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2018-019-Contract for Goods & Services
Contract for GOODS AND SERVICES Small Procurement Less than $5,000 CITY OF INDEPENDENT CONTRACTOR: Copeland Construction LLC ASHLAND CONTACT: Taunya Copeland 20 East Main Street ADDRESS: 321 Pruett Rd Ashland, Oregon 97520 Telephone: 541/488-6002 Eagle Point, OR 97524 Fax: 541/488-5311 TELEPHONE: 541-826-1014 EMAIL: copelandconst.llc@earthlink.net BEGINNING DATE: January 1, 2018 orwhen executed COMPLETION DATE: January 31, 2018 COMPENSATION: Lump sum of $4,900.00 GOODS AND SERVICES TO BE PROVIDED: Remove cap and weld section of 24 inch steel pipe water-tight into existing TID 24 inch waterline at the Water Treatment Plant. City to provide additional pipe section, Contractor to cut repair section from additional pipe. Schedule to be closely coordinated with the Water Treatment Plant as work requires the shut-down of the Plant. Quotation attached as Exhibit B. In the event of conflicts or discrepancies among Contract Documents, this standard form of the City of Ashland Contract 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 this standard form 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. Ownership of Production: All documents, materials or items produced by Contractor pursuant to this contract shall be the property of City. 4. Statutory Requirements: ORS 279B220, 2798.225, 2798.230, 279B.235, ORS Chapter 244 and ORS 670.600 are made part of this contract. 5. Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless from those losses, expenses, or other damages resulting from injury to any person or damage to property arising out of or incident to the negligent performance of this contract by Contractor its employees, or agents. Contractor shall not be held responsible for any losses, expenses, or other damages, directly, solely, and proximately caused by the negligence of City. 6. Termination: City's Convenience. This contract may be terminated at any time by the City. 7. 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. 8. 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. 9. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an asbestos abatement license. 10. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work. 11. 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. 11 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. 13. Insurance. Contractor shall at its own expense provide the following insurance: a. 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. Worker's compensation insurance is required if work is performed by employees, subcontractors, or volunteers. BY INITIALING THIS SENTENCE, CONTRACTOR CERTIFIES UNDER PENALTY OF LAW THAT THE WORK REQUIRED BY THIS CONTRACT SHALL BE PERFORMED SOLELY BY THE UNDERSIGNED: b. General Liability insurance with a combined single limit, or the equivalent, of not less than $1,000,000 for each occurrence for Bodily Injury and Property Damage. C. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than $1,000,000 for each accident for Bodily Injury and Property Damage, including coverage for owned, hired or non-owned vehicles, as applicable. 14. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws of the State of Oregon 15. 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. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by reference. Contractor: City of Ashland- By--, A, i( C G t_ By ig ure Department Head Ov),e 6A,~ t ~114 t Print Name Print Name 3 JA-AJ 20/8 - Tit Date rj W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. APPROVED AS-TO FORM AShI omey Revised 10-28-14 Page 1 of 2 atel ~ EXHIBIT A CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified it that it is no longer subject to backup withholding. Contractor further represents and warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms, (c) the work under the Contract shall be performed in accordance with the highest professional standards, and (d) Contractor is qualified, professionally competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on behalf of the entity designated above and authorized to do business in Oregon or is an independent Contractor as defined in the contract documents, and has checked four or more of the following criteria.. (1) 1 carry out the labor or services at a location separate from my residence or is in a specific portion of my residence, set aside as the location of the business. _ (2) Commercial advertising or business cards or a trade association membership are purchased for the business. (3) Telephone listing is used for the business separate from the personal residence listing. (4) Labor or services are performed only pursuant to written contracts. (5) Labor or services are performed for two or more different persons within a period of one year. (6) 1 assume financial responsibility for defective workmanship or for service not provided as evidenced by the ownership of performance bonds, warranties, errors and omission insurance or liability insurance relating to the I bor or services to be provided. Contr for (Date) Revised 10-28-14 Page 2 of 2 EXHIBIT B Copeland Construction, Iic 321 Pruett Rd. Eagle Point, OR 97524 Office: 541-826-2314 Fax: 541-826-1014 copelandconst.llc[c@earthIink. net Date: 12/21/2017 To: City of Ashland-Kevin Caldwell Project: Weld 24" Waterline The Price includes the following: *Mobilization *Welder (16 hours) *(2) Laborers-assist welder The Price does not include the following: *Permits, Fees, or Bonding *Lay out or Surveying *Landscaping *Materials We propose to furnish equipment, materials, and labor in accordance with above specifications, For the lump sum of: $4,900.00 Here and accepted by authorized signature. Signed: Date: Page 1 of 1 AC~ ® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 6/2/2017 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 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 endorsements . PRODUCER CONTACT Jessica Embree NAME: Zarosinski-Leavitt Ins Agency of Oregon, Inc PHONE (503)639-4220 FAX (503) 639-4449 (AIC. No): Leavitt Group of Portland E-MAIL - ADDRESS: 3 essica-embree@leavitt . com 8285 SW Nimbus Ave, Ste 120 INSURER(S)AFFORDINGCOVERAGE NAIC# Beaverton OR 97008 INSURE_RA:Cincinnati Insurance Con any 110677 INSURED INSURER _B :SAIF 036196 Copeland Construction LLC INSURER C : 321 Pruett Rd. INSURER O: INSURER E : Eagle Point OR 97524 INSURER F : COVERAGES CERTIFICATE NUMBER:17/18 Pckg 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 POLICY EFF POLICY EXP POLICY NUMBER LIMITS X COMMERCIAL GENERAL LIABILITY ' 1,000,000 EACH OCCURRENCE _ _ I I DAMAGE TO RENTED A CLAIMS-MADE X OCCUR F_PREMISES (Ea