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2018-058-Personal Services Agmt-Applied Geotechnicall Engineering & Geologic Consulting
PERSONAL SERVICES AGREEMENT $25,000.00 or less CONSULTANT: Applied Geotechnical Engineering & Geologic Consulting CITY or -ASHLAND CONSULTANT'S CONTACT: Robin Warren, PE, GE, RG 20 East Main Street Ashland, Oregon 97520 ADDRESS: 1314-B Center Drive #452, Medford, OR 97501 Telephone: 541-488-6002 Fax: 541-488-5311 TELEPHONE: 541-226-6658 EMAIL: robin.warren@agegc.com This Personal Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and Applied Geotechnical Engineering ("hereinafter "Consultant"), for geotechnical services for lower Beach Creek bank repair and stabilization. NOW THEREFORE, in consideration of the mutual covenants contained herein, the City and Consultant hereby agree as follows: 1. Effective Date and Term: This Agreement shall become effective on the date of execution on behalf of the City, as set forth below (the "Effective Date"), and unless sooner terminated as specifically provided in Section 11, shall terminate upon the City's affirmative acceptance of Consultant's Work as complete and Consultant's acceptance of the City's final payment therefore, but not later than October 1, 2018. 2. Scope of Work: Consultant shall provide geotechnical engineering services for bank repair and stabilization in North Mountain Park, as more fully set forth in Consultant's Scope of Work dated March 25, 2018, which is attached hereto as "Exhibit A" and incorporated herein by this reference. Consultant's services are collectively referred to herein as the "Work." 3. Compensation: City shall pay Consultant the sum of 5130/hr. for time and materials as full compensation for Consultant's performance of all Work under this Agreement. In no event shall Consultant's total of all compensation and reimbursement under this Agreement exceed the sum of $10,000 without the express, written approval from the City official whose signature appears below, or such official's successor in office. Payments shall be made within thirty (30) days of the date of receipt by the City of Consultant's invoice. Should this Agreement be terminated prior to completion of all Work, payments will be made for any phase of the Work completed and accepted as of the date of termination. 4. Supporting Documents/Conflicting Provisions: This Agreement and any exhibits or other supporting documents shall be construed to be mutually complimentary and supplementary wherever possible. In the event of a conflict between this Agreement and the supporting documents which cannot be resolved, the provisions of this Agreement shall control over any conflicting provisions in any of the exhibits or other supporting documents. Page 1 of 6: Personal Services Agreement with Applied Geotechnical Engineering & Geologic Consulting 5. All Costs Borne By Consultant: Consultant shall, at its own risk and expense, perform the Work described above and, unless otherwise specified in this Agreement, furnish all labor, equipment, and materials required for the proper performance of such Work. 6. Qualifications: Consultant has represented, and by entering into this Agreement now represents, that all personnel assigned to the Work to be performed under this Agreement are fully qualified to perform the service 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. 7. Ownership of Work/Documents: All Work product or documents produced in furtherance of this Agreement belong to the City, and any copyright, patent, trademark proprietary or any other protected intellectual property right shall vest in and is hereby assigned to the City. 8. Statutory Requirements: The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 27913.220, 27913.230 and 27913.235. 9. Living Wage Requirements: If the amount of this Agreement is $20,688.86 or more, Consultant is required to comply with Chapter 3.12 of the Ashland Municipal Code by paying a living wage, as defined in that chapter, to all employees performing Work under this Agreement and to any Subcontractor who performs 50% or more of the Work under this Agreement. Consultant is also required to post the notice attached hereto as "Exhibit B" predominantly in areas where it will be seen by all employees. 10. Indemnification: Consultant shall defend, save, hold harmless and indemnify the City and its officers, employees, and agents from and against any and all claims, suits, actions, losses, damages, liabilities, costs, and expenses of any nature resulting from or arising out of, or relating to the performance of any Work pursuant to this Agreement by Consultant (including but not limited to, Consultant's employees, agents, and others designated by Consultant to perform Work or services under this Agreement). However, Consultant shall not be held responsible for any losses, expenses, claims, subrogations, actions, costs, judgments, or other damages, caused solely by the negligence of City. 11. Termination: a. Mutual Consent. This Agreement may be terminated at any time by the mutual consent of both parties. b. City's Convenience. This Agreement may be terminated by City at any time upon not less than 30 days' prior written notice delivered by certified mail or in person. C. For Cause. City may terminate or modify this Agreement, in whole or in part, effective upon delivery of written notice to Consultant, 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 Agreement or are no longer eligible for the funding proposed for payments authorized by this Agreement; or Page 2 of 6: Personal Services Agreement with Applied Geotechnical Engineering & Geologic Consulting iii. If any license or certificate required by law or regulation to be held by Consultant to provide the services required by this Agreement is for any reason denied, revoked, suspended, or not renewed. d. For Default or Breach. i. Either City or Consultant may terminate this Agreement in the event of a breach of the Agreement by the other. Prior to such termination the party seeking termination shall give to the other party written notice of the breach and its intent to terminate. If the party committing the breach has not entirely cured the breach within fifteen (15) days of the date of the notice, or within such other period as the party giving the notice may authorize in writing, then the Agreement 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 Consultant's performance of each and every obligation and duty under this Agreement. City by written notice to Consultant of default or breach may at any time terminate the whole or any part of this Agreement if Consultant fails to provide services called for by this Agreement within the time specified herein or within any extension thereof. iii. The rights and remedies of City provided in this subsection (d) are not exclusive and are in addition to any other rights and remedies provided by law or under this Agreement. e. Obligation/Liability of Parties. Termination or modification of this Agreement 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 Subsection a, b, c, or d of this section, Consultant shall immediately cease all activities under this Agreement, unless expressly directed otherwise by City in the notice of termination. Further, upon termination, Consultant shall deliver to City all Agreement documents, information, works-in-progress and other property that are or would be deliverables had the Agreement been completed. City shall pay Consultant for Work performed prior to the termination date if such Work was performed in accordance with this Agreement. 