HomeMy WebLinkAbout2014-224 Contract - Liquivision Technology
Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: Liqui Vision Technology
-ASHLAND CONTACT: Sherri Trigg
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 711 Market Street, Klamath Falls, Oregon 97601
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 1-800-229-6959
DATE AGREEMENT PREPARED: 8-6-14 FAX: 541-883-1361
BEGINNING DATE: 8-6-14 COMPLETION DATE: 7-30-15
COMPENSATION: Not to exceed $4,995.00 per scope of work attached as C
GOODS AND SERVICES TO BE PROVIDED: Detect any leaks present in Crowson reservoir and repair
using only NSF 61 compliant materials.
ADDITIONAL TERMS:
NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the
CITY AND CONTRACTOR AGREE as follows:
1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and
expense, perform any work described above and, unless otherwise specified, furnish all labor, equipment and
materials required for the proper performance of such work.
2. Qualified Work: Contractor has represented, and by entering into this contract now represents, that any personnel
assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned
in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are
so registered, licensed and bonded. Contractor must also maintain a current City business license.
3. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no later
than the date indicated above and start performing the work under this contract by the beginning date indicated
above and complete the work by the completion date indicated above.
4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and
expenses, the sum specified above. Payments shall be made within 30 days of the date of the invoice. Should the
contract be prematurely terminated, payments will be made for work completed and accepted to date of termination.
Compensation under this contract, including all costs and expenses of Contractor, is limited to $25,000.00, unless a
separate written contract is entered into by the City.
5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of
City.
6. Statutory Requirements: ORS 2796.220, 2796.225, 2796.230, 2796.235, ORS Chapter 244 and ORS 670.600 are
made part of this contract.
7. Living Wage Requirements: If contractor is providing services under this contract and the amount of this contract
is $20,142.20 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:
Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 1 of 5
i. If City funding from federal, state, county or other sources is not obtained and continued at levels
sufficient to allow for the purchase of the indicated quantity of services;
ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way
that the services are no longer allowable or appropriate for purchase under this contract or are
no longer eligible for the funding proposed for payments authorized by this contract; or
iii. If any license or certificate required by law or regulation to be held by Contractor to provide the
services required by this contract is for any reason denied, revoked, suspended, or not renewed.
d. For Default or Breach.
i. Either City or Contractor may terminate this contract in the event of a breach of the contract by
the other. Prior to such termination the party seeking termination shall give to the other party
written notice of the breach and intent to terminate. If the party committing the breach has not
entirely cured the breach within 15 days of the date of the notice, or within such other period as
the party giving the notice may authorize or require, then the contract may be terminated at any
time thereafter by a written notice of termination by the party giving notice.
ii. Time is of the essence for Contractor's performance of each and every obligation and duty under
this contract. City by written notice to Contractor of default or breach, may at any time terminate
the whole or any part of this contract if Contractor fails to provide services called for by this
contract within the time specified herein or in any extension thereof.
iii. The rights and remedies of City provided in this subsection (d) are not exclusive and are in
addition to any other rights and remedies provided by law or under this contract.
e. Obligation/Liability of Parties. Termination or modification of this contract pursuant to subsections a, b, or
c above shall be without prejudice to any obligations or liabilities of either party already accrued prior to such
termination or modification. However, upon receiving a notice of termination (regardless whether such notice is
given pursuant to subsections a, b, c or d of this section, Contractor shall immediately cease all activities under
this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination,
Contractor shall deliver to City all contract documents, information, works-in-progress and other property that are
or would be deliverables had the contract been completed. City shall pay Contractor for work performed prior to
the termination date if such work was performed in accordance with the Contract.
10. Independent Contractor Status: Contractor is an independent Contractor and not an employee of the City.
Contractor shall have the complete responsibility for the performance of this contract.
11. Non-discrimination Certification: The undersigned certifies that the undersigned Contractor has not discriminated
against minority, women or emerging small businesses enterprises in obtaining any required subcontracts.
Contractor further certifies that it shall not discriminate in the award of such subcontracts, if any. The Contractor
understands and acknowledges that it may be disqualified from bidding on this contract, including but not limited to
City discovery of a misrepresentation or sham regarding a subcontract or that the Bidder has violated any
requirement of ORS 279A.110 or the administrative rules implementing the Statute.
12. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an
asbestos abatement license.
13. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work
without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be
void. Contractor shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all
persons employed by them, and the approval by City of any assignment or subcontract shall not create any
contractual relation between the assignee or subcontractor and City.
14. Use of Recyclable Products: Contractor shall use recyclable products to the maximum extent economically feasible
in the performance of the contract work set forth in this document.
15. Default. The Contractor shall be in default of this agreement if Contractor: commits any material breach or default of
any covenant, warranty, certification, or obligation it owes under the Contract; if it loses its QRF status pursuant to
the QRF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a
QRF if Contractor has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has
instituted against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing
business on a regular basis of the type identified in its obligations under the Contract; or attempts to assign rights in,
or delegate duties under, the Contract.
16. Insurance. Contractor shall at its own expense provide the following insurance:
a. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to
provide Oregon workers' compensation coverage for all their subject workers
b. General Liability insuranc 5omblned single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000,000, $2,000,000 r Not Applicable for each occurrence for Bodily Injury and Property
Damage. It shall include contractua is i i y coverage for the indemnity provided under this contract.
C. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, 1,000,00t, )or Not Applicable for each accident for Bodily Injury and Property Damage,
including coverage for owne , fired or non-owned vehicles, as applicable.
d. Notice of cancellation or chan e. There shall be no cancellation, material change, reduction of limits or
Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 2 of 5
intent not to renew the insurance coverage(s) without 30 days' written notice from the Contractor or its insurer(s) to
the City.
e. _ Additional Insured/Certificates of Insurance. Contractor shall name The City of Ashland, Oregon, and its
elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only
with respect to Contractor's services to be provided under this Contract. As evidence of the insurance coverages
required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to commencing work
under this contract. The contractor's insurance is primary and non-contributory. The certificate will specify all of the
parties who are Additional Insureds. Insuring companies or entities are subject to the City's acceptance. If
requested, complete copies of insurance policies, trust agreements, etc. shall be provided to the City. The
Contractor shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self-
insurance.
17. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws
of the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or
proceeding (collectively, "the claim") between the City (and/or any other or department of the State of Oregon) and
the Contractor that arises from or relates to this contract shall be brought and conducted solely and exclusively within
the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal
forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the
District of Oregon filed in Jackson County, Oregon. Contractor, by the signature herein of its authorized
representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this section be
construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United
States Constitution, or otherwise, from any claim or from the jurisdiction.
18. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE
PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL
BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT,
MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR
THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR
REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT.
CONTRACTOR, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT
HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND
CONDITIONS.
19. Nona ppropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and
authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Contractor
understands and agrees that City's payment of amounts under this contract attributable to work performed after the
last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow
City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In
the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this
contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further
liability to Contractor.
20. Prior Approval Required Provision. Approval by the City of Ashland Council or the Public Contracting Officer is
required before any work may begin under this contract.
21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by
reference.
Contractor: City of Ashland
B
Y
4 ° Signature a rtment Head
Hn/tciiLS Fi~v~Y
Print Name Print Name
IAL5 ink, E4 ta' L`\
Title Date
W-9 One copy of a W-9 is to be submitted with
the signed contract. Purchase Order No.
Contract for Goods and Services Less than $25,000, Revised 07/08/2014, 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.
17.114-
ContrAor (Date)
Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 4 of 5
IF
r
LiQuiVisiopj TkCHHOLOGY
DIVING SERVICES
Offioe/Mailing Address Phone: ;800) 729-6959 Fax: (541) 883-1381 Western Operations
711 Market Street liquivisionQdivingserviaes.com 835 Madcet Street
Klamath Falls, OR 97601 www.divingservioes.com Klamath Falls, OR 97601
Steve Walker 8/5/2014
Ashland, City of Wk: 541-552-2326
90 N. Mountain Ave. Fx: 541-552-2329
Ashland, OR 97520 *OR82365-14rlT_
We are pleased to provide you the following firm quotation and outline of the conditions of our services.
Tank Type Dia. Hgt. Maximum Surface Price for Price for Price for
or (Feet) Calculated Area Diver Diver Additional
LxW Capacity (S.F.) Inspection Cleaning & Sediment
(Feet) (Gallons) Only Ins ection Per inch
Mobilization Charge - Flat charge to mobilize and demobilize to your location. $450
1. Crowson BG Concrete 145x115 22 2,744,229 16,675 $2,250 $4,117
Leak Detection and Repair - Day Rate - $2700.00 for 1st 8 hr day, $375.00/hr for additional time
Manus/Epoxy is charged at $35.00/tube as incurred.
Estimated project duration is 8 hrs.
Subtotal $2,700
Multitank Discount (after the first two tanks).
Total *Plus sales tax if applicable $2,700
Scope of Work:
Leak detection and Repair. Removal of accumulated sediment from the floor of the tank. The effluent will be disposed
of at the districts direction. A final and comprehensive inspection will be performed documenting the condition of the entire
structure and recorded on DVD. Written documentation with digital pictures, descriptions of the images and any
recommendations will be provided to the district on a USB flash drive.
Our bids are based on a variety of factors that pertain to the length of time it takes to accomplish our work. The main
consideration is the amount of sediment that has to be removed, 4" of normal sediment is included in this bid.
Initials Please initial the line items below to verify that you have reviewed them.
Entry hatch on top of the tank is at least 18" diameter.
The water level is kept within ten (10) feet of the top of the tank.
Tank dimensions are correct.
Scope of work is correct.
1. Placement and disposal of effluent removed from the tank is done at the direction of the Customer.
2. Quotes for cleaning assume that the sediment is normal material (such as silt, flocculated material, insects,
manganese, rust, etc.) found in potable water tanks that is easily removed by our vacuum system. If the sediment is
difficult to remove such as large amounts of concrete chips, gravel, sand, rocks, detached coating debris, etc., then
our hourly rate shall apply for each hour (over the first hour) for removing this material.
711 Market Street
Klamath Falls, OR 97601
LiQuNisioN TECHNOLOGY Phone: (541) 883-6473
Fax: (541) 883-1361
3. Unless specified in quote detail we clean all submerged horizontal and angled berms or sloped surfaces 35 degrees
or less. Surfaces exceeding this angle such as the walls can be cleaned but must be listed separately in the quote
detail or estimated by the divers upon inspection. We do not clean surfaces that are out of the water.
4. If any information provided to us is incorrect or if any problems exist that inhibit our ability to complete the job on a
timely schedule, then we will notify you of the problem and reserve the right to add on to the quote based on our
estimate of the additional time it will take to complete the work. Charges for time delays are $200 per hour. This
paragraph only applies to any problems that are your responsibility (i.e. rescheduling with less than 2 business days
notice, set up and start of work before cancelation, etc.) Charge for going remote (if required and not addressed in
advance) is $375 per hour.
5. For coating repair in steel tanks we use a two part underwater epoxy. Each rust nodule or area of coating defect is
wire brushed to bare metal and epoxy is applied over the area. The epoxy chemically bonds to the steel, displaces
water, and remains intact with a greater bond than the original coating. All of our repair, sealing and coating materials
meet or exceed NSF 60 & 61 standards. Repairs are done at the districts direction for the rate of $375 per hour and
$35 per tube of Manus or epoxy.
6. If dechlorination is required it will be charged at $15.00 per hour. If filtration is required then the filter bags will be
charged at $200.00 per bag. Unless specified LVT does not remove the bags they become the districts responsibility
to dispose of.
7. If payment is not made within sixty days of the date of the invoice, an interest charge of 3% shall begin to accrue each
month on the unpaid balance. This interest will continue to accrue each month until the balance is paid in full. To
avoid any interest charges, payment must be received or postmarked within the sixty days following the date of the
invoice. Statements will be sent each month to reflect the new balance. Final pricing may be adjusted to reflect
prevailing wage requirements if it is not determined before job outset.
Our cleaning procedure is accomplished utilizing our proprietary vacuum cleaner, the "LiquiVacT°"" (Patented). The
LiquiVacTM pumps an average of 200 gallons per minute. It has a rotating soft bristle brush that scrubs the floor clean and
removes all sediment without creating turbidity in your tank. This is the only way to ensure that all biofilm is removed from
the interior surfaces without getting any of it mixed into the water column. This system also enables us to clean walls.
In a conscious effort to preserve our nations natural resources LVT will provide our reports to the district on USB flash
drives. If you require a printed and bound copy of the reports please notify our office staff. There will be an additional fee of
$125 per copy.