occurrences $ 100,000 X BPP0441387 6/3/2017 6/3/2018 ! MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER. ~L GENERAL AGGREGATE $ 2,000,000 r X POLICY PERO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 A x ANY AUTO BODILY INJURY (Per person) S ALL OWNED SCHEDULED EBA0441387 AUTOS AUTOS 6/3/2017 j 6/3/2018 BODILY INJURY (Per accident) $ PROPERTY DAMAGE NON-OWNED (Per accident) a ~L ~ HIRED AUTOS AUTOS Is , j - $ X ;UMBRELLA LIAB R -j OCCUR ij EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ ___1,000,000 DIED RETENTIONS 'iEPP0441387 6/3/2017 6/3/2018 $ WORKERS COMPENSATION P AND EMPLOYERS' LIABILITY X~ STATUTE ! ER _ ANY PROPRIETORPARTNERIEXECUTIVE NH) EXCLUDED? YIN' EL EACH ACCIDENT $ 500,000 B OFFICER/MEMBER N/A (Mandatory in NH , 980838 1/1/2017 1/1/2018 E.L DISEASE - EA EMPLOYE $ 500,000 If yes, describe under ! - - DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 500 000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Ashland, Oregon and its elected officials, officers and employees are named as additional insured in regards to the general liability coverage per written contract or agreement per form GA2330R0910 attached. Coverage is primary and non contributory. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Public Works ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main St Ashland, OR 97520 AUTHORIZED REPRESENTATIVE J Embree, Exec/JDE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OREGON CONTRACTORS' COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement - Table of Contends: gmraop. Benin on Paue: 1. Employee Benefit Liability Coverage....................... 2. Unintentional Failure to Disclose Hazards...._..._..:..._..._. '•_-2 0 3. Damage to Premises Banded to You e 4 Supplementary Pa yments..... ..9. 5 Medical Payments 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.) .10 7. 180 Day Coverage for Newly Formed or Acquired Organizations 10 S. Waiver ofSubrogation _..._........_......:...._....x..._..._.....10 9. Automatic Additional Insured - Specified Relationships:..................................................... x Managers or lessors of Premises; 11 x Lessor of Leased Equipment x Vendors: x State or Political Subdivisions- Permits Relating to Premises; x State or Political Subdivisions - Permits; and x Contractors' Operations 10. Broadened Contractual Liability- Work Within SO' of Railroad,Property 16 11. Property Damage to Borrowed Equipment 12. Employees as Insureds -Specfied Health Care Services :...16 16 x Nurses; x Emergency Medical Technicians; and x Paramedics 13. Broadened Notice of Occurrence 16 B. Limits of Insurance: The Commercial General Liability Limits of insurance app" the insurance provided by this endorsement, except as provided below: 1. Employee Benefit Liability Coverage Each Employee Limit $ i,0D0,000 Aggregate Limit $ 3•oD0,000 Deductible: $ 11000 3. Damage to Premises Rented to You The lesser of a. The Each Occurrence Limit shown In the Declarations; or b. $500;000 unless otherwise stated $ 4. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 5. Medical Payments Medical Expense Limit $ 10,000 Includes copyrighted material of insurance GA 233 OR 0910 Services Office, Inc, with its permission. Page 1 of 16 6. Voluntary Property Damage (Coverage a.) and Care. Custody or Control Liability Coverage (Coverage W Limits of Insurance (Each Occurrence) Coverage a. $1,000 Coverage b. $5,000 unless otherwise stated $ Deductibles (Each Occurrence) Coverage a. $250 Coverage b. $250 unless otherwise stated $ COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM (a) Area (For Limits in Excess of (For Emits in Excess of (b) Payroll $5,000) $5,000) (c) Gross Sales (d) Units e Other b. Care, Custody $ or Control TOTAL ANNUAL PREMIUM 11. Property Damage to Borrowed Equipment Each Occurrence Limit $ 10.000 Deductible: $ 250 C. Coverages: 2) Our right and duty to 1. Employee Benefit Liability Coverage defend ends when we have used up the appi- a. The following is added to SECTION I cable limit of insurance - COVERAGES: Employee Benefit in the payment of Liability Coverage. judgments or settle- (1) Insuring Agreement merrts. (a) We will pay those sums that No other obligation or liabit- the insured becomes legally ityy to pay sums or perform obligated to pay as darn ads or services is covered ages caused by any act, er- unless explicitly provided for ror or omission of the in- under Supplementary Pay- sured, or of any other per- ments. son for whose ads the irk- (b) This insurance applies to sured is legally liable, to damages only if the act, er- which this insurance ap- ror or omission, is negi- plies. We will have the right gently committed in the and duty to defend the in- "administration" of your sured against arty "suit" "employee benefit program"; seeking those damages. and However, we will have no duty to defend against any 1) Occurs during the pol- "suit" seeking damages to icy period; or which this insurance does Red prior to the not apply. We may, at our 2) Occu Occu ive date this discretion, investigate any endorsement provided: report of an act, error or omission and settle arry a) You did not have claim or "suit" that may re- knowledge of a suit. But: claim or "suit" on 1) The amount we will pay or before the ef- for damages is limited fective date of this as described in SEC- endorsement. TION III - LIMITS OF You will be INSURANCE; and deemed to have includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Pace 2 of 16 knowledge of a 1) Failure of any invest- claim or "suit" ment to perform; when any "author- ized representa- 2) Errors in providing in- tive"; formation on past per- formance of investment U Reports all, or vehicles; or a ►ry part, of the ad, error or 3) Advice given to arty omission to us person with respect to or any other that person's decision insurer; to participate or not to participate in any plan ii Receives a included in the "em- written or ver- ployee benefit pro- bal demand or gram" claim for dam- ages because M Workers' Compensation of the act, error and Similar Laws and omission; Any claim arising out of your failure to comply with the b) There is no other mandatory provisions of any applicable insur- workers' compensation, un- ance. employment compensation (2) Exclusions insurance, social security or disability benefits law or any This insurance does not apply to: similar law. (a) Bodily Injury, Prop (g) ERISA Damage or Personal and Damages for which any in- Advertising Injury sured is liable because of Ik "Bodily injury, "property ability imposed on a fiduci- damage" or "personal and ary by the Employee Re- advertising injury. tirement