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2016-100 Contract - Sabel Painting
3 Contract for GOODS AND SERVICES Less than $25,000 CITY OF CONTRACTOR: Sabel Painting Company -A5 H LAND CONTACT: James Sabel 20 East Main Street Ashland, Oregon 97520 ADDRESS: 3181 Old Stage Road, Central Point, OR 97502 Telephone: 541/488-6002 Fax: 541/488-5311 TELEPHONE: 541-773-1555 DATE AGREEMENT PREPARED: 4-26-16 FAX: 541-773-1555 BEGINNING DATE: 5-2-16 COMPLETION DATE: June 24th 2016 COMPENSATION: Not to Exceed $15,563.00 Bid attached as Exhibit " C" GOODS AND SERVICES TO BE PROVIDED: See Carter Memorial Fountain repair and painting scope of work attached as Exhibit "D" Paint to be used is Devoe coatings DC-7470 Uni-Brown 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. 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 06/02/2015, 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 06/02/2015, Page 2 of 5 Damage. 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. 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 By e«' By J Signature Department Head Print Name Print Name 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 06/02/2015, 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. nz-> (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. C ntoctor' (bate) Contract for Goods and Services Less than $25,000, Revised 06/02/2015, Page 4 of 5 CITY OF ASHLAND, OREGON EXHIBIT B City of Ashland LIVING WA-E per hour effective June 30, 2015 (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 y 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- y 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 50% 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 06/02/2015, Page 5 of 5 ~sabe~ ~q~~t~wg► Coyu~avL~ A FkLL SFRV10F Pf}1N77Nq GOMP,4Nr City of Ashland 25 April 2016 Water Department 90,N. Mountain Ave. Ashland, Oregon 97520 Steve Walker Proposal for the Carter Memorial Fountain Repair and Painting project as per RFP dated 21 January 2016. Total Cost - $15,563.00 Project Plan - properly protect finished walkways, erect scaffold system for the entire perimeter of the work area and wrap with containment cloth, provide burms to collect any runoff to storm drains, provide safety delineators and tape to mark work area outside of scaffold system. Interior of structure - provide air exchanger for duration, remove any loose material and coat all surfaces with Rust Converter/ no paint this area as per walk through Exterior - Clean and rinse by hand to limit water runoff, fill major imperfections in metal work with Bondo as discussed at our walk through, coat as per specification. Remove all equipment, scaffold and debris All work performed as per OROSHA Regulations All non-painted surfaces and pedestrian traffic properly protected Plumbing work by others City to provide power and water 2 year warranty provided for all labor and material Respe tfully 1 es Sabel/Owner /j 4 r Foreword The documents and forms which are attached, or for which provisions are made, must be used in submitting proposals for the Carter Memorial Fountain Repair and Painting for the City of Ashland, Oregon, as covered by the Oregon Standard Specifications for Construction, 2015 edition, Oregon Department of Transportation and American Public Works Association, Oregon Chapter and other appurtenant specifications where indicated. The Technical Specifications in Part II of this Invitation to Bid govern if there is a conflict between those specifications and the Oregon Standard Specifications for Construction. These bid and contract documents, specifications, and plans, although bound separately, are made a part of the complete document with the same force and effect as though all parts and plans referred to were under one binding. Should addenda to the specifications become necessary and be issued prior to the date of receiving bids, they shall be deemed a part of the Special Provisions. Part II Fountain Repair & Repainting_ GOAL: To address existing damage to the cast-iron and stone elements of the Carter Memorial Fountain, in anticipation of the summer 2016 reinstallation of the "Pioneer Mike" statue on the Ashland Plaza. Work to include the following elements; Remove/consolidate existing areas of rust and damage on the fountain interior. • Existing areas of rust to be cleaned using appropriate non-damaging methods to good substrate. Appropriate methods include gentle wire-brush removal not to damage surrounding material or applied sealer/consolidation products (Must for Rust, Devoe Coatings Pre-Prime 167 penetrating sealer or similar, subject to prior approval). • Prime and Paint interior to reduce further rust damage. Remove/consolidate existing areas of rust and damage on the fountain exterior. • Existing areas of rust to be cleaned using appropriate non-damaging methods to good substrate. Appropriate methods include gentle wire-brush removal not to damage