12. Independent Contractor Status: Consultant is an independent contractor and not an employee of the City for any purpose. Consultant shall have the complete responsibility for the performance of this Agreement. Consultant shall provide workers' compensation coverage as required in ORS Chapter 656 for all persons employed to perform Work pursuant to this Agreement. 13. Assignment: Consultant shall not assign this Agreement 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. Consultant shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all persons employed by them, and the approval by City of any assignment or subcontract of the Work shall not create any contractual relation between the assignee or subcontractor and City. 14. Default. The Consultant shall be in default of this Agreement if Consultant: commits any material breach or default of any covenant, warranty, certification, or obligation under the 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 Agreement; or attempts to assign rights in, or delegate duties under, this Agreement. Page 3 of 6: Personal Services Agreement with Applied Geotechnical Engineering & Geologic Consulting 15. Insurance. Consultant shall, at its own expense, maintain 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. Professional Liability insurance with a combined single limit, or the equivalent, of not less than $1,000,000 (one million dollars) per occurrence. This is to cover any damages caused by error, omission or negligent acts related to the professional services to be provided under this Agreement. c. General Liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 (two million dollars) per occurrence for Bodily Injury, Death, and Property Damage. d. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than $1,000,000 (one million dollars) for each accident for Bodily Injury and Property Damage, including coverage for owned, hired or non-owned vehicles, as applicable. e. 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' prior written notice from the Consultant or its insurer(s) to the City. f. Additional Insured/Certificates of Insurance. Consultant shall name the City of Ashland, Oregon, and its elected officials, officers, and employees as Additional Insureds on any insurance policies, excluding Professional Liability and Workers' Compensation, required herein, but only with respect to Consultant's services to be provided under this Agreement. The consultant's insurance is primary and non-contributory. As evidence of the insurance coverages required by this Agreement, the Consultant shall furnish acceptable insurance certificates prior to commencing the Work under this Agreement. 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 Consultant shall be financially responsible for all pertinent deductibles, self-insured retentions, and/or self-insurance. 16. Nondiscrimination: Consultant agrees that no person shall, on the grounds of race, color, religion, creed, sex, marital status, familial status or domestic partnership, national origin, age, mental or physical disability, sexual orientation, gender identity or source of income, suffer discrimination in the performance of any Work under this Agreement when employed by Consultant. Consultant agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. Further, Consultant agrees not to discriminate against a disadvantaged business enterprise, minority-owned business, woman-owned business, a business that a service-disabled veteran owns or an emerging small business enterprise certified under ORS 200.055, in awarding subcontracts as required by ORS 279A.110. 17. Consultant's Compliance With Tax Laws: 17.1 Consultant represents and warrants to the City that: 17. 1.1 Consultant shall, throughout the term of this Agreement, including any extensions hereof, comply with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS Chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Consultant; and (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. Page 4 of 6: Personal Services Agreement with Applied Geotechnical Engineering & Geologic Consulting 17.1.2 Consultant, for a period of no fewer than six (6) calendar years preceding the Effective Date of this Agreement, has faithfully complied with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS Chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Consultant; and (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 18. Governing Law; Jurisdiction; Venue: This Agreement 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 the Consultant that arises from or relates to this Agreement shall be brought and conducted solely and exclusively within the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the District of Oregon filed in Jackson County, Oregon. Consultant, by its signature hereon 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. 19. THIS AGREEMENT AND THE ATTACHED EXHIBITS CONSTITUTE THE ENTIRE UNDERSTANDING AND AGREEMENT BETWEEN THE PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS AGREEMENT 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 AGREEMENT. CONSULTANT, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT HE/SHE HAS READ THIS AGREEMENT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND CONDITIONS. 20. Force Majeure. Neither party to this Agreement shall hold the other responsible for damages or delay in performance caused by acts of God, strikes, lockouts, accidents, or other events beyond the control of the other or the other's officers, employees or agents. 21. Amendments. This Agreement may be amended only by written instrument executed by both parties with the same formalities as this Agreement. 22. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and authorized for expenditure to finance the costs of this Agreement within the City's fiscal year budget. Consultant understands and agrees that City's payment of amounts under this Agreement 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 Agreement. In the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this Agreement without penalty or liability to City, effective upon the delivery of written notice to Consultant, with no further liability to Consultant. Page 5 of 6: Personal Services Agreement with Applied Geotechnical Engineering & Geologic Consulting 23. Certification. Consultant shall execute the certification attached hereto as "Exhibit C" and incorporated herein by this reference. IN WITNESS WHEREOF the parties have caused this Agreement to be signed in their respective names by their duly authorized representatives as of the dates set forth below. THE CITY OF ASHLAND, OREGON: CONSU ANT: Signature Signatu OkI V1 m, J, M4 Vroi Printed Name Printed Name 0~ C; Title Title 3~ 4 r Ay Date Date (W-9 is to be submitted with this signed Agreement) Page 6 of 6: Personal Services Agreement Nvith Applied Geotechnical Engineering & Geologic Consulting Exhibit A 4 pplied eotech n ica l March 25, 2018 ilgineerin N: (i:.'ukot,i: ('oll 1111mt, Ashland Parks & Recreation Attention: Jeffrey McFarland 340 S. Pioneer Street Ashland, OR 97520 Subject: Scope of Work and Budget for Geotechnical Services Lower Beach Creek Bank Repair and Stabilization Ashland, Oregon Applied Geotechnical Engineering and Geologic Consulting LLC (AGEGC) is pleased to submit this scope of work and budget to provide geotechnical engineering services to the Ashland Parks & Recreation Department for the Lower Beach Creek bank repair and stabilization in North Mountain Park in Ashland, Oregon. AGEGC met with you at the site to discuss potential remedial repair options. The intent of our work is to provide support as needed and requested by you for preparing documents necessary for design and repair of the creek bank adjacent to the pedestrian bridge across the creek. ANTICIPATED SCOPE OF WORK AGEGC will provide project consulting, geotechnical design and engineering services to the City of Ashland Parks and Recreation Commission (APRC) for APRC to perform agency permitting and work for repair, bank stabilization, and protection of the creek bank and infrastructure at the Lower Beach Creek Bank Stabilization project site. AGEGC design and engineering services for the project will enable APRC to repair, armor, and stabilize a section of the westerly bank of Beach Creek that has become eroded by seasonal creek flows directly below the existing pedestrian bridge and where two existing sewer lines run under the creek close to the downstream side of the bridge. Design and repair/stabilization work will include armoring of the lower creek bank areas, some pull back of upper bank with bioengineering/planting/intermittent armoring of the upper bank areas, construction of embedded boulder structures in the berm behind the bank upstream and downstream of the bridge, and design to accommodate for protection of the existing sewer lines during the project. Work provided by AGEGC will be designed for APRC to meet Federal, State, and local regulating agency permit conditions and requirements. Currently, agency representatives have stated to APRC that required permitting will be covered for the project through a USACE Nationwide 12 (bank stabilization) & Nationwide 13 (utility line activities) joint permit, and a City of Ashland Water Resources Ordinance/Planning Dept. permit. Work 1314B Center Drive, No. 452, Medford, Oregon 97501 (541) 226-6658 will be designed to be performed during the approved in-stream water work period (June 15 - Sept. 15). Work provided by AGEGC will be completed by an Oregon licensed geotechnical engineer (GE) and Oregon geologist (RG). We anticipate that AGEGC's work will include consulting, design, GE stamped construction specifications, materials, cut & fill quantities, construction notes, drawings, site visits/inspections, and a final stamped letter of significant completion to APRC. The project work will be designed to provide bank stabilization and repair, protection for the pedestrian bridge, protection of the utilities, and strengthening of the bank and the berm near the bridge against future erosion in high water events (and help minimize the chance of the creek jumping outside the channel and onto the adjacent sports fields). 1. AGEGC to provide project consulting and Geotechnical Engineering services for the City of Ashland Parks and Recreation as needed for the project scope. 2. AGEGC to provide GE stamped project design, specifications, materials, construction notes, drawings and inspections for City of Ashland Parks and Recreation Commission to perform the construction & repair work at the lower Beach Creek Project site. Design, specifications, materials, construction notes, and drawings for the project will comply with USACE permit requirements (Nationwide 12-utilities & Nationwide 13-bank stabilization) and local City of Ashland permit requirements. (APRC has consulted with the Oregon Division of State Lands and Oregon Division of Fish & Wildlife about this project. The DSL has said no direct reporting to DSL will be required for this project as long as the total cut & fill materials below OHW are less than 50 cu. yds. (per APRC phone consult (3-5-18)with DSL regional rep. Melodic Rudenko). ODFW states that they do not expect any anadromous fish to have entered the stream this winter or be in the stream channel of the project during the project time-frame so they will not require direct reporting (per APRC phone consult & email (3-1-18) received from ODFW regional rep. Dan Van Dyke). 3. AGEGC will work with APRC staff to provide needed specifications, documents, quantities, drawings, and project description/information as needed to APRC for APRC to timely complete the permit application/s for USACE N 12&13 and City of Ashland permit and submit for permitting process. 4. AGEGC will also provide site visits for consulting, design work, inspections, and other similar GE work associated with any unseen changes that might occur during the project. 5. AGECG to provide a stamped letter of significant completion to City of Ashland Parks and Recreation Completion for the project. 2 6. AGEGC will provide a current insurance certificate for City of Ashland with minimal coverages as per contract requirements (contract example attached). FEE The fee for the above work will be computed on a time and material basis. The hourly rate for a licensed, Principal geotechnical engineer/geologist is $130/hr. The work will also be completed on a not-to-exceed basis with maximum billing of $10,000. We look forward to being of service to you on this project. Submitted for AGEGC, Z, . Robin Warren, G.E., R.G. Principal 3 EXHIBIT B CITY OF ASHLAND, OREGON City of Ashland LIVING . WAGE 0.0, per hour, effective June 30, 2017. The Living Wage is adjusted annually every June 30 by the Consumer Price Index. portion of business of their 401 K and IRS eligible employer, if the employer has cafeteria plans (including ten or more employees, and childcare) benefits to the has received financial amount of wages received by assistance for the project or the employee. ➢ For all hours worked under a business from the City of service contract between their Ashland in excess of ➢ Note: For temporary and