HomeMy WebLinkAbout2015-058 Contract - Liquivision Technology
Contract for GOODS AND SERVICES Less than $25,000
C I T Y OF CONTRACTOR: Liquivision Technology Inc.
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: 2-18-15 FAX: 541-883-1361
BEGINNING DATE: 2-23-15 COMPLETION DATE: 6-30-15
COMPENSATION: $3,300 per scope of work/quote attached as exhibit C
GOODS AND SERVICES TO BE PROVIDED: Clean all internal vertical and horizontal wetted surfaces
in Ashland's Fallon Reservoir using certified potable water divers as described in exhibit C
ADDITIONAL TERMS:
In the event of conflicts or discrepancies among the contract documents, the City of Ashland Contract for Goods and Services will be primary and take
precedence, and any exhibits or ancillary contracts or agreements having redundant or contrary provisions will be subordinate to and interpreted in a
manner that will not conflict with the said primary City of Ashland Contract.
Liquivision to dispose of effluent through sprinklers placed approx.350' from base of tank in an area
chosen b City of Ashland Water Dept.
NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the
CITY AND CONTRACTOR AGREE as follows:
1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and
expense, perform any work described above and, unless otherwise specified, furnish all labor, equipment and
materials required for the proper performance of such work.
2. Qualified Work: Contractor has represented, and by entering into this contract now represents, that any personnel
assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned
in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are
so registered, licensed and bonded. Contractor must also maintain a current City business license.
3. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no later
than the date indicated above and start performing the work under this contract by the beginning date indicated
above and complete the work by the completion date indicated above.
4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and
expenses, the sum specified above. Payments shall be made within 30 days of the date of the invoice. Should the
contract be prematurely terminated, payments will be made for work completed and accepted to date of termination.
Compensation under this contract, including all costs and expenses of Contractor, is limited to $25,000.00, unless a
separate written contract is entered into by the City.
5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of
City.
6. Statutory Requirements: ORS 27913.220, 27913.225, 27913.230, 27913.235, 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 an time b mutual consent of both parties.
Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 1 of 5
b. City's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing
and delivered by certified mail or in person.
C. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of
written notice to Contractor, or at such later date as may be established by City under any of the following
conditions:
i. If City funding from federal, state, county or other sources is not obtained and continued at levels
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 insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000,000, $2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property
for Goods and Services Less than $25,000, Revised 07/08/2014, Page 2 of 5
Damage. It shall include contractual liability coverage for the indemnity provided under this contract.
C. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000,000, or Not Applicable for each accident for Bodily Injury and Property Damage,
including coverage for owned, hired or non-owned vehicles, as applicable.
d. Notice of cancellation or change. There shall be no cancellation, material change, reduction of limits or
intent not to renew the insurance coverage(s) without 30 days' written notice from the Contractor or its 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. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and
authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Contractor
understands and agrees that City's payment of amounts under this contract attributable to work performed after the
last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow
City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In
the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this
contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further
liability to Contractor.
20. Prior Approval Required Provision. Approval by the City of Ashland Council or the Public Contracting Officer is
required before any work may begin under this contract.
21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by
reference.
Contractor: City of Ashland
By r~< By Q~
Signature Depart men ead
. ~H N N T +CW'Z rLS M cG Jt d:j,/ 2
Print Name Print Name
IV4"VC14_ MCA,
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.
c'"; (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
ear.
(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.
LS l
or (Date)
Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 4 of 5
CITY OF ASHLAND, OREGON
EXHIBIT B
City of Ashland
LIVING
WAGE
. •
per hour effective June 30, 2014
ILA (Increases annually every June 30 by the
Consumer Price Index)
portion of business of their 401 K and IRS eligible
employer, if the employer has cafeteria plans (including
ten or more employees, and childcare) benefits to the
has received financial amount of wages received by
assistance for the project or the employee.
➢ For all hours worked under a business from the City of
service contract between their Ashland in excess of ➢ Note: "Employee" does not
employer and the City of $20,142.20. include temporary or part-time
Ashland if the contract employees hired for less than
exceeds $20,142.20 or more. ➢ If their employer is the City of 1040 hours in any twelve-
Ashland including the Parks month period. For more
➢ For all hours worked in a and Recreation Department. details on applicability of this
month if the employee spends policy, please see Ashland
employee's or more of the ➢ In calculating the living wage, Municipal Code Section
employee's time in that month employers may add the value 3.12.020.
working on a project or of health care, retirement,
For additional information:
Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator, City Hall,
20 East Main Street, Ashland, OR 97520 or visit the city's website at www.ashland.or.us.
Notice to Employers: This notice must be posted predominantly in areas where it can be seen by all
employees.