surrounding material or applied sealer/consolidation products (Must for Rust, Devoe Coatings Pre-Prime 167 penetrating sealer or similar, subject to prior approval). • Repair existing damage to cast iron: o Remove all failing "Bondo" or other applied patching to good substrate. o Carefully rebuild damaged areas in epoxy, bondo or other appropriate material subject to prior approval, finishing to smooth, crater or pocket-free surface free of tooling or application marks. o Repair/re-attach/tighten loose or damaged support corbels below the cantilevered drinking trays. o Drill 3/8" diameter holes at all four corners of drinking tray for drainage with attached steel drain tube (not to exceed 3/4" projection below tray epoxied into place). Holes to be neatly drilled on axis to the corner, spaced no more than 3/4" from interior edges. • Clean exterior painted areas to remove dirt, rust, grime, and any loose or flaking paint or failing prior repair work. NO sandblasting 1S permitted. Cleaning is limited to water pressure wash, soft-brush scrubbing (no wire brushing permitted) or chemical cleaners to remove damaged areas necessary to provide appropriate substrate for repainting. Light sanding for feathering if required is permitted, leaving a smooth and crater-free substrate. Large areas to be filled with epoxy or Bondo type product and smoothed to good finish. • Prime exterior with tinted exterior enamel primer (Spray or brush application, applied according to manufactures specifications) • Paint/Coat with two coats durable exterior enamel (gloss), color spec to be provided by the City but generally matched to existing brown (Spray or brush application, to be applied according to manufactures specifications). • Paint/Detail highlights with metallic gold to match existing (Modernmasters metallic paints (http://www.iiiodei-niiiastei-s.coiii/pi-oducts.as)), color spec to be provided by the City but generally matched to the existing gold. Clean granite base. • Clean granite base stones to remove dirt and grime, including areas of rust-staining. Use of a non-damaging industrial quality exterior cleaner suitable for granitic substrate (Prosoco Enviro-Klean or similar, subject to approval), is required. http://w-ww.prosoco.com/products/enyiro-klean-satrestorer Work Site • Contractor is responsible for all applicable regulatory agencies requirements including all equipment necessary for OSHA related activities for example confined space entry and fall protection etc. • Site will be covered completely by contractor in a safe manner without endangering the public during the projects entire duration • Water will be provided at site but contractor must not allow anything to enter storm drain system or gutters including water. chemicals, dust, and foreign materials. • All water, dust, paint, chemicals, construction debris must be removed from site by contractor and disposed of properly by contractor without using City owned dumpsters or trash cans. • Work Hours are 7: A.M.-7 P.M. Weekdays and 8 A.M. - 6 P.M. on weekends or Holidays AMC. 9.08.170 Part D #6 • 6. Construction or Repair of Buildings, Excavation of Streets and Highways. The construction, demolition, alteration or repair of any building or the excavation of streets and highways other than between the hours of 7:00 a.m. and 7:00 p.m., on weekdays, and 8:00 a.m. and 6:00 p.m. on weekends and holidays, except in the case of an emergency in the interest of the public welfare and safety. In cases of emergency, construction or repair noises are exempt from this provision. In non- emergency situations, the City Administrator may issue a permit, upon application, if the City Administrator determines that the public health and safety, as affected by loud and raucous noise caused by construction or repair of buildings or excavation of streets and highways between the hours of 7:00 p.m. and 7:00 a.m. will not be impaired, and if the City Administrator further determines that loss or inconvenience would otherwise result. The permit shall grant permission in non-emergency cases for a period of not more than five days. The permit may be renewed once for a period of five days or less. The actual owner of property may do work on property which is owner occupied between the hours of 6:00 p.m. and 10:00 p.m. without obtaining a permit under this paragraph. Completion Date Project must be completed with all equipment removed and site completely cleaned with acceptance from City of Ashland by June 24th 2016 SABELA OP ID: DR ACORO- CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDD/YYYY) 04/2612016 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(ies) 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 endorsemen s . PRODUCER Phone: 541-779-0177 NAME: CONTACT Insurance Marketplace, Inc. PHONE Fax: FAX 772-8235 FAx _ 1998 Skypark Dr Suite 100 Arc No Exti: Medford, OR 97504 E-MAIL ADDRESS: Kevin Cope-IM