Income Security Act of 1974, as now or (b) Dishonest Fraudulent, hereafter amended, or by Criminal or Malicious Act any similar federal, state or local laws. Damages arising out of any intentional, dishonest, (h) Available Benefits fraudulent, criminal or mall cious act, error or omission, Any claim for benefits to the extent committed by any insuredextent that such benefits are including the willful or rack- available, with reasonable less violation of any statute, effort and cooperation the insured, from the applis icable (c) Failure to Perform a Con- funds accrued or other col- tract lectible insurance. Damages arising out of fail- (i) Taxes, Fines or Penalties ure of performance of con- trail by lily insurer. Taxes, fines or penalties, including those imposed (d) Insufficiency of Funds under the Internal Revenue Damages arising out of an Code or any similar state or insufficiency of funds to bcallaw' meet any obligations under U) Employment-Related arty plan included in the PrWUCes employee benefit program". Any liability arising out of (e) Inadequacy of Perform- any. ance of Investment f Ad- (1) Refusal to em vice Given With Respect PIoY: to Participation (2) Termination of em- Any claim based upon: Ployment; Includes copyrighted material of insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 3 of 16 (3) Coerciori, demotion, tors are insureds, but only evaluation, reassign- with respect to their duties ment, discipline, defa- as your officers or directors. mation, harassment, Your stockholders are also humiliation, discrimina- insureds, but only with re- tion or other empty- spect to their liability as ment-related practices, stockholders. acts or omissions; or (c) A trust, you are an insured. (4) Consequential liability Your trustees are also in- as a result of (1), (2) or sureds, but only with respect (3) above. to their duties as trustees. This exclusion applies (2) Each of the following is also an whether the insured may be insured: held liable as an employer (a) Each of your "employees" or in any other capacity and to any obligation to share who is or was authorized to damages with or repay administer your employee someone else who must benefd program . pay damages because of (b) Any persons, organizations the injury. or "employees" having (3) Supplementary Payments proper temporary authoriza- tion to administer your "em- SECTION I - COVERAGES, p1qyee benefit program" if SUPPLEMENTARY PAY- you die, but only until your MENTS - COVERAGES A AND legal representative is ap- B also apply to this Coverage. pointed. b. Who Is an Insured (c) Your legal representative If you die, but only with re- As respects Employee Benefit Liabil- spect to duties as such. ity Coverage, SECTION II - WHO IS That representative will AN INSURED is deleted in its entirety have all your rights and du- and replaced by the following: ties under this Coverage (1) If you are designated in the Dec- Pat larations as: (3) Any organization you newly ac- (a) An individual, you and your quire or form, other than a part- nership, joint venture or limited only with respect to the con- liability company, and over which duct of a business of which you maintain ownership or ma- you are the sole owner. jority interest, will qualify as a Named Insured if no other simi- (b) A partnership or joint ven- lar insurance applies to that or- ture, you are an insured. ganization. However, coverage Your members, your part- under this provision: ners, and their spouses are also insureds but only with (a) Is afforded only until the 180th day respect to the conduct of or after you acquire your business. or form the organization or the end of the policy period, (c) A limited liability company, whichever is earlier, and you are an insured. Your members are also insureds, (b) Does not apply to any act, error but only with respect to the or omission that was conduct of your business. committed before you ac- managers are insur- zquired or formed the organi- Your eds, but only with respect to ' their duties as your manag- c. Limits of Insurance ers. organization other than a As respects Employee Benefit Liabil- (d) An ity Coverage, SECTION III - UMITS partnership, joint venture or OF INSURANCE is deleted in its en- limited liability company, you tirety and replaced by the following: are an insured. Your "ex- ecutive officers" and direc- Includes copyrighted material of insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 4 of 15 (1) The Limits of insurance shown in amount stated in the Decla- Section B. Limits of Insurance, rations as applicable to 1. Employee Benefit Liability Each Employee. The Omits Coverage and the rules below of insurance shag not be re- fix the most we will pay regard- duced by the amount of this less of the number of deductible. (a) Insureds; (b) The deductible amount (b) Claims made or "suits" stated in the Declarations brought; applies to all damages sus- tained by any one "em- (c) Persons or organizations ployee". including such making claims or bringing "employee's" dependents "suits"; and beneficiaries, because of all acts, errors or omis- (d) Acts, errors or omissions; or sions to which this insur- (e) Benefits included in your ance applies. "employee benefit program (c) The terms of this insurance, (2) The Aggregate Limit shown in including those with respect Section B. Limits of Insurance, to: 9. Employee Benefit Liability 1) Our right and duty to Coverage of this endorsement is defend the insured the most we will pay for all dam- against any "suits" ages because of acts, errors or seeking those dam- omissions negligently committed ages; and in the "administration" of your "employee benefit program". 2 Your duties and the (3) Subject to the limit described in duties of any other in- (2) above, the Each Employee vow insured, in the Limit shown in Section B. Limits omission, event o an act, error or of Insurance, 1. Employee n, or claim. Benefit Liability Coverage of apply irrespective of the ap- this endorsement is the most we plication of the deductible will pay for all damages sus- amount tained by any one "employee", including damages sustained by We may pay any part or all such "employee's" dependents of the deductible amount to and beneficiaries, as a result of: effect settlement of any claim or "suit" and, upon no- (a) An act, error or omission; or tification of the action taken, (b) A series of related acts, er- you shall promptly reim- rors or omissions, regard- burse us for such part of the deductible amount as we less of the amount of time have paid. that lapses between such acts, errors or omissions, d. Additional Conditions negligently committed in the As respects Employee Benefit Li- "administration" of your "em- ability Coverage, SECTION IV - ployee benefit program". COMMERCIAL GENERAL LIABIL- However, the amount aid under CONDITIONS is amended as fol- P lows: this endorsement shall not ex- ceed, and will be subject to the (1) Item 2. Duties in the Event of limits and restrictions that apply Occurrence, Offense, Claim or to the payment of benefits in any Suit is deleted in its entirety and plan included in the "employee replaced by the following: benefit program". 