CITY OF
-ASHLAND
Contract for Goods and Services Less than $25,000, Revised 07/08/2014, Page 5 of 5
UQUiViSiON TECHNOLOGY
.DIVING SERVICES
OffioeiMailing Address Phone: (800 729-5959 Fax: (541) 883-13$1 western Operations
711 Market Street liquivision@divingswvioes.com 835 Market Street
Klamath Falls, OR 97601 www.divingsmioes.com Klamath Falls, OR 97601
Steve Walker 2/10/2015
City of Ashland Wk: 541-552-2326
90 N. Mountain Ave. Fx: 541-552-2329
Ashland, OR 97520 -OR20103-15r1
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.) Wall Cleaning & Sediment
(Feet) (Gallons) Cleaning Inspection Per inch
Mobilization Charge - Flat charge to mobilize and demobilize to your location. - $450
1. Fallon Reservoir I OG Concrete 59 27 500,000 2,733 $500 $2,250 $675
Sprinklers will be a flat rate of $200. $200
Additional hose $350
-
Subtotal $500 $3,250
Discount ($450)
Total
Total -Plus sales tax if applicable $500 $2,800 $3,300
Scope of Work:
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" dlameter(If divers cannot enter minimum charges will apply
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
LiQuIVISION 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 "LiquiVacTM" (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.
r
Accepted by: Date:
John N Bowers
Sales/Financial Mgr. Signature: Title:
711 Market Street
Klamath Falls, 1117111
(541) 883-6473
Fax: (541) 883-11361
LQUIVISION TECHNOLOGY Phone:
Billing/Change Order/Estimate Form
Steve Walker 2/10/2015
City of Ashland Wk: 541-552-2326
90 N. Mountain Ave. Fx: 541-552-2329
Ashland, OR 97520 *OR20103-15r1
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.) Wall Cleaning & Done
(Feet) Gallons Cleaning Ins ection
Mobilization Charge - Flat charge to mobilize and demobilize to your location. - $450
1. Fallon Reservoir OG Concrete 59 27 500,000 2,733 $500 $2,250
Sprinklers will be a flat rate of $200. $200
Additional hose flat rate of $350 $350
Subtotal $500 $3,250
TTotal Plus saes tax if applicable $500 $2,800 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
UQU14 OP ID: JS
CERTIFICATE OF LIABILITY INSURANCE 0212612015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER Nom; Janice Sharp
Great Basin Insurance PHONE
826 Main Street M& me, . 541-882-5507 Arc No : 541-8840052
P. O. Box 69
Klamath Falls, OR 97601 . anice.sha r8basin.com
Matt Hurley INSU 8 AFFORDING COVERAGE NAIL s
INSURER A: American States Insurance Co. 19704
INSURED Uquivision Technology Inc. Nsum a: Navigators Specialty Irks Co
Arrow Manufacturing Inc. INSURER c: Ube Mutual Group
711 Market St
Klamath Falls, OR 97601 INSURER D: RockhilI Insurance Company
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.
iNSR PAM SUMP EFF POLICY
TYPE OF INSURANCE 2W WvD POLICY NUMBER POLICY EXP LIMITS
GENERAL LABILITY EACH OCCURRENCE S 11000,00
DAMAGE TO RERTEff-
C X COMMERCIAL GENERALLIABILrrY X C1711676-2 0810112014 0810112015 PR
EMISE Ea cccurmnce) S 11000,00
CLAIMS-MADE 7X OCCUR MED EXP (Arty ors person) S 10,
PERSONAL & ADV INJURY S 1,000,00
GENERAL AGGREGATE S 2,000,00
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS • COMPIOP AGG S 2,000,00
X POLICY PRO LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ridan 10000.00
A X ANY Auro X 010171167620 08!0112014 08/0112015 BODILY INJURY (Per Person) S
OOYS4NE0 SCHEDULED BODILY INJURY (Per swidem) S
NON-OWNED ONAM
OS IPER PROPER ACCIDENT) S
HIRED AUTOS AUT
S
UMBRELLA LL48 X OCCUR EACH OCCURRENCE S 51000,00
B X EXCESS LAS CLAIMS-MADE X E14EXCO206MIC 0910112014 06/0112015 AGGREGATE $
DED RETENTION S S
WOFUUM COMPENSATION X WNC STATU• 0& AND EMPLOYERS' LIABILITY
C ANY PROPRIETORIPARTNERA:XECUTIVE Y!❑N N IA 06393319580023 10101/2014 10101/2016 E.L. EACH ACCIDENT $ 11000,
OFACERAdEMSER EXCLUDED?