AFFORDING COVERAGE NAIC if _ INSURER A : Security National INSURED Sabel Painting Co INSURER B : Commerce & Industry Co Jim Sabel INSURER C : 3181 Old Stage Rd Central Point, OR 97502 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, 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 . LTR TYPE OF INSURANCE ADOLB POLICY NUMBER'-' MM DD/YYYY MMLDDIYYYY LIMITS - GENERAL LIABILITY j EACH OCCURRENCE $ 1+000,00 ] DAMAGE T RENTED A ~X COMMERCIAL GENERAL LIABILITY X INA103733803 10/07/2015 10/0712016 PREMISES Ea occurrence$ _ 100,00 CLAIMS-MADE OCCUR MED EXP (Any one person) $ - 5,00 PERSONAL s ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000.00 GEN'L AGGREGATE LIMIT APPLIES PER. I PRODUCTS _COMPIOP AGG $ 2,000,00 77 1 POLICY ` X PRO- LN AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO~ BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS NAUTOS ON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB XI OCCUR EACH OCCURRENCE $ ~,000,OO B X ;EXCESS Lu►B CLAIMS-MADE EBU067907944 01/2512016 10/07/2016 AGGREGATE $ 1,000,00 DED Iv RETENTION $ prod/comp $ 1,000,00 WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN j T RY LIMITS R i ANY PROPRIETORlPARTNERIEXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E. I. D_I_SEASE_- EA EMPLOYEE N yes, describe under DESCRIPTION OF OPERATIONS below E.L- DISEASE -POLICY LIMIT $ i i ~ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Ashland and its elected officials, officers and employees are additional insured. re: Carter Memorial Fountain, 26 N Main St. CERTIFICATE HOLDER CANCELLATION CITYOFA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERER IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. Steve Walker 90 N Mtn Ave AUTHORIZED REPRESENTATIVE Ashland, OR 97520 Kevin Cope-IM ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ tT CAREFULLY BLANKET ADDITIONAL INSUREDS - OWNERS, LESSEES OR CONTRACTORS This erndorsu+rrnexrt rnodifies insurance proovided under the foilowinq COMMERCt& GENERAL LIABILITY COVERAGE PART SCHEDULE Policy Number. NA10373=3 Endorsement ENeCti": 10/07/15 1201 a.m. Named Insured Authorized Representative; JAMES PAUL. SABEL Z57~ 1 !'iCNt~t!!.E Alamo of Person or Orpnbcatlon: Any person or organization that the narned insured is obligated by vlrhm of a written contract or agreement to provide insurance such as is afforded by this poficy. Location: (if no entry appears above, infom*ion required to complete this endomemard will be shorn In the Deciaratiom as appkmbie to this erdosement ) A. Section If - Who Is An Insured is amended to InoWe as an insured the person or orgartzatdon shorn In the Schedule, WA only to the a xlent that the person or or pwftation shown in the Schedule is held liable for your ects or omissions arising out of yoLr ongoing operations perbrrmed for that insured. B. With respect to the insurance afforded to these additlonal incunads, the fallowing exck stn iz added: 2. Ekcluskos This inmi arnce does not apply to'bodlly iratury" or "property darrnalge" comring after: (1) All worts, including materials, parts or equipment furnished in connection with such work, -on 1he behalf of a(other than service, maintenance, or dditional insureds) the site ft } oovered oto be perations by or on has beew completed; or (2) That portion d'yw work" otA of which the injury or darrrape arises has been pLA to Its intended use by any person or orgerdAbon other than another oantmeW or suboontrac for engaged In performing operations for a principal as a part of the same blest. C. The words'yoLr and 'your refer to the Neared Insured shown in the DedarationsL D. "Your worn` means worts or operations performed by you or on your behalf and rrialeria ls, parts or egLAprrx t hv*,hW In connection wwlthh suoh work or operations. MMIX If raqdred by w~ contract or agreement: Such Insurance as cis afforded by this policy shall be primary ira uenm and any insurance or self-insurance rmwitained by the above addibonal hwed(s) shell be eoma of the Iisuranoe afdbrded to the named Insured and shell not oast We lot. If required by when contract or algreemarnk V* waW arry right of reoovwy we rney have agaiiW an entity that is an addkbnol insured per the terrns of this endorsement because of payrneMs we =ire for iryluy or damage arisirp out of "your work" done under a contact with that person or organization. 