In over 20 years of providing diving services we continue to treat every customer as if they were our only customer. We
are dedicated to accomplishing every job with the utmost professionalism, safety and efficiency.
Please sign this quote and FAX both pages back to us with an approximate time frame of when you would like the work
done. If you have any questions please give us a call. We look forward to working with you.
Quote is valid for 90 days. Upon signature the work shall be accomplished at a mutually acceptable date within one year.
Sincerely, I find the above and preceding page of contingencies and procedures
acceptable.
Accepted by: Date:
John N Bowers
Sales/Financial Mgr. Signature: Title:
711 Market Street
Klamath Falls, 1117111
(541) 883-73
541) 883-1361
Fax: (
LIQUIVISIONTECHNOLOGY Phone:
Billing/Change Order/Estimate Form
Steve Walker 8/5/2014
Ashland, City of Wk: 541-552-2326
90 N. Mountain Ave. Fx: 541-552-2329
Ashland, OR 97520 -OR82365-14r1T_
Team Leader: Diver #1:
Diver #2: Diver #3:
Tank Type Dia. Hgt. Maximum Surface Price for Price for Date
or (Feet) Calculated Area Diver Diver Work
LxW Capacity (S.F.) Inspection Cleaning & Done
(Feet) (Gallons) Only Inspection
Mobilization Charge - Flat charge to mobilize and demobilize to your location. $450
1. Crowson BG Concrete 145x115 22 2,744,229 16,675 $2,250
Leak Detection and Repair - Day Rate - $2700.00 for 1st 8 hr day, $375.00/hr for additional time
Manus/Epoxy is charged at $35.00/tube as incurred.
Subtotal $2,700
Multitank Discount (after the first two tanks). $0
Total -Plus sales tax if applicable $2,700
Itemize work: Time or Quantity: Extended:
Sales Tax if any:
Total
Authorization Signature:
Estimation of cost for recommendations that LVT can erform.
Recommendations: Estimated Labor Total Estimate
Total
LIQUI-1 OP ID: JS
ACOR,D" DATE IMMIDDnY,m
CERTIFICATE OF LIABILITY INSURANCE 08108/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and Conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endomeme s .
PRODUCER COOP Janice Sharp
Great Basin Insurance P(AM, PA Fjd,o HONE 841$82-5507 F No 841-884.OOS2
826 Main Street
P. 0. Box 69 ADDRESS: janice.sharp@grObasin.com
Klamath Falls, OR 97601
Matt Hurley INSU B AFFORDING COVERAGE NAIC0
INSURER A: American States Insurance Co. 19704
INSURED Uquivision Technology Inc. INaumm a : United Specialty Insurance Co. 12537
Arrow Manufacturing Inc. INSURER c : Uberty Mutual Group
711 Market St.
Klamath Falls, OR 97601 "CURER 0:
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. 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.
IN
LML SR TYPE OF INSURANCE POLICY NUMBER MMID M LIMITS
GENERAL LYIBILITY EACH OCCURRENCE S 11000,
A X cowAERCIALGENERAL UAmuTY X OIC1711675-2 0810112014 0810112015 PREMISES Eaooaarsnos $ 1,000,00
CLAIMS-MADE ❑X OCCUR MED EXP (Any one penmm) S 10,00
PERSONAL & ADV INJURY S 1,000,00
GENERAL AGGREGATE S 2,000,00
GEN'L AGGREGATE LIMIT APPUES PER PRODUCTS - COMPIOP AGG S 2,000,00
X POLICY PRO LOC S
AFCT
AUTOMOBILE LIABILnY Qa:g1, I
IdM EEDD SINGLE 1100010
A X ANY AUTO X GI C171167520 08101/2014 0810112015 BODILY INJURY (Per person) S
ALL OWNED
AUTOS AUTOSULED BODILY INJURY (Per s0ditM S
NON-OWNED AUTO ED ME R Emj ffiGE
S
S
UMBRELLA UAB X OCCUR EACH OCCURRENCE s 51000100
B X OMM UAS CLAIMS-MADE X USA4022991 0810112014 08/3012014 AGGREGATE s
$ s
V=XERS COMPENSATION
X WC STATU• MEN -
C EMPLOYERS' LIABILITY
C ANY PROPRIETORIPARTNERIEXECUTIVE YIN NIA C639S319580023 1010112013 10101/2014 E.L. EACH ACCIDENT S 1,000,00
OFFICERIMEMBEREXCLUDED? EJ
(Myaansdelm In NH) E.L DISEASE - EA EMPLOYEE s 11000100
DE IPTION OPERATIONS bobw E.L. DISEASE . POLICY LIMIT S 1,000,00
DESCRIPnON OF OPERATIONS! LOCATIONS! VEHICLES (Adsch ACORD 101. AddidonU Remaly Sdwmkdo. N mare speeo b mqulred)
City of Ashland Oregon is an additional insured per the attached policy
endorsement forms.
CERTIFICATE HOLDER CANCELLATION
ASHLAND
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Ashland THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
90 N Mountain Ave.
Ashland, OR 97520 AUTHORIZED REPRESENTATIVE
0199872010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010f0S) The ACORD name and logo are registered marks of ACORD
Insurance COMMERCIAL GENERAL LIABILITY
CO 76 38 02 07
e
Policy #01C171167510
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
UABILiTY PLUS ENDORSEMENT
This endorsement moMes Insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
City of Ashland Oregon
ADDITIONAL INSURED BY WRITTEN tease or occupy, subject to the following
CONTRACT, AGREEMENT OR PERMIT, OR additional provisions:
SCHEDULE (a) This insurance does not apply to
The following paragraph Is added to WHO IS AN any 'occurrence 0 which takes p~
after you cease to be a tenant In
INSURED (Section IQ: any premises [eased to or rented to
4. Any person or organization shown In the Sched- YO:
ule or for whom you are required by written con- (b) This insurance does not apply to
tract, agreement or permit to provide Insurance any structural alterations, new con-
Is an Insured, subject to the following additional structlon or demolition operations
provisions, performed by or on behatf of the
a. The contract, agreement or permit must be person or organization added as an
In effect during the policy period shown in Insured;
the Declarations, and must have been exe. (2) Your ongoing operations for that In-
cuted prior to the 'bodily Injury'. 'property sured. whether the work is performed
damage', or &personal and advertising by you or for you.
