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HomeMy WebLinkAbout2018-017-Contract for Purchase of Equipment-Huhges Fire CITY OF ASHLAND CONTRACT FOR PURCHASE OF EQUIPMENT CONTRACT Contract made this 4th day of December , 2017, between the City of Ashland ("City") and Hughes Fire Equipment, Inc. ("Contractor"). City and Contractor agree: 1. Contract Documents: This contract is made as a result of an Invitation to Bid issued by City entitled "INVITATION TO BID" for a TYPE 1, AMBULANCE, Bid No. 92017-102, Contractor was awarded the bid as the lowest responsible bidder on 11/28/2017 . The contract documents are comprised of the Invitation to Bid and all included attachments, which are hereby incorporated by this reference, and the Contractor's Bid, which is also incorporated by this reference. In the event of a conflict between this contract and the Invitation to Bid, the terms of this contract govern. In the event of a conflict between the Invitation to Bid and the Bid, the Invitation to Bid shall take precedence over the Bid. 2. Scope: Contractor shall produce and deliver the equipment described in the contract documents within the time prescribed in the contract documents. 3. Price and Payment: City shall pay Contractor the sum of $240,805.00 (total amount) for one (1) Ford F-450 Liberty Ambulance (d) $234,634.00 and one (1) Ferno Cot (a, $6,171.00 (equipment) to be delivered FOB Ashland within 240 - 330 calendar days after receipt of fully executed purchase order. CORPORATE OFFICER CITY OF ASHLAND BY ~ BY vL- Signat re Administ for Print ame REVIEW D AS TO F Title: BY l v Legal Department Fed ID ? y ~ Date 1,-2, -4 I ~l Purchase Order ` Page 16 of 16 - ITB, GEN COND, SPECIFICATIONS, SPECIAL PROVISIONS, BID FORM, CONTRACT Hughes Fire Equipment, Inc. 910 Shelley Street Springfield, OR 97477 T:541-747-0072 F:541-747-0073 HUGHES F. r.t EQUic x%Av .hughestire.com November 28, 2017 City of Ashland 90 N. Mountain Avenue Ashland, OR 97520 Braun Industries and Hughes Fire Equipment, Inc. are pleased to offer for your consideration the following Amendment to our Proposal for one (1) Ford F-450 Braun Liberty Ambulance that meets current NFPA 1917 and KKK-A-1 822F standards, per your Invitation to Bid #2017-102 on one (1) Type 1 Ambulance. The price for one (1) Ford F-450 Liberty Ambulance JR10062-0003 is $234,634.00 F.O.B. Ashland, Oregon. The unit would be ready for pick up from the factory within 240 to 330 calendar days after receipt of fully executed Purchase Contract, order submission to the manufacturer, drawing approval between the manufacturer/dealer and the City and receipt of chassis from manufacturer. A payment in the amount of 90% of the purchase price will be due upon final factory inspection. The remaining balance will be due within thirty (30) days after delivery of unit to the customer's facility. *Please note: The delivery time referenced above indicates when the unit will be ready for delivery from the factory. This does not include the time it will take to transport the unit to the local dealer, complete the pre-delivery inspection and other items to satisfy contract requirements, and transported to the customer location. Delivery time is subject to change prior to contract execution. Price Recap Description Amount One 1 Ford F-450 Liberty Ambulance per JR10062-0003 $234,634.00 Less Customer Transport Discount 4,500.00 Total Price Including Transport Discount $230,134.00 Terms: Transportation Discount - This option is available for the District to transport the unit from the factory in Van Wert, Ohio to Ashland, Oregon. The unit will be required to be delivered to a Hughes Fire Equipment facility for a pre-delivery inspection. Please Note: The above referenced transportation funds have been included to transport the apparatus under its own power from the factory to the customer location. If, due to Federal and/or State DOT regulations or customer preference, delivery via flatbed or rail system is necessary additional transportation charges will be required. If we are unable to obtain the necessary permits to transport the apparatus to the customer's location the customer will be responsible for transporting the apparatus from the manufacturer's facility to the