��� Cn,1a,o ACORD 20 (2008101) FAX: 503.684.8840 II) 19804009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Leavitt Group Vernal Fax:4357810001 Feb 10 2011 04:34pm P002/002 IMPORTANT if the certificate holder is on ADDITIONAL INSURED, the polloy(les) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing Insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or atter the coverage afforded by the policies listed thereon. • ACORD 25 (2008101) Best's Citedit Rating Center - Company Informat' for Scottsdale Indem... http://www3.ambest ' Ratings & Analysis Center Regional Centers: Asia Pacific I Canada J Europe, Middle East and Africa Home I About Us I Contact Us I Sitemap Scottsdale Indemnity Company Print this page t Member Center Ratings & Analysis v For ratings and product access » Home (a member of Nationwide Group) Assigned to Financial atr.,pm Rating n Best's Credit Ratings + AM. 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Industry Information • Affiliation Code: p (Pooled) Outlook: Stable Financial Size Category: X ($500 Million to Action: Upgraded Corporate v $750 Million) Date: October 01, 2010 Support & Resources • Outlook: Stable Conferences and Events w Action: Affirmed Effective Date: October 01, 2010 • Denotes Under Review Best's Ratings Office: AM. Best Company Senior Financial Analyst: David S. Blades Assistant Vice President: Joseph M. Roethel Reports and News Visit our NewsRoom for the latest news and press releases for this company and its AM. Best Group. AMB Credit Report - Insurance Professional - includes Bests Financial Strength 1 Rating and rationale along with comprehensive analytical commentary, detailed business overview and key financial data. Report Revision Date: 10/01/2010 (represents the latest significant change). 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Each report also features the latest Best's Ratings, Rating Rationale and an excerpt from our Business Review commentary. Data Status: Contains data compiled as of 2/9/2011 (Duality Cross Checked). 0 Best's Key Rating Guide Presentation Report - includes Best's Financial Strength Rating and financial data as provided in Best's Key Rating Guide products. Data Status: 2009 Financial Data (Quality Cross Checked). Financial and Analytical Products Best's Key Rating Guide - P /C, US & Canada Best's Statement File - P /C, US Best's Statement File - Global Best's Insurance Reports - P /C, US & Canada Best's State Line - P /C, US Best's Insurance Expense Exhibit (IEE) - P /C, US 1 of 2 2/16/2011 9:22 AM From:Ti• ement FaxID:504 482 -1475 Page 1 of 1 Date:10172008 03:40 PM Page:1 of 1 ACORD_ CERTIFICATE OF LIABILITY INSURANCE OP ID TC DATE(MMIDDIYYYY) POTAB -1 10/07/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTE 7 OF INFORMATIOA ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE John N. Fisk Company HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR 4833 Conti Street Suite 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW New Orleans LA 70119 Phone:504- 486 -5411 Fax: 504 - 482 -1475 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Great American Ins. Co. INSURER B Potable Divers, Inc. David Harvey INSURER C: P.O. 474 NSURER D: Vernal UT 84078 NSURER E: COVERAGES 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 CERTIRCATE 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 PAID CLAIMS. LT R INSRE POLICY NUMBER e j P 4 arlopiN LIMITS LTR NSRC TYPE OF INSURANCE GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY OMH 4631364 -02 02/17/08 02/17/09 PR EMISES (tao nce) $ 50000 CLAIMS MADE © OCCUR MED EJw (My one person) $ 5000 X Primary Endt. PERSONAL BADVINJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GENt AGGREGATE LIMIT APPLESPER: PRODUCTS - COMP/OP AGG $ 1000000 POLICY n 7CfC n LOC AUTOMOBILE UABLfTY COMBNm SINGLE LIMIT $ ANYAUTO (Eaaccident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY Is/JURY NON -OWNED AUTOS (Per accident) $ - PROPERTY DAMAGE $ (Peracaderd) GARAGELIABLITY AUTO