2. Duties in the Event of an (4) Deductible Amount Act, Error or Omission, or (a) Our obligation to pay dam- Claim or Suit ages on behalf of the in- a. You must see to it that sured applies only to the we are notified as soon amount of damages in ex- as practicable of an act, cess of the deductible error or omission which Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 5 of 16 may result in a claim surance may also To the extent possible, apply. notice should include: d. No insured will, except (1) What the act, error at that insured's own or omission was cost. voluntarily make a and when it oc- payment, assume any curred: and obligation, or incur any (2) The names and consent without our addresses of any- one who may suf- (2) Item S. Other Insurance is de- fer damages as a leted in its entirety and replaced result of the act, by the following: error or omission. 5. Other Insurance b. If "suir a claim is made or If other valid and collectible any iisnsured, brought you must against insurance is available to the any insured for a loss we cover (1) Immediately re- under this Coverage Part. cord the specifics our obligations are limited of the claim or as follows: "suit" and the date received; and a. Primary Insurance (2) Notiry us as soon This insurance is Ari- as practicable. mary except when c. below applies. if this in- You must see to it that surance is primary, our we receive written no- obligations are not af- tice of the claim or fected unless any of the "suit" as soon as practi- other insurance is also cable. primary. Then, we will share with all that other c. You and any other in- insurance by the Yoh►ed insured must: method described in b. (1) Immediately send below. us copies of any b. Method of Sharing demands, notices, summonses or le- If all of the other insur- gal papers re- ance permits contribu- ceived in connec- tion by equal shares, lion with the claim we will follow this or "suit"; method also. Under this (2) Authorize us to ob- approach each insurer fain records and contributes equal amounts until it has other information; paid its applicable limit (3) Cooperate with us of insurance or none of in the investigation the loss remains, or settlement of whichever comes first. the claim or de- If any of the other in- fense against the surance does not per- "suit'; and mit contribution by (4) Assist us, upon equal shares. we will our request, in the contribute by limits. enforcement of Under this method, any right against each insurer's share is any person or or- based on the ratio of its ganization which applicable limit of in- may be liable to surance to the total ap- the insured be- plicable limits of insur- cause of an act, ance of all insurers. error or omission c. No Coverage to which this in- Includes copyrighted material of insurance GA 233 Olt 0910 Services office. Inc., with its permission. Page 6 of 16 This insurance shall not providing some or all of the cover any loss for following benefits to "em- which the insured is en- ployees", whether provided titled to recovery under through a "cafeteria plan" or any other insurance in otherwise: force previous to the ef- fective date of this a. Group life insurance; Coverage Part group accident or e. Additional Definitions heahh insurance; den- tal, vision and hearing As respects Employee Benefit Li- plans; and flexible ability coverage, SECTION V - spending accounts; DEFINMONS is amended as fol- provided that no one lows: other than an 'em- ployee" may subscribe (1) The following definitions are to such benefits and added: such benefits are made generally available to 1. "Administration" means: those "employees" who a. Providing information to satisfy the plan's eligi- "employees", including bility requirements; their dependents and b. Profit sharing plans, beneficiaries, with re- employee savings spect to eligibility for or plans, employee stock scope of benefit ployee ownership plans, pen- benefit plans and stock b. Interpreting the "em- subscription plans. pro- ployee benefit pro- vided that no one other grams"; than an "employee" may subscribe to such c. Handling records in benefits and such connection with the benefits are made gen- "employee benefit pro- erally available to all grams": or "employees" who are eligible under the plan d. Effecting, continuing or for such benefits; terminating any "errr ployee's" participation c. Unemployment insur- in any benefit included anee. social security in the "employee bene- benefits, workers' com- fit program". pensation and disability However. "administration" benefits; and does not include d. Vacation plans, includ- ing buy and sell pro- a. Handling payroll deduc- grams: leave of ab- tions; or sence programs, in- b. The failure to affect or cluding military, mater- maintain any insurance nity, family, and civil or adequate limits of leave; tuition assistance coverage of insurance, plans; transportation including but not limited and health dub subsF to unempto dies. yment in- surance. social security (2) The following definitions are de- benefits, workers' com- leted in their entirety and re- pensation and disability placed by the following: benefits. 21. "Suit" means a cM pro- 2. "Cafeteria plans" means ceeding in which money plan authorized by appfica- damages because of an act, ble law to allow "employees" error or omission to which to elect to pay for certain this insurance applies are benefits with pre-tax dollars. alleged. "Suit" includes: 3. "Employee benefit pro- a. An arbitration proceed- grams" means a program ing in which such dam- Includes copyrighted material of Insurance GA 233 OR 02 10 Services Office, Inc., with its permission. Pape 7 of 16 ages are claimed and The exclusions under SECTION to which the insured 1 - COVERAGES, COVERAGE must submit or does A. BODILY INJURY AND submit with our con- PROPERTY DAMAGE LIABIL- sent; ITY. 2. Exclusions, other than i. War and the Nucear Energy b. Any other alternative Liablilty Exclusion, are deleted dispute resolution pro- and the following are added: ceeding in which such damages are claimed This insurance does not appy to: and to which the in- sured submits with our (a) 'Property damage"; consent; or 1) Assumed in any con- c. An appeal of a civil pro- tract or ceeding. 