customer's location. Ford Fleet Incentive Discount - A Ford Fleet Incentive Discount in the amount of $3,800.00 is included in the Proposal Price. Inspection Trips - One (1) factory inspection trip for two (2) fire department customer representatives is included in the above pricing. The inspection trip will be scheduled at a time Page 1 of 2 mutually agreed upon between the manufacturer's representative and the customer. Airfare, lodging and meals while at the factory are included. Warranty service on the module unit will be provided by our facility located in Springfield, Oregon. Service can be scheduled by calling 800-747-6510. This proposal may be utilized for Cooperative Purchasing by other public agencies. We would like to thank you for considering this proposal. If we can be of further assistance, please feel free to contact us. Sincerely, Rex Hughes J Renner President Sales Representative Hughes Fire Equipment, Inc. Hughes Fire Equipment, Inc. RH/ss J R/ss Page 2 of 2 Hughes Fire Equipment, Inc. 910 Shelley Street Springfield, OR 97477 w T: 541-747-0072 LJ F: 541-747 0073 www,huahesfire.eom September 28, 2017Ga City of Ashland 90 N. Mountain Avenue Ashland, OR 97520 Braun Industries and Hughes Fire Equipment, Inc. are pleased to offer for your consideration the enclosed proposal for one (1) Ford F-450 Braun Liberty Ambulance that meets current NFPA 1917 and KKK-A-1 822F standards, per your Invitation to Bid #2017-102 on one (1) Type 1 Ambulance. The price for one (1) Ford F-450 Liberty Ambulance JR10062-0003 is $234,634.00 F.O.B. Ashland, Oregon. The unit would be ready for pick up from the factory within 240 to 330 calendar days after receipt of fully executed Purchase Contract, order submission to the manufacturer, drawing approval between the manufacturer/dealer and the City and receipt of chassis from manufacturep.- final payment for the unit will be due within five (5) days of final inspection at the manufacturer's fa ' ity. If payment is not made at that time, interest at a rate of 6% per day for the balance owing will be plicable. *Please note: The delivery time referenced above indicates wh the unit will be ready for delivery from the factory. This does not include the time it will take to ansport the unit to the local dealer, complete the pre-delivery inspection and other items to s isfy contract requirements, and transported to the customer location. Delivery time is subject to ch ge prior to contract execution. Price Recap Description Amount One 1 Ford F-450 Liberty Ambulance er R10062-0003 $234,634.00 Less Customer Transport Discount (4,500.00 Total Price Including Transport Dis punt $230,134.00 Terms: Transportation Discount - This option is available for the District to transport the unit from the factory in Van Wert, Ohio to Ashland, Oregon. The unit will be required to be delivered to a Hughes Fire Equipment facility for a pre-delivery inspection. Please Note: The above referenced transportation funds have been included to transport the apparatus under its own power from the factory to the customer location. If, due to Federal and/or State DOT regulations or customer preference delivery via flatbed or rail system is necessary additional transportation charges will be required. If we are unable to obtain the necessary permits to transport the apparatus to the customer's location, the customer will be responsible for transporting the apparatus from the manufacturer's facility to the customer's location. Ford Fleet Incentive Discount -A Ford Fleet Incentive Discount in the amount of $3,800.00 is included in the Proposal Price. Inspection Trips - One (1) factory inspection trip for two (2) fire department customer representatives is included in the above pricing. The inspection trip will be scheduled at a time mutually agreed upon between the manufacturer's representative and the customer. Airfare, lodging and meals while at the factory are included. Page 1 of 2 Warranty service on the module unit will be provided by our facility located in Springfield, Oregon. Service can be scheduled by calling 800-747-6510. This proposal may be utilized for Cooperative Purchasing by other public agencies. We would like to thank you for considering this proposal. If we can