ONLY- EAACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ BXCESSIUMBRELLA LUIBLITY EACH OCCURRENCE $ 7 OCCUR CLAMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND ITORYLIIM S I H EMPLOYERS LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE El_ EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE- EA EMPLOYEE $ If yes. describe under SPECIAL PROVISIONS below EL DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Certificate holder shown as additional insured with waiver of subrogation in their favor, as required by written contract in respect of insured's operations. CERTIFICATE HOLDER CANCELLATION TIGARD]. SHOULD ANY OF THE ABOVE DESC RMED POLICIES BE CANCELLED BEFORE TIE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TIE LEFT, BUT FAILURE TO DO SO SHALL City of Tigard IMPOSE NO OBLIGATION OR UABHJTY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 13125 SH Hall Blvd. REPRESENTATIVES. Tigard OR 97223 A ATM ACORD 25 (2001!08) © ACORD CORPORATION 1 Leavitt Grou Vernal Fax:435101M Oct 1 2008 09:45am , PQQZ/ p ? „ A CORL) CERTIFICATE OF LIAB INSURANCE j 10/07/2008 PPODUCEa. (435) 781 -0000 FAX k )781 -0001 THIS CERTIFICATE IS IS: AS A MATTER OF INFORMATION Schaefenneyer- Leavitt Ins ONLY AND CONFERS NO....>;HTS UPON THE CERTIFICATE 23 East Main Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Vernal, UT 84078 • INSURERS AFFORDING COVERAGE NAIC # INSURED Potable Divers, Inc INSURER AI Allstate 19232 DBA: David Harvey INSURERS: Workers Compensation Fund 10033 PO Box 474 INSURER C: Vernal, UT 84078 INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. PERADDI POUCY EFFECTIVE POUCYEXPRATION LTR MSRC TYPE OF INSURANCE POLICY NUIGER DATE IMMIDDIYYI DATE IMMIDDIYYI LIMITS GENERAL LIABIUTY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES !Fa aro renew CLAIMS MADE Li OCCUR MED EXP (My one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ a GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COP /OP AGG $ — I POLICY n P n LOC AUTOMOBILE LIABILITY 048695011 02/05/2008 02/05/2009 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 1,000 000 ALL OWNED AUTOS BODILY INJURY A X SCHEDULED AUTOS (Per Person) HIRED AUTOS BODILY INJURY $ X NON- OWNED.Auros (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ 1 ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGO S EXCESSAA16RELLA LIABLITY EACH OCCURRENCE $ OCCUR I CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION 5 WORKERS COMPENSATION AND 2490036 02/18/2008 02/18/2009 I TORY I ER EMPLOYERS' 1LlIY E.L. EACH ACCIDENT $ 1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE /PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED' E.L. DISEASE - EA EMPLOYEE, S 1,000, 000 If yes desthbe under SPECIAL PROVISIONS Wow E.L. DISEASE - POLICY LIMIT $ 1,000, 000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE TIE EXPRATION DATE THEREOF, THE ISSUING INSURER VILL ENDEAVOR TO MAL 10 DAYS WRITTEN NOTICE TO TIE CERTIFICATE HOLDER NAMED TO THE LEFT, City of Tigard BUT FAILURE TO MAL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABLITY 13125 SW Hall Blvd. OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Tigard, OR 97223 AUTHOR® REPRESENTATIVE Mills /HAMILL , ACORD 25 (2001108) FAX: (503)684 -8840 OACORD CORPORATION 1988 Leavitt Group Vernal Fax:4357810001 Oct 7 2008 09:45am P002 /002 . I MPORTANT If the certificate holder is an ADDfTIONAL INSURED, the policy (ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). • DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) a . . TIGARD September 29, 2009 City of Tigard Potable Divers, Inc. Attn: David Harvey PO Box 474 Vernal UT 84078 REF.: City of Tigard Cleaning and Inspection of Potable Water Storage Facilities Period: October 1, 2009 — September 30, 2010 CONTRACT NOTICE OF AWARD - RENEWAL Dear Mr. Harvey: The City of Tigard has determined that your company has performed in accordance with the requirements of our Agreement. Therefore, the City of Tigard, pursuant to the renewal /extension clause contained in the terms and conditions of the Agreement, desires