WMenddem in NH) E.L. DISEASE . EA EMPLOYE $ 1,000,00
0 dIPTM OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 11000100111
D Pollution Liabilk ENVP01138600 10!16!2014 1011612015 Ea Condit 2,000,00
Aggregate 2,000,0
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AUsch ACORD 101, Addllsnal Remarks Schsdwa. N more space is regal rod)
City of Ashland Oregon is an additional insured per the attached policy
endorsement fo=s.
CERTIFICATE HOLDER CANCELLATION
ASHLAND
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City ACCORDANCE WITH THE POLICY PROVISIONS.
90 N Mountain Ave.
Ashland, OR 97520 AUTHORIZED REPRESENTATIVE
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ACORD 26 (201(I105) The ACORD name and logo are registered marks of ACORD
Insurance COMMERCIAL GENERAL LIA8tLITY
CG 76 38 02 07
Policy 4101 C171167520
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
UABiLTTY PLUS ENDORSEMENT
This endorsement mod€lles insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
City of Ashland
ADDITIONAL INSURED - BY WRITTEN lease or occupy, subject to the following
CONTRACT, AGREEMENT OR PERMIT, OR additional provisions:
SCHEDULE (a) This Insurance does not apply to
any `occurrence which takes place
The INSURED (Section ction IQ: paragraph is added to WHO IS AN after you cease to be a tenant in
any premises leased to or rented to
4. Any person or organization shown In the Sched- you,
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 struction or demolitlon operations
provisions: performed by or on behalf of the
a. The contrast, agreement or permit must be person or organization added as an
In effect during the poky 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 'personas and advertising by you or for you,
juryo,
b. The person or organization added as an In. (3) The equipment ent. leased operation t to o you by
you of f equid you use by such
sured by this endorsement Is an insured only person or organization, subject to the
to the extent you are held Qabie 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:
Includes Copyrighted Material of Insurance Services Office, Inc., with Its psrmisslon.
Copyright, Insurance Services, 2001
03 6dew eed to Bsao by ua d Uto
i 78 36 02 07 Page 1 of 4 EP
NEi1~P1e0AltllBillAReUWiMY""
(b) This Insurance dares not apply to This ex islon applies aver if the ddm
ft* IrW or °p dam- a~nst any Inured diage negligence or
age' arbbtg out of the ode negli- oihar wrongdolM In the aupewbton, hhkgg
genes of such person or employment, training or mordfoft of others
agarkaftc. by trat Insured, t ire boarrrence- snide
caused rte 'mfr Injury' or 'properly
('g ~ ~ to opersdons mam u tree hwoWed the o afdp. male any
nance, at e~lr8b'nend b m affrays of any
pwbynsd by you or on your behalf. almraft 'lauto° or watate raft teat b owned
adoct to the foflovhg adddfreml pro. or operated rd by or rented or hand to any In•
tu
Thb b surmce, does not apply to 'body This eoaduelon does not eppty m:
kW, VVwV derneW, or
.personal and advertbing IIMW $1181M (1) A vwsfe while sensors on promises
out of vpe perfonrted for the state you own or or re~ .
or nner>&~agty. M A watercraft you do not awn tfret b:
a. The insuranos wth respect to any amtdl@A (a) Lou then 52 feet long: and
erolneer, or surveyor added as an Insured (b) Not bekq used ro carry persona or
by gds andormnant does not apply to prof -yen Mr a dray's;
"body Injury, property darrangs'. or 'per-
sonal and advartieing I duW tubing out of (3) Pu tg an %uto° on, or on the ways
the rertderbtg of or qte failure to render any next to. prembse you own or rent, pro-
m clasebrml smvioes by or for you, imffud- vided tee %uto' is not owned by or
low rented or loaned to you or the Insured;
(1) Tire propeeltg, approft or f tft to (4) ft assumed sender any Insured
prepare or approve maps, dmwbW mnlred- for the
use of afroult wmeW r
deM deefgnaa o~aped&mftM and °f (g) w ° of rh► dame4W
i on or womft Wising out at
swvkm& (a) the qma* n at nachirmy or
d. We Insurance does not apply to laccol r ant that Is altactted to, or
btjW ° or `property dam" I4uded whlbn peat of, a Ind vahlob that would
the 'pros oompkftd opmOons hur ' d& a under • ff deftition k were not
,
and°. subjed to a compubory or Inandal
balky new or other rotor ve-
A penesis or organk eton"a $Ufua as an Insured un. Itstuhmce fear in the state
der tide andmaeernent ends when your operations for where fl Is Rewind or pdh o*
UN Insured are omplsted. garaged; or
No ccuere99 wiu be pmvWed t. In the absence of tide (b) the operation of any d the msddn.