be of further assistance, please feel free to contact us. Sincerely, Rex Hughes 'Jihi Renner President Sales Representative Hughes Fire Equipment, Inc. Hughes Fire Equipment, Inc. RH/ss JR/ss r Page 2 of 2 Hughes Fire Equipment, Inc. 910 Shelley Street ~r Springfield, OR 97477 T:541-747-0072 F:541-747-0073 rww,hk lies fire. corn December 13, 2017 City of Ashland Attn: Kari Olson, Purchasing Representative 90 N. Mountain Avenue Ashland, OR 97520 Dear Kari, We have enclosed the following requested documentation from both the Contractor and Manufacturer for the purchase of the Type 1 Ambulance and Ferno Cot option: Hughes Fire Equipment Certificate of Insurance for General Liability and Automobile, including the City of Ashland as additional insured, and Workers' Compensation Certificate Braun Industries Certificate of Insurance for General Liability and Automobile, including the City of Ashland as additional insured, and Workers' Compensation Certificate Upon contract execution, please email the electronic copy of the fully executed contract to Contract Administrator, Shelby Sebright at ssebright(a),hughesfire.com or fax at (541) 747-0073. Once the contract has been received, we will complete the ordering process. We are looking forward to ordering a new Braun Ambulance for the City of Ashland! Please let us know if we can be of any further assistance at this time, we can be reached at (541) 747-0072. Thank you, Rex Hughes President Hughes Fire Equipment Inc. RH/ss Page 1 of 1 ® DATE (MM/DDIYYYY) A CERTIFICATE OF LIABILITY INSURANCE 12/11/2017 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 have ADDITIONAL INSURED provisions or 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 CONTACT NAME: KPD Insurance, Inc. PHONE FAX PO Box 784 c N. E 541-741-0550 A/C No): 541-741-1674 Springfield OR 97477 ADDRIESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Traveler's Pro Cas Co of Amer 25674 INSURED HUGHOIC INSURER B : Traveler's Indem Co of America 25666 Hughes Fire Equipment, Inc. 910 Shelley St INSURER C : Springfield OR 97477 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1913687008 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 TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM DDIYYYY MM DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY 9G187828 3116/2017 3/1612018 EACH OCCURRENCE $1,000,000 FV7 DAMA E TO RENTED CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 100,000 X Lmtd Contractual MED EXP (Any one person) $ 5,000 X Stop gap Liab-WA PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F-] PRO [ X] LOC PRODUCTS - COMP/OP AGG $ 2,000,000 JECT OTHER: Stop Gap Limit $ 1,000,000 A AUTOMOBILE LIABILITY 9G2G251173 3/16/2017 3/16/2018 COMBINED SINGLE LIMIT $ Ea accident 1 000 000 IX ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A X UMBRELLA LIAB X OCCUR CUP9G187828 3/16/2017 3/16/2018 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEM BER EXCLUDED? ❑ NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Garage Keepers Liability 96187828 3/16/2017 3/1612018 $4,305,000 Oregon $1,350,000 Arizona Customer Veh in Insd Care, $2,400,000 Washington $800,000 Idaho Custody & Control $1,000 Ded-Comp $1,000 Ded-Coll DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Re: All Operations. City of Ashland is additional insured per form CGD037 4/05. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Ashland It 90 N. Mountain Avenue C4 Ashland OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Saf1 corporation Carrier No: 20001 Information Page Policy No: 629009 Employer Identification No: 93-0962404 NCCI Risk ID No: 911969726 Item 1. The Insured: Entity Type: HUGHES FIRE EQUIPMENT INC CORPORATION Mailing address: Agency: HUGHES FIRE EQUIPMENT INC BONNIE ROMANE 910 SHELLEY ST KPD INSURANCE INC SPRINGFIELD, OR 97477-1975 PO BOX 29 SPRINGFIELD, OR 97477 Other workplaces not shown above: NONE Item 2. The policy period is from 03-01-2017, 12:01 A.M. to 03-01-2018, 12:01 A.M. at the insured's mailing address Item 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: OREGON B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $1,000,000 each accident Bodily Injury by Disease $1,000,000 each employee Bodily Injury by Disease $1,000,000 policy