2) Loss caused by or re- 8. "Employee" means a person suiting from any of the actively employed, formerly following: employed, on leave of ab- a) Wear and tear sence or disabled, or re- tired. "Employee' includes a b) Rust, corrosion, "leased worker'. "Employee" fungus, decay, de- does not include a "tempo- terioration. hidden rary worker". or latent defect or 2. Unintentional Failure to Disclose Haz- any quality i that arcs property that causes it to dam- SECTION IV - COMMERCIAL GENERAL age or destroy it- LIABILITY CONDITIONS, 7. Represen- self, tations is hereby amended by the adds c) Smog; tion of the following: Based on our de endence u on ur re d) Mechanical break- P P Yo p- down including resentations as to existing hazards, if un- rupture or bursting intentionally you should fail to disclose all caused by cen- such hazards at the inception date of your trifugal fiorce; policy, we will not reject coverage under this Coverage Part based solely on such e) Setting, cracking, failure. shrinking or ex- 3. Damage to Premises Rented to You pansion; or f) Nesting , or discharge a. The last Subparagraph of Paragraph Lion 2. SECTION I - COVERAGES, or release of waste COVERAGE A. - BODILY INJURY products or secre- AND PROPERTY DAMAGE. 2. U- tions, by insects, ABILITY Exclusions is hereby de- birds, rodents or leted and replaced by the following: other animals. Exclusions c. through q. do not apply (b) Loss caused directly or indi- to damage by fire, explosion, light- rectly by any of the follow- ning, smoke or soot to premises ing: while rented to you or temporarily oc- cupied by you with permission of the 1) Earthquake, volcanic owner. eruption, landslide or any other earth move- b. The insurance provided under SEC- ment; 71ON I - COVERAGES. COVERAGE A. BODILY INJURY AND PROP- 2) Water that backs up or ERTY DAMAGE LIABILITY applies overflows from a sewer, to "property damage" arising out of drain or sump; water damage to premises that are both rented to and occupied by you. 3) Water under the ground surface pressing on, or (1) As respects Water Damage Le- flowing or seeping gal Liability, as provided in Para- through: graph 3.b. above: Includes copyrighted material of insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 8 of 16 a) Foundations, one "occurrence" to which walls, floors or this insurance applies. paved surfaces; b) Basements, (3) The amount we will pay is limited as described in Section B. Lim- whetnot;hher paved or its °f Insurance. 3. Damage to Premixes Rented to You of this c) Doors, windows or endorsement other openings. 4. Supplementary payments (c) Loss caused by or resulting Under SECTION I - COVERAGE. SUP. from water that leaks or PLEMENTARY PAYMENTS - COVER- flows from plumbing, heat- AGES A AND B: ing. air conditioning, or fire protection systems caused a. Paragraph 2. is replaced by the fol- by or resulting from freezing, lowing: unless: Up to the limit shown in section B. 1) You did your best to Limits of Insurance, 4.a. Bail Bonds maintain heat in the of this endorsement for cost of bail building or structure; or bonds required because of accidents or traffic law violations arising out of 2) You drained the equip- the use of any vehicle to which the ment and shut off the Bodily Injury Liability Coverage ap- water supply if the heat plies. We do not have to furnish was not maintained. these bonds. (d) Loss to or damage to: b. Paragraph 4. is replaced by the fol- 1) Plumbing, heating, air lowing: conditioning, fire pro- All reasonable expenses incurred by tection systems, or the insured at our request to assist us other equipment or ap- in the investigation or defense of the pliances; or claim or "suit", including actual loss of 2) The interior of any earnings up to the limit shown in Sec- building or structure, or tion B. Limits of Insurance, 4.b. to personal property in Loss of Earnings of this endorsement the building or structure per day because of time off from caused by or resulting work from rain, snow, sleet S. Medical Payments or ice, whether driven by wind or not. The Medical Expense Limit of Any One Person as stated in the Declarations is c. Limit of insurance amended to the limit shown in Section B. The Damage to Premises Rented to Limits of Insurance, S. Medical Pay.. You Limit as shown in the Declara- meats of this endorsement tions is amended as follows: 6. Voluntary Properly Damage and Care, (2) Paragraph 6. Of SECTION III - Custody or Control Liability Coverage LIMITS OF INSURANCE is a. Voluntary Property Damage Cow hereby deleted and replaced by erage the following: We will pay for "property damage" to 6. Subject to g, above, the property of others arising out of op. Damage to Premises erations incidental to the insureds Rented to You Limit is the business when: most we will pay under COVERAGE A. BODILY (1) Damage is caused by the in- INJURY AND PROPERTY sured, or DAMAGE LIABILITY, for damages because of "prop- (2) Damage occurs while in the in- erty damage" to premises sured's possession. while rented to you or tem- With your consent, we will make porarily occupied by you these payments regardless of fautL with pemission of the owner, arising out of any Includes copyrighted material of Insurance GA 233 OR 09 1o Services Office, Inc, with its permission. Page 9 of 16 b. Care. Custody or Control Liability deductible amount as has been Coverage paid by us. SECTION I - COVERAGES, COW 7. 1811 Day Coverage for Newly Formed or ERAGE A. BODILY INJURY AND Acquired Organizations PROPERTY DAMAGE LIABILITY. 2. Exclusions, J. Damage to Property. SECTION II -WHO IS AN INSURED is Subparagraphs (3), (4) and (5) do not amended as follows: apply to "property damage" to the Subparagraph a. of Paragraph 4. is property of others described therein. hereby deleted and replaced by the fol- With respect to the insurance provided by lowing: this section of the endorsement, the fol- a, insurance under this provision is af- lowing additional provisions apply: forded only until the 180th day after a. The Limits of Insurance shown in the you acquire or form the organization Declarations are replaced by the lkn- or the end of the policy period, its designated in Section B. Limits of whichever is earlier; Insurance, & Voluntary Property 8. Waiver of Subrogation Damage and Care, Custody or Control Liability Coverage of this SECTION IV - COMMERCIAL GENERAL endorsement with respect to cover- LIABILITY CONDITIONS, 9. Transfer of age provided by this endorsement. Rights of Recovery Against Others to These limits are inclusive of and not Us is hereby amended by the addition of in addition to the limits being re- the following: placed. The Limits of insurance shown in Section B. Limits of insur- We waive any right of recovery we may ante, S. Voluntary Property Dam- have because of payments we make for age and Caro. Custody or Control injury or damage arising out of our ongo- Liability Coverage of this endorse- ing operations or "your work" done under ment fix the most we will pay in any a written contract requiring such waiver one "occurrence" regardless of the with that person or organization and in- number of cluded in the "products-completed opera- tions hazard". However, our rights may (1) Insureds; only be waived prior to the "occurrence" (2) Claims made or "suits" brought; giving rise to the injury or damage for which we make payment under this Cov- or erage Part The insured must do nothing (3) Persons or organizations making after a loss to impair our rights. At our re- claims or bringing "suits" quest, the insured will bring "suit" or trans- fer those rights to us and help us enforce b. Deductible Clause those rights. (1) Our obligation to pay damages 9, Automatic Additional Insured - Specl- on your behalf applies only to the fled Relationships amount of damages for each a. The following is hereby added to "occurrence" which are in excess of the deductible amount stated SECTION It -WHO IS AN INSURED: in Section B. Limits of insur- (1) Any person or organization de- ance, 6. Voluntary Property scribed in Paragraph 9.a.(2) be- Damage and Care. Custody or low (hereinafter referred to as Control Liability Coverage of additional insured) whom you are this endorsement. The limits of required to add as an additional insurance will not be reduced by insured under this Coverage Part the application of such dedudti- by reason of. ble amount. (2) Condition 2. Duties in the Event (a) me~ o contract or agree of occurrence, Offense, Claim or Suit, applies to each claim or (b) An oral agreement or con- "sult" irrespective of the amount tract where a certificate of We may art or all of the insurance showing that per- (3) Pay any p son or organization as an deductible amount to effect set additional insured has been tlement of any claim or "suit" issued, and. upon notification of the ac- tion taken, you shall promptly re- is an insured, provided: imburse us for such part of the includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc, with its permission. Page 10 of 16 (a) The written or oral contract or use of equipment leased or agreement is: to you by such person(s) or 1) Currently in effect or organizations(s). However, becomes effective dur- this insurance does not ap- ing the policy period; ply to any "occurrence" and which takes place after the 2 Executed prior to an equipment lease expires. "occurrence" or offense (c) Any person or organization to which this insurance (referred to below as ven- would apply, and dor) with whom you have agreed per Paragraph (b) They are not specifically 9.a.(1) above to provide in- named as an additional in- surance, but only with re- sured under any other pro- spect to "bodily injury or vision of or endorsement added to, this Coverage out of 'Your « products" which Part. are distributed or sold in the (2) Only the following persons or or- regular course of the ven- gan"tions are additional insur- dot's business, subject to eds under this endorsement, and the following additional ex- insurance coverage provided to elusions: such additional insureds is lim- 1) The insurance afforded ited as provided herein: the vendor does not (a) The manager or lessor of a aPPty to: premises leased to you with a) "Bodily injury" or whom you have agreed per %property damage" Paragraph 9.a.(1) above to for which the ven- provide insurance, but only dor is obligated to with respect to liability aris- pa damages b ing out of the ownership, reason of the as maintenance or use of that sumption of liability part of a premises leased to in a contract or you, subject to the following agreement This additional exclusions: exclusion does not This insurance does not ap- apply to liability for T ply his to damages that the vendor would have 1) Any "occurrence" which in the absence of takes place after you the contract or cease to be a tenant in agreement; that premises. b) Any express war- t) Structural alterations, ranty unauthorized new construction or by you: demolition operations performed by or on be- c) Any physical or half of such additional chemical change insured. in the product made intentionally (b) Any person or organization by the vendor, from which you lease d) Repackaging, ex- equipment with whom you cept when un- have agreed per Paragraph packed solely for 9.a.(1) above to provide in- the purpose of in- surance. Such person(s) or spection, demon- organization(s) are insureds, stration, testing, or but only to the extent that the substitution of the liability for bodily injury", parts under in- "proper y damage" or "per- Parts from the sonal and advertising injury" structions manufacturer, and is caused by your negw then repackaged Bence, acts or omissions in in the original con- the maintenance, operation twiner, Includes copyrighted material of Insurance GA 233 OR 09 10 Services office, Inc, with its permission. Page 11 of 16 e) Any failure to Part with respect make such inspec- to such products. tions, adjustments, (d) Any state or political sub& tests or servicing vision with which you have as the vendor has agreed per Paragraph agreed to make or normally under- 9.a.(1) above to provide in- takes to make in surance, subject to the fol- the usual course of lowing additional provision: business, in con- This insurance applies only nection with the with respect to the following distribution or sale hazards for which the state of the products; or political subdivision has Demonstration. in- issued a permit in connec- f) Demonstservicing tion with premises you own, stallatiost repair opera- rent or control and to which tions, except such this insurance applies: operations per- 1) The existence, mainte- formed at the ven- nance, repair, construc- dor's premises in tion, erection, or re- connection with moval of advertising the sale of the signs, awnings, cano- product; pies, cellar entrances, g) Products which, coal holes, driveways, after distribution or manholes, marquees, sale by you, have hoist away openings, been labeled or re- sidewalk vaults, street labeled or used as banners, or decorations a container, part or and similar exposures: ingredient of any other thing or sub- 2) The construction, erec- stance by or for tion, or removal of ele- the vendor, or vators: or h) "Bodily injury" or 3) The ownership, main- "property damage" tenance, or use of any arising out of the elevators covered by negligence, acts or this insurance. omissions of the vendor, its em- (e) Any state or political sub& ployees or anyone vision with which you have else acting on its agreed per Paragraph behalf. 9.a.(1) above to provide in- surance, subject to the fol- 2) This insurance does not lowing provisions: apply to any insured person or organization: 1) This insurance applies ) From whom only with respect to op- a) erations performed by have acquired you or on your behalf such products, or for which the state or any ingredient, political subdivision has part or container, issued a permit. entering into, ac- companying or 2) This insurance does not containing such apply to "bodily injury", products; or "property damage" or liability in- "personal and adverds- b) cl When ed within the ing injury" arising out of "products- for the state or political completed opera- subdivision. tions hazard" has been excluded un- (f) For "your work" performed der this Coverage in Oregon, any person or Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 12 of 16 organization with which you (a) Subparagraphs (e), (f) and have agreed per Paragraph (g) do not a d 9.a.(1) above to provide in- *Property p to "boilly in- surance, but only to the ex- jury" or damage" tent that the liability is included within the "prod- caused by your work" per- ucts-completed operations formed for that additional in- hazard"; sured and only to the extent (b) Subparagraphs (a). (d), (a) that such liability is caused and (g) do not apply to "bod- by your negligence or the illy injury". "property dam- negligence of those acting age" or "personal and ad- on your behalf. A person or vertising injury" arising out organization's status as an of the sole negligence or insured under this provision willful misconduct of the ad- of this endorsement contin- ditional insured or its "em- ues for only the period of ployees% or time required by the written contract or agreement. but Subparagraph M and (q) do in no event beyond the expi- not apply to "bodily injury". ration date of this Coverage "property damage" or "per- Part. If there is no written sonal and advertising injury" contract or agreement or if arising out oil: no period of time is required 1) The rendering of, or by the written contract or failure to render, any agreement, a person or or- professional services ganization's status as an in-by on sured under this endorse- half, y~ or your be- but only with ce- ment ends when your op- sped to either or both erations for that insured are completed. of the following opera- tions: (g) For your work" performed in the "coverage territory" a) Providing engi- ying but not in Oregon, any per- total nearing or . arc surveying son or organization with which you have agreed per services to others; Paragraph 2.a.(1) above to and provide insurance, but only b) Providing, or hiring with respect to liability aris- independent pro- ing out of "your work" per- fessionals to pro- formed for that additional in- vide, engineering, sured by you or on your be- architectural or half. A person or organiza- surveying services tion's status as an insured in connection with under this provision of this construction work endorsement continues for you perform only the period of time re- quired by the written con- 2) Subject to Paragraph 2) tract or agreement, but in no below, professional event beyond the expiration services include: date of this Coverage Part If there is no written contract a) Preparing, approv- or agreement, or if no period pre re fading to of time is required by the prepare or ap- written contract or agree- prove, maps, shop ment, a person or organ¢a- drawings, opin- tion's status as an insured ions, reports, orders, under this endorsement vet's, ~i o orders, ends when your operations change orders, or for that insured are drawings and com- pleted. specifications; and (3) Any insurance provided to an b) Supervisory or in- additional insured designated spection activities under Paragraph 9.a.(2): performed as part of any related ar- Includes copyrighted material of Insurance GA 233 OR 09 1o Services Office, Inc., with its permission. Page 13 of 16 91, 10 VL laud wissmad q 411M "aul `aaylp sa3was CL So ZIO EEZ V9 aauejnsul io leualew pa446wCdoa sapnlaul -eyed io swJ81 ay; aq IIEys luawasiopua sry; ';uawaaZe Jo 1:)B.4 JO3 /Cq paplAojd aouejnsw Kul( (q) uawm ;ey; uI pannb -aj f4le3ylaads sem 'a3uejnsul siyi ueyi ajypu;saj ajow ypM •sa.dde JanayalyM `6ul sI pajnsul leuog!ppe atp -;nquluomou jo /pue sm 01 paplnojd a6ejanoa -xa aq Ileys jv4od 93uejns jo svwll ay; aiayM pue -uI Jay;o vans pue 'pains -U{ leuorllppe a4; of panssl :.VoM jna1 . joi Nod a~uejnsui Jayio due a6ejaAoo apnlaul (E) spedsaJ se fuolnquluoauou jo -suogeia jo / pue fiewud sr aweJnsul -do palaldwoa joi slyl `iuawaoiBe J0 pe4uoa a6ejanoa apnlaul (Z) uamm a /(q paJlnbaJ aja4M (a) jo :E9 ZE :apnlau o; papuawe 97 jo Z9 Z£ 90 aaueunsul jaq;O 'S uo!vpuo7 (L) 'L9 ZE 97 jagwnu :sMolloi se papuawe Agajay uJJOi pajnsul leuog sI SNOWQNO3 unlern -1Va3 -lppe aaylp saalA -N39 1V1J213WW00 - Al NOLUMS -Jas aauejnsul 041Aq pap!Awd ag (L) •suogeimea ayi ul umoys aauejnsul io sllwq ayi of uogrppe :pajnsui leuoll ul iou pue io amsnlaul aye ameJns -Ippe ay; Joi a6eAAOa -u1 io silw!I ayl '1Jed aftano' slyl MR saylaads pajnsu! }o suogeM:)ad a4l w payloads asoy; leuol:pppe ayi pue noK aye pajnsul Ieuoruppe ayi o; algealld ua8h4aq juawao16e -de sllwll ay; 'luawaoiBe jo pe4uoa jo peAuoa uegjM a it uaAl ou sl ajay; it Jo 'luawaaj6e jCiuo anoge (1)(1)•e•g jo pejluoa uawm ayi ur paylaads aJe ydej6ejed w pagPs WIN ou iI -ssal We Jan84314M 'Ved -ap spajnsul Ieuog aBeJaAO:) SILO io suogejepaa a41 -lppe of padsaJ 41r.M 'e u! 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With respect to addi- 10. Broadened Contractual Llabillty -Work tional insureds de- Within 50' of Railroad Property scribed in Paragraph 9.a.(2)(g) above only. It is hereby agreed that Paragraph f.(1) of Definition 12. "Insured contract" (SEC- If a written contract or TION V - DEFINITIONS) is deleted. agreement between you and the additional 11. Property Damage to Borrowed Equip- insured specifies that ment coverage for the addi- a. The followi tionaJ insured: ng is hereby added to Ex- clusion J. Damage to Property of a. Be provided by the Paragraph 2., Exclusions of SEC- Insurance Ser- TION 1 - COVERAGES, COVERAGE vices Office addi- A. BODILY INJURY AND PROP- tional insured form ERTY DAMAGE LIABILITY: number CG 20 10 Para ra hs or CG 20 37 9 P (3) and (4) of this excfu- {where edition sion do not apply to tools or equip- ( specifi where or ment loaned to you, provided they are not being used to perform operations b. Include coverage at the time of foss. for completed op- b. With res p erations; or Pect to the insurance ro- vned by this section of the endorse- c. Include coverage ment, the following additional provi- for ")our work"; sions apply. and where the limits or (1) The Limits of insurance shown in coverage provided to the Declarations are replaced by the additional insured is the limits designated in Section more restrictive than B. Limits of Insurance, 11. of was specifically re- this endorsement with respect to quired in that written coverage provided by this en- contract or agreement, dorsement. These limits are in- the terms of Para- clusive of and not in addition to graphs 9.a.(3Xa), the limits being replaced. The 9.a.(3)(b) or 9.b. above, Limits of Insurance shown in or any combination Section B. Limits of Insurance, thereof, shall be inter- 11. of this endorsement fix the preted as providing the most we will pay in any one "oc- limits or coverage re- currence' regardless of the quired by the terms of number of the written contract or agreement, but only to (a) Insureds; the extent that such im- (b) Claims made or "suits" its or coverage is in- brought; or cluded within the terms of the Coverage Part to (c) Persons or organizations which this endorsement making claims or bring is attached. If, however, "suits". the written contract or Includes copyrighted material of insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 15 of 16 r ' (2) Deductible Clause a. Nurses; (a) our obligation to pay dam- b. Emergency Medical Technicians; or ages on your behalf applies only to the amount of dam- c. Paramedics, ages for each "occurrence" in the jurisdiction where an "occurrence" which are in excess of the or offense to which this insurance applies Deductible amount stated in takes place. Section S. Limits of Insur- ance, 11. of this endorse- 13. Broadened Notice of Occurrence ment. The limits of insur- ance will not be reduced by Paragraph a. of Condition 2. Duties In the application of such De- the Event of Occurrence, Offense, ductible amount Claim or Suit (SECTION IV - COMMER- CIAL GENERAL LABILITY CONDI- (b) Condition 2. Duties in the TIONS) is hereby deleted and replaced by Event of Occurrence, Of- the following: fense, Claim or Suit, ap- plies to each claim or "suit" a, You must see to it that we are notified irrespective of the amount as soon as practicable of an "occur- rence" or an offense which may result (c) We may pay any part or all in a claim To the extent possible, no- of the deductible amount to tice should include: effect settlement of any claim or "suit" and, upon no- (1) How, when and where the "oc- tdication of the action taken, currence" or offense took place; you shall promptly reim- (2) The names and addresses of burse us for such part of the any injured persons and wit- deductible amount as has nesses; and been paid by us. 12. Employees as Insureds - Specified (3) The nature and location of any injury or damage arising out of Health Care Services the "occurrence" or offense. It is hereby agreed that Paragraph This requirement applies only when 2.a.(1)(d) of SECTION 11 - WHO IS AN the "occurrence" or offense is known INSURED, does not appy to your "em- to an "authorized representative". ployees" who provide professional health care services on your behalf as duly li- censed: Includes copyrighted material of insurance GA 233 OR 09 10 Services office, Inc., with its permission. Page 16 of 16 Purchase Order V " i Fiscal Year 2018 Page: 1 of: 1 } il5 PL !NLjf i,BER-MUST APPEAR UN ALL B City of Ashland INVOICES AND SHIPPING' DOCUMENTS L 20 E. ATTN: Accounts Payable Purchase L Ashland, Main 20181167 Asand, OR 97520 Order # T Phone: 541/552-2010 O Email: payable@ashland.or.us V H C/O Engineering Division E COPELAND CONSTRUCTION, LLC 1 51 Winburn Way N 321 PRUETT ROAD D EAGLE POINT, OR 97524 P Phone: 541/488-5347 O O Fax: 541/488-6006 R o~ gn~N~am_ _ =-17 da u _ _ 13- i7ooll _ _ _ rv ers = _ 541 826-2314 _ Kevin Caldwell DAT-~~rdered WTMrpqW-l rg; _ = L?e~~r m:_entlL eafion _ 01/08/2018 742 FOB ASHLAND OR/NET30 Cit Accounts Pa able Item#= _ ft~r# -QJn~t P~iee Extended- Replace Waterline WTP 1 Remove cap and replace section of 24 inch waterline at the WTP, 1 $4,900.0000 $4,900.00 per the attached scope of work. Contract for Goods and Services Small Procurement Less than $5,000 Beginning date: January 1, 2018 Completion date: January 31, 2018 Project Account: E-201531-999 GL SUMMARY************* 081900 - 704200 $4,900.00 Ile By. Date: AW orized ignature O Total $4,900.00 FORM #3~ CITY OF ASHLAND REQUISITION ' ' Date of request: Jan 3, 2018 Required date for delivery: ASAP Vendor Name (n I;;n Constr ction I i r Address, City, State, Zip 321 ptt Rd Fagla Pnint OR 97524 Contact Name & Telephone Number ,,.,,,laod 541-826-1014 Email address~~ C""` ooelandronst IlcBearthlink net 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 # ❑ Verbal/Written quote(s) or proposal(s) -(Attach copy of council communication) ❑ State of Washington Intermediate Procurement ❑ Sole Source Contract # GOODS & SERVICES ❑ Applicable Form (#5,6, 7 or 8) ❑ Other government agency contract $5,000 to $100,000 ❑ Written quote or proposal attached Agency ❑ (3) Written quotes and solicitation attached ❑ Form #4, Personal Services $5K to $75K Contract # PERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement $5,000 to $75,000 ❑ Form #9, Request for Approval ❑ Agency ❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached Date original contract approved by Council: ❑ (3) Written proposals/written solicitation Date approved by Council: (Date) ❑ Form #4, Personal Services $5K to $75K Valid until: Date - (Attach copy of council communication) Description of SERVICES Total Cost Remove cap and replace section of 24inch steel waterline at the WTP, per the attached $4,900.00 scope of work. Item # Quantity Unit Description of MATERIALS- Unit Price Total Cost TOTAL COST ® Per attached quote/proposal $ Project Number 2015-31 Account Number 081900-704200 `Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department taapprove-all hardware and software purchases: IT Director Date Support -Yes /No By signing this requisition form 'fy that the City's public contracting requirements have been satisfied. Employee: a Department Head: (Equal to orgreater than $5,000) Department Manager/Supervisor: City Administrator (Equal to or greater than $25,000) Funds appropriated for current fiscal year YES / NO Finance Director- (Equal to or greater than $5,000) Date Comments: Form V - Reouisition