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HomeMy WebLinkAbout2018-021-Contract for Goods & Services - Bill's Glass Contract for GOODS AND SERVICES less than $25,000 C I T Y OF CONTRACTOR: Bill's Glass -ASHLAND CONTACT: Rick Gallagher/fa ~ e 5 k e&lv e S 20 East Main Street Ashland, Oregon 97520 ADDRESS: 2407 Siskiyou Blvd., Ashland, OR 97520 Telephone: 541 /488-6002 Fax: 541 /488-5311 TELEPHONE: 541-488-2500 DATE AGREEMENT PREPARED: 12/13/17 FAX: 541-488-3270 BEGINNING DATE: 7/1/2017 COMPLETION DATE: 6/30/2018 COMPENSATION: Per fee schedule attached as Exhibit C. GOODS AND SERVICES TO BE PROVIDED: Glass Repairs and Maintenance Services to be provided on an on-call or as needed basis including situations requiring immediate attention as determined by a representative of the Cite o'f Ashland for the remainder of FY18_ ADDITIONAL TERMS: In the event of conflicts or discrepancies among the contract documents, the City of Ashland Contract for Goods and Services will be primary and take precedence, and any exhibits or ancillary contracts or agreements having redundant or contrary provisions will be subordinate to and interpreted in a manner that will not conflict with the said prima Cit of Ashland Contract. NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the CITY AND CONTRACTOR AGREE as follows: 1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and expense, perform any work described above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance of such work. 2. Qualified Work: Contractor has represented, and by entering into this contract now represents, that any personnel assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are so registered, licensed and bonded. Contractor must also maintain a current City business license. 3. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no later than the date indicated above and start performing the work under this contract by the beginning date indicated above and complete the work by the completion date indicated above. 4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and expenses, the sum specified above. Payments shall be made within 30 days of the date of the invoice. Should the cor, sa m ted to date of termination. and expe ses of completed and ccepted i n Judi g al will be made for work contract under terminated, payments 00, unless a Compensaton separate written contract is entered into by the City. 5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of City. 6. Statutory Requirements: ORS 279B.220, 2796.225, 279B.230, 2796.235, ORS Chapter 244 and ORS 670.60 are made part of this contract. 7. Living Wage Requirements: If contractor is providing services under this contract and the amount of this contract is $20,688.86 or more, Contractor is required to comply with chapter 3.12 of the Ashland-Municipal Code by paying a living wage, as defined in this chapter, to all employees performing work under this contract and to any subcontractor who performs 50% or more of the work under this contract. Contractor is also required to post the notice attached hereto as Exhibit B predominantly in areas where it will be seen by all employees. 8. Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless from any and all losses, claims, actions, costs, expenses, judgments, subrogations, or other damages resulting from injury to any person (including injury resulting in death), or damage (including loss or destruction) to property, of whatsoever nature arising out of or incident to the performance of this contract by Contractor (including but not limited to, Contractor's employees, agents, and others designated by Contractor to perform work or services attendant to this contract). Contractor shall not be held responsible for any losses, expenses, claims, subrogations, actions, costs, judgments, or other damages, directly, solely, and proximately caused by the negligence of City. 9. Termination: a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties. b. City's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing and delivered by certified mail or in person. c. For Cause. Cit ma terminate or modi this contract, in whole or in art, effective u on delive of Contract for Goods and Services Less than $25,000, 06/19/2017, Page 1 of 5 . , .i~ , written notice to Contractor, or at such later date as may be established by City under any of the following conditions: i. If City funding from federal, state, county or other sources is not obtained and continued at levels sufficient to allow for the purchase of the indicated quantity of services; ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way that the services are no longer allowable or appropriate for purchase under this contract or are no longer eligible for the funding proposed for payments authorized by this contract; or iii. If any license or certificate required by law or regulation to be held by Contractor to provide the services required by this contract is for any reason denied, revoked, suspended, or not renewed. d. For Default or Breach. i. Either City or Contractor may terminate this contract in the event of a breach of the contract by the other. Prior to such termination the party seeking termination shall give to the other party written notice of the breach and intent to terminate. If the party committing the breach has not entirely cured the breach within 15 days of the date of the notice, or within such other period as the party giving the notice may authorize or require, then the contract may be terminated at any time thereafter by a written notice of termination by the party giving notice. ii. Time is of the essence for Contractor's performance of each and every obligation and duty under this contract. City by written notice to Contractor of default or breach, may at any time terminate the whole or any part of this contract if Contractor fails to provide services called for by this contract within the time specified herein or in any extension thereof. M. The rights and remedies of City provided in this subsection (d) are not exclusive and are in addition to any other rights and remedies provided by law or under this contract. e. Obligation/Liability of Parties. Termination or modification of this contract pursuant to subsections a, b, or c above shall be without prejudice to any obligations or liabilities of either party already accrued prior to such termination or modification. However, upon receiving a notice of termination (regardless whether such notice is given pursuant to subsections a, b, c or d of this section, Contractor shall immediately.cease all activities under this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination, Contractor shall deliver to City all contract documents, information, works-in-progress and other property that are . or would be deliverables had the contract been completed. City shall pay Contractor for work performed prior to the termination date if such work was performed in accordance with the Contract. 10. Independent Contractor Status: Contractor is an independent Contractor and not an employee of the City. Contractor shall have the complete responsibility for the performance of this contract. 11. Non-discrimination Certification: The undersigned certifies that the undersigned Contractor has not discriminated against minority, women or emerging small businesses enterprises in obtaining any required subcontracts. Contractor further certifies that it shall not discriminate in the award of such subcontracts, if any. The Contractor understands and acknowledges that it may be disqualified from bidding on this contract, including but not limited to City discovery of a misrepresentation or sham regarding a subcontract or that the Bidder has violated any requirement of ORS 279A.110 or the administrative rules implementing the Statute. 12. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an asbestos abatement license. 13. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be void. Contractor shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all persons employed by them, and the approval by City of any assignmentor subcontract shall nr)tcreate any contractual relation between the assignee or subcontractor and City. 14. Use of Recyclable Products: Contractor shall use recyclable products to the maximum extent economically feasible in the performance of the contract work set forth in this document. 15. Default. The Contractor shall be in default of this agreement if Contractor: commits any material breach or default of any covenant, warranty, certification, or obligation it owes under the Contract; if it loses its QRF status pursuant to the QRF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a QRF if Contractor has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has instituted against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing business on a regular basis of the type identified in its obligations under the Contract; or attempts to assign rights in, or delegate duties under, the Contract. 16. Insurance. Contractor shall at its own expense provide the following insurance: a. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide Oregon workers' compensation coverage for all their subject workers b. General Liability insurance with a combined single limit, or the equivalent, of not less than Enter one: $200,000, $500,000, $1,000,000, 2-D00 000 or Not Applicable 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 Enter one: $200,000, $500,000, $1,000,000, or Not Applicable for each accident for Bodily Injury and Property e, Contract for Goods and Services Less than $25,000, 06119/2017, Page 2 of 5 . , r _ - _ ~ ~ ~ r:, including coverage for owned, hired or non-owned vehicles, as applicable. d. Notice of cancellation or change. There shall be no cancellation, material change, reduction of limits or intent not to renew the insurance coverage(s) without 30 days' written notice from the Contractor or its insurer(s) to the City. e. Additional Insured/Certificates of Insurance. Contractor shall name The City of Ashland, Oregon, and its elected officials, officers and employees as Additional Insureds on any insurance policies, excluding Workers' Compensation, required herein but only with respect to Contractor's services to be provided under this Contract. As evidence of the insurance coverages required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to commencing work under this contract. The contractor's insurance is primary and non-contributory. The certificate will specify all of the parties who are Additional Insureds. Insuring companies or entities are subject to the City's acceptance. If requested, complete copies of insurance policies, trust agreements, etc. shall be provided to the City. The Contractor shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self-insurance. 17. Governing Law; Jurisdiction; Venue_ This contract shall be governed and construed in accordance with the laws of the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or proceeding (collectively, "the claim") between the City (and/or any other or department of the State of Oregon) and the Contractor that arises from or relates to this contract shall be brought and conducted solely and exclusively within the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the District of Oregon filed i;i Jackson County, Oregon. Contractor, by the sionature herein of its authorized representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this section be construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United States Constitution, or otherwise, from any claim or from the jurisdiction. 18. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT, MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT. CONTRACTOR, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND CONDITIONS. 19. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Contractor understands and agrees that City's payment of amounts under this contract attributable to work performed after the last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further liability to Contractor. 20. Prior Approval Required Provision. Approval by the City of Ashland Council or the Public Contracting Officer is required before any work may begin under this contract. 21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by reference. - - - Contractor: City of Ashland By n.... " By ignature Departm nt Head `J ci M e, ✓ f.S Print Name Print Name Gai;,~ gin"ar I I 1211S. Title D to W-9 One copy of a W-9 is to be submitted with the signed contract. Purchase Order No. ' Contract for Goods and Services Less than $25,000, 06119/2017, Page 3 of 5 EXHIBIT A CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified it that it is no longer subject to backup withholding. Contractor further represents and warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms, (c) the work under the Contract shall be performed in accordance with the highest professional standards, and (d) Contractor is qualified, professionally competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury that its business is not in violation of any Oregon tax laws, it is an independent Contractor as defined in the contract documents, it is authorized to do business in Oregon, it is authorized to act on behalf of the City, and Contractor has checked four or more of the following criteria that apply to its business. (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. L// (2) Commercial advertising or business cards or a trade association membership are purchased for the business. -L~ (3) Telephone listing is used for the business separate from the personal residence listing. (4) Labor or services are performed only pursuant to written contracts. (5) Labor or services are performed for two or more different persons within a period of one year. (6) 1 assume financial responsibility for defective workmanship or for service not provided as evidenced by the ownership of performance bonds, warranties, errors and omission insurance or liability insurance relating to the labor or services to be provided. n I"-)- Contractor (Date Contract for Goods and Services Less than $25,000, 06/19/2017, Page 4 of 5 _ I 1 1. _ CITY OF ASHLAND, OREGON EXHIBIT B City of Ashland LIVING, A -AGE per hour effective June 30, 2017 (Increases annually every June 30 by the Consumer Price Index) business of their and IRS eligible cafeteria employer, if the employer plans (including ' has ten or more childcare) benefits to the employees, and has amount of wages received financial received by the ➢ For all hours worked assistance for the project employee. under a service contract or business from the City between their employer of Ashland in excess of ➢ Note: "Employee" does and the City of Ashland if $20,688.86. not include temporary or the contract exceeds part-time employees $20,688.86 or more. ➢ If their employer is the hired for less than 1040 City of Ashland including hours in any twelve- For all hours worked in a the Parks and Recreation month period. For more month if the employee Department. details on applicability of spends 50% or more of this policy, please see the employee's time in ➢ In calculating the living Ashland Municipal Code that month working on a wage, employers may Section 3.12.020. project or portion of add the value of health care, retirement, 401 K For additional information: Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator, City Hall, 20 East Main Street, Ashland, OR 97520 or visit the city's website at www.ashland.or.us. Notice to Employers: This notice must be posted predominantly in areas where it can be seen by all employees. CITY OF ASHLAND Contract for Goods and Services Less than $25,000, 06/19/2017, Page 5 of 5 ,b1t C, 2407 SISKIYOU BLVD ~Xh ASHLAND OR 97520 0{ 541-488-2500 FAX-541-488-3270 g BILL'S GLASS SERVICE City of Ashland Schedule of Labor Rates Dec 15 2017-Dec 31 2018 Butler's Glass Service Inc. DBA Bill's Glass & Windshields. Cost per hour will be _$60.00_ *per hour per man for work scheduled within the hours of 8:00am-5:00 pm Monday through Friday. Cost per hour will be $120.00_ *per hour per man for work that is performed outside of the above hours or days. *Additional men may be needed on some repairs due to size or safety restrictions. This is the labor rate only, materials and equipment rental if needed are additional. After hours Boardups-$350.00 MINIMUM FOR LABOR AND MATERIALS- LABOR TO INCLUDE TRAVEL TIMES FROM MEDFORD New commercial construction projects are exempt from this pricing and will be bid on a per job basis. Sincerely, General Manager Bill's Glass & Windshields 319 E. McAndrews Rd. Medford, OR. 97501 541-773-5881 Page 1 of 1 r CERTIFICATE OF LIABILITY INSURANCE 1 OA 2/15/20 2017 12/1517 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: Thomas Xaldunaki Hart Insurance Agency - Medford PHONE VC. PO Box 1240 N EA I, (541) 779-4232 No: E-MAIL ADDRESS: Grants Pass OR 97528 INSURERSAFFORDINGCOVERAGE NAIC# INSURERA: Cincinnati Insurance Company 10677 INSURED (541) 773-5881 INSURER B: Cincinnati Specialty Onderwrit Butler's Glass Service Inc. Dba Advanced Glass INSURERC: Dba Bill's Glass INSURERD: 319 E McAndrews Road Medford OR 97501 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: Cert ID 2823 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 NUMBER POLICY TR IYYYY MMIDDNYY LIMITS D A X COMMERCUILGENERALUABILITY EACHOCCURRENCE $ 2,000,000 CLAIMS-MADE FxIOCCUR Y EPP 0374731 02/19/2017 02/19/2016 PREMISES Ea occurrence $ 500,000 MED Up (My one person) $ 10,000 PERSONAL&ADVINJURY $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE $ 4,000,000 POLICY ❑ PROJECTF] LOC PRODUCTS-COMP/OPAGG $ 4,000,000 OTHER: Empl Benefits Liab $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE OMIT $ Ea accident 1,000,000 A X ANY AUTO SEA 0374731 02/19/2017 02/19/2018 BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident B UMBRELLALIAB X OCCUR CS00086650 02/19/2017 02/19/2018 EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB CWMS-MADE AGGREGATE $ 11000,000 DED RETENTION$ $ PER TH- WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN STATUTE OR ANYPROPRIETOR/PARTNERIEXECUTIVE ❑ NIA E.L. EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED7 (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $ $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, AddiUonal Remarks Schedule, may be attached if more space is required) certificate holder is listed as additional insured per attached forme CA4720R and GA210 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. City of Ashland 90 N Mountain AUTHORIZED