limit C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: NONE D. This policy includes these endorsements and schedules: WC360601 E Oregon Cancellation Endorsement W0000421 D Catastrophe (other than Certified Acts of Terrorism) Premium End W0000422B Terrorism Risk Insurance Prog Reauthorization Act Disclosure End W0000414 Notification of Change in Ownership Endorsement W0000406A Premium Discount Endorsement WC360406 Premium Due Date Endorsement WC990309C SAIFPIus Endorsement WC990602 Subject Officer Payroll Requirement - Corporation W00001 06A Longshore and Harbor Workers' Coverage Endorsement WC360304 Oregon Amendatory Endorsement W0000424 Audit Noncompliance Charge Endorsement WC990616 Confidentiality Endorsement Item 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. The premium and rates and the experience rating modification factor, if any, may change on your anniversary rating date of 03-01-2018. All information required below is subject to verification and change by audit. Client#: 1097449 BRAUNIND DATE (MM/DDIYYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE F1211212017 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 have ADDITIONAL INSURED provisions or 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAMEA T Lesli Haughan USI Insurance Services LLC PHONE 260 435-4110 AX, No :610 537-4126 A/C No, Ext 9910 Dupont Circle Dr. E E-MAIL ADDRESS: lesli.haughan@usi.com Suite 120 INSURER(S) AFFORDING COVERAGE NAIC # Fort Wayne, IN 46825 INSURER A: Cminnati Insurance Company 10677 INSURED INSURER 8 : Cincinnati specialty Underwriting 13037 Braun Industries, Inc. INSURER C 1170 Production Dr Van Wert, OH 45891 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 CONTRACTOR 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 ADDL SUB POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR W_ VD POLICY NUMBER (MM/DD/YYYY MM/DDIYYYY LIMITS A XI COMMERCIAL GENERAL LIABILITY X MFG0011204 12/01/2017 12/01/201 EACH OCCURRENCE $1,000,000 I-XI OCCUR PREMISESOEa occu ence $500 OOO CLAIMS-MADE MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- X LOC PRODUCTS -COMP/OP AGG $2,000,000 I POLICY JECT OTHER: $ A AUTOMOBILE LIABILITY X MFA0011204 2/01/2017 12/01/201 Ea aB.deDtSINGLE LIMIT $1,000,000 O X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS j HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY Per accident $ A XI UMBRELLA LIAB X OCCUR MFG0011204 2101/2017 12/01/201 EACH OCCURRENCE $5 000,000 B X EXCESS LIAB CLAIMS-MADE CS00092166 2/01/2017 12/01/201 AGGREGATE $5 000,000 _ DED X RETENTION $0 Excess Liab $4.00.0_z000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N TAT T ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Ohio Stop Gap MFG0011204 2/01/2017 12/01/201 $1,000,000/$1,000,000 Garagekeepers - MFG0011204 2/01/2017 12/01/201 $2,000,000; Coll $1000 Prima coverage Comp $1,000/$2500 ded DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Supplemental Name First Supplemental Name applies to all policies - Braun Industries, Inc. Policy# MFG0011204 - : Braun Real Estate, Ltd Policy# MFG0011204 Braun Holdings, LLC (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 N. Mountain Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S22059152/M21968929 JYCZP DESCRIPTIONS (Continued from Page 1) The General Liability and Auto policy(s) includes an automatic Additional Insured endorsement that provides Additional Insured status to the Certificate Holder only when there is a written contract that requires such status, and only with regard to work performed on behalf of the named insured. SAGITTA 25.3 (2016/03) 2 of 2 #S22059152/M21968929 Bureau of Workers' 30 W. Spring St. Ohio Compensation Columbus, OH 43215 Certificate of Ohio Workers' Compensation This certifies that the employer listed below participates in the Ohio State Insurance Fund as required by Iaw.Therefore, the employer is entitled to the rights and benefits of the fund for the period specified.This certificate is only valid if premiums and assessments, including install- ments, are paid by the applicable due date.To verify coverage, visit www.bwc.ohio.gov, or call 1-800-644-6292. This certificate must be conspicuously posted. Policy number and employer Period specified below 