to exercise its second (2nd) one -year extension to the Contract effective from October 1, 2009 through September 30, 2010. This renewal period shall be governed by the specifications, pricing, and the terms and conditions set forth per the above referenced Contract. Please acknowledge acceptance of this renewal by signing this document in the space provided below and returning it to me within ten (10) days. You may keep a copy for your records. The City looks forward to doing business with Potable Divers in the next year. Sincerely, 4 0 1— i557: Greer Gaston Management Analyst 503 - 718 -2595 greer @tigard - or.gov c: John Goodrich I /We hereby acknowledge acceptance of this Contract renewal, and agree to be bound by all requirements, terms, and conditions as set forth in the above ref j- - - -4 ontra _di Lipp Company: _P0 3 /e D1'ii Signe Date: Lam-/ C 4007 Printed: Oqvc /Ark.- 13125 SW Hall Blvd. • Tigard, Oregon 97223 • 503.639.4171 TTY Relay: 503.684.2772 • www.tigard or.gov City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 UI October 3, 2008 T I GARD Potable Divers, Inc. Attn: David Harvey PO Box 474 Vernal, UT 84078 REF.: City of Tigard Contract No.: 8 -1075 Cleaning & Inspection of Potable Water Storage Period: October 1, 2008 — September 30, 2009 CONTRACT NOTICE OF AWARD - RENEWAL Dear David: We have determined that your company has performed in accordance with the requirements of our Agreement. Therefore, the City of Tigard, pursuant to the renewal /extension clause contained in the terms and conditions of the Agreement, desires to exercise its first (1st) option to renew the Contract effective from October 1, 2008 through September 30, 2009. This renewal period shall be governed by the specifications, pricing, and the terms and conditions set forth per the above referenced Contract. Acknowledge your acceptance of this renewal by signing this document in the space provided below and returning it to this office within ten (10) days. You may keep a copy for your records. Sincerely, Kathy Mollusky Acting Management Analyst 503- 718 -2594 I/We hereby acknowledge acceptance of this Contract renewal, and agree to be bound by all requirements, terms, and conditions as set forth in the above refer - . ontrac Company � /. o (/(°/ -S Sign : Date: Printed Name: Asp, d //9Cke Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigara, OR 97223 • • U1 October 19, 2007 T I CARD Potable Divers, Inc. Attn: David Harvey P.O. Box 474 Vernal, UT 84078 NOTICE TO PROCEED Cleaning and Inspection of Potable Water Storage Facilities The contract documents for the above contracts were received by our office in complete form. You are hereby notified to proceed with the work required under the contract. The contract will expire, unless otherwise terminated or extended, on September 30, 2008. A fully executed copy of the contract document for this project is enclosed. If you have any further questions, I can be reached at (503) 718 -2594. Sincerely, J e Marshall Management Analyst City of Tigard Public Works Ph: (503) 718 -2594 Encl. Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard- or.gov • TTY Relay: 503.684.2772 City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223 III September 27, 2007 T I GARD Potable Divers, Inc. Attn: David Harvey P.O. Box 474 Vernal, UT 84078 RE: City of Tigard Cleaning and Inspection of Potable Water Storage Facilities Dear Mr. Harvey, Enclosed please find two copies of the Service Agreement for the City of Tigard Cleaning and Inspection of Potable Water Storage Facilities. Please sign both copies and return them to me. Upon receipt of these items and approval of the contract by City staff, a Notice to Proceed and a fully executed copy of the contract will be sent to you. If you have any questions please call me at the number shown below. Sincerely / I/ � �/ . me Marshall City of Tigard 13125 SW Hall Blvd. Tigard, OR 97223 (503) 718-2594 / Phone: 503.639.4171 • Fax: 503.684.7297 • www.tigard or.gov • TTY Relay: 503.684.2772