employer and the City of $20,688.86. part-time employees, the Ashland if the contract Living Wage does not apply exceeds $20,688.86 or more. y If their employer is the City of to the first 1040 hours worked Ashland, including the Parks in any calendar year. For For all hours worked in a and Recreation Department. more details, please see month if the employee spends Ashland Municipal Code 50% or more of the In calculating the living wage, Section 3.12.020. employee's time in that month employers may add the value working on a project or of health care, retirement, additional For 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 Page 1 of l: Exhibit B EXHIBIT C CERTIFICATIONS/REPRESENTATIONS: Consultant, by and through its authorized representative, 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) Consultant 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. Consultant further represents and warrants to City that: (a) it has the power and authority to enter into this Agreement and perform the Work, (b) the Agreement, when executed and delivered, shall be a valid and binding obligation of Consultant enforceable in accordance with its terms, (c) the work under the Agreement shall be performed in accordance with the highest professional standards, and (d) Consultant is qualified, professionally competent, and duly licensed (if applicable) to perform the Work. Consultant 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 Agreement, it is authorized to do business in the State of Oregon, and Consultant has checked four or more of the following criteria that apply to its business. (1) Consultant carries out the work or services at a location separate from a private residence or is in a specific portion of a private 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) Consultant assumes financial responsibility for defective workmanship or for service not provided as evidenced by the ownership of performance bonds, warranties, errors and omission (professional liability) insurance or liability insurance relating to the Work or services to be provided. Consu tant's signature ~ Date CITY OF ASHLAND WORKERS' COMPENSATION INSURANCE CERTIFICATION [CONTRACTOR MUST INITIAL APPLICABLE BLANK BELOW] CERTIFICATION OF COVERAGE: Contractor will maintain Workers' Compensation insurance coverage for the term of the contract and will provide Certificate of Workers' Compensation Insurance before Project Beginning Date. CERTIFICATION OF EXEMPTION FROM COVERAGE: Contractor is exempt from the requirement to obtain workers compensation insurance under ORS Chapter 656 for the following reason (initial the appropriate box). SOLE PROPRIETOR • Contractor is a sole proprietor, and • Contractor has no employees, and • Contractor will not hire employees or subcontractors to perform this contract. CORPORATION - FOR PROFIT • Contractor's business is incorporated; and • All employees of the corporation are officers and directors and have a substantial ownership interest* in the corporation, and • All work will beperformed by the officers and directors; Contractor will not hire other employees or subcontractors to perform this contract. CORPORATION - NONPROFIT • Contractor's business is incorporated as a nonprofit corporation, and • Contractor has no employees; all work is performed by volunteers, and • Contractor will not hire employees or subcontractors to perform this contract. PARTNERSHIP • Contractor is a partnership, and • Contractor has no employees, and • All work will be performed by the partners; Contractor will not hire employees or subcontractors to perform this contract, and • Contractor is not engaged in work performed in direct connection with the construction, alteration, repair, improvement, moving or demolition of an improvement to real property or appurtenances thereto.** LIMITED LIABILITY COMPANY • Contractor is a limited liability company, and • Contractor has no employees, and All work will be performed by the members; Contractor will not hire employees or subcontractors to perform this contract, and • I f Contractor has more than one member, Contractor is not engaged in work performed in direct nection with the construction, alteration, repair, improvement, moving or demolition of an improvement to real property or appurtenances thereto nature of Authorized Signer) (Date) (Si 7) f A ('ri q I (Sign er'sTrtle) *NOTE: Under OAR 436-50-050 a shareholder has a "substantial ownership" interest if the shareholder owns 10% of the corporation, or if less than 10% is owned, the shareholder has ownership that is at least equal to or greater than the average percentage of ownership of all shareholders. **NOTE: Under certain circumstances partnerships and limited liability companies can claim an exemption even when performing construction work. The requirements for this exemption are complicated. Consult with City Attorney's Office before an exemption request is accepted from a contractor who will perform construction work. A~'~ ® DATE (MMIDD/YWY) AC~ CERTIFICATE OF LIABILITY INSURANCE 4/12/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Dianna Sealy- Gi p ner NAME: Redwoods Leavitt Insurance Agency PHONE (541)479-2667 FAX (A(C No Ext): IA/C, No): 122 NE Beacon Dr. E-MAIL dianna-seal 1 ner@leavitt.com ADDRESS: yg p INSURERS) AFFORDING COVERAGE NAIC # Grants Pass OR 97526 INSURERA:CNA Insurance Co. R18313 INSURED INSURER B Applied Geotechnical Engineering & Geologic INSURERC: 904 MYSTIC DR INSURERD: INSURER E : GRANTS PASS OR 97527 INSURER F: COVERAGES CERTIFICATE NUMBER:17/18 Renewal Cert 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 ADDL SUBR - POLICY EFF POLICY EXP I' T" TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED A CLAIMS-MADE ❑X OCCUR PREMISES (Ea occurrence $ 300,000 X B4030654736 5/1/2017 5/1/2018 MED_ EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 4,000,000 X POLICY PRO ~ LOC PRODUCTS - COMP/OPAGG $ 4,000,000 PRO- OTHER: Pollution Liability $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident) _ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS _JPer accident~_ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 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 additional insured and coverage is primary and non-contributory per attached for SB146932-E 06/11 CERTIFICATE HOLDER CANCELLATION betsy.harshman@ashland.or. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ashland Parks and Recreation Commission ACCORDANCE WITH THE POLICY PROVISIONS. Betsy Harman AUTHORIZED REPRESENTATIVE D Sealy-Gipner/BRLIND ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) CNA SB-146839-F (Ed. 06/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SEWER OR DRAIN BACK UP This endorsement modifies insurance provided under the following: BUSINESSOWNERS SPECIAL PROPERTY COVERAGE FORM CONCURRENT CAUSATION, EARTH MOVEMENT & WATER EXCLUSION CHANGES The following coverage is added to your Businessowners (i) "Flood," surface water, waves, tides, tidal Special Property Coverage Form: waves, overflow of any body of water, or their Unless otherwise stated, payments made under the spray, all whether driven by wind or not; following coverage will not increase the applicable Limits of (ii) Mudslide or mudflow. Insurance. b. The most we will pay for direct physical damage is Subject to the Exclusions, Conditions and Limitations of the limit of insurance shown in the Declarations for this policy, you may extend this insurance as indicated Sewer or Drain Back Up. below. 