337040-0 07/01/2017 through 06/30/2018 0 3 a r : 0 BRAUN INDUSTRIES INC 3 1170 PRODUCTION DR o VAN WERT, OH 45891-9391 0 0 www.bwc.ohio.gov h " o Issued by: Administrator/CEO You can reproduce this certificate as needed. Ohio Bureau of Workers' Compensation Required Posting Effective Oct. 13, 2004, Section 4123.54 of the Ohio Revised Code requires notice of rebuttable presumption. Rebuttable presumption means an employee may dispute or_prove untrue the presumption (or belief) that alcohol or a controlled substance not prescribed by the employee's physician is the proximate cause (main reason) of the work-related injury. The burden of proof is on the employee to prove the presence of alcohol or a controlled substance was not the proximate cause of the work-related injury. An employee who tests positive or refuses to submit to chemical testing may be disqualified for compensation and benefits under the Workers' Compensation Act. Bureau of Workers' Ohio Compensation You must post this language with the Certificate of Ohio Workers' Compensation DP-29 BWC-1629 (Rev. April 11, 2016) 'Bureau of Workers' Governor John R. Kasich Ohi*O Compensation Administrator/CEO Sarah D. Morrison 30W. Spring St. www.bwc.ohio.gov Columbus, OH 43215-2256 1-800-644-6292 April 14, 2017 BRAUN INDUSTRIES INC 1170 PRODUCTION DR VAN WERT, OH 45891-9391 Policy Number: 337040-0 3 RE: 2017 Policy Renewal, Notice of Estimated Annual Premium and Workers' Compensation o Certificate 2016 Policy True-Up Reminder o 0 Dear Employer: o This letter directs you to our website to obtain information pertaining to your estimated annual ° premium, installment schedule and certificate of coverage for the upcoming workers' compensation policy year that begins July 1, 2017. To view this information, you must first create a BWC e-account at www.bwe.ohio.gov. After creating the e-account, click on Employers, and then click the Premium Installment Schedule link. You will receive your first invoice for the 2017 policy year in June. Payment is due by July 3. New this year, you have the option to receive a 2-percent discount by paying the full 12-month estimated annual premium on or before July 3, 2017. You can find details concerning the early payment discount on page 2. We based your premium estimate on your most recently reported payroll. If you believe the payroll estimate is incorrect, or you have a change in operations that will affect your payroll for the upcoming policy year, notify us either by phone or through our website. If you would like to request a change in your installment schedule, you will have until May 16, 2017, or your premium installment schedule will remain the same. Failure to pay a premium install- ment by the due date will result in penalties and interest. You will also be responsible, dollar for dollar, for the costs of any claims that occur during any period of non-coverage. As a reminder, the payroll true-up process for the current policy year begins in July. The true- up requires you to report your actual payroll fog the period of July 1, 2016, to June 30, 2017. We will then reconcile the actual payroll with the estimated payroll used to calculate your premium. You must complete this true-up online on our website. Failure to file your true-up and pay any balance due will result in disqualification from BWC programs. If you have any questions, please visit our website or call us at 1-800-644-6292. Sincerely, O Sarah D. Morrison Administrator/CEO General Information Payment of premium Failure to pay premium by the installment due date will result in a lapse in coverage and penalties. If a claim occurs during this lapsed period, you will be responsible for all claim costs associated with that claim. Please pay all installment billings timely to avoid penalties. True-up report At the conclusion of this policy year, we will require you to file an annual payroll true-up report online at www.bwc.ohio.gov. If the final premium is more than the premium you paid to us, you must pay the outstanding balance. If it is less, we will refund the balance to you. Failure to file the annual payroll true-up report timely will result in removal from all employer discount programs and rating plans. You will receive a reminder