Injury". (3) The maintenance, operation or use by
b. The person or organization added as an In. you of equipment leased to you by such
sured by this endorsement Is an Insured only person or organization, subject to the
to the extent you are held liable due to: following additional provisions:
(1) The ownership, maintenance or use of (a) This insurance does not apply to
that part of premises you own, rent, any "occurrence' which takes place
after the equipment lease expires;
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(b) Thlo I smanae does not apply to Ttb exdu don apples even N the dalms
l kujttdy° or 'p thq ads l► s* =W in amp
apI am a off out pemon or employmerd. tr loft or moniloring of oftas
d to ftdfV ~kulwyr° of 40ropf►
(4) Psmft Issued by any able or poUtlcel damage" involved the aurnrarah% mahde-
aud on wah respect to operations ramm Use Of N*Ustm t b nitte~a of any
performed by you or on your sl mtf, or alromit %W or almaxalt by orrie or loenneedt tIs owned
o anylow
sublerd to the foibtu~ing addNaml pm- aurod.
Vfml=
Ibb insurance does not apply to 1m* This exdualm does not apply to:
'p o nal "property d~, or and advefthm kW adft abate yyouown or ren% . Wftyned for the
or out M A watercraft you do not own that b:
c. The hmmnos with mepect to any aahitect. (a) Lou then 52 fast IM and
engineer. or surveyor added as an insured (b) Not being used to owry persons or
by lids andonramant does not apply to property for a charge;
ft ft knjary'. 'property damage. out of (3) 9 9aulo° on, or on to ways
on r and adt or the tkdury- eguoe Ong render any next to. P NJ doom you own or rtert>', pW
the rendering of f or e f a r for vidsd Ow ftW Is not owed by or
b services or you om' ranted or loaned loyou or the inured;
(1) The pmpwk%& @Rxw neg. orfaft to (4) UabMly assumed under any Insured
conbaot° for the ownsld* amints-
pmpare or approve maps, dwbng% name or use of airoratt or weteroaft or
domig , or spedfloadons; eland or (5) ms0cmy I*rr or °propmN dams'
(l) seru ry' °n (a) the operadon of maddrmy or
equipment that Is attached &N or
d. Thle kmuranoe does not apply to °bodily part of. a land vel>lole that wotdd
lrW or "properly damage" Included win Wit under the dsilnalon of
the kited operations hu. 'tnoble equip<rmrnt° if ft ware not
ard•. subject to a compulsory or lrmncW
resporuslbtiUy taw or other motr vs-
A person's or orgardmtiorA' status as an insured urn• tddddee ;nuance law in the state
der We endorsement ends when your operations for where it b pomsed or prkwW*
dial km ved are omvbted. OR" or
operallort No coverage w8l be WmAded >f. In the abm= of the (b) ft o of any of the mautidn-
ery or su~pment laced lo Paragraph
otdorsemeK no Gsbft would be Imposed by law an I.M or L(S) of the deihdNotr of
you. Coverage ahsli be billed to the sclera of your °mobils
rua~gernoe or WA aomWbV to ft applic" pruned- (s) An aircraft you do not own proovtded It IS
of aompara>tuee not opmatsd by any Insured.
KON47MED WATERCRAFT AND NON-OWNED
AItCRAFT LIABILITY A ,PROPERTY DAMAGE LIA13LITY
Exclusion g. of OOVE'ItAaE A {Section 1) is roplaoed T
Camage
shown In do Declaniftno, Bmkmbn j of by a, t3ea8orr 1 a replaced by the tollawins: fallovArv
t Me o nneemiddp mabdenance. use or 1• Damage To Property
anbueb i Nd to others of any al om% °aw ~Pmpe*i damage" to
or watKcmft owned or opemled by or raided
or loaned to any haw" Use bnctudes oper- (1) Property you awI% rent', or occupy, includbV
adon and tg or rm any coats or a tpermes Wour ed by you, or
hP 2d4
' -~aoa®rreowneroawsuaww+r-
any otrer pereorh. oqpnkadon or oft for WHO 18 AN INSURED - MANAGERS
rapatr. replacement entumoemork mdm
ft or main manta of such properly for any The ta@awing Is added b Paragraph 2.a. Of WHO IS
reasork i mdxbv prevention of Way to a AN ML ED (Sedan U).
person at damage to m* w% PMPW.
(2~ P1elrtiees you sell. gin may or abandon. V Paragraph (i) does not apply to eo OAM otfiows. or
supaiv
iew favor or shave.
the 'properly damages arfeee out of any pert to managers at the
of Close promises; SUPPLEMENTARY PAYMENTS - COVERAGES A
(3) Properly loaned to You; AND B - BAIL BONDS - TIME OFF FROM
(4) Personal properly In the carer onto* or WORK
am" of the bhatured; Paragraph 9.b. of SUPPLEMENTARY PAYMENTS -
(s) That pardoular Part of real property on whkh OOVEIUGES A AND 8 Is replaced by the followbw
you or any cis or euboonlraafom b. up to s%oeo for cost of ball bands r0lphir
wodit dlredly or kn y an your beW because of a or trWdo kw Violations
ere lydrW off . fl tet °~nlaperly► arising out of tte use of any vehicle to MA110h
damages wge' auMes out of floss aperaBarle, or the Bod ly b*uy Lily CONVO age aPOW
(8) denyor We do not have to itardati time bonds. replaced became
your works was kicorrody performed an IL Paragraph Id. of SUPPLEMENTARY PAYMENTS -
Paragraphs (1). (3) and (4) of the adudon do OWSPAB A AND 8 Is replaced by the foltoWbW
not qq* to 'property damages (other Ilm d. AI reasonable errperms Incurred by the bn-
da mage by flre) to preudses. buk dug the con- =-ad ad our request to a soN us In the bn-
tents of such Premlsea. rented b you. A separate won or defense of the claim or 'mehrits.
W of ineuranae appdn tD Damp To Proof- Mclucling actual lose of eaminge up to $500
Ieae Ranted To You as desaibed In Sedlon W a ray became of tone off from wok.
- Umb Of Insurance.
paragraph (2) of ids exclusion does not apply N EMPLOYEES AS {NSUREDS - HEALTH CARE
the promisee are -your works and were never SEIMES
occuo d, rehnn or held for mntW by you. ProvMm 2.a.(1)(d) of WHO M AN INSURED (Boon
Paragraphs (3). (4h and (0) of ft eoo
AUUM 0) 18 1 , unless excluded by separate endarae.
mvt
do not
tradt av6or L
Paragraph (d) of this excluelon does not apply to GE FOR NEWLY ACOARED
OR~~
aroperly damage bwkxW to hsproduds-
Od. Provldon 3.a. of WHO W AN INSURED (Section 1) la
Paragraph a of I.iNNTB OF imRANCE (Sedton En replaced by the mawbw
N replaced by to fdbw*q L Coverage under d ft provision Is afforded
(I. Shfject to t3. abw^ to Damage To Premleee only urhtl ttm end of the Ply putod.