REPRESENTATIVE Ashland OR 97520 u ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Page 1 of 1 / 1 ® DATE (MMIDDIYYY) A`~ CERTIFICATE OF LIABILITY INSURANCE 12/15/2017 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: Kii Hart Insurance Agency - Medford PHONE ati R Dolma a FAX PO Box 1240 A/C N Ex (541) 779-4232 A/C No: E-MAIL ADDRESS: Grants Pass OR 97528 INSURERS AFFORDING COVERAGE NAIC # INSURERA: Cincinnati Specialty Underwrit INSURED (541) 773-5881 INSURER B: Butler's Glass Service Operations Inc. dba Advanced Glass INSURER C: dba Bill's Glass INSURER D: 319 E McAndrews Medford OR 97501 INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: Cert ID 2824 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 ADDL SUBR POLICY NUMBER MPOLICY EFF POLICY EXP M/DD/YYYY MMIDDIY YY LIMITS LTR A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR Y CSU0079916 02/19/2017 02/19/2018 PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL S ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO F LOC PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OT WORKERS EMPLOYERS' LIABILITY Y I N STATUTE ER ANYPROPRIETOR/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 $ $ $ DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) certificate holder is listed as additional insured per attached forms CSGA4032 and waiver CSGA4087 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. City of Ashland 90 N Mountain AUTHORIZED REPRESENTATIVE Ashland OR 97520 YU(G~~/~E I- I ©19988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT l This endorsement modifies insurance provided under the following: COMMERCIAL. GENERAL LIABILITY COVERAGE PART A. Endorsement - Table of Contents. Cho er49e: Bgains on Pane: 1. Employee Benefit Liability Coverage ...............................................2 2. Unintentional Failure to Disclose Hazaids ........................................_..............._........_............7 3. Damage to Premises Rented to You ....._.............................................-.......7 4. Supplementary Payments 9 5. Medical Payments ...._............................................................9 6. 180 Day Coverage for Newly Formed or Acquired Organizations 9 7. Waiver of Subrogation ............................................._........................9 8. Automatic Additional Insured - Specified Relationships: 9 • Managers or Lessors of Premises; • Lessor of Leased Equipment; • Vendors: and • State or Pokical Subdivisions - Permits Relating to Premises 9. Property Damage to Borrowed Equipment i2 10. Employees as Insureds - Specified Health Care Services: ..12 • Nurses; • Emergency Medical Technicians; and • Paramedics 11. Broadened Notice of Occurrence 12 B. Limits of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorsement, except as provided below. 1. Employee Benefit Liability Coverage Each Employee Limit: $ 1,000,000 Aggregate Limit: $ 3.000,000 Deductible: $ 1,000 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. Suppk4nentary Payments a. Ball bonds: $ 1,000 b. Loss of earnings: $ 350 5. Miedcal Payments Medical Expense Limit. $ 10,000 9. Property Damage to Borrowed Equipment Each Occurrence Limit: $ 10,000 Deductible: 3 250 GA 210 02 07 Page 1 of 12 C Coverages a) kkrr You wf~ not have 8e of a 1. Employee Benefit tiabilityCoverage daim or'suft' on or before the effective a. The following Is added to SECTION I date of this en- - COVERAGES: Employee Benefit dorsement. Liability Coverage. You will be (1) Insuring Agreement deemed to have (a) We will pay those sums that kedge of a the insured becomes legally when any "author- obligated to pay as damages ~ caused by any act, error or fiver omission of the Insured, or of any other person for h Reports all, or whose ads the insured is le- - - any part, of the gaily liable, to which this in- act, error or surance applies' We will omission to us have the right and duty to or any other defend the Insured against insurer, any "suit" seekng those damages. However, we will 11) Receives a have no duty to defend written or ver- againsl any 'suit seeking bal demand or damages to which this In- claim for dam- surence does not apply. We ages because may, at our discretion, Imes- of the act, er- tigate any report of an ad, - ror or omis- error or omission and settle sign; and any claim or'suir that may result. But: b) There is no other 1) The amount we will pay anoD. icable insur- for damages is limited as described in SEC. (2) Exclusions TION Iii - ILIMITS ; and OF This insurance does not apply to: INSURANCE; and INSURANCE; 2) Our right and duty to de a Bodily fend ends when we Dam 8a or Personal and have used up the appli- Advertising Injury cable limit of insurance "Bodily hjur/. "ppperty, In the payment of judg- damages or 'personal and menu orsettlements. advertisirg kluy, No other obligation or liability (y) Dishonest, Free to pay sums or perform ads Criminal or Malicious Act or services is covered unless explicitly provided for Damages arising out of any under Supplementary Pay- Intentional, dishonest, manta, fraudulent, criminal or mail- (b) This insurance applies to dous act, error or omission. committed by any insured, damages only if the ad, or- Including the willful or reck- ror or omission. Is negli- less violation of any statute. gently committed In the 'administration' of your 'am. (c) Failure to Perform a Con- ployse benefit program"; and tract 1) Occurs during the policy Damages arising out of fai- peno(t or ure of performance of con- 2) Occurred prior to the ef- tract by arty insurer. festive date of this en- (d) Insufficiency of Funds dorsement provided: Damages arising out of an insufficiency of funds to GA 210 02 07 Page 2 of 12 i meet any obligations under Employment-Related Prac- any plan included in the tic" "employee benefit program". Any liability arising out of (e) Inadequacy of Perform- any: ance of Investment / Ad- vice Given With Respect (1) Refusal to employ; to Participation (2) Termination of employ- Any claim based upon: ment; 1) Failure of any invest- (3) Coercion, demotion, ment to perform; evaluation, reassign- ment, discipline, deta- 2) Errors in providing in- mation, harassment, formation on past per- humiliation, discrtmina- formance of investment Lion or other employ- vehicles; or ment-related practices, ads or omissions; or 3) Advice given to any person with respect to (4) Consequential liability that person's decision to as a result of (1), (2) or participate or not to par- (3) above. ticipate in any plan in- cluded in the "employee This exclusion applies benefit program'. whether the insured may be held liable as an employer or (f) Woriters' Compensation in any other capacity and to and Similar Laws any obligation to share dam- Anyclaim arising out of your ages with or repay someme else who must pay damages failure to comply with the because of the injury. mandatory provisions of any workers' compensation, un- (3) Supplementary Payments employment compensation SECTION I - COVERAGES, insurance, social security SUPPLEMENTARY PAYMENTS disability benefits law or any y similar law, - COVERAGES A AND B also apply to this Coverage. (g) ERISA b. Who is an Insured Damages for which arty in- sured is liable because of Ii- As respects Employee Benefit Liability ability imposed on a fiduciary Coverage, SECTION II - WHO IS AN by the Employee Retirement INSURED is deleted in its entirety and Income Security Act of 1974, replaced by the following: as now or hereafter amended, or by any similar (1) If you are designated in the Dec- ions a9 federal, state or local laws. larat (h) Available Benefrtts (a) An individual, you and your spouse are insureds, but Any claim for benefits to the only with respect to the con- extent that such benefits are dud of a business of which available, with reasonable you are the sole owner. effort and cooperation of the (b) A partnership or joint ven- insured, from the applicable tore, you are an insured. funds accrued or other col- Your members, your part- lectibte insurance. ners, and their spouses are (l) Taxes, Fines or Penalties also insureds but only with respect to the conduct of Taxes, fines or penalties, in- your business. duding those imposed under the Internal Revenue Code (C) y limited liability company, or any similar state or local you are an insured. Your law. members are also insureds, but only with respect to the conduct of your business. Your managers are insur- GA 210 02 07 Page 3 of 12 eds, but only with respect to G Limits of Insurance their duties as your manag- ers. As respects Employee Benefit Liability ers. Coverage, SECTION DI - UMiTS OF (d) An organization other than a INSURANCE Is deleted in its entirety partnership, joint venture or and replaced by the following: limited liabilityd. ompany, you are an insured. Your Your 'ex- (1) The Limits of Insurance shown in ecutive oflirers" and direc- Section B. Limits of Insurance, tors are insureds, but only I. Employee Benefit Liability with respect to their duties Coverage and the rules below fa as your officers or directors. the most we will pay regardless Your stockholders are also of the number d: Insureds, but only with re- (a) Insureds: sped to their liability as stockholders. (b) Clams made or "suits" (e) A trust, you are an insured. brought; Your trustees are also