from us, but please mark your calendar. Early payment discount You must pay all installments for the policy year in full on or before the due date of the first installment. When we receive your full premium payment by the due date of the first installment for the policy year, we will credit your account for the 2-percent discount. We will issue you a refund of this credit less any balance due. The discount cannot reduce the total amount due below the o required miminum premium of $120. You elect this payment option by logging on to www.bwc.ohio.gov a and clicking on premium installment schedule or by calling us at 1-800-644-6292. o Policy cancellation 2 If you cancel your policy, you must notify us in writing. When cancelling your coverage, you must - O file a final payroll true-up report. Important note: Once you cancel the policy, you may be entitled o to a refund. We cannot modify the name on the refund. Prior to closing your business bank account, o we recommend that you confirm with us that no additional refunds are in order. o Premium audit We reserve the right to audit the information you submit on your annual true-up payroll report. To obtain information regarding payroll-reporting guidelines, please log on to www.bwc.ohio.gov, and click BWC Library/Glossary/Employer/Reporting Payroll. Change in operations If you have a significant change in operations and would like to modify your estimated premium exposure for the upcoming year, please call 1-800-644-6292. Changing the installment schedule If you would like to change your installment schedule by May 16, 2017, log on to www.bwc.ohio.gov, and click on premium installment schedule link on the Employers page, or call us at 1-800-644-6292. Workplace injuries Remember to contact your managed care organization if one of your employees has a workplace injury. Employer discount programs We offer many opportunities for employers to reduce their premiums and promote workplace safety. Please visit www.bwc.ohio.gov to see what opportunities your company may have. Safety services Our Division of Safety & Hygiene (DSH) can assist you in making your workplace safer. We provide these services to you at no additional cost. To contact DSH, please call 1-800-644-6292. Important Dates to Remember Date Item June 1, 2017 First installment/invoice mailed for 2017 policy year July 3, 2017 First installment due for 2017 policy year July 1, 2017 Annual true-up payroll notice mailed for 2016 policy year Aug 15, 2017 Annual payroll true-up due or 2016 policy year Client#: 1097449 BRAUNIND DATE (MMIDDIYYYY) ACORD,. CERTIFICATE OF LIABILITY INSURANCE 12/12/2017 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 have ADDITIONAL INSURED provisions or 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER I NAMEACT Lesli Haughan USI Insurance Services LLC PHONE 260 435-4 AIC, No, Ext : 110 FA A/Cx, No): 610 537-4126 9910 Dupont Circle Dr. E E-MAIL lesli.haughan@usi.com ' ADDRESS: Suite 120 _ INSURER(S) AFFORDING COVERAGE NAIC # Fort Wayne, IN 46825 INSURER A Cincinnati Insurance Company 10677 : INSURED ll INSURER B : Cincinnati Specialty Underwriting 13037 Braun Industries, Inc. INSURER C : 1170 Production Dr INSURER Van Wert, OH 45891 D INSURER E : j 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 CONTRACTOR 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE_ _'INSR WVD _ POLICY NUMBER - - - (MM/DD/YYYY1AMM11DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X MFG0011204 12/01/2017,12/01/2018 EACH OCCURRENCE $1,000,000 I V1 DAMAGE TO RENTED CLAIMS-MADE L_J OCCUR PREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 _ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY F7 JECT I X LOCI PRODUCTS - COMP/OP AGG $2,000,000 OTHER: I $ A AUTOMOBILE LIABILITY X MFA0011204 12/01/2017 12/01/20181' COMBINED SINGLE LIMIT 1 000 000 Ea accident $ 'LX ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS XI AHIRED UTOS ONLY X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY Per accident $ A X UMBRELLA LIAB X OCCUR MFG0011204 12/01/2017 12/01/2018 EACH OCCURRENCE $5,000,000 B X EXCESS LAB CLAIMS-MADE CS00092166 12/01/2017 12/01/2018 AGGREGATE S5,000,000 _ DED 11 X RETENTION $0 Excess Llah s4.000,_000 WORKERS COMPENSATION "PER - T'_ AND