2. With respect to otherwise covered Business Income 1. We will pay for loss or damage to covered property and Extra Expense, loss or damage to covered caused by water that backs up or overflows from a property caused by water that backs up or overflows sewer, drain, sump, or from water that overflows due from a sewer, drain, sump, or from water that to the failure of a sump pump, sump pump well, or any overflows due to the failure of a sump pump, sump other type of system designed to remove subsurface pump well, or any other type of system designed to water from the foundation area, subject to the following remove subsurface water from the foundation area, limitations: will be considered a Covered Cause of Loss. a. We will not pay for loss or damage under this 3. Exclusion 13.1.g. (3) of the Businessowners Special Additional Coverage caused by the emanation of Property Coverage Form does not apply to this water from a sewer or drain, sump, sump pump, Additional Coverage. sump pump well, or any other type of system designed to remove subsurface water from the foundation area, that itself caused by, or is the result of: SB-146839-F Page 1 of 1 (Ed. 06/11) CNA SB-146932-E (Ed. 06/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - LIABILITY EXTENSION This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM Coverage afforded under this extension of coverage endorsement does not apply to any person or organization covered as an additional insured on any other endorsement now or hereafter attached to this Policy. 1. ADDITIONAL INSURED - BLANKET VENDORS own acts or omission or those of its employees or anyone else acting on its WHO IS AN INSURED is amended to include as an behalf. However, this exclusion does not additional insured any person or organization (referred apply to: to below as vendor) with whom you agreed, because of a written contract or agreement to provide (1) The exceptions contained in insurance, but only with respect to "bodily injury" or Subparagraphs d. or f.; or "property damage" arising out of "your products" which (2) Such inspections, adjustments, tests or are distributed or sold in the regular course of the servicing as the vendor has agreed to vendor's business, subject to the following additional make or normally undertakes to make in exclusions: the usual course of business, in 1. The insurance afforded the vendor does not apply connection with the distribution or sale of to: the products. a. "Bodily injury" or "property damage" for which 2. This insurance does not apply to any insured the vendor is obligated to pay damages by person or organization, from whom you have reason of the assumption of liability in a acquired such products, or any ingredient, part or contract or agreement. This exclusion does container, entering into, accompanying or not apply to liability for damages that the containing such products. vendor would have in the absence of the 3. This provision 2. does not apply to any vendor contract or agreement; included as an insured by an endorsement issued b. Any express warranty unauthorized by you; by us and made a part of this Policy. c. Any physical or chemical change in the 4. This provision 2. does not apply if "bodily injury" or product made intentionally by the vendor; "property damage" included within the "products- completed operations hazard" is excluded either d. Repackaging, except when unpacked solely by the provisions of the Policy or by endorsement. for the purpose of inspection, demonstration testing, or the substitution of parts under 2. MISCELLANEOUS ADDITIONAL INSUREDS instructions from the manufacturer, and then WHO IS AN INSURED is amended to include as an repackaged in the original container; insured any person or organization (called additional e. Any failure to make such inspections, insured) described in paragraphs 2.a. through 2.h. adjustments, tests or servicing as the vendor below whom you are required to add as an additional has agreed to make or normally undertakes to insured on this policy under a written contract or make in the usual course of business, in agreement but the written contract or agreement must connection with the distribution or sale of the be: products; 1. Currently in effect or becoming effective during the f. Demonstration, installation, servicing or repair term of this policy; and operations, except such operations performed 2. Executed prior to the "bodily injury "property at the vendor's premises in connection with damage" or "personal and advertising injury," but the sale of the product; Only the following persons or organizations are g. Products which, after distribution or sale by additional insureds under this endorsement and you, have been labeled or relabeled or used coverage provided to such additional insureds is as a container, part or ingredient of any other limited as provided herein: thing or substance by or for the vendor; or a. Additional Insured -Your Work h. "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its That person or organization for whom you do work is an additional insured solely for liability SB-146932-E Page 1 of 5 (Ed. 06/11) I CNA S (Ed. due to your negligence specifically resulting This insurance does not apply to "bodily from your work for the additional insured injury," "property damage" or "personal and which is the subject of the written contract or advertising injury" arising out of operations written agreement. No coverage applies to performed for the state or municipality. liability resulting from the sole negligence of c. Controlling Interest the additional insured. The insurance provided to the additional Any persons or organizations with a insured is limited as follows: controlling interest in you but only with respect to their liability arising out of: (1) The Limits of Insurance applicable to the additional insured are those specified in (1) Their financial control of you; or the written contract or written agreement (2) Premises they own, maintain or control or in the Declarations of this policy, while you lease or occupy these whichever is less. These Limits of premises. Insurance are inclusive of, and not in addition to, the Limits of Insurance shown This insurance does not apply to structural in the Declarations. alterations, new construction and demolition operations performed by or for such additional (2) The coverage provided