Rented To You funk is the most we wyl pay un- EXTENDED "PROPERTY DAMAGE"
der Coverage A for damages because of
- damage" to rsrhto dose of daur 1110. Dochldtoln a. of COVERAGE A (Sedtal 0 Is replaced
yo% or In ft wthBe rwrled to you or twnporarlly o=q tad by by the B.
you wil h permledo n of the owner. L -UIy Injur Or qty darter' e30eC11ed
The Damage To Pmrdm Rwnted To You M* Is the or hltarudus from oea p t of the insured.
higher of tine Each oonurrernoe I.irrdt ethown in one TMs enmluebn does not ot apply ly to -bodAy irtjuty°
a Vap" danhager' mmdmfg tram the use of
the amount shown to ire ~
as Damage To PrenfMees Rued To You t.indt reasonable force to Protect persons or Property.
ce is U as or also 3d4 EP
FROM~i~DpiSwRl1AY^
EXTENDED DEFINIM OF BODILY INJURY hhtemhpbd only by a sheet, roadway. waterwall. or
right-oPmay of a reiboad.
Pwagmpfh & of DEMONS (Section V) Is replaced
by to byyb8. INCREASED MEDICAL EXPENSE LIRVT
3. 'Soft btjwy' means boft injury. etda►eas or The k1ledlcal EVerae lbnb is amended to $10.000.
dome statairred by a person. Mdu ft mental
angtfth or dech restdtlng trOm any of ttm at KNOWLEDGE OF OCCURRENCE
arty tMe.
TRANSFER OF RIGHTS OF RECOVERY The totiawtng Is added to Parsgraph Z Dulles In The
Event of Ooowrence. Oftsnee. Claim Or thrlt of
COMMCIAL CONDITIONS
The ftomdrtg Is added to Paragraph L Transfer Of ( GENERAL LIAB0.1f1f
FVhts Of Reoohray Against Often To Us of COM-
MERCIAL GOAL UABILITY CONDITIONS (San Knowbdgs of an 'boctmm en. ddm or %W by
don your agent fahovservant or atedpe of themaenad shell
Msured wdese an
We wdo any rigtrfs of r cmW we may have egstnet offer of to named brewed hu received such not0he
~rr we nmdoe ft toy or daage arfg art of n on age servant or ernPlcyea
for your aVft
cps 19 9 i or youu work" done wider a corhhact with UNWTENnONAL FAILURE 7o DI8CL3t3E ALL
Mat person or orgodzedOn and included In the HAZARDS
oawoompteted operations hazard'. Thu waterer
41i6 0* to a Pmm Or OWfdz@dcn for whom You ft Nowft is added to re**W by wdon conVv A agreetnM permit Om of M. GENE UABUff MCI-
to valve these ri9tds of recoNety. TIONS (SecOan Nk
AGGREGATE UMFM OF INSURANCE PER if lin urdtrierdtart* fa to dEedose any hazards ex
LOCATION left at the btoepdon date of your policy, we will not
For all sunre whiolh to brehared beoontea le9fly old- deny coverep under this Coverage Fam bsomrae of
pled to pay as ~r mW pursed by - such tlM to Fbwav+er, trio provblorh dose not affect
cobd adolal
der CO1f R48E A (Seddon & anti for all medlw[ ow of oat ar atlon (ter nal ~ or eooer rlse our
under
pewees caused by aadde~ under COVERAGE C
(Section Q. wMch can be 8ttr0>trted only to operdora L[BEsRAMTWN CLAUSE
at a abtgle loattbM:
Tire t mft paragraph Is added to COMIMCIAL
(ton lI appgl~a sly to each of you looglorso
owned by or rented to you. 10. K a reWdon to fhb Coverage Pare wMdh would
won' mean prenims kwoMng the saw or mkn. beconres elsollre durbhg the policy period
0=90ft bte, or prendees whose oonneotiott IS in the state du m In the Dedweton, your pol-
loy will auloundc gi pwrfrfe thN addllond cov-
arags on the et eclive date of the r+ev ebm
Pap 4d4
»•-REPROMPROMTHEARCHWE THEORPOIW1LTRANiIM MM1%V0K WAOOnK 4%L FORMS
COMMERCIAL. AUTO
Pddloy #01C171167510 CA 71 10 03 07
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AUTO PLUS ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With rem to coverage provided by this endorsement. the provisions of the Coverage Form apply unless
modified by the endorsement.
EXTENDED CANCELLATION CONDITION BLANKET ADDITIONAL INSURED
Paragraph 2.b. of the CANCELLATION Common SECTION Ii - LIABILITY COVERAGE - A.I. WHO
Policy Condition Is replaced by the following: IS AN INSURED provision is amended by the addition
of the following:
b. 60 days before the effective date of cancellation
If we cancel for any other reason. e. Any person or organization for whom you are re-
quired by an Insured contract" to provide Insur-
TEMPORARY SUBSTITUTE AUTO - PHYSICAL ance is an 'insured", subject to the following
DAMAGE COVERAGE additional provisions:
Under paragraph C. - CERTAIN TRAILERS, MO- (1) The 'insured contract" must be in effect
Decla-
BILE EQUIPMENT AND TEMPORARY SUBSTITUTE during the policy period shown to the d prior
AUTOS of SECTION 1 - COVERED AUTOS, the rations. and must have been executed prior
to the "bodily Injury' or 'property damage".
following is added:
(2) This person or organization is an 'insured"
If Physical Damage coverage is provided by this Cov- only to the extent you are liable due to your
erage Form, then you have coverage for ongoing operations for that insured. whether
the work is performed by you or for you, and
Any 'auto' you do not own while used with the per- orgy to the extent you are held Gable for an
mission of its owner as a temporary substitute for a laccident' occurring while a covered 'auto"
covered 'auto" you own that Is out of service be- Is being driven by you or one of your em-
cause of Its breakdown, repair. servicing, loss" or Pl•
destruction. (3) There is no coverage provided to this person
or organization for "bodily Injury" to its em-
BROAD FORM NAMED INSURED ployess, nor for 'properly damage" to its
SECTION U - LIABILITY COVERAGE - A.I. WHO property-
IS AN INSURED provision Is amended by the addition (4) Coverage f for this
the extent of your neion
of the following: gshall be enre or fault according to the applicable
d. Any business entity newly acquired or formed by principles of comparative negligence or fault
you during the policy period provided you own (5) The defense of any claim or "suit" must be
50% or more of the business entity and the tendered by this person or organization as
business entity Is not separately insured for soon as precdo We to all other insurers
Business Auto Coverage. Coverage Is extended which potentially provide insurance for such
up to a maximum of 180 days following acquisi- claim or 'suit".
tion or formation of the business entity. Coverage
under this provision is afforded only until the end
of the policy period.