49.0100 0711 May Include Copyrighted Material of Insurance Services Offroes, Inc. page 1 of 1 Used with parr "kin SABEL-1 OP ID: DR A °r CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 04/26/2016 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(ies) 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 endomement(s . PRODUCER Phone: 541-779-0177 CONTACT Insurance Marketplace, Inc. -PHONE FAX 1998 Sk ark Dr Suite 100 Fax: FAX 772-8235 AI( C. No•EX* Medford OR 97504 E-MAIL R_ SS: - Kevin Cope-IM INSURER(S) AFFORDING COVERAGE NAB # INSURER A : Mutual of Enumclaw 114761 INSURED Sabel Painting Co INSURER B : Jim Sabel INSURER C : 3181 Old Stage Rd - Central Point, OR 97502 INSURER a: 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 _ POLICY EFF-- PO~ tI P LTR Y ~EX LIMITS ►NSR TYPE OF INSURANCE POLICY NUMBER _-MM/DDIYYYY MM/DD/YYYY ' GENERAL LIABILITY EACH OCCURRENCE $ DAMA E T ENTED -Ii COMMERCIAL GENERAL LIABILITY PREMISES Es occurrence $ # CLAIMS-MADE OCCUR MED EXP (Any one person) $ - PERSONAL 8 ADV INJURY $ - GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ . POLICY PRO- LOC AUTOMOBILE LIABILITY EB COMBINED tSINGLE LIMIT $ 11000,00 A ANY AUTO X BAP0004670 00 10/1512015 10/1512016 BODILY INJURY (Per person) $ - ALL OWNED SCHEDULED BODILY INJURY (Per accident); $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS accident X AUTOS Per $ UMBRELLA LIAR OCCUR E { EACH OCCURRENCE $ EXCESS LIAB _i CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION i WC STATU- OTH' YIN TORY LIMIT~i__._~ ER_ AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED' j N / A - (Mandatory in NH) E1 DISEASE - EA EMPLOYEE It yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below I ' II I 'I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) additional insured - re: Carter Memorial Fountain, 26 N Main St. - 1990 Chevrolet 02500 PICKUP 1GCGC24MME262449 CERTIFICATE HOLDER CANCELLATION BLANK-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland all officers ACCORDANCE WITH THE POLICY PROVISIONS. and Employees Steve Walker AUTHORIZED REPRESENTATIVE 90 N Mtn Ave Kevin Cope-IM Ashland, OR 97520 01988.2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO EA 9911 11 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SPECIAL BUSINESS AUTO ENHANCEMENT 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 this endorsement. The following changes revise SECTION I - COVERED The coverage that applies is the same as the AUTOS coverage provided for the vehicle being replaced. Paragraph C.I. is deleted and replaced with the Physical Damage Coverage is extended to the following: temporary substitute auto for the lesser of the 1. Trailers following number of days: a. "Trailers" with a load capacity of 2,000 1. The number of days reasonably required to pounds or less designed primarily for travel repair or replace the covered "auto" that is out on public roads; or of service; or b. "Trailers" designed primarily for travel on 2. 30 days. public roads when: The following changes revise SECTION II - LIABILITY (1) Pulled by an owned private passenger COVERAGE auto specifically described in Item The f wing is added to Paragraph A.1.: Three of the Declarations as a covered d Blanket Additional Insured "auto" for Liability Coverage under this Coverage Form; and Any person or organization that you are (2) Not used for business, farming or required to include as an additional insured g on this Coverage Form in a written contract ranching purposes. or agreement that is signed and executed Private passenger auto means a motor by you before the "bodily injury" or "property vehicle of the private passenger, station damage" occurs and that is in effect during wagon, pickup or van type designed for use the policy period is an "insured" for Liability on public highways and subject to motor Coverage, but only for damages to which vehicle registration. this insurance applies. The following is added: A person's or organization's status as an D. Temporary Substitute Autos - Physical Damage additional insured under this endorsement ends when your contract or agreement with If Physical Damage Coverage is provided by this such person or organization ends. Coverage Form, the following types of vehicles are The Limits of Insurance applicable to the also covered "autos" for Physical Damage Additional Insured are those specified in the Coverage: written contract or agreement but not more Any "auto" you do not own while used with the than the Limits of Insurance specified in the permission of its owner as a temporary substitute Declarations of this policy. The Limits of for a covered "auto" you own that is out of service Insurance applicable to the Additional because of its: Insured are inclusive of and not in addition 1. Breakdown; to the Limits of Insurance shown in the 2. Repair; declarations for the Named Insured. 3. Servicing; This Coverage does not apply to lessors of leased "autos". 