EMPLOYERS' LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE -E.L. EACH ACCIDENT $ OFFICEPJMEMBER EXCLUDED? NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below _ II_E. L. DISEASE -POLICY LIMIT $ A iOhio Stop Gap MFG0011204 12/01/2017 12/01/2018 $1,000,000/$1,000,000 Garagekeepers - MFG0011204 12/01/2017,12/01/2018 $2,000,000; Coll $1000 Prima coverage i Comp $1,0001$2500 ded DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Supplemental Name First Supplemental Name applies to all policies - Braun Industries, Inc. Policy# MFG0011204 - : Braun Real Estate, Ltd Policy# MFG0011204 Braun Holdings, LLC (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 90 N. Mountain Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) 1 of 2 The ACORD name and logo are registered marks of ACORD #S22059152/M21968929 JYCZP DESCRIPTIONS (Continued from Page 1) The General Liability and Auto policy(s) includes an automatic Additional Insured endorsement that provides Additional Insured status to the Certificate Holder only when there is a written contract that requires such status, and only with regard to work performed on behalf of the named insured. SAGITTA 25.3 (2016/03) 2 of 2 #S22059152/M21968929 USI INSURANCE SERVICES ATTN: RETURNED MAIL DEPARTMENT PO BOX 629035 EMS: EL DORADO HILLS CA 95762-9035 CITY OF ASHLAND 90 N MOUNTAIN AVE ASHLAND OR 97520-2014 Purchase Order Fiscal Year 2018 Page: 1 of: 1 THIS PO NUMBER MUST APPEAR ON ALL B City of Ashland INVOICES, AND SHIPPING DOCUMENTS I ATTN: Accounts Payable Purchase L 20 E. L Ashland, Main OR 97520 Order # 20181147 T Phone: 541/552-2010 O Email: payable@ashland.or.us V H C/O Fire and Rescue Department E HUGHES FIRE EQUIPMENT, INC 1 455 Siskiyou Blvd N 910 SHELLEY STREET P Ashland, OR 97520 D SPRINGFIELD, OR 97477 Phone: 541/482-2770 O T Fax: 541/488-5318 R O Vendor P brie um- er Ngn=d0r, ~r Numfz =R yo = - ~iueryRefer rr _ 541 747-0072 _ David Shepherd J]atercferedndenbe =_a ewe ak~M o~rejllhfJ`rn - =DeeartmentlLocation - _ 12/18/2017 151 FOB ASHLAND OR Cit Accounts Pa able fte7n - _ - f ~n 3i fi' lJ lM prig Extended FW - - - Type 1 Ambulance Veh #1069 1 Invitation to Bid #2017-102 1 EACH 240,805.0000 $240,805.00 TYPE 1, AMBULANCE Ford F-450 Liberty Ambulance $234,634.00 Ferno Cot $6,171.00 Lead time: 240-330 Calendar Days ARID Approved by City Council November 7, 2017 Department: Fire Vehicle #1069 (Replacing Vehicle #462) Project Account: GL SUMMARY 081000 - 703000 $240,805.00 i By ' ~'~c--" Date: t t f' Authori d Signature PO' Total $240,805.00 FORM #3 CITY OF -ASHLAND REQUISITION Date of request: Required date for delivery: Vendor Name Address, City, State, Zip Contact Name & Telephone Number Email address 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 -(Attach co of council communication If council approval required, attach co of CC ❑ Small Procurement Cooperative Procurement Less than $5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon ❑ Direct Award Date approved by Council: Contract # r I^"9.ch copy of council communication) ❑ State of Washington mo w, !a Source Contract # ~licable Form (#5,6, 7 or 8) ❑ Other government agency contract ;ten quote or proposal attached Agency m #4, Personal Services $5K to $75K Contract # Intergovernmental Agreement ~cial Procurement n #9, Request for Approval ❑ Agency 4 ten quote or proposal attached Date original contract approved by Council: roved by Council: (Date) (Attach copy of council communication t.,~.~x I: Date PY ) f ` Total Cost j $ Item # Quantity Unit Description of MATERIALS Unit Price - Total Cost q i e . / ` x. -1i;Z 44 TOTAL COST ❑ Per attached quotelproposal $ Project Number _ _ _ _ _ _ - c' _ _ _ Account Number Account Number _ _ _ _ _ _ _ _ _ _ Account Number "Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: IT Director Date Support -Yes /No By signing this, requisition form, I certify that the, City's public contracting requirements have been satisfied. a Employee: ? Department Head: (EgPa o or greater than $5,000) Department Manager/Supervisor: City Administrator: E al to or greater than $25,000) Funds appropriated for current fiscal year: -YESy NO j i "ate Finance Direcfflr- (Equal to or greater than $5,000) Date Comments: Form #3 - Requisition