axioreeement, no lablIlty would be lmposed by law an my or equipment Rated In Paragraph
daft n of
you. Cominige slag[[ be Malted to the extant of your i L of the
M909 or faun according to the applIcebte pdrud- _
ON of compara ll" fatdt. (8) An reu on do not own provided it is Insured.
NON.OWNED WATERCRAFT AND NOMMED
AIRCRAFT LIAR Li7Y TENANTS I PROPERTY DAMAGE LUUHLFTY
EXOAlm g. of COVERAGE A (Sept Q to replaced When a Damage To Premises Rented To You Umn Is
bytemmko shown In the DBdamdons, Ehodha lon J. of Cmirage
to. ' injtry' or oprops* damew ad** A. Sedfonn I Is replaced by the tolbwkW
out of the OwmBn ^ mak termnce, use or J. Damage To Property
4 MUSInterd m olltsra of any alarm % t 'Properly dada's" tm
or watercraft owned or operated by or rented
or band to any Insured. Use includes open- (1) Property you own. rent or occupy. Including
adon and %a ft or u nbadf V. any costs or expenses Inxmed by ycu. or
Pqp xd4
RaPWNrW irlDM7rlelORIIBIIrRARY'"'
any other petum cigenballon or oft for WHO W AN WSURED - MANAGERS
rapalt. ~a artmmement reslota
ton of of 81&dm for roN The tong Is added tD Paragraph 2.a. of WHO IS
h*xlng fin- of d*W to s AN MM Pedon llr
parson or damp to anoteees properly;
(2) Pmmises you ail. give away or sbmedazm. U ftmgq* (1 ~ go ~ moec*ve ofters, or
the °propoW damage" arises out of any part of aces, promises; SUPPLEMENTARY to managem PAYMENTS - COVERAGE$ A
(3) Pmperpr loaned m you; AND S - BAIL BONDS - TIME OFF FROM
(4) Patsonal properly in the care. oustody or WORK
oardrol of die kured; Paragreph 1.b. of SUN UMENTARY PAYMENTS -
(i) That parlicrdar part of rest property on waft CUBMS A ANQ 8 to replaced by the folto< ko
yo
wodft u or arty ly cowadora
Indio or sn your behalf! b. Up to $3„000 for cost of ball bonds required
g qMdom If on lp because of a*Ww to or WfEc law vbkftm
darreaW siless out of boss operadone. or arising out of *re use of any vedde to WhIch
the Godly Injury LJabW Coverage M*89 .
(8) 7W padloular resto res of
or replaced bbeecau~sa We do not hears lb fiurdsh ihsse bores.
your woflr" vM Mooneady perfomred on it Paragaph 1.d. of SUPPLEiMIWARY PAYMETB -
PansgrWU (1). (3) and (4) of this eorderelon do 0WOMES A AND B is replaced by the Mcwbeg:
riot apply to Vop=V damage" (other then d. Al reasonable eopensee h=u ed by the In•
damage by f1m) to ptertdse s. 6r uft Ire can sured at our request to asslst to In the Ta-
lents of such premises, rarrled to you. A separate vestgeton or defereee of the datm or IsW,
ft oT Y dasatb to TSadion n. 6eirdtrrg actual loss of san Np up to SIM
Lire Of limuence. a day because of lime oft Iran work
Paragraph (2) of ft exclusion dces not apply fl EMPLOYEES AS INSUREDS - HEALTH CARE
the prembee are 'your wow and were never SERVICES
ooarpla4 rested or held for rental by you. ftvMan 2AL(1)(d) of WHO IBM INSURED (Becton
Paragiaphe (9), (4). (fQ and (8) of fhb oondustcn 0) Is dsleled, unties excluded by sepmele wgIorse-
do nd q" to assumed under a side. Mont.