to the additional insured. insured by this endorsement and paragraph F.9. of the definition of "insured d. Managers or Lessors of Premises contract" under Liability and Medical A manager or lessor of premises but only with Expenses Definitions do not apply to respect to liability arising out of the ownership, "bodily injury" or "property damage" maintenance or use of that specific part of the arising out of the "products-completed premises leased to you and subject to the operations hazard" unless required by the following additional exclusions: written contract or written agreement. (3) The insurance provided to the additional This insurance does not apply to: insured does not apply to "bodily injury," (1) Any "occurrence" which takes place after "property damage," or "personal and you cease to be a tenant in that premises; advertising injury" arising out of the or rendering or failure to render any professional services. (2) Structural alterations, new construction or demolition operations performed by or on b. State or Political Subdivisions behalf of such additional insured. A state or political subdivision subject to the e. Mortgagee, Assignee or Receiver following provisions: A mortgagee, assignee or receiver but only (1) This insurance applies only with respect with respect to their liability as mortgagee, to the following hazards for which the assignee, or receiver and arising out of the state or political subdivision has issued a ownership, maintenance, or use of a premises permit in connection with premises you by you. own, rent, or control and to which this This insurance does not apply to structural insurance applies: alterations, new construction or demolition (a) The existence, maintenance, repair, operations performed by or for such additional construction, erection, or removal of insured. advertising signs, awnings, canopies, f. Owners/Other Interests - Land is Leased cellar entrances, coal holes, driveways, manholes, marquees, An owner or other interest from whom land hoistaway openings, sidewalk vaults, has been leased by you but only with respect street banners, or decorations and to liability arising out of the ownership, similar exposures; or maintenance or use of that specific part of the (b) The construction, erection, or land leased to you and subject to the following removal of elevators; or additional exclusions: (2) This insurance applies only with respect This insurance does not apply to: to operations performed by you or on your (1) Any "occurrence" which takes place behalf for which the state or political after you cease to lease that land; or subdivision has issued a permit. SB-146932-E Page 2 of 5 (Ed. 06/11) CHA SB-146932-E (Ed. 06/11) (2) Structural alterations, new Damage To Property, is replaced by the construction or demolition operations following: performed by or on behalf of such k. Damage To Property additional insured. Co-owner of Insured Premises "Property damage" to: 9• A co-owner of a premises co-owned by you 1. Property you own, rent or occupy, and covered under this insurance but only including any costs or expenses with respect to the co-owners liability as co- incurred by you, or any other person, owner of such premises. organization or entity, for repair, replacement, enhancement, h. Lessor of Equipment restoration or maintenance of such Any person or organization from whom you property for any reason, including lease equipment. Such person or organization prevention of injury to a person or damage to another's property; are insureds only with respect to their liability arising out of the maintenance, operation or 2. Premises you sell, give away or use by you of equipment leased to you by abandon, if the "property damage" such person or organization. A person's or arises out of any part of those organization's status as an insured under this premises; endorsement ends when their written contract 3. Property loaned to you; or agreement with you for such leased equipment ends. 4. Personal property in the care, With respect to the insurance afforded these custody or control of the insured; additional insureds, the following additional 5. That particular part of any real exclusions apply: property on which you or any This insurance does not apply: contractors or subcontractors working directly or indirectly in your behalf are (1) To any "occurrence" which takes place performing operations, if the "property after the equipment lease expires; or damage" arises out of those (2) To "bodily injury," "property damage" or operations; or "personal and advertising injury" arising 6. That particular part of any property out of the sole negligence of such that must be restored, repaired or additional insured. replaced because "your work" was Any insurance provided to an additional insured incorrectly performed on it. designated under paragraphs b. through h. above Paragraph 2 of this exclusion does not does not apply to "bodily injury" or "property apply if the premises are "your work" and damage" included within the "products-completed were never occupied, rented or held for ° operations hazard." rental by you. 3. The following is added to Paragraph H. of the Paragraphs 1, 3, and 4, of this exclusion BUSINESSOWNERS COMMON POLICY do not apply to "property damage" (other CONDITIONS: than damage by fire or explosion) to H. Other Insurance premises: 4. This insurance is excess over any other (1) rented to you: insurance naming the additional insured (2) temporarily occupied by you with the as an insured whether primary, excess, permission of the owner, or contingent or on any other basis unless a (3) to the contents of premises rented to written contract or written agreement you for a period of 7 or fewer specifically requires that this insurance be consecutive days. either primary or primary and A separate limit of insurance applies to noncontributing. _ Damage To Premises Rented To You as 4. LEGAL LIABILITY - DAMAGE TO PREMISES described in Section D - Liability and A. Under B. Exclusions, 1. Applicable to Medical Expenses Limits of Insurance. Business Liability Coverage, Exclusion k. SB-146932-E Page 3 of 5 (Ed. 06/11) CNA SB(Ed.606/1 ) Paragraphs 3, 4, 5, and 6 of this (2) Any partner, if you or an additional exclusion do not apply to liability insured is a partnership; assumed under a sidetrack agreement. (3) Any manager, if you or an additional Paragraph 6 of this exclusion does not insured is a limited liability company; apply to "property damage" included in the "products-completed operations (4) Any "executive officer" or insurance hazard." manager, if you or an additional insured is a corporation; B. Under B. Exclusions, 1. Applicable to (5) Any trustee, if you or an additional Business Liability Coverage, the last paragraph of 2. Exclusions is deleted and insured is a trust; or replaced by the following: (6) Any elected or appointed official, if you or Exclusions c, d, e, f, g, h, i, k, I, m, n, and