4. "Loss"; or 5. Destruction. EA 9911 11 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 6 e. Broadened Named Insured This coverage is excess over Any business entity newly acquired or a. any limit shown in the Declarations for formed by you during the policy period towing and labor costs; and provided you own 51% or more of the b. any other collectible insurance. business entity and the business is not separately insured for Business Auto This coverage applies only for an "auto" Coverage. Coverage is extended up to a covered on this policy for maximum of 180 days following acquisition c. Comprehensive or Specified Causes of or formation of the business entity or until Loss Coverage, and the end of the policy period, whichever d. Collision Coverage. comes first. f. Employee Hired Auto The following is added to Paragraph A.3 An "employee" of yours is an "insured" while Glass Repair -Waiver of Deductible operating an "auto" hired or rented under a No deductible will apply to glass breakage if contract or agreement in that "employee's" such glass is repaired in a manner acceptable name, with your permission, while to us rather than replaced. performing duties related to the conduct of Paragraph A.4.a. is deleted and replaced with the your business. following: Paragraphs A.2.a.(2) and A.2.a.(4) are deleted and 4. Coverage Extensions replaced with the following; a. Limited Rental Reimbursement or Travel 2. Coverage Extensions Expense a. Supplementary Payments We will pay up to $75 per day to a (2) Up to $5,000 for cost of bail bonds maximum of $2,250 for rental (including bonds for related traffic law reimbursement expenses for the rental of violations) required because of an an "auto" or other transportation expense "accident" we cover. We do not have to incurred by you because of "loss" to a furnish these bonds. covered "auto" which is covered by (4) All reasonable expenses incurred b Comprehensive, Specified Causes of Loss, or Collision coverage under this policy. No the "insured" at our request, including g deductible applies to this coverage. actual loss of earnings up to $500 a day because of time off from work. (1) We will pay only for those expenses Paragraph B.S. is deleted and replaced with the incurred as a result of a covered "loss" occurring during the policy period following: beginning 24 hours after the "loss" and 3. Fellow Employee ending, regardless of the policy's "Bodily Injury" to any fellow "employee" of the expiration, with the lesser of the "insured" arising out of and in the course of the following number of days: fellow "employee's" employment or while (a) The number of days reasonably performing duties related to the conduct of your required to repair or replace the business. This exclusion does not apply to an covered "auto". If "loss" is caused "insured" who occupies a position as an officer, by theft, this number of days is manager or supervisor. added to the number of days it The following changes revise SECTION III - PHYSICAL takes to locate the covered "auto" DAMAGE COVERAGE and return it to you; or This coverage applies only for a covered "auto" for (b) 30 days. which Physical Damage Coverage is provided for on (2) Our payment under this Coverage this policy. Extension (4.a.) is limited to the lesser Paragraph A.2. is deleted and replaced with the of the necessary and actual expenses following. incurred or the maximum amount A. COVERAGE shown, $2,250. (3) Coverage under this Coverage 2. Towing Extension (4.a.) does not apply while We will pay up to $200 for a covered "auto" for there are spare or reserve "autos" towing and labor costs incurred each time the available to you for your operations. covered "auto" is disabled. However, the labor must be performed at the place of disablement. EA 9911 11 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 2 of 6 (4) If a covered "auto" is described or (b) We will pay with respect to a designated as a covered "auto" on covered "auto" described in the endorsement EA 99 01, the coverage Schedule for "loss" to any provided by this extension is excess accessories used with the over coverage provided by electronic equipment described in endorsement EA 99 01. Paragraph (1)(a) above. However, The following is added to paragraph A.4. this does not include tapes, records or discs. c. Tapes, Records and Discs (2) Exclusions We will pay for "loss" to tapes, records, The exclusions that apply to Physical compact discs, or other similar devices Damage Coverage, except for the used with audio, visual or data electronic exclusion relating to Audio, Visual and devices. Data Electronic Equipment, also apply (1) We will pay only if the tapes, records, to coverage provided by this extension. compact discs, or other similar devices: In addition, the following exclusions (a) Are your property or that of a family apply: member; or We will not pay, under this extension, (b) Are the property of an "employee" for either any electronic equipment or using a covered "auto" in your accessories used with such electronic business affairs at the time of the equipment that is: "loss"; and (a) Necessary for the normal operation (c) Are in a covered "auto" which of the covered "auto" or the sustains other covered "loss" under monitoring of the covered "auto's" Comprehensive or Collision operating system; or coverage at the time of the "loss" to (b) An integral part of the same unit tapes, records, compact discs, or housing any sound reproducing