Includes copyrighted material of Insurance Services Office, Inc., with he permission.
Copyright. Insurance Services Office. Inc., 1997
CA 71 10 03 07 ftp 1016 EP
-R0WffEDPR0U'9GAI0WF TMEOR MALTRML4ACTMMAYO{CLUMADOMOMALFOMO
(6) The coverage provided will not exceed the PERSONAL EFFECTS COVERAGE
lesser of: A. SECTION III - PHYSICAL DAMAGE COVER-
(a) The coverage and/or limits of this policy; AGE, A.4. COVERAGE EXTENSIONS. Is
or amended by adding the following:
(b) The coverage and/or limits required by c. Personal Effects Coverage
the Insured contract'. For any Owned "auto" that is Involved In a
(7) A person's or organization's status as an covered 'loss". we will pay up to $500 for
insured" under this subparagraph d ends 'personal effects" that are lost or damaged
when your operations for that Insured" are as a result of the covered 'loss", without
completed, applying a deductible.
EMPLOYEE AS INSURED EXTRA EXPENSE - BROADENED COVERAGE
Under Paragraph A. of Section it - LIABILITY COW Paragraph A. - COVERAGE of SECTION III -
ERAGE item I. Is added as follows: PHYSICAL DAMAGE COVERAGE is amended to
add:
Youi 'employee, while using his owned 'auto or an
"auto" owned by a member of his or her household, S. We will pay for the expense of retuning a stolen
In your business or your personal affairs, provided you covered "auto" to you.
do not own, hire or borrow that 'auto". This coverage
Is excess to any other collectible Insurance coverage. AIRBAG COVERAGE
FELLOW EMPLOYEE COVERAGE Under paragraph B. - EXCLUSIONS of SECTION III
- PHYSICAL DAMAGE COVERAGE, the following is
Exclusion S. FELLOW EMPLOYEE of SECTION II - added:
LIABILITY COVERAGE - B. EXCLUSIONS is
amended by the addition of the following: The exclusion relating to mechanical breakdown does
not apply to the accidental discharge of an airbag.
However, this exclusion does not apply if the 'bodily
injury" results from the use of a covered -aub" you NEW VEHICLE REPLACEMENT COST
own or hire. and provided that any coverage under
this provision only applies in excess over any other Under Paragraph C - LIMIT OF INSURANCE of
collectible insurance. Section 01 - PHYSICAL DAMAGE COVERAGE sec-
tion 2 1s amended as follows:
* * BLANKET WAIVER OF SUBROGATION 2. An adjustment for depredation and physical con-
We wahre the right of recovery we may have for pay- diton well be made in determining actual cash
ments made for `bodily injury" or 'properly damage' value in the event of a total loss. However, In the
on behalf of the persons or organizations added as event of a total loss to your "new vehicle to
ftwireds" under Section 11 - LIABILITY COVERAGE which this coverage applie% as shown in the
- AA.D. BROAD FORM NAMED INSURED and declarations, we will pay at your option;
A.1.e. BLANKET ADDITIONAL INSURED. a. The verifiable "new vehicle" purchase price
you paid for your damaged vehicle, not in-
PHYSICAL DAMAGE - ADDITIONAL TRANS- eluding any insurance or warranties pur.
PORTATION EXPENSE COVERAGE chased;
The first sentence of paragraph AA. of SECTION M b. The purchase price, as negotiated by us, of
- PHYSICAL DAMAGE COVERAGE Is amended as a new vehicle of the same make, model and
follows, equipment, not including any furnishings,
parts or equipment not installed by the
We will pay up to $50 per day to a maximum of manufacturer or manufacturer's dealership.
$1,500 for temporary transportation expense Incurred if the same model Is not available pay the
by you because of the total theft of a covered "auto" purchase price of the most similar model
of the private passenger type. available;
PW 206
-REMMMPROMTHEAR04NE THEW06PMLTRANSACnMMAYU0 =MACDffK 46LFMMS
c. The market value of your damaged vehicle, a. Actual cash value of the damaged or stolen
not including any furnishings, parts or equip- property as of the time of the 'toss". less an
mentt not installed by the manufacturer or adjustment for predation and physical
manufacturer's dealership.
This coverage applies only to a covered "auto" b. Balance due under the terms of the loan or
of the private passenger, light truck or medium lease that the damaged covered "auto" is
tuck type (20,000 Ibs or less gross vehicle subject to at the time of the loss toss any
weight) and does not apply to initiation or set up one or all of the following adjustments:
costs associated with loans or leases. (1) Overdue payment and financial
TWO OR MORE DEDUCTIBLES penalties associated with those
payments as of the date of the
*loss*.
Under SECTION 111 - PHYSICAL DAMAGE COFinancial penalties Imposed under a
ERAGE, if two or more "c:ompany" policies or cover (2) FWass due to high mileage, under
-
age forms apply to the same accident, the following alas use or abnormal wear and tear.
applies to paragraph D. Deductible:
a. If the applicable Business Auto deduct- (3) Co is Life for Insurance. Health, Accident
ibis is the smaller waived: (or smallest) deduct- or Disability Insurance purchased
iWe it will be e walved: or with the loan or lease.
b. If the applicable Business Auto deduct- Transfer or rollover balances from
ible is not the smaller (or smallest) de- (4)
ductible it will be reduced by the amount previous loans or leases.
of the smaller (or smallest) deductible; Final payment due under a 'Balloon
or Loan".
c. If the loss involves two or more Buss- (6) The dollar amount of any
r>ess Auto coverage forms or policies un-repaired damage that
be occurred
be smalls[ (or smallest) deductible will prior to the 'total loss" of a covered
e waived. "auto".