Insur- (c) Persons or organizations eds, but only with respect to making claims or bringing their duties as trustees. •sufte" (2) Each of the follaving is also an (d) Acts, errors or omissions; or insured: (a) Each of your "employees" (e) emploloyinducted in your mee benefit program*. who is or was authorized to administer your "employee (2) The Aggregate Limit shown in benefit program". Section B. Limits of Insurance, (b) Any persona organizations 1, Employee Benefit LiabDity Coverage of this endorsement is or 'employees having the most we will pay for all dam- proper temporary authoriza- ages because of ads, errors or lion to administer your "em- omissions negligently committed ployee benefit program" If in the administretion" of you you die, but only until your "employee benefit program`. legal representative is ap- pointed. (3) Subject to the limit described in (c) Your legal representative if (2) above the Each Employee you die, but only with respect Limit shown in Insurance, Section 1. B Limits Uobl 1. Employee to duties as such. That rep- Benefit Uabil resentative will have all your this endorsem nt is the most a of we rights and dudes under this will pay for ad damages sus- Coverage ParL taired by any one "employee", ",(3), Any organization you newly ao- including damages sustained by quire or form, other than a part- such "employee's dependents nerahip, joint verdure or limited and beneficiaries, as a result d: liability company. and over which (a) An act, error or omission; or you maintain ownership or major- Ity interest, will qualify as a (b) A series of related ads, er- Named Insured If no other similar rom or omissions, regard Insurance applies to that organi- less of the amount of time zadm._ However, coverage un- that lapses between such der this provision ads, errors or omissions, ! (a) Is afforded only until the negligently committed in the i IBM day after you acquire "adminilstradon" of your •em- or form the organization or ployee benefit program". the end of the policy period. However, the amount paid under winikihever is earlier; and this endorsement shall not ex- i (b) Does not apply to any ad, Deed, and wig be subject to the error or omission that was limits and restrictions that apply committed before you ac- to the payment of benefits in any quired or formed the orgard plan included in the "employee zation, benefit program'. GA 210 02 07 Page 4 of 12 i i r ' (4) Deductible Amount a. You must see to it that (a) Our obligation to pay dam- we are notified as soon ages on behalf of the in- as practicable of an act, sured applies only to the error or omission which amount of damages in ex- may result in a claim cars of the deductible To the extent possible, amount stated in the Deda- notice should include: rations as applicable to Each (1) What the act, error Employee. The limits of in- or omission was surance shall not be reduced and when it oc- by the amount of this de- curred; and dudible. (2) The names and (b) The deductible amount addresses of ary- stated in the Declarations one who may suf- applies to all damages sus- fer damages as a tained by any one "em- result of the act, er- ployee", induding such 'em- ror or omission. ployee's" dependents and benefidaries, because of all b. If a claim is made or acts, errors or omissions to "suit" is brought against which this insurance applies. any insured, you must: (c) The terns of this insurance, (1) Immediately record including those with respect the specifics of the to: claim or "suit" and the date received; 1) Our right and duty to de- and fend the insured against any "suits" seeking (2) Notify us as soon those damages; and as practicable. 2) Your duties, and the du- You must see to it that des of any other in- we receive written no- volved insured, in the tice of the claim or 'suit" event of an act, error or as soon as practicable. omission, or claim, c. You and any other in- apply irrespective of the ap- volved insured must: plication of the deductible ~ (1) Immediately send us copies of any (d) We may pay any part or all demands, notices, of the deductible amount to summonses or le- effect settlement of any gal papers re- claim or "suit and, upon no- calved In connec- tification of the action taken, tion with the claim you shall promptly reimburse or "suit'; us for such part of the de- (2) Authorize us to ot - dudible amount as we have twin records and paid. other information; d. Additional Conditions (3) Cooperate with us As respects Employee Benefit U. in the Investigation ability Coverage, SECTION IV - or settlement of the COMMERCIAL GENERAL LIABIL" claim or defense ITY CONDITIONS Is amended as fol- against the "suit; kma and (1) Item 2. Duties in the Event of (4) Assist us, upon our Ocewence, Offense, Claim or request, in the en- Suit is deleted in Its entirety and forcement of any replaced by the followirxj right against any 2. Duties in the Event of an zaatiionn whichr may Act, Error or Omission, or be liable to the in- Claim or Suit sured because of GA 210 02 OT Page 5 of 12 an act, error or c. No Coverage omission to which this insurance may This insurance shall not also apply. cover any loss for which the insured is entitled to d. No Insured will, except recovery under any at that insureds own other insurance In force cwt, voluntarily make a previous to the effective payment, assume any date of this Coverage obligation, or incur any Part. expense without our consent. e. Additional Definitions (2) Item S. Other Insurance Is de- As respects Employee BeneM Li- Ieted in its entirety and replaced abillty Coverage, SECTION V by the fbHoMng: DEFT IONS is amended as follows 5. Other Insurance (1) The following definitions are added: If other valid and collectible insurance is available to the 1. "Adrriristratiorf'rreans insured for a loss we cover a. Prodding Information to under this Coverage Part, "employeed', Including our obligations are limited as their dependents and follows beneficiaries, with re- a. Primary Insurance spect to eligibility for or This Insurance is scope of "employee mary except when e. benefit progrems"; belowapplies. IfWsii- b. Interpreting the "em- suanw is primary, our ployee benefit pro- obligations are not af- grants`, fatted unless any of the c. Handling records In other insurance is also primary. Than, we will *employee connection banwith ebenefit the share with all that other 'emplo pro- Insurance by the "rams'; or method described In b. d. Effecting, continuing or below. terminating any em- b. Method of Sharing ployea's" participation in any benefit included in If all of the other Insur- the "employee benefit ante pamdts corddbu- progm°. tion by equal shares, we However, 'admIr"relioW wilt follow this method does not include: also. Under this ap- proach each Insurer a. Handling payroll deduc- contributes equal tions; or ' amounts until it has paid Its applicable limit of In. b. The failure to effect or surarrw or none of the maintain any insurance loss remains, whichever or adequate limits of comes first coverage of insurance, including but not limited If any of the other insur- to unemployment Insur- anoe does not permit ance, social security contribution by equal benefits, workers' corn- snares. we we will =ddb- pensation and disability ute bylimhs. Under this benefits, method, each insurer's scan: is based on the 2. "Cafeteria plane means ratio of Its applicable plans authorized by apWka- limit of insurance to the de law to alloy"employees;' total applicable limits of to elect to pay for certain insurance of all insur- benetitswith pre-tax dollars. ers. GA 210 02 07 Page 6 of 12 i I t 3. 'Employee benefit pro- ages are claimed and to grains" means a program which the insured must providing some or all of the submit or does submit folk awing benefits to "em- with our consent; ployse . vwtwther provided ftnugh a "cafeteria plarf or b. Any other alternative otherwise: dispute resolution pro- ceeding in which such a. Group life insurance; damages are claimed group accident or health and to which the insured insurance; dental, vision submits with our con- and hearing plans; and sent; or flexible spending ac- counts; provided that no c. An appeal of a civil pro- one other than an *em- ceeding• ployee" may subscribe 8. "Employee" means a person to such benefits and actively employed, fomner ly such benefits are made employed on leave of ab. generally available to senoe or disabled. or retired. those "employees" who Employee" includes a satisfy the plan's eligloil- leased worker' "Ern- ity requirements; ployee" does not include a b. Profit sharing plans,yworkier"• employee savings 2. Unintentional Fallum to Disclose Haz- plans, employee stock ards ownership plans, pen- sion plans and stock SECTION IV - COMMERCIAL GENERAL subscription plans, pro- LIABILITY CONDITIONS, 7. Representa- vided that no one other tions is hereby mended by the addition than an "employee' may of the following: subscribe to such bene- fits and such benefits Based on our dependence upon your rep- are made generally resentations as to existing hazards, if un- available to all "employ- intentionally you should fail to disclose all eee who are eligible such hazards at the inception date of your under the plan for such policy, we will not reject coverage under benefits; this Coverage Part based