Paragraph (6) of lids exclusion does not apply to EXTENDED COVERAGE FOR NEWLY ACQUIRE
JxgxrV damage' Included In the -products- ORGANIZATIONS
aompleled operallars hamirr.
Provwar sa. of WHO IS AN INSl1RW (Becton In is
paragraph S. of LUTS OF INSURANCE (SWUM M replaced by to following:
Is replaced by to MwAa a Coverage Murder Ids prontielon Is afforded
e. Subject to S. above, Ire Damage To Premises only unE the end of to policy period.
Rated To You Umit N the most we will pay urn EXTENDED ~ ~ DAMAGE"
der Coverage A for damages because of
°propartt► darraege° to cany a one da alsesr white f~xdusTon a. of COVERAGE A (Sedum 0 Is replaced
it, to you, or In the case of damage by f* v*& ranted to you or temporra ft occupied by by the wowks
you with panm belon of the owner. a. 'ety fnj ur or Vopsity d~ e*ecbed
The Damage To Premises Rented To You omit is the or Iretarnded from the aunt of the Insure&
"
ttter of the Each Ooourrerwe Lpnit sfnown In the This md~^ does not apply to boeEy heJW
Deafaaattmrs or ft amount shown In the Dedarasons or ~ ~ ~ " from pr use of
as Damage To Prerrdsea Ranted To You WrdL tatsorsbta tote to protect persons or property.
os 74 s6 aQ W PeF 3414 EP
^ Rri00A1nIei+ORM81taRARY~
EXTENDED DEFlNRION OF BODILY INJURY M9a opted " by a straet, roadway, watwaw. or
dght-otvey of a ra8road.
Paragraph & of I)EIU MONS (Section V) to replaced
by the followkV INCREAS® MEDICAi. EXPENSE L. Mff
a. ' Wary" Mum bodily WW. *101086 Of The Medcaf Expense Umh Is amended 1b $10M(k
doom sustained by a person, trig mental
anguish Or death MOM ng from any Of 91010 at MOWLEDGE OF OCCURRENCE
any time.
TRANSFER OF RIGHTS OF RECOVERY The fall b added to Paragraph L Duties In The
ttient of Ocamerm Ofisteo, claim of M Of
COMMERCIAL
j SAL LIABILITY CONDITIONS
The Mov tg b added to Path S. Trarrater Of (g
MghtB Of Reoarery Against Often To Us of COM-
MERCIAL GENERAL UABM CONDMON8 {Sea Ifrnowbdge of an bocu is -co-, claim or 'audt° by
your age servant or employee shall not In bell'
We wain any rlgtds of recouay we may have against conednb lounadedge of the nomad bwxW union an
caorn because of payments we officer of the tamed hatred has received such «otios
any person or
melee for M(ury or damage arM% out of your ongOblg fn>t11 agent, servant or enepbyse`
op 11
or under
conbact
with IM peracn or ougsrizelion and Mwdad M the OVAL FAIUiRE 7b Di8CLOiE ALL
HAZARDS
~rodrrotsoonepbted ope"ons hezard°. This waiver
applin only to a person or ici by wMen arpntzdon for Whom you The fo of OO bMaddsd to Paragraph 8. Rep Cowl -
b waAre these rights of recovery. 710M (season " GEN1EiAL. UABILf[Y CONIN-
AGOREGATE L INM OF INSURANCE - PER If yoU Unkbntto * fall to dbdose any hazards eX
LOCATION Gating at the inoeptlon date of yaw pOlicy, We will not
For a9 sums which the Msured beoonnes legally obti+ deM coverage uruler this Omearage Fans because of
gated to pay as damages caused by renCes° such failure Had wew, aadditional tinb provision does not affect
under COVERAGE A (Section Q, and for all med[cal ouftht r of of Oooarnoecalled aetion Or non MKrenewal. or exercise our
eD MOW by aoclft* under COQ C
(fin 0, Which can be aEributed Only to operations LIBERALIZATION CLAUSE
at a eVb location":
Paragraphs 2& and 2b. of Lbnils of irneWanoe (Sec- The fotiow&ig paragraph Is added to COApMVIAL.