other similar devices. equipment designed solely for the (2) The most we will pay for "loss" under reproduction of sound if the sound this Coverage Extension (4.c.) is $200. reproducing equipment is (3) Physical Damage Coverage provisions permanently installed in the apply to this coverage, except that any covered "auto" in the opening of the deductible applicable to dash or console normally used by Comprehensive or Collision coverage the manufacturer for the installation does not apply to this Coverage of a radio. Extension (4.c.). (3) Limit of Insurance d. Audio, Visual and Data Electronic With respect to coverage under this Equipment extension the Limit of Insurance (1) Coverage provision of Physical Damage Coverage is replaced by the following (a) We will pay with respect to a (a) The most we will pay for all "loss" to covered "auto" described in the audio, visual or data electronic Schedule for "loss" to any electronic equipment and any accessories equipment that receives or used with this equipment as a result transmits audio, visual or data signals and that is not designed of any one "accident" is the lesser of: solely for the reproduction of sound. This coverage applies only if the (i) The actual cash value of the equipment is permanently installed damaged or stolen property as in the covered "auto" at the time of of the time of the "loss'% the "loss" or the equipment is (il) The cost of repairing or removable from a housing unit replacing the damaged or which is permanently installed in stolen property with other the covered "auto" at the time of the property of like kind and quality; "loss", and such equipment is or designed to be solely operated by use of the power from the "auto's" {iii) $500. electrical system, in or upon the covered "auto". EA 9911 11 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 3 Of 6 (b) An adjustment for depreciation and When a Travel Trailer, "Camper" or Motor physical condition will be made in Home is a scheduled auto for physical determining actual cash value at damage coverage, we will pay up to $1,000 the time of the "loss". for "loss" to personal property belonging to (c) If a repair or replacement results in you or a family member that is within the better than like kind or quality, we Travel Trailer, "Camper" or Motor Home. will not pay for the amount of We will pay up to $250 for "loss" to personal betterment. property belonging to you or a family member that is outside the Travel Trailer, (4) Deductible "Camper" or Motor Home. No deductible applies to this coverage. (1) We will not pay for "loss" to: The insurance provided by this extension is (a) Articles carried or held for sale, excess over any other collectible insurance. storage or repairs, or for later e. Custom Signs and Decorations delivery; goods kept to show or sell; or theatrical wardrobes. Physical Damage coverage on a covered "auto" may be extended to "loss" to custom (b) Business, store of office furniture or signs and decorations including custom equipment. murals, paintings or other decals or (c) Records or accounts, money, graphics. bullion, deeds, contracts, evidences Our limit of liability for loss to custom signs of debt, securities, tokens or tickets, and decorations shall be the least of: stamps in current use or manuscripts. (1) Actual cash value of the stolen or damaged property; (d) Animals, private passenger "autos," motorcycles, aircrafts, boats or any (2) Amount necessary to repair or replace other motorized vehicles or their the property; or equipment, furnishings or (3) $500. appurtenances. f. Personal Effects Coverage (e) Equipment or accessories while (1) Physical Damage Coverage on a your Travel Trailer, "Camper" or covered "auto" may be extended to Motor Home is leased or rented to "loss" to your "personal effects" or, if any organization or any person you are an individual, the "personal other than you or a family member. effects" of a family member, that are in (2) The maximum we will pay for "loss" is the covered "auto" at the time of the the lesser of. "loss". (a) The actual cash value of the (2) "Personal effects" as used in this personal property at the time of extension means tangible property that "loss"; is worn or carried by the "insured". (b) The cost of repairing the damage; "Personal effects" does not include or tools, jewelry, money, securities, radar or laser detectors, or tapes, records, (c) The cost of replacing the damaged discs or similar audio, visual or data personal property with other electronic equipment. personal property of like kind, (3) The most we will pay for any one "loss" condition, quality and value. under this coverage extension is $500. 