o, an additional insured is a political do not apply to damage by fire to premises subdivision or public entity. while rented to you or temporarily occupied by This paragraph e. applies separately to you you with permission of the owner or to the and any additional insured. contents of premises rented to you for a period of 7 or fewer consecutive days. A 7. Bodily Injury separate limit of insurance applies to this Section F. Liability and Medical Expenses coverage as described in Section D. Liability Definitions, item 3. "Bodily Injury" is deleted and And Medical Expenses Limits Of replaced with the following: Insurance. "Bodily injury" means bodily injury, sickness or C. The first Paragraph under item 5. Damage To disease sustained by a person, including death, Premises Rented To You Limit of Section humiliation, shock, mental anguish or mental D. Liability And Medical Expenses Limits injury by that person at any time which results as Of Insurance is replaced by the following: a consequence of the bodily injury, sickness or The most we will pay under Business Liability disease. for damages because of "property damage" g, Expanded Personal and Advertising Injury to any one premises, while rented to you, or Definition temporarily occupied by you, with the permission of the owner, including contents of a. The following is added to Section F. Liability such premises rented to you for a period of 7 and Medical Expenses Definitions, item 14. or fewer consecutive days, is the Damage to Personal and Advertising Injury, in the Premises Rented to You limit shown in the Businessowners General Liability Declaration. Coverage Form: 5. Blanket Waiver of Subrogation h. Discrimination or humiliation that results in injury to the feelings or reputation of a natural We waive any right of recovery we may have person, but only if such discrimination or against: humiliation is: a. Any person or organization with whom you 1. Not done intentionally by or at the have a written contract that requires such a direction of: waiver. 6. Broad Knowledge of Occurrence a. The insured; or b. Any "executive officer," director, The following items are added to E. stockholder, partner, member or Businessowners General Liability Conditions manager (if you are a limited liability in the Businessowners Liability Coverage company) of the insured; and Form: 2. Not directly or indirectly related to the e. Paragraphs a. and b. apply to you or to any employment, prospective employment, additional insured only when such past employment or termination of "occurrence," offense, claim or "suit" is known employment of any person or person by to: any insured. (1) You or any additional insured that is an b. The following is added to Exclusions, Section individual; B : SB-146932-E Page 4 of 5 (Ed. 06/11) ANA SB-146932-E (Ed. 06/11) I (15) Discrimination Relating to Room, Personal and Advertising Injury Liability is Dwelling or Premises excluded either by the provisions of the Policy or by endorsement. Caused by discrimination directly or indirectly related to the sale, rental, lease 9. Personal and Advertising Injury Re-defined or sub-lease or prospective sale, rental, Section F. Liability and Medical Expenses lease or sub-lease of any room, dwelling or premises by or at the direction of any Definitions, item 14, Personal Advertising Injury, insured. Paragraph c. is replaced by the following: (16) Fines or Penalties c. The wrongful eviction from, wrongful entry into, or invasion of the right of private Fines or penalties levied or imposed by a occupancy of a room dwelling or premises governmental entity because of that a person or organization occupies discrimination. committed by or on behalf of it's owner, c. This provision (Expanded Personal and landlord or lessor. Advertising Injury) does not apply if i o I n 0 n °o N O SB-146932-E Page 5 of 5 (Ed. 06/11) DATE CERTIFICATE OF LIABILITY INSURANCE (MMIDDMfYn 1 03/26/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOTAFFIRMATIVELY 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 WANED, 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 Orion Insurance NAME: Orion Insurance Group AHoNN , (425) 771-5197 FAX (425) 673-4427 3405 188th ST SW (A/C No E-MAIL generdlmail nonins rou com Suite #302 ADDRESS. ~ 9 p• INSURER(S) AFFORDING COVERAGE NAIC S Lynnwood WA 98037 Admiral Insurance Company INSURED INSURER a Applied Geotechnical Engineering & Geologic Consulting INSURER C : 904 Mystic Dr INSURER O INSURER E : Grants Pass OR 97527 INSURER F COVERAGES CERTIFICATE NUMBER: CL1712701530 REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFF POLICY EXP LTR rCOMMIF-RCIALGGENERAL SURANCE INSD WVD POLICY NUMBER JMM/DDIYYYY) MM/DD LIMITS LIABILITY EACH OCCURRENCE S ❑ OCCUR AMA N PREMISES Fz ocwrtarxe S MED EXP (Any one person) S PERSONAL B ADV INJURY S GEN'LAGGREGATE LIMITAPPUES PER: GENERALAGGREGATE 5 POLICY ❑ LOC JEC OT- PRODUCTS -COMPlOPAGG 5 OTHER; S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO Ea accident BODILY INJURY (Per person) $ 4A_C.S CHEDULED UTOS BODILY INJURY (Per accident) 5 ON-ONIJED UTOS ONLY PROPERTY DAMAGE accident OCCUR EACH OCCURRENCE CWMSMADE AGGREGATE S S WORKERS COMPENSATION $ AND EMPLOYERS' UABILJTY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICERlMEMBER EXCLUDED? NIA E.L. EACH ACCIDENT $ (Mandatory in NH) EL yes, describe under L DISEASE - EA EMPLOYEE S DESCRIPTION OF OPERATIONS below E.LDISEASE - POLICY LIMIT $ Professional Liability Insurance $1,000,000 Each Claim $5,000 A E0000033437-02 05/0112017 05/0112018 $1,000,000 Aggregate Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ashland Parks and Recreation Commission ACCORDANCE WITH THE POLICY PROVISIONS. 340 S. Pioneer Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD f • = StateFarm VEHICLE INFORMATION Review your policy information carefully. If anything is incorrect, or if there are any changes to your vehicle information, please let us know right away. Vehicle Identification Vehicle Description Number (VIN) Who principally drives this vehicle? How is this vehicle normally used? 2001 DODGE RAM 2500 1B7KF23611J550970 ROBIN WARREN, a separated male, who To Work, School or Pleasure. will be age 58 as of April O8, 2018. Other Household Vehicle(s) Your premium may be influenced by other State Farm policies that currently insure the following vehicle(s) in your household: 2017 FORD MUSTANG Premium Adjustment annually to determine which makes and models have Each year, we review our medical payments and personal eamed decreases or increases from State Farm's standard injury protection coverages claim experience to determine rates. If any changes result from our reviews, adjustments the vehicle safety discount that is applied to each make and are reflected in the rates shown on this renewal notice. model. In addition, we review the comprehensive, collision, bodily injury and property damage claim experience DRIVER INFORMATION Assigned Driver(s) The following driver(s) are assigned to the vehice(s) on this policy. Age as of Marital Name April 8, 2018 Gender Status ROBIN L WARREN 58 Male Separated Principal Driver & Assigned Drivers Your premium may be influenced by the information shown For each automobile, the Principal Driver is the individual for these drivers. who most frequently drives it. Each driver is designated as an Assigned Driver on the household automobile that he or she most frequently drives. COVERAGE AND LIMITS See yourpolicyforan explanation of these coverages. A Liability Bodily injury 1,000,000/1,000,000 Property Damage 1,000,000 P2 Personal Injury Protection Includes Medical 25,000 Income Loss 3000/mo/yr $137.26 D 500 Deductible Comprehensive $18.03 G 500 Deductible Collision $42.38 H Emergency Road Service $5.30 (continued on next page) Policy Number. 