solely on such failure. c. Unemployment insur- ance, social security 3. Damage to PrentSes Rented to You benefits, workers' corn- a. The last Subparagraph of SECTION I pensation and disability - CMMV0M COVERAGE A benefits, and BODILY INJURY AND PITY d. Vacation plans, induct- DAMAGE LIAR LITY, I Eodusions ing buy and sell pro- is hereby deleted and replaced by the grams; leave of ab- folloWng: sence programs, indud- Exclusions c. through q. do not apply Ing military, matemity, to damage by fire, explosion, light- family, and civil leave; ping, smoke or soot to premises while tuition assistance plans; rented to you or temporarily occupied transportation and by you with permission of the owner. health club subsidies. (2) The following definitions are de- b. The insurance provided under SEC- leted in their entirety and re- TION I - CCM3VMA COVE placed by the following: A BODILY INJURY AND PROP- ERTY DAMAGE LIABILITY applies 21. "Suit" means a civil proceed- to "property damage" arising out of ing in which money dam- water damage to premises that are ages because of an act, er- bolt rented to and occupied by you. ror or omission to which this (1) As respects Water Damage Le- insurance applies are al- gal Liability, as provided in Para- teged. ,.Soft" irdudes graph 3.b. above: a. An arbitration proceed- ing in which such dam- GA 210 02 07 Page 7 of 12 The exclusions under SECTION 1 a) Foundations, walls, - COVERAGES, COVERAGE A. floors or paved sur- BODILY INJURY AND PROP- faces; ERTY DAMAGE LIABILITY, 2. Exclusions, other than 1. Vim b) Basements, and the Nuclear Energy Liabih whether paved or ity Exclusooe are deleted and not or thefdloWngareaddad: c) Doors, windows or This irsuaiwe does not apply tD: other openings. (a) "Property da age": (c) Loss caused by or resulting from water that leaks or 1) Assumed in any con- flows from plumbing, heat- tract, or ing, air conditioning, or fire 2) Loss caused by or re protection systems caused suiting from any of the by unle resulting from freezing. Wooing: ss' Wear and tear; 1) You did your bast to a maintain heat in the b) Rust, corrosion, building or structure; or fungus, decay, de- 2) You drained the equip- terioration, hidden ment and shut off the or talent defect or water supply if the heat any quality in prop- was not maintained. arty that causes it to damage or de- (d) Loss to or damage to. stroy Itself. 1) Plumbing, healing, air c) Smog; conditioning, fire protect d) Mechanical break- tion systems, or other eor appll- equipment including rup- anoes; cs;or ture or bursting caused by cen- 2) The interior of any build- ' trifugal force; Ing or structure. or to e) Settling, packing, bu9~ ngd or ire structure shrinking or ex- caused by or resulting pansion; or from rain, snow, steel or f) Nesting or infests- Ice, whether driven by tfon, or discharge wind or noL or release of waste c. Urnit of Insurance products or seas- - I tions, by insects, The Damage to Premises Rented to birds, rodents or You Limit as shorn In the Dedare- other animals. lions is amended as follows: (b) Loss caused directly or Ind- (2) Paragraph 6. of SECTION 111 - racily by any of ft fdlowing: LIMITS OF INSURANCE is 1) Earthquake, volcanic hereby deleted and replaced by the eruption, landslide or fdbnAng any other earth move- 6. Subject to 5. above, the ment; Damage to Prenises 2) Water that backs up or Rented to You Limit is the rnost overflows from a sewer, COVERAAGE A. w BODILY under IN- drain or sump; COVERAGE JURY AND PROPERTY TY 3) Water under the ground DAMAGE LIABILITY for surface pressing on, or damages because of 'prop- flowing or seeping arty damage" to premises through: while rented to you or tem- porariy ooeupled by you with permission of the owner, arising out of any one -oc- GA 210 02 07 Page 6 of 12 , i! I r currence" to which this in- Us Is hereby amended by the addition of suranoe applies. the fdIowing: (3) The amount we will pay is limited We waive any right of recovery we may as described in Section B. Limits have because of payments we make for of Insurance. 3. Damage to injury or damage arising out of your ongo- Premises Rented to You of this ing operations or "your work" done under a endorsement. written contract requiring such waiver with 4. Supplementary Payments that person or organization and Included in the "products-ccimpleted operations hax- Under SECTION I - COVERAGE SUP- ard". However, our rights may only be PLEMENTARY PAYMENTS - COVER- warved pnor to the "occurrence" giving rise AGES A AND B: to the injury or damage for which we make 2. is payment under this Coverage Part. The a. Paragraph replaced by the fol- insured must do nothing after a loss to im- lowing pair our rights. At our request, the insured LIP to the limit shown in Section B. will !ring "suit" or transfer those rights to Limits of Insurance, 4.a. Sail Bonds us and help us enforce those rights. of this endorsement for cost of bail S. Automatic Additional Insured - Sped. bonds required because of accidents fled Relationships or traffic law violations arising out of the use of any vehicle to which the a. The following is hereby added to Bodily Injury Liability Coverage ap- SECTION II - WHO IS AN INSURED: plies. We do not have to furnish (1) Any person or organization de- these bonds. scribed in Paragraph 8.a.(2) bo- b. Paragraph 4. is replaced by the fd- low (hereinafter referred to as loving additional insured) whom you are required to add as an additional All reasonable e)penses InQured by Insured under ths Coverage Part the Insured at our request to assist us by reason of in the investigation or defense of the claim or, "suit , including actual loss of (a) A written contract or agree- eamings up to the fimit shown In Sao- merit; or tion B. Limits of Insurance, 4.b. (b) An oral agreement or con- Loss of Earnings of this endorsement tract where a certificate of per day because of time off from Insurance showing that per- work• son or organization as an 5. Medical Payments additional insured has been issued, The Medical Emgmense Limit of Any One Person as stated In the Declarations is is an insured, provided: amended to the limit shown in Section B. (a) The written or oral contract Limits of Insurance, 5. Medical Pay- or agreement is: merit of this andomement. 1) Currently f effect or 6. 180 Da Coverage for Newty Formed or becomes effective dur- Acquired Organiaat'ons ing the policy period; iod; SECTION N -WHO IS AN INSURED Is and amended as follows: 2) Executed prior to an Subparagraph a. of Paragraph 4. Is hereby "occurrence" or offense deleted and replaced by the following: to which this insurance would apply; and a. Insurance under this provision is af- forded only untl the 180th day after you acquire or form the organization named as an additional in- or the end of the policy period, which- sured under any other provi- ever is earlier, sion of, or endorsement added to, this Coverage 7. Waiver of Subrogation Part. SECTION IV - COMMERCIAL GENERAL (2) Only the following persons or or- LIABILITY CONDITIONS, 9. Transfer of garrzations are additional Insur- Rights of Recovery Against Others to eds under this endorsement, and insurance coverage provided to GA 210 02 07 Page 8 of 12 i such additional insureds is Gm- a) "Bodily injury" or iced as provided herein: "property damW (a) The manager or lessor of a for Is ooWito van-to gated premises leased to you with pay darnages by whom you have agreed per reason of the as~ Paragraph e.a.(1) above to strrption of liability provide Insurances, but only in a contract or with respect to liability aris- agrheernert. This ing out of the ownership, exclusion does rat maintenance or use of that apply to liability, for part of a premises leased to damages that the you, subject to the following vendor would have additional excluslons: In the absence of This insurance does not ap- the contract or ply la- agreement; 1) Any "occurrence" which b) Any express war- takes place after you ranty unauthorized cease to be a tenant in by you; that premises. c) Any physical or 2) Structural alterations, chemical change in new construction or the product made demolition operations Intentionally by the performed by or on be- vendor; hall of such additional d) Repadoaging, un- insured. less unpacked (b) Any person or organization solely for the pur- from which you loose pose of Inspection, equipment with whom you demonstration, have agreed per Paragraph testing, or the sub- 8.a.(1) above to provide In- stitution of parts surance. Such person(s) or under instructions agan'izatim(s) are insureds from the manufac. solely with rasped to their fi- turer, and then re- ability, arising out of the packaged in the maintenance, operation or original container; use by you of equtMwd e) Any failure to make leased to you by such per- such Inspect-ions, son(s) or organization(s). adjustments, tests However, this insurance or servicing as the does not apply to any 'tom vendor has agreed c rrenoe" which takes place to make or nor- after the equiprnorrt Wass malty undertakes expires to make in the (c) Any person or organization usual course of (referred to below as vendor) business, In con- with whom you have agreed nedion with the per Paragraph 8.a.