GENERAL LIABgJTY OD~ONB (Seailon K
d =MI apply sal to each of your °Iaaftw°
by or rerttsd to Yam 10. If a wAstan to fhb Coverage Part, which would
provide more oovenage with no addlitonal pre-
lacedon° nneans premises invol ft the same or mGrm, becomes efkotive dwbV the policy parlod
connedrig lots, or premises whom connsolton is M the state sham In the Dederadam your pol-
icy will aubnsfically provide tide addMond cou-
erage on the elbdn dab of the revislom
Pqp 4414
-REPRDJrEDMOUIMARO WL TNEONCOWTRANSAGMUMYOKLUDEADWK AL raft"
Policy 901C171167S20 COMMERCIAL AUTO
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 respect 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 11 - LIABILITY COVERAGE - A.I. WHO
Poky Condition Is replaced by the following: IS AN INSURED provision Is amended by the addition
b. 60 days before the effective date of cancellation of the toliowing:
0 we cancel for any other reason. e. Any person or organization for whom you are re-
quired by an insured contract' to provide tnsur-
TEMPORARY SUBSTITUTE AUTO - PHYSICAL ante is an 'insured", subject to the following
DAMAGE COVERAGE additional provisions:
Under paragraph C. -CERTAIN TRAILERS, MO- (1) duThe 'insured ring the policy contract"
pertod shown to the Oeda-
BILE EQUIPMENT AND TEMPORARY SUBSTITUTE rations, and must have been executed prior
AUTOS of SECTION 1 - COVERED AUTOS, the to the 'bodily injury" or property damage".
following is added:
(2) This person or orgenludon Is an 'Insured"
If Physical Damage coverage Is provided by this Cov- only to the extent you are 11" 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- only to the extent you are held liable for an
mission of its owner as a temporary substitute for a "accident" 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 Rloyess•
destruction. (3) There is no coverage provided to this person
BROAD FORM NAMED INSURED or organization for "bodily Injury" to its em-
ployees, nor for eproperty damage" to its
SECTION U - LABILITY COVERAGE - A.I. WHO property.
IS AN INSURED provision Is amended by the addition (4) Coverage for this person or organization
of the following: shall be limited to the extent of your negfi-
gence 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 The defense of any claim or 'suit" must be
50% or more of the business entity and the
organization as
business entity is not separately insured for soon as practicable tendered this to person or all other insurers
Business Auto Coverage. Coverage is extended
up to a maximum of 180 days following aoquisi- which potentially ly provide insurance for such
tion or formation of the business entity. Coverage claim or "suit".
under this provision is afforded only until the end
of the policy period.
Includes copyrighted material of insurance Services Office. Inc., with its permission.
Copyright, Insurance Services Office, Inc., 1997
CA 71 10 03 07 Pays 1 do EP
-REPRARECFROUTWAROV& MCRMD"LYRANSACTWNVAYNtaU0EACDffK tpoms
(6) The coverage provided will not exceed the PERSONAL EFFECTS COVERAGE
lesser of:
(a) The coverage and/or Nmits of this policy; A. ASECTION GE, 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 S.
A person's or arganlzathon's status as an For any Owned auto" that Is Involved in a
Insured" under this subparagraph d ends "personcoveredal doss, effects"" that will are pay lost up or to x500 for
when your operations for that Insured- are damaged
as a result of the covered Ions", without
completed. applying a deductible.
EMPLOYEE AS INSURED EXTRA EXPENSE - BROADENED COVERAGE
Under Paragraph A. of Section Il - LIABILITY COV- Paragraph A. - COVERAGE of SECTION 01 -
ERAGE item f. Is added as follows: PHYSICAL DAMAGE COVERAGE Is amended to
You" -employee- while using his owned -auto or an add.
'aub' owned by a member of his or her household, 5. We will pay for the expense of returning a stolen
In your business or your personal affairs, provided you covered Wo" 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 IN
- PHYSICAL DAMAGE COVERAGE, the following Is
Exclusion 5. FELLOW EMPLOYEE of SECTION 11 - added:
LIABILITY COVERAGE - S. 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 "bodly
Injury" results from the use of a covered "auto- 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 ql - PHYSICAL DAMAGE COVERAGE sac-
# * tion 2 Is amended as follows:
BLANKET WAVER OF SUBROGATION 2. An adjustment for depredation and physical con-
We waive the right of recovery we may have for pay- didon will be made in determining actual cash
manta made for -bodily Injury" or -property 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
Insureds" under Section II - LIABILITY COVERAGE which this coverage applies, as shown in the
- A.I.D. BROAD FORM NAMED INSURED and declarations, we will pay at your option:
A.1.e. BLANKET ADDITIONAL INSURED. a. The verifiable lnew vehk:le" purchase price
PHYSICAL DAMAGE -ADDITIONAL TRANS- you paid for your damaged vehicle, not In-
cluding any insurance or warranties pur-
PORTATION EXPENSE COVERAGE chased;
The first sentence of paragraph AA. of SECTION Ill 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 funtwngs,
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;
Page 2014
- REPRVf1EpMU THE AROWE THE 0MOKAl TRANSACTON MAY DILL OE ADDff KKft Fomm
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 dhe time of the "Loss". less an
menf not Installed by the manufacturer or adjustment for depreciation and physical
manufacturer's dealership. condition; or
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
truck type (20.000 Ibs or less gross vehicle subject to at the time of the 'toss", less any
weighty 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
Under SECTION III - PHYSICAL DAMAGE COV- 'loss"'
ERAGE, if two or more "company" policies or cover- (2) Financial penalties imposed under a
age forms apply to the same accident, the following lease due to high mileage, exoss-
applies to paragraph D. Deductible: sive use or abnormal wear and tear.