1. Vacation Expense Allowance No deductible applies to this extension. We will pay you $50 per day to a maximum of $500 for extra expenses when The insurance provided by this extension is a Travel excess over any other collectible insurance. Trailer, "Camper" or Motor Home is a scheduled auto for physical damage g. Camper Bodies coverage, and the Travel Trailer, "Camper' In the event of a "loss" to a detached or Motor Home: "camper," physical damage coverage will (1) Is damaged or destroyed and is apply as if it were part of the covered "auto" uninhabitable; and on which it is rated. (2) While being used for vacation purposes h. Contents of a Travel Trailer, Camper or within the policy period. Motor Home EA 9911 11 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 4 Of 6 Extra expenses must by supported by d. Subject to the above limit, deductible and receipts or other valid evidence. excess provisions, we will provide coverage The following is added to Paragraph A.: equal to the broadest coverage applicable to any covered "auto" you own. 6. Extra Expense - Broadened Coverage If a limit for Hired Auto Physical Damage is We will pay for the direct expense of returning a indicated in the Declarations, then that limit stolen covered 'auto" to you. We will pay only replaces, and is not in addition to, the $50,000 for those covered "autos" for which you carry limit indicated above. Comprehensive or Specified Causes of Loss Coverage. This coverage will only apply to The following is added to Paragraph 8.3.a.: vehicles recovered inside the 48 contiguous Airbag Coverage-Accidental Deployment United States. This coverage does not apply to However, this exclusion does not apply to the an "auto" we deem a total "loss". unintended inflation of an airbag if the inflation 6. Auto Loan/Lease Gap Coverage is caused by mechanical or electrical In the event of a covered total "loss" to a breakdown. covered "auto" described or designated in the The following is added to Paragraph C.2. Schedule or in the Declarations, we will pay up New Vehicle Replacement Cost to $2,000 for any unpaid amount due on the lease or loan for a covered "auto" less: If, however, we deem a covered "auto" to be a total a. The Amount paid under the Physical "loss" within 180 days of your purchase of the "auto" Damage Coverage section A.I. of the and it has not been previously titled under the motor policy, and vehicle law of any state, we will pay at your option: a. the cost to replace the covered "auto" with a b. Any: new "auto" of like make, model and year; or (1) Overdue lease/loan payments at the b. an amount equal to the original purchase price time of the "loss"; you paid to acquire the vehicle, including taxes, (2) Financial penalties imposed under a but excluding any extended warranties and lease for excessive use, abnormal wear licensing fees. and tear or high mileage; This coverage applies only to a covered "auto" of (3) Security deposits not returned by the the private passenger, light truck or medium truck Lessor; type (20,000 lbs. or less gross vehicle weight). (4) Costs for extended warranties, Credit The following changes revise SECTION IV - Life Insurance, Health, Accident or BUSINESS AUTO CONDITIONS Disability Insurance purchased with the The following is added to Paragraph A.2.a.: loan or lease; and 5 previous Amended Duties in the Event of an Accident, Carry-over balances from p Claim, Lawsuit or Loss loans or leases. 7. Hired Auto Physical Damage Coverage However, this duty is only required when the 9a 9a accident" is known to: If hired "autos" are covered "autos" for Liability (1) You, if you are an individual; Coverage and if Comprehensive, Specified Causes of Loss or Collision Coverages are (2) A partner, if you are a partnership; provided under this coverage form for any (3) A member, if you are a limited liability company; "auto" you own, then the Physical Damage or Coverages provided are extended to "autos" (4) An executive officer or insurance manager, if you hire of like kind and use, subject to the you are a corporation. following: a. The most we will pay for any one "loss" is The following is added to Paragraph A.: $50,000 or the actual cash value or the cost 6. Blanket Waiver of Subrogation to repair and replace, whichever is less, We waive any right of recovery we may have minus a deductible; against any person or organization to the extent b. The deductible will be equal to the largest required of you by a written contract executed prior deductible applicable to any owned "auto" to any "accident" because of payments we make for for that coverage; damages under this coverage form. c. Hired Auto Physical Damage coverage is excess over any other collectible insurance; and EA 99 11 11 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 6 of 6 The following is added to Paragraph 8.2.: The following changes revise SECTION V - Unintentional Failure to Disclose Hazards DEFINITIONS Any unintentional failure to disclose all exposures or The following is added: hazards existing as of the effective date of the Q. "Camper' means a portable dwelling unit without Business Auto Coverage Form or at any time during axles or wheels that has been manufactured for the policy period will not invalidate or adversely attachment on the bed of a pickup truck to be used affect the coverage for such exposure or hazard. for casual travel or camping. However, you must report the undisclosed exposure or hazard to us as soon as reasonably possible after its discovery. Paragraph B.S.b. is deleted and replaced with the following: a. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in that individual "employee's" name, with your permission, while performing duties related to the conduct of your business. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". The following is added to Paragraph B.S. d. To the extent required by an "insured contract", this insurance is primary on behalf of the additional insured, and any other insurance maintained by the additional insured is excess and not contributory with this insurance. If the "insured contract" does not require this provision, then Paragraph a. above will apply. EA 9911 11 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 6 of 6 SABEL-1 OP ID: DR ACURO" DATE (MM/DDfYYYY) CERTIFICATE OF LIABILITY INSURANCE 04/26/2016 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(ies) 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 Phone: 541-779-0177 NAME CT Insurance Marketplace, Inc. PHONE FAX 1998 Skypark Dr Suite 100 Fax: FAX 772-8235 Arc No Ext : ~ (Arc, No): - Medford, OR 97504 'MAIL ADDRESS: Kevin Cope-EM INSURERS) AFFORDING COVERAGE _ NAIC M INSURER A : Saif Corporation INSURED Sabel Painting CO INSURER B : Jim Sabel 3181 Old Stage Rd INSURER C Central Point, OR 97502 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, 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. tNSRT TYPE OF INSURANCE ~A~~L BR- LIMITS INSIR POLICY NUMBER - MMIDD/YYYY MMIDDIYYYY LTR GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISE5.(Ea occurrence) 1 CLAIMS-MADE l~ OCCUR i MED EXP (Any one person) $ - - - I PERSONAL & ADV INJURY $ I GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: ! PRODUCTS - COMP/OP AGG ! $ POLICY PRO- LOC I } $ AUTOMOBILE LIABILITY ~ COMBINED SINGLE LIMIT r-- i I Ea accident $ ANY AUTO BODILY INJURY (Per person) ` $ - ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident); $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS ~PeraccidentZ._- 7 7 s $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WRY LIMITS OER AND EMPLOYERS LIABILITY A ANY PROPRIETOR IPARTNERrfXECUTNE Y❑ 970729 07101/2015 07/01/2016 , E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBEREXCLUDED) NIA; I-.--.-.-...-----.-.-------.- (Mandatory in NH) [E.L .L. DISEASE - EA EMPLOYEE $ 1,000,00 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below ' .DISEASE -POLICY LIMIT $ i i I 1 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION CITYOFA 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. Steve Walker 90 N. Mtn Ave AUTHORIZED REPRESENTATIVE Ashland, OR 97520 Kevin Cope-IM ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD CITY OF ASHLAND DATE PO NUMBER 20 E MAIN ST. 4/29/2016 13503 ASHLAND, OR 97520 (541) 488-5300 VENDOR: 011256 SHIP TO: Ashland Water Department SABEL PAINTING, JAMES P SABEL (DBA) (541) 488-5354 3181 OLD STAGE ROAD 90 N MOUNTAIN CENTRAL POINT, OR 97502 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 REPAIR AND PAINTING OF CARTER MEMORIAL 15,563.00 FOUNTAIN CONTRACT FOR GOODS AND SERVICES LESS THAN 25K BEGINNING DATE 05/02/16 COMPLETION DATE 06/24/16 SUBTOTAL 15 563.00 BILL TO: Account Payable TAX 0.00 20 EAST MAIN ST FREIGHT 0.00 541-552-2010 TOTAL 15, 563.00 ASHLAND, OR 97520 Account Number Project Number Amount Account Number Project Number Amount E 710.01.02.00.60410 15 563.00 Authoriz Signature VENDOR COPY FORM ##3~ CITY OF ASHLAND REQUISITION Date of request: 4-26-16 Required date for delivery: ASAP Vendor Name Sabel Painting Company Address, City, State, Zip 3181 Old Stage Road, Central Point Oregon, 97502 Contact Name & Telephone Number Jim Sabel 541-773-1555 Fax Number 541-773-1555 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 ❑ 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 X (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 $15,563.00 .Repair and painting of the Carter Memorial Fountain Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST Per attached quote/proposal $ Project Number _ _ _ _ _ _ - _ _ _ Account Number 710.01.02.00.604100 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: I T Director Date Support -Yes /No By signing this requisition form, I certify that the City's public contracting requirements have been satisfied. Employee: Department Head: ~c ~o (Equal to or greater than $5,000) Department Manager/Supervisor:City Administrator: (Equal to or greater than $25,000) Funds appropriated for current fiscal year / NO iizv lI'l- Finance Director- (Equal to or great than $5,000) Date Comments: Form #3 - Requisition