(1) above distribution or sale to provide Insurance, but of the products; only with rasped to "bodily f) Demonstration. In- injury' or "properly damage stallation, servicing arising outof*your producis' or repair opera- witirh are distributed or sold tiors, except such in the regular course of the operations per- vendor's business, subject to formed at the ven. the following additional ex- dots premises in elusions: connection with the 1) The Insurance afforded sale of the product; the vendor does not ap- ply a g) Products which, af- ter distribution or i sale by you, have i GA 210 02 07 Page 10 of 12 i been labeled or re- elevators covered by labeled or used as this insurance. a container, part or ingredient of any (3) Any insurance provided to an ad- other thing or sub- ditional Insured designated under stance by or for the Paragraph 8.a.(2) Subpara- vendor. graphs (a), (b) and (d) does not 2j This insurance does not apply to "bodly Injury; "property darnaW or personal and adver_ apply to any insured tising W arising person or organization safe out of the e negligence or willful Msoon- a) From whom you dud of the additional insured or have acquired their agents, employees" or any such products, d other representative of the addf_ or Insured. any ingredient, part troned or container, enter- b. SECTION IV - COMMERCIAL GEN- ing into, accompa- ERAL LIABILITY CONDITIONS is nying or containing hereby amended as Wlows: such products; or Condition 5. Other Insurance Is b) When liability in- arnended to include: cluded within the 'products- (1) Where required by a written con- completed opera- tract or agreement, this insur- tions hazard" has ance is primary and / or noncon- been excluded un- tributory as respects any other der this Coverage insurance policy issued to the Part with respect to additional Insured, and such such products. other insurance policy shall be excess and / or noncontributing, (d) Any state or political subdivi- whichever applies, with this in- sion with which you have surance. agreed per Paragraph 8.&(1) above to provide in- (2) Any insurance provided by this suiance, subject to the fd- endorsement shall be primary to III lowing additional provision: other insurance available to the additional insured except; This insurance applies only with respect to the folio-wing (a) As otherwise provided in hazards for vvhich the state SECTION IV - COMMER- or political subdivision has CIAL GENERAL LIABILITY issued a permit in connec- CONDITIONS, 5, Other In- tion with premises you own, sumnee, b. Excess Insur- rent or control and to vvtdch anoe; or Oft inmxenoe applies. (b) For any other valid and coi- l) The existence, mainte- leetible insurance available nance, repair, construc- to the additional insured as tion. erection, or re- an additional Insured b at- moval of advertising tachment of an endorsement signs, awnings, carom- to another Insurance policy pies, cellar entrances, that is written on an excess coal holes, driveways, basis. In such case, the manholes. marquees, overage provided under hoist away openings, this endorsement shall also sidewalk vaults, street be excess. banners, or decorations 9. Property Damage to Borrowed Equip- and similar exposures; or 2) The construction, area a. The following is hereby added to Ex- ton, or removal of ele- chrsion vators; or Paragraph 2 Dama to , EExxcclusions of SEC- TION I - CWUtAGES, C 3) The ownership, maints- A BODILY INJURY AND PROP- nance, or use of any ERTY DAMAGE LIABILITY. GA 210 02 07 Page 11 of 12 Paragraphs (3) and (4) of this exclu- effect settlement of any sion do not apply to tools or equip- claim or'suir and, upon no- ment loaned to you, provided they are tificalbn of the action taken, not being used to perform operations you shall promptly reimburse at the fine of loss. us for such part of the de- b. With respect to the Insurance pro- ductible amount as has been vided by this section of the endorse- paid by us. ment, the following additional provi- 10. Employees as insureds - Specified sion apply. Health Care Services (1) The Limits of Insurance shown in It Is hereby agreed that Paragraph the Declarations are replaced by 2.a(1xd) of SECTION If - WHO IS AN the limits designated In Section INSURED does not apply to your *am- B. Limits of Insurance, 9. ployeW Nta provide professicnal health Property Damage to Borrowed care services on your behalf as duty 11- Equipment of this endorsement eensect with' respect to coverage pro- vided by this endorsement a. Nurses; These limits are inclusive of and b. Emergency Mechcal Technk:lons: or not In addition to the limits being replaced. The Limits of Inur- c. Paramedics, anoe shown in Section B. Limits in the jurisdiction where an 'occumance' of to Borrowed Equipment o or offense to which this insurance applies this endorsement fix the most we lakes place. will pay in any one occurrence' 11. Broadened Notice of Occurrence regardless of the number of: (a) Insureds Paragraph a. of SECTION IV - COM- MERCIAL GENERAL LIABILITY CONDI- (b) Claims made or -suits' TIONS, 2. Duties In the Event of Occur- brought; or rence, Offence, Claim or Suit is hereby deleted and replaced by the following (c) Persons or organizations making claims or bring a. You must see to it thetwe ere notified 'suits". as soon as predicable of an "oaour- renoe" or an offense which may result (2) Deductible Clause in a claim. To the extend possible, no- (a) Our obligation to pay dam- rice should include: ages on your behalf applies (1) How, when and where the 'oo- only to the amount of dam- currence' or offense took place; ages for each 'occurrence' which are in excess of the (2) The names and addresses of any ; deductible amount staled in injured persons and witnesses. Section B. Limits of Incur- ad arse, 9. Properly Damage (g) The nature and location of any In- to Borrowed Equipment of jury or damage arising out of the this endorsement The limits 'oeourrence'oroffense. of Insurance will not be to. duced by the application of This requirement applies only when such deductible an o mt. the -occurrence' or offense is known (b) SECTION IV - COMMER- to on -authorized representative'. CIAL GENERAL LIABILITY CONDITIONS, 2. Dirties In the Event of Occurrence, Offence, Claim or Suit, ap- plies to each claim or "soft' Irrespective of the amount. (c) We may pay any part or all of the deductible amount to i GA 210 02 07 Page 12 of 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OREGON AUTOMATIC ADDITIONAL INSURED - WHEN REQUIRED IN CONTRACT OR AGREEMENT WITH YOU This endorsement modiiies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. For "your work" performed in Oregon: 1. Automatic Additional Insured Pro- 1. SECTION 11- WHO IS AN INSURED, 2. Is vision amended to Include: The written or oral contract or agree- s. Any person or organization, hereinaf- ment must be currently in effect or become is Coverage during the term of ter referred to as ADDITIONAL. IN- th SURED: this Coverege Part. The contract or agreement also must be executed (1) Who or which Is not specifically prior to the "bodily Injury", "property named as an additional insured damage" or "personal and advertising under any other provision of, or injury" to which Inis endorsement per- endorsement added to, this tains. Coverage Part; and 2. Conformance to Spedfic Written (2) For whom you are required to Contract or Agreement add as an additional insured on If a written contract or agreement be- this Coverage Part tween you and the additional insured under specifies that coverage for the addi- tional insured: (1) A written contract or agreement; or a. Be provided by the Insurance Services Office additional in- (2) An oral agreement or contract sured form number CG 32 01, where a certiflcate of Insurance CG 32 62 or CO 32 63, or showing that person or organiza- tion as an additional insured has b. Include coverage for completed been Issued. operations; or but only to the extent that the liability c. Include coverage for "your work"; is caused by your work' performed and where the limits or coverage pro- for that additional Insured and only to vided to the additional Insured is the extent that such liability is caused more restrictive than was speciticagy by your negligence or the negligence required in that written contract or of those acting on your behalf. A per- son or organization's status as an in- agreement, the terms of Paragraphs sured under this endorsement con- lion A3. and / thereof. f, of this endorsement or any she- tinues for only the period of time re- be d t as his providing fcing the shah he limits quired by the written contract or interpreted agreement, but in no event beyond or coverage required by the terms of the expiration date of this Coverage the written contract or agreement, but only Part. If there is no written contract or coverage ra ~ the is extent Included that thsuch in emits s agreement, or If no period of time Is rage Part to the t this of the Coverage Part to which this required by the written contract or endorsement Is attached agreement, a person or organiza- tion's status as an insured under this 3. SECTION 111- LIMITS OF INSURANCE is endorsement ends when your opera- amended to Include: tions for that insured are completed. The limits applicable to the additional in- 2. SECTION IV -COMMERCIAL GENERAL sured are those specified in the written LIABILITY CONDITIONS Is amended to contract or agreement or in the Declara- include: tions of this Coverage Part, whichever are less. if no limits are specified in the written contract or agreement, or If there is no includes copyrighted material of Insurance i GA 472 OR 0910 Services Office, Inc., with its permission. Page 1 of 4 written contract or agreement, the limits the 'products-completed operations applicable to the additional Insured are hazard`. those specified in the Declarallona of this Coverage Part The limits of insurance 6 "Badly injury" or 'property damage" arising out of "yourworW for which a are Inclusive of and not In addition to the limb of Insurance shown in the Declare- consolidated (wrap-up) Insurance Bons. program has been provided by the prime contractor / project manager or 4. The fdlowirg ere added to SECTION I - owner of the construction project In COVERAGES, COVERAGE A. BODILY which you are Involved. IN ABILITY, JURY AND PROPERTY DAMAGE U- S. SECTION IV -COMMERCIAL COVERACOVERAGEGES, , COVERAGE andRAGE SECTION B B. . PER- - LIABILITY CONDITIONS, 5. Other in- SONAL AND ADVERTISING INJURY surancce Is amended to include: LUIBDJTY, 2. Exclusions: a, r The Insurance provkled to the additional= f n r Insured does not apply to; a. 