a. It the applicable Business Auto deduct- (3) Costs for extended warranties, Cre-
Ibis Is the smaller (or smallest) deduct- dit Life Insurance, Health, Accident
ibis it will be waived; or or Disability Insurance purddumd
b. If the applicable Business Auto deduct with the loan or lease.
Ibis is not the smaller (or smallest) de- (4) Transfer or rollover balances from
ductible it will be reduced by the amount previous loans or leases.
of the smaller (or smallest) deductible; (5) Final payment due under a 'Balloon
or Loan°
c. if the loss involves two or more Busi-
ness Auto coverage forms or policies (6) The dollar amount of any
the smaller (or smallest) deductible will prior t to trek
be waived yr~Oio the "total damage loss" of that occurred
a covered
uto".
For the purpose of this endorsement
'company" means: (7) lessor. deposits not refunded by a
lesssor. .
s. Salem Insurance Company of America
b. American States Insurance I8y All refunds payable or paid to you
Company as a result of the early termination
c. General Insurance Company of America of a lease agreement or any war-
d. American Economy y ~Y or extended service agree-
Homy insurance Company ment on a covered wauto
e. First National Insurance Company of (9) Any amount representing taxes.
America (10) Loan or lease termination fees
L American States Insurance Company of
Texas GLASS REPAIR - WAIVER OF DEDUCTIBLE
g. American States Preferred Insurance Under paragraph D. - DEDUCTIBLE of SECTION 111
Company - PHYSICAL DAMAGE COVERAGE, the following Is
h. Salem Insurance Company of Illinois added:
LOANILEASE GAP COVERAGE No deductible applies to glass damage 0 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 9oss" In any one The requirement In LOSS CONDITION 2a. -
%ccident" Is the greater of the following, subject DUTIES IN THE EVENT OF ACCIDENT. CLAIM,
to a $1,500 maximum Omit: SUIT OR LOSS - of SECTION IV - BUSINESS
AUTO CONDITIONS that you must notify us of an
CA 71 10 83 07 Page 3 d 6 EP
REPM I M M M THE ARCHIVE THE OWMAL TMWACTM WY MMUOE ADW101 AL 11
laident" applies only when the 'accident" 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. if you are an individual;
(2) A partner, If you are a partnership. or HIRED AUTO PHYSICAL DAMAGE COVERAGE -
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" if it results from
SECTION IV - BUSINESS AUTO CONDITIONS - an accident, you are legally liable and the lessor W
62. Is amended by the addition of the following: curs an actual financial loss.
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 fallure. However, this provision does not affect cause of a covered 'floss" to a covered "auto".
our right to collect additional premium or exercise our payment applies in addition to the otherwise ap-
right of cancellation or non-renewal. pllcable amount of each coverage you have on a
HIRED AUTO - LIMITED WORLD WIDE COVER- covered "auto No deductibles apply to this
AGE coverage.
B. We will pay only for those expenses Incurred
Under Section IV - Business Conditions, Paragraph during the policy period beginning 24 hours after
B.T.b.e(1) is replaced by the foRowing: the loss" and ending, regardless of the policy's
(1) The l3ccident" or gloss" 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 covered "auto". N
RESULTANT MENTAL ANGUISH COVERAGE gloss" 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.
'BcxMy 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 "autos" for Liability oov- 2. S50 per day.
erage and if Comprehensive, Specified causes of D. This coverage does not apply while there are
Loss or Collision coverages are provided under this spare or reserve 'autos" availableto you for your
Coverage Form for any "auto" you own, then the operations.