For the purpose of this endorsement g,~y app not refunded by a
'bompany" means: lessor.
a. Safeco Insurance Company of America (S) All refunds payable or paid to you
b. American States Insurance Company as a result of the early termination
of a tease agreement or any war-
c. General Insurance Company of America ranty or extended service agree-
d. American Economy Insurance Company ment on a covered 'auto".
e. First National Insurance Company of (8) Any amount representing taxes.
America (10) Loan or lease termination fees
C American States Insurance Company of
Taxes GLASS REPAIR - WAIVER OF DEDUCTIBLE
g. American States Preferred Insurance Under paragraph D. - DEDUCTIBLE of SECTION Ill
Pant - PHYSICAL DAMAGE COVERAGE, the following is
h. Safeoo Insurance Company of Illinois added:
LOANA EASE GAP COVERAGE No deductible applies to glass damage if the glass is
repaired rather than replaced.
Under paragraph C - LIMIT OF INSURANCE of
SECTION III - PHYSICAL DAMAGE COVERAGE. AMENDED DUTIES IN THE EVENT OF ACCI-
the following is added: DENT, CLAIM, SUIT OR LOSS
4. The most we will pay for a total loss" in any one The requirement In LOSS CONDITION 2.a. -
'accident" 18 the greater of the following, subject DUTIES IN THE EVENT OF ACCIDENT. CLAIM.
to a $1,500 maximum limit: SUIT OR LOSS - of SECTION IV - BUSINESS
AUTO CONDITIONS that you must notify us of an
G 71 10 03 07 Pape 3d6 EP
REPRRftEOPROM"Ar CWL THE ORIODUL TRMgACI M MAY OICUM AOORIONAL FORMS
"accident" applies only when the 'aocident" Is known deductible and excess provisions, we will provide
to. coverage equal to the broadest coverage applicable
to any covered 'auto" you own.
(1) You, N you are an individual;
A r. N you are a partnership; or HIRED AUTO PHYSICAL DAMAGE COVERAGE -
(2j panne yo LOSS OF USE
(3) An executive officer or Insurance manager. If you SECTION III -PHYSICAL. DAMAGE AA.b. Form
are a corporation. does not apply.
UNINTENTIONAL FAILURE TO DISCLOSE Subject to a maximum of $1,000 per accident, we will
HAZARDS cover loss of use of a hired -auto" N it results from
SECTION IV - BUSINESS AUTO CONDITIONS - an accident, you are legally liable and the lessor in-
B.2. Is amended by the addition of the following: cure an actual financial toss.
If you unintentionally fail to disclose any hazards ex- RENTAL REIMBURSEMENT COVERAGE
isting at the inception date of your policy, we will not A. We will pay for rental reimbursement expenses
deny coverage under this Coverage Form because of incurred by you for the rental of an "auto" be-
such failure. However. this provision does not affect of a covered 'loss' to a covered "auto cause our right collect additional premium or exercise our Payment applies
in addition to the otherwise ap-
right of cancellation or non-renewal. plicable amount of each coverage you have on a
HIRED AUTO - LIMITED WORLD WIDE COVER- covered "auto". No deductibles apply to this
coverage
AGE
B. We will pay only for those expenses incurred
Under Section IV - Business Conditions. Paragraph during the policy period beginning 24 hours after
IL7.b.e(1) Is replaced by the following: the loss" and ending, regardless of the policy's
(1) The 'accident" or 'loss" results expiration, with the lesser of the following number
from the use of an 'auto" hired for of days:
30 days or less. 1. The number of days reasonably required to
repair or replace the evened -auto". N
RESULTANT MENTAL ANGUISH COVERAGE loss" is caused by theft, this number of
days is added to the number of days it takes
SECTION V -DEFINITIONS - C. is replaced by the to locate the covered 'auto" and return it to
following: you.
IWIY Injury" means bodily injury, sickness or dis- 2. 30 days.
ease sustained by a person Including mental anguish C. Our payment is limited to the lesser of the fol-
or death resulting from any of these. lowing amounts:
HIRED AUTO PHYSICAL DAMAGE COVERAGE 1. Necessary and actual expenses Incurred.
If hired 'autos" are covered wautos" for Liability cov- 2. $50 Per day.
erage and if Comprehensive, Specified CaU99S of D. This coverage does not apply while there are
Loss or Collision coverages are provided under this spare or reserve "autos" available to you for your
Coverage Form for any "auto" you own, then the operations.
Physical Damage Coverages provided are extended
to "autos" you hire or borrow. E. If 'floes" results from the total theft of a covered
"auto" of the private passenger type. we will pay
The most we will pay for loss to any hired 'auto" Is under this coverage only that amount of your
550,000 or Actual Cash Value or Cost of Repair, rental reimbursement expenses which is not al.
whichever Is smallest. minus a deductible. The de- ready Provided for under the PHYSICAL DAM-
ductible will be equal to the largest deductible appo- AGE COVERAGE Coverage Extension.
cable to any owned "auto" of the private passenger F. The Rental Reimbursement Coverage described
or light fink type for that coverage. Hired Auto Phy. above does not apply to a covered 'auto" that is
skal Damage coverage is excess over any other c 0ol- "auto" on
lectible Insurance. Subject to the above omit, described or designated as a covered
Pays 4 of 8
- REPRMWFROM THE ARCHNE. THE ORIOOM iRAMBACnOM ANY PIDACE ADOO O►ML FONMS
Rental Reimbursement Coverage Form the manufacturer for the installation of a
CA 99 23. radio.