364 7285-D08-37 Page number 2 of 4 Prepared March 2, 2018 AA o~ o® CERTIFICATE OF LIABILITY INSURANCE 4 DA/2/2018 4/2/ 018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NA FACT Dianna Sealy-Gipner Redwoods Leavitt Insurance Agency PHONE (541)479-2667 FAX AIC No: 122 NE Beacon Dr. ADDRIESS:dianna-sealygipner®leavitt.com INSU S AFFORDING COVERAGE NAIC # Grants Pass OR 97526 INSURERA:CNA Insurance Co. 8-18313 INSURED INSURER 8 Applied Geotechnical Engineering & Geologic INSURER C: 904 MYSTIC DR INSURER D INSURER E : GRANTS PASS OR 97527 INSURER F: COVERAGES CERTIFICATE NUMBER:17/18 Renewal Cert 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 ADDL SUBR LTR TYPE OF INSURANCE POUCY NUMBER POLICY EFF POLICY EXP MM/DD/YYW MM/OOfYYYY LIMITS X COMMERCIAL GENERAL UABILITY ~ EACH OCCURRENCE $ 2,000,000 A CLAIMS-MADE XI OCCUR PREMGET Ea occccurrence $ 300,000 84030654736 5/1/2017 5/1/2018 MED EXP An one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'LAGGREGATELIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PRO- JECT LOC PRODUCTS - COMPlOPAGG $ 4,000,000 OTHER: Pollution Liability $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIREDAUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLA LIAB OCCUR CESS LIAB EACH OCCURRENCE $ EXCESS CLAIM_MADE AGGREGATE $ [)ED RETENTION $ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY YIN PEAT TE ERH ANY PRCPRIETORIPARTNERIEXECUTIVE OFFICERMEMBER EXCLUDED? ❑N/A EL EACH ACCIDENT $ (Mandatory In NH) It yes, describe under E.L. DISEASE - EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be atta d if more space is required) Certificate holder as additional insured per attached for SB 66932-E 06/11 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FOR INFORMATION ONLY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE D Sealy-Gipner/BRLIND ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401) I aSy< o Purchase Order Fiscal Year 2018 Page: 1 of: 1 THIS PO NUMBER MUST APPEAR ON ALL B Ashland Parks Commission INVOICES, AND SHIPPING DOCUMENTS. - - I ATTN: Accounts Payable 20 E. Main Purchase L Ashland, OR 97520 Order# 20181298 T Phone: 541/552-2010 O Email: payable@ashland.or.us V S C/O Parks Department E APPLIED GEOTECHNICAL ENGINEER, AGEGC H Admin Office N 1314-B CENTER DRIVE #452 P 340 South Pioneer D MEDFORD, OR 97501 Ashland, OR 97520 O T Phone: 541/488-5340 R O Fax: 541/488-5314 AvB MrdR-WNWM-W =~_len, 6 max Ns hee - -rnrrHU_mEsae - _ - - st _ _ 541 226-6658 Bets Harshman Ddf Qider~as_C do lru_n- _=auir~_ = Fretgk Jl7fet- - _ _~pa ent/Loeatlon 04/13/2018 767 FOB ASHLAND OR/NET30 Parks Accounts Pa able -Item _ = rt - _ =-nltPrice Extended Pncel Geotechnical Engineering 1 Provide geotechnical enggineering services for the lower Beach 1 $10,000.0000 $10,000.00 Creek bank repair and sfabilization in North Mountain Park Personal Services Agreement ($25,000 or less) Completion date: 10701/2018 Project Account: $10,000.00 GL SUMMARY 123000 - 704200 $10,000.00 - By: Date: r = - Authorized Signature ~PO Total ' _ $10,000.00 7 FORM #3 CITY OF ASHLAND 4 REQUISITION (Date of request: April 6, Zotg s Required date for delivery: Vendor Name Annlipd antprhniral Fnnina ri~nn anrt„ (,Pningdr (nn,;id Address, City, State, Zip 1314-R ('Pnter nriup #452, Medford, OR 97501 Contact Name & Telephone Number Robin Warren, 541-226-6658 Email address Robin warrenQagegr. c:om 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 Date approved by Council: ❑ Direct Award Contract # F1 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 El Written quote or proposal attached Date original contract approved by Council: F-71 (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 Provide geotechnical engineering services for the lower Beach Creek bank repair and stabilization $ 10,000 in North Mountain Park. Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST ® Per attached quotelproposal $ Project Number _ _ _ _ _ _ _ Account Number 12300.704200 Account Number - Account Number `Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: IT Director Date Support -Yes /No By signing this requisition form, I certify that the City's public contracting requirements have been satisfied. sq, F ~ ~ - ' ~ s ~;~°.1 - Employee: c' ~.4 Department Hea /(Equal to or greater than $5,000) Department Manager/Supervisor: City Administra r: (Equal to or greater than $25,000) Funds appropriated for current fiscal year YE ; t/ NO e qual to or greater than $5,000) Date Comments:" Form #3 - Requisition CITY OF FORM #4 -ASH LAN D DETERMINATIONS TO PROCURE PERSONAL SERVICES $5,000 to $75,000 To: Adam Hanks, City Administrator From: Michael Black, Director Date: April 6, 2018 Re: DETERMINATIONS TO PROCURE PERSONAL SERVICES In accordance with AMC 2.50.120(A), for personal services contracts greater than $5,000, but less than $75,000, the Department Head shall make findings that City personnel are not available to perform the services, and that the City does not have the personnel or resources to perform the services required under the proposed contract. Background The department intends to hire Robbin Warren with Applied Geotechnical Engineering to provide geotechnical engineering services for the bank repair and stabilization on the lower Beach Creek project. The estimated cost is not to exceed $10,000. The project is intended to be completed by October 1, 2018. The department has developed, and fully plans to implement, a written plan for utilizing such services which will be included in the contractual statement of work. Pursuant to AMC 2.50.120(A), has a reasonable inquiry been conducted as to the availability of City personnel to perform the services, and that the City does not have the personnel and resources to perform the services required under the proposed contract? The city does not have a geotechnical engineer on staff or anyone else qualified to do the work. Requested 'Date: -rl 2~ epartme t He Approved by:` Date: y/61 B Adam Hanks, City Administrator Comments: Form #4 - Department Head Determinations to Procure Personal Services, Page 1 of 1, 4/6/2018