Physical Damage Coverages provided are extended
ro "autos" you hire or borrow. E. If loss" 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 leuto" 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 appli- AGE COVERAGE Coverage Extension.
cable to any owned 'auto" of the private passenger F. The Rental Reimbursement Coverage described
or light truck We for that coverage. Hired Auto Phy- above does not apply to a covered 'auto" that is
sktat Damage coverage Is excess over any other col-
lectible insurance. Subject to the above limit, described or designated as a covered "auto" on
hp 4 d 6
-REPAMEDFROMTHEAROWE THEOAI*"TR1HSAcnommAYWCWDEADOt11OHALrafto "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 '"emuto" 1. The most we will pay for "loss' to audio, vi-
for gloss" 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 "accident" Is the lesser of.
reproduction of sound. This coverage applies
only if the equipment is permanently Installed a. The actual cash value of the damaged
In the covered lauto" 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 tike 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.I. 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. If Audio, Visual and Data Electronic Equip-
ment Coverage form CA 99 80 or CA 99 94 1. If 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 result of a loss" to the
age described above does not apply. covered "auto" under the Business Auto
Coverage Form's Comprehensive or CoUl-
B. Exclusions sion Coverage, then for each covered "bubo"
The exclusions that apply to PHYSICAL DAM- our obligation to pay for, repair, retum or re-
AGE COVERAGE, except for the exclusion relat- place damaged or stolen property will be re-
Ing to Audio. Visual and Data Electronic duosd by the applicable deductible shown in
Equipment, also apply to this coverage. In adds- 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 fare or
mmht or accessories used with such electronic lightning.
equipment that Is' 2. If gloss" to the audio, visual or data elec-
t. Necessary for the normal operation of the ironic equipment or accessories used with
covered "auto' for the monitoring of the this equipment In the result of a loss" to the
covered "auto's" operating system; or covered "auto' under the Business Auto
2. Both: Coverage Form's Specified Causes of LASS
Coverage. then for each covered "auto" our
a. an integral part of the same unit housing 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. If "loss" occurs solely to the audio, visual or
equipment 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 10 W 07 PW 6 d a EP
REPRW OFROM THE At1CMNE. THE OAICI M TRM180.MM MAY INCLUDE MM MAL Fow"
retum 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 W Q. "Personal effects" means your tangible
ptiCable deductible. only the highest deduct- property that Is worn or carried by you, ex-
[We will apply. In no event will more than one cept for tools, jewelry, money, or securities.
deductible apply. R. 'Now vehicle" means any 'auto" of which
you are the original owner and the "auto"
has not been previously titled and is leas
than 365 days past the purchase date.
Page 8 at B
Page 1 / 1
CITY OF~
-DATE PO NUMBER
. -ASHLAN1`'
20 E MAIN ST. 3/13/2015 12767
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: Ashland, Oreqon Req. No.:
Terms: Net Dept.:
Req. Del. Date: Contact: Steve Walker
Special Inst: Confirming? No
Quantity Unit Description Unit Price Ext. Price
Clean and inspect the interior of 3,300.00
Fallon Reservoir by potable underwater
divers
Contract for Goods and Services
Beqinninq date: 02/23/2015
Completion date: 06/30/2015
SUBTOTAL 3,300.00
BILL To: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 3,300.00
ASHLAND, OR 97520
Account Number Project Number Amount Account Number Project Number Amount
E 670.08.18.00.60240 3,300.00
3
VENDOR COPY
Aut ized Signature
FORM #3
CITY OF
_ ASHLAND
REQUISITION Date of request: 3-9-15
Required date for delivery: ASAP
Vendor Name Liquivision Technology Inc.
Address, City, State, Zip 711 Market Street. 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 pro osal attached
X 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 El Special Procurement Intergovemmental Agreement
$5.000 to $75.000 ❑ Agency
❑ Form #9, Request for Approval
❑ Less than $35,000, by direct appointment El 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
$3,300 ri
Clean and inspect the interior of Fallon Reservoir b potable underwater divers.
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
TOTAL COST
X 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, 1 certify that the City's public contracting requirements have been satisfied.
Employee: Department Head: 3
(qual to dRAter $5,000)
Department Manager/Supervisor: Administrator:
(Equal to or greater than $25,5,000)
Funds appropriated for current fiscal year: YES
Finance Director- (Equal to org aterthan $5,000) Date
Form #3 - Requisition