'Bodily Injury'. 'property damage" or a r, "personal and advertising injuy arcs- Ing out of the: (1) Rendering of, or failure to ran. der, any professional services by you or on your behalf, but only b. Any Insurance provided by this en- with reaped to either or both of domement shall be primary to other thefdhowing operations: Insurance available to the additional a) Providi insured except ( ng engineering, er- chiteclural or surveying sar- (1) As otherwise provided in SEC. vices b others; and TION N - COMMERCIAL GEN- (b) Providing or hiring inde- ERALLJABILITYCONDITIONS. pendent professionals to S. Otter Insurance, b. Excess provide, engineering, arcr& Insurance; or tedural or surveying aer- (2) For any other valid and oollecti- vices In connection with ble insurance available to the construction work you per- additional Insured as an addr- form. tlonal Insured by attachment of (2) Subject to Paragraph (3) below, an endorsement to another in- professlonal services include: seance polity that is written on an excess basis. In such case, (a) Preparing, approving, or fan- the coverage provided underthls Ing to prepare or approve, endorsement shall also be ex- maps, shop dranJngs, opin- cess.. - w Ions, reports, surveys, field B. For "your work perfonnad in the "coverage orders, change orders. or territory' but not In Oregon: drawings and specifications; and 1. SECTION II -WHO ISM INSURED, 2. is (b) Supervisory or Inspection amended to Include: activifies performed as part o. Any person or organization, hereinaf- of any related amhdectural ter referred to as ADDITIONAL IN- or engineering acthrfiies. SURED: (3) Professional services do not in- (1) who or which Is not specifically dude services within canstruo- reamed as an additional insured tion means, methods, tech- under any other provision of, or niques, sequences and proce- endorsement added to, this dures employed by you in oon- Coverage Part; and nectbn with construction work q) For whom you are required to perform. you ( add as an additional insured on b. "Bodily injury- or "property damage" this coverage Part arising out of your work" included In under. i Includes copyrighted material of Insurance GA4T2 OR 0810 Services Office, Inc., with ft pemtsslon. Page 2 of 4 (1) A written contract or agreement; B.3., BA b. and I or 0.4.c., or any or combination thereof, of this an- (2) An oral agreement or contrail dorsement shall be interpreted as where a certificate of insurance providing the limits or ooverage re- showing that person or organize- quired by the terms of the written tion as an additional Insured has contractor agreement, but only to the been issued; extent that such limits or coverage is Included within the terms of the Cov- but only with respect to liability arising erage Part to which this endorsement out of "your work° performed for that is attached. If, however, the written additional insured by you or on your contract or agreement specifies the behalf. A person or organization's Insurance Services Office additional status as an insured under this en- Insured form number CG 20 10 but dorsement continues for only the pe- does not specify which edition, or riod of time required by the written spedfies an edition that does not ex- contr°act or agreement, but in no ist, Paragraphs B.3. and BA.b. of event beyond the expiration date of this endorsement shall not apply and this Coverage Part. If there is no writ- Paragraph BA.c. of this endorsement ten contract or agreement, or if no shall apply. period of time is required by the writ- 3. SECTION 1111 - LIMITS OF INSURANCE is ten contract or agreement, a person amended to include: or organizations status as an insured under this endorsement ends when The limits applicable to the additional in- your operations for that Insured are sured are those specified in the written completed. contract or agreement or in the Declare- 2. SECTION IV - COMMERCIAL GENERAL dons of this Coverage Part, whichever are LIABILITY CONDITIONS Is amended to less. If no limits are spedfied In the written include: contract or agreement, or if there is no written contract or agreement, the limits 1. Automatic Additional Insured Pro- applicable to the additional insured are vision those specified in the Declarations of this Coverage Part. The limits of insurance The written or oral contract or agree- are inclusive of and not In addition to the ment must be currently in effect or limits of insurance shown in the Dedara- become effective during the term of tions. this Coverage Part. The contract or 4. The following are added to SECTION ! - agreement to the 'also must be executed COVERAGE, COVERAGE A. BODILY prior r ge" th w bodily "personal inju and ry", 'property INJURY AND PROPERTY DAMAGE L11- damage" injury" ABILITY, 2 Exclusions and SECTION I - jury" to which ich this this endorsement per- tains. COVERAGES, COVERAGE B. PER- SONAL AND ADVERTISING INJURY 2. Conformance to SpecNlc Written LIABILITY, 2 Exclusions: Conbwt or Agreement The insurance provided to the additional If a written contract or agreement be- insured does not apply to: tween you and the additional insured i specifies that coverage for the addi- a. Bodily injury", "property damage" or tlonal Insured: 'personal and advertising injury' arcs- Ing out of the: a. Be provided by the Insurance Services Office additional in- (1) Rendering of, or failure to ren- srred form number CO 2010 or der, any professional services by CG 20 37 (where edition sped- you or on your behalf, but only fied); or with respect to either or both of the following operations; b. Include coverage for completed operations; or (a) Providing engineering, ar- Inducts coverage chltectural or surveying ser- C. for "your worK; vices to others; and and where the limits or coverage pro- (b) Providing or Wring Inds- vided to the additional insured is pendent professionals to more restrictive than was specifically provide, engineering, arcW- required in that written contract or tedural or surveying ser- agr+eement. the terms of Paragraphs vices in connection with Includes copyrighted material of Insurance GA 472 OR 0910 Services Of ics, Inc., with its permission. Page 3 of 4 I construction work you per- program has been provided by the form. prime contractor! project manager or (2) Subject to Paragraph (3) blow, owner of the construction project In which professional services include: you are involved. (a) Preparing, approving, or fah- S. SECTION IV - COMMERCIAL GENERAL In to prepare v approve, LIABILITY CONDITIONS, S. Other In- maps, shop drawings, opfn suratttm is amended to include: Ions, reports, surveys, field a. Where required by a written contract orders, change orders, or or agreement this Insurance is pri- drawings and specifications: mary and / or nonoontributory as re- and spells any other Insurance policy is- (b) Supervisory or inspection sued to the additional insured, and s ry performed r In as part such other insurance policy shall be auperv of any related architecture] part excess and / or nonconhibuting, orengineerirgactivitiea whichever applies, with this inscr- anoe. (3) Professional services do not In- b. Any insurance provided by this en- clude services within condruc- dorsement shell be primary to other den means, methods, tech- Insurance available to the additional niques, sequences and proce. Insured except: dures employed by you in con- nection with construction work (1) As otherwise provided in SEC- you perform. TION IV - COMMERCIAL GEC- b. 