AUDIO, VISUAL AND DATA ELECTRONIC C. Limit of Insurance
EQUIPMENT COVERAGE With respect to this coverage, the LIMIT OF IN-
SURANCE provision of PHYSICAL DAMAGE
A. Coverage COVERAGE is replaced by the following;
1. We will pay with respect to a covered "auto" 1. The most we will pay for loss" to audio, vi-
for toss" to any electronic equipment that sual or data electronic equipment and any
receives or transmits audio, visual or data accessories used with this equipment as a
signals and that is not designed solely for the result of any one %ocident" is the lesser of
reproduction of sound. This coverage applies
only 0 the equipment Is permanently installed a. The actual cash value of the damaged
In the covered "auto" at the time of the or stolen property as of the time of the
'loss" or the equipment Is removable from a loss". or
housing unit which is permanently installed b. The cost of repairing or replacing the
In the covered "auto" at the time of the damaged or stolen property with other
loss", and such equipment is designed to property of like kind and quality.
be solely operated by use of the power from
the "auto's" electrical system, in or upon the c. $1,000.
covered *auto". 2. An adjustment for depredation and physical
2. We will pay with respect to a covered "auto" condition will be made in determining actual
for "loss" to any accessories used with the cash value at the time of the "loss".
electronic equipment described in paragraph 3. If a repair or replacement results In better
A.1. above. than like kind or quality, we will not pay for
However. this does not Include tapes, the amount of the betterment.
records or discs. D. Deductible
3. It Audio, Visual and Data Electronic Equip-
ment Coverage form CA 99 60 or CA 99 94 1. N 'loss" to the audio, visual or data elec-
Is attached to this policy, then the Audio, VI- tronic equipment or accessories used with
sual and Data Electronic Equipment Cover. this equipment is the resuft of a'loss" to the
age described above does not apply. covered "auto" under the Business Auto
Coverage Form's Comprehensive or CotA-
S. Exclusions sion Coverage, then for each covered "auto"
The exclusions that apply to PHYSICAL DAM- our obligation to pay for, repair, return or to.
AGE COVERAGE, except for the exclusion relat- Place damaged or stolen property will be re-
ing to Audio, visual and Data Electronic duoed by the applicable deductible shown in
Equipment. also apply to this coverage. In addi- the Declarations. Any Comprehensive Cov-
tion, the following exclusions apply; erage deductible shown In the Declarations
does not apply to loss" to audio, visual or
We will not pay for either any electronic equip. data electronic equipment caused by ore or
rent or accessodes used with such electronic lightning.
equipment that is: 2. If loss" to the audio, visual or data ehea
1. Necessary for the normal operation of the tronic equipment or accessories used with
covered "auto" for the monitoring of the this equipment Is the result of a loss" to the
covered %uto's" operating system; or covered "auto" under the Business Auto
2. Both- Coverage Form's Specified Causes of Loss
Coverage. then for each covered "auto" our
a. an integral part of the same unit horsing obligation to pay for, repair, return or replace
any sound reproducing equipment de- damaged or stolen property will be reduced
signed solely for the reproduction of by a $100 deductible.
sound if the sound reproducing 3. It loss" occurs solely to the audio, visual or
ecprip ere is permanently Installed in data electronic equipment or accessories
the covered "auto and used with this equipment, then for each cov-
b. permanently installed in the opening of ered "auto" our obligation to pay for, repair,
the dash or console normally used by
CA 71 to 03 07 Pace 5 d 6 EP
-REPRWMFROMTHEARCME 7W0RM TRAW8AC7MMAVW MAOOIffO"ioR4
return or replace damaged or stolen property SECTION V - DEFINITIONS is amended by adding
will be reduced by a $100 deductible. the following:
4. In the event that there is'more than one ap- Q. "Personal effects" means your tangible
placable deductible. only the highest deduct- property that is wom or carried by you. ex-
ible will apply. In no event will more than one cept for tools, jewelry, money, or securltles,
deductible apply. R. "New vehide" means any 'auto" of which
you are the original owner and the "auto"
has not been previously titled and is less
than 365 days past the purchase date.
Pape 6 W 6
~PPage 1 / 1
. CITY OF
ASHLAND DATE FPO NUMBER
20 E MAIN ST. 8/15/2014 12440
ASHLAND, OR 97520
(541) 488-5300
VENDOR: 003671 SHIP To: Ashland Water Department
LIQUIVISION TECHNOLOGY (541) 488-5354.
711 MARKET STREET 90 N MOUNTAIN
KLAMATH FALLS, OR 97601 ASHLAND, OR 97520
FOB Point: Req. No.:
Terms: Net Dept.:
Req. Del. Date: Contact: Steve Walker
Special Inst: Confirming? No
Quantity Unit Description Unit Price Ext. Price
Detect anv leaks present in Crowson 4,995.00
Reservoir and repair usinq only NSF 61
compliant.
Contract for Goods and Services
Beqinninq date: 08/06/2014
Completion date: 07/30/2015
SUBTOTAL 4,995.00
BILL To: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 4,995.00
ASHLAND, OR 97520
Account Number Project Number Amount Account Number Project Number Amount
E 670.08.18.00.60240 4,995.00
Authorized ignature VENDOR COPY
FORM #3 CITY OF
_ ASHLAND
REQUISITION Date of request: 8-14-14
Required date for delivery: asap
Vendor Name LiquiVision Technology Inc.
Address, City, State, Zip 711 Market St. Klamath Falls, Oregon 97601 \
Contact Name & Telephone Number Sherri Trigg 1-800-229-6959
Fax Number 541-883-1361
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Emergency
❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization
❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached
❑ Written quote or proposal attached
❑ Small Procurement Cooperative Procurement
Less than $5.000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon
X Direct Award Date approved by Council: Contract #
❑ Verbal/Written quote(s) or proposal(s) ❑ State of Washington
Intermediate Procurement ❑ Sole Source Contract #
GOODS & SERVICES ❑ Applicable Form (#5,6, 7 or 8) ❑ Other government agency contract
$5.000 to $100,000 ❑ Written quote or proposal attached Agency
❑ (3) Written quotes and solicitation attached ❑ Form #4, Personal Services $5K to $75K Contract #
PERSONAL SERVICES Special Procurement Intergovernmental Agreement
$5,000 to $75.000 ❑ Form #9, Request for Approval ❑ Agency
❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached Date original contract approved by Council:
❑ (3) Written proposals/written solicitation Date approved by Council: (Date)
❑ Form #4, Personal Services $5K to $75K Valid until: Date
Description of SERVICES Total Cost
Detect any leaks present in Crowson Reservoir and repair using only NSF 61 compliant $4,995
materials
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL COST
❑ Per attached quote/proposal $
Project Number _ _ _ _ _ _ - _ _ _ Account Number 670.08.18.00.602400
Account Number--- - Account Number
'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures.
IT Director in collaboration with department to approve all hardware and software purchases:
IT Director Date Support -Yes /No
By signing this requisition form, I certify that the City's public contracting requirements have been satisfied.
ejvi1,,
Employee: Department Head:
gal to or greater than $5,000)
Department Manager/Supervisor:.,~2r.~~ amity Administrato .
(Equal to or greater than $25,000)
Funds appropriated for current fiscal year YES / NO
Finance Director- (Equal to or greater than $5,000) Date
Comments:
Form #3 - Requisition