'Bodily iMury", property damage' or ERAL LIABRM CONDITIONS. "personal and advertising injury' arW InOther Insurance, b Excess Ing cut of the sole negligence or will- nsurance: or ful misconduct of, or for defects In (2) For any other valid and coilecd- design fumes by, the additional In- bte insurance available to the suredorIts'emptoyeaO. additional Insured as an addl- . "Bodily Injury" or "property damage finnan insured by attachment of arising out of your wnrk" Included In an endorsement another In- the "products-complated operations a policy y that t is written on an n excess basis. In such one, hazard". the coverage provided under this d Badly Injury" or "property damage' endorsement shall also be ex- arising out of "your work" for which a Casa• consolidated (wraP-up) Insurance i 1 i i Includes copyrighted material of Insurance GA472 OR 0910 SerAoes Office, inc., with Its permission. Page 4 of 4 i r COMMERCIAL GENERAL LIABILITY CSGA 4032 06 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED i SCHEDULED PERSON OR ORGANIZATION - COMPLETED OPERATIONS ONLY (LIMITED) This endorsement modifies insurance provided under the following: PRODUCTS / COMPLETED OPERATIONS LIABLrTY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or ftanization(s): As Required by Written Contract. A. SECTION II - WHO IS AN INSURED is other because of damages arising out of amended to indude as an additional insured such injury, any person or organization shown in the schedule, but only with respect to "bodily in- 4. "Bodily injury' or "property damage" for jury" or "property damage" caused by 'your which the Named Insured Is afforded no wait" performed for the additional insured and coverage under this policy of Insurance. included in the "products-completed opera- C. With respect to the Insurance afforded to tions hazard". Chase additional Insureds, SECTION III - LIM- B. With respect to the insurance afforded to ITS OF INSURANCE is amended to Include: these additional Insureds, the following adds- The limits tonal exclusions apply; applicable to the additional insured are those specified In any written contract or This insurance does not apply to: agreement or In the Declarations of this Cov- erage Part, whichever Is Ion. If no limits are 1. "Bodily injury' or "property damage arising specified in any written contract or agreement. out of the rendering of, or the failure to the limits applicable to the additional insured render, any professional architectural, en- are those specified in the Declarations of this gineering or surveying services, including: Coverage Part. The limits of Insurance are Irr- a. The preparing, approving, or failing to clusive of and not in addition to the limits of in- I prepare or approve, maps, shop $ce shown in the Declarations. drawings, opinions, reports. surveys, D. With rasped to the insurance afforded to the- field orders, change orders or draw- se additional Insureds, SECTION IV - COM- ings and specifications, or MERCIAL GENERAL LIABILITY CONDI- b. Supervisory, inspection, architectural TiONS, 4.Other Insurance is amended to in- or engineering activities, dude: 2. 'Bodily Injury' or "property damage" arts- Any coverage provided herein will be excess ing out of 'yaur worm' for whlefi a le" art r- over any other valid and collectible insurance avalWe the add4onal insured whether dated (wrap-up) Insurance program has primary, , excess. contingent been provided by the prime contractor / basis prim unless . eorrtagree or on any other project manager or owner of the construc- you have agreed in a written con- tionproject in which you are involved. trail or written agreement executed prior to any loss that this insurance will be primary. 3. "Bodily injury' or'propetty damage" to any This insurance will be noncontributory only if employee of you or to any obligation of you have so agreed in a written contract or the additional insured to Indemnity an- written agreement executed prior to any loss and this coverage is determined to be primary. r Includes copyrighted material of insurance i CSGA 4032 0612 Services Office, Inc, with its permission. Page 1 of I COMMERCIAL GENERAL LIABILITY CSGA 40871212 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - PER CONTRACT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART The following Is added to Paragraph 8. Transfer of Rights of Recovery Against Others lo Us of SECTION IV " CONDITIONS: If you have agreed, in a written contract or agreement, to provide a waiver of any right of recovery against a person or organization, we will waive any right of recovery we may have against that person or organization because of payments we make for ir4ury or damage arising out of your ongoing operations or your work" done under a contract with that person or organization and included in the 'products-completed operations hazard". This waiver applies only to that person or organization for which you have agreed to in a written contract to provide said waiver. s Includes copyrighted material of Insurance CSGA 40871212 Services Office, Inc., with Its permission. Page 1 of 1 f r 905384 A N~ BesowmMmogemmt Cnmpmry December28,2017 BUTLER'S GLASS SERVICE INC 319 E MCANDREWS RD MEDFORD, OR 97501 Re: Barrett Business Services, Inc. ("BBSI") Letter of Self-Insurance for Workers' Compensation Coverage As the named addressee of this Letter, your company's required workers' compensation coverage is provided through BBSI's state approved Self-Insured Workers' Compensation Plan byway of your co-employment contract with BBSI. Additional information is as follows: State: Oregon Workers' Compensation Limits:. Emolovar u4bility Limits: Self Insurance Certification 1068 Statutory $5,000,000:00 Each Accident $5 000,000.00 Disease Coveraqe Limit by Client $5,000,000.00 Disease; Each Employee Other Comments (place an "X" if applicable)EKNamed "Letter Holder": The City of Ashland 90 N Mountain Ave Ashland, OR 97520 FX Other. This letter of self-insurance for workers' compensation replaces Acord form 25. Contract effective 111/16, renewed through 12/31118. Subject to 30 days' notice of cancellation. Additionally, BBSI's self-insured program is further supported by an excess workers' compensation insurance policy with ACE American Insurance Co.: Copy of certificate is available upon request. For additional information, please contact your local IBBSI office at: MEDFORD (541) 772-5469 3512 Excel Drive Suite 107 Very ytruly yours, ~J Medford, OR 97504 Michael L. Elich President and Chief Executive Officer doc: LOST-2 Purchase Order Fiscal Year 2018 gage: 1 of: 1 OW® _THIS PO NUMBER MUST APPEAR ON ALL INVOICES, AND SHIPPING DOCUMENTS. B City of Ashland L ATTN: Accounts Payable Purchase 20181165 L 20 E. Main Order # Ashland, OR 97520 T Phone: 541/552-2010 O Email: payable@ashland.or.us V H C/O Facilities Maintenance Div E BILL'S GLASS & WINDSHIELDS I 90 North Mountain Ave N 2407 SISKIYOU BLVD P Ashland, OR 97520 D ASHLAND, OR 97520 Phone: 541/488-5358 R TO Fax: 541/552-2304 1Zendor Phone Numfser _[~n~or am sc J~:quis~tr`~rL-c- O~~taFefernce , = - 541 488-2500 David Arnold F qulred= a R1enULoeation Date Ordered Vendor Numbef R 01/03/2018 114 _ FOB ASHLAND OR CIt Accounts Pa able Item#er ttirr~-fr1_ _ =rree :Extended Price=: Glass Repairs & Maintenance 1 Glass repair and maintenance services to be provided on an as 1 $4,500.0000 $4,500.00 needed basis, including situations requiring immediate attention as determined by a representative of the City of Ashland for the remainder of FY 2018. Contract for Goods and Services less than $25,000 Beginning date: 07/01/2017 Completion date: 06/30/2018 Project Account: GL SUMMARY 082400 602400 $4,500.00 By: Date: 0, AuthorizedSidnature PO Total $4,500. FORM#3 rN~cc CITY of -ASHLAND REQUISITION Date of request: 12/27/2017 Required date for delivery: Vendor Name Bill's Glass Address, City, State, Zip 2407 Siskiyou Boulevard Ashland OR 97520 Contact Name & Telephone Number Rick Gallagher (541)488-2500 FAX: (541)488-3270 Fax Number SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form #13, Written findings and Authorization Date approved by Council: ❑ Written quote or proposal attached ❑ AMC 2.50 ❑ Written quote or proposal attached ® Small Procurement Cooperative Procurement Less than $5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon ® Direct Award Date approved by Council: Contract # ❑ Verbal/Written quote(s) or proposal(s) ❑ State of Washington Contract # Intermediate Procurement ❑ Sole Source ❑ Other government agency contract GOODS & SERVICES ❑ Applicable Form (#5,6, 7 or 8) Agency $5,000 to $100,000 ❑ Written quote or proposal attached Contract # ❑ (3) Written quotes and solicitation ❑ Form #4, Personal Services $5K to $75K Intergovernmental Agreement attached 171 Agency PERSONAL SERVICES ❑ Special Procurement Date original contract approved by Council: $5,000 to $75,000 ❑ Form #9, Request for Approval (Date) ❑ Less than $35,000, by direct ❑ Written quote or proposal attached appointment Date approved by Council: ❑ (3) Written proposals/written solicitation El Form #4, Personal Services $5K to $75K Valid until: (Date) Description of SERVICES Total Cost Glass Repairs and Maintenance Services to be provided on an on-call or as needed basis including situations requiring immediate attention as determined by $ 4,500.00 a representative of the City of Ashland for the remainder of FY18 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST ® Per attached quote/proposal Project Number _ _ _ _ _ _ - _ _ _ Account Number 082400-602400 Account Number Account Number "Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: IT Director Date Support -Yes /No By signing this requisition form, I~c~ertify that the City's public contracting requirements have been satisfied. _ aT Department Head Signature: Employee Signature _ ~ to (Eq ~ reaer than $5,000) City Administrator: @ org (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: