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HomeMy WebLinkAbout2019-110 20190026 Two Dogs Fabricating GOODS & SERVICES AGREEMENT PROVIDER: Two Dogs Fabricating, LLC CITY OF PROVIDER'S CONTACT: Anne-Marie Durham ASHLAND 20 East Main Street ADDRESS: 684 Brian Way, Medford, OR 97501 Ashland, Oregon 97520 Telephone: 541/488-5587 PHONE: (541)826-5200 Fax: 541/488-6006 This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and Two Dogs Fabricating, LLC, a limited liability corporation ("hereinafter "Provider"), for supplying and installing crane body as per attached quote for vehicle #1075. 1. PROVIDER'S OBLIGATIONS 1.1 Supply and install crane body on vehicle #1075 as set forth in the "SUPPORTING DOCUMENTS" attached hereto and, by this reference, incorporated herein. Provider expressly acknowledges that time is of the essence of any completion date set forth in the SUPPORTING DOCUMENTS, and that no waiver or extension of such deadline may be authorized except in the same manner as herein provided for authority to exceed the maximum compensation. The goods and services defined and described in the "SUPPORTING DOCUMENTS" shall hereinafter be collectively referred to as "Work." 1.2 Provider shall obtain and maintain during the term of this Agreement and until City's final acceptance of all Work received hereunder, a policy or policies of liability insurance including commercial general liability insurance with a combined single limit, or the equivalent, of not less than $2-,699,9 (two million dollars) per occurrence for Bodily Injury and Property Damage. 1% or,&, 1.2.1 The insurance required in this Article shall include the following coverages: • Comprehensive General or Commercial General Liability, including personal injury, contractual liability, and products/completed operations coverage; and • Automobile Liability. 1.2.2 Each policy of such insurance shall be on an "occurrence" and not a "claims made" form, and shall: • Name as additional insured "the City of Ashland, Oregon, its officers, agents and employees" with respect to claims arising out of the provision of Work under this Agreement; • Apply to each named and additional named insured as though a separate policy had been issued to each, provided that the policy limits shall not be increased thereby; • Apply as primary coverage for each additional named insured except to the extent that two or more such policies are intended to "layer" coverage and, taken together, they provide total coverage from the first dollar of liability; • Provider shall immediately notify the City of any change in insurance coverage • Provider shall supply an endorsement naming the City, its officers, employees and agents as additional insureds by the Effective Date of this Agreement; and • Be evidenced by a certificate or certificates of such insurance approved by the City. Page I of 5: Agreement between the City of Ashland and Two Dogs Fabricating, LLC 1.3 All subject employers working under this Agreement are either employers that will comply with ORS 656.017 or employers that are exempt under ORS 656.126. 1.4 Provider 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 this Agreement when employed by Provider. Provider agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. Further, Provider 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. 1.5 In all solicitations either by competitive bidding or negotiation made by Provider for work to be performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Providers of the Provider's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider the sum of $24,637.00 as provided herein as full compensation for the Work as specified in the SUPPORTING DOCUMENTS. 2.2 In no event shall Provider's total of all compensation and reimbursement under this Agreement exceed the sum of $24,637.00 without express, written approval from the City official whose signature appears below, or such official's successor in office. Provider expressly acknowledges that no other person has authority to order or authorize additional Work which would cause this maximum sum to be exceeded and that any authorization from the responsible official must be in writing. Provider further acknowledges that any Work delivered or expenses incurred without authorization as provided herein is done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement. 3. GENERAL PROVISIONS 3.1 This is a non-exclusive Agreement. City is not obligated to procure any specific amount of Work from Provider and is free to procure similar types of goods and services from other providers in its sole discretion. 3.2 Provider is an independent contractor and not an employee or agent of the City for any purpose. 3.3 Provider is not entitled to, and expressly waives all claims to City benefits such as health and disability insurance, paid leave, and retirement. 3.4 This Agreement embodies the full and complete understanding of the parties respecting the subject matter hereof. It supersedes all prior agreements, negotiations, and representations between the parties, whether written or oral. 3.5 This Agreement may be amended only by written instrument executed with the same formalities as this Agreement. 3.6 The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220, 279B.230 and 27913.235. Page 2 of 5: Agreement between the City of Ashland and Two Dogs Fabricating, LLC 3.7 This Agreement shall be governed by the laws of the State of Oregon without regard to conflict of laws principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is in federal court, in which case exclusive venue shall be in the federal district court for the district of Oregon. Each party expressly waives any and all rights to maintain an action under this Agreement in any other venue, and expressly consents that, upon motion of the other party, any case may be dismissed or its venue transferred, as appropriate, so as to effectuate this choice of venue. 3.8 Provider 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, arising out of, or relating to the activities of Provider or its officers, employees, contractors, or agents under this Agreement. 3.9 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. 3.10 If any provision of this Agreement is found by a court of competent jurisdiction to be unenforceable, such provision shall not affect the other provisions, but such unenforceable provision shall be deemed modified to the extent necessary to render it enforceable, preserving to the fullest extent permitted the intent of Provider and the City set forth in this Agreement. 4. SUPPORTING DOCUMENTS The following documents are, by this reference, expressly incorporated in this Agreement, and are collectively referred to in this Agreement as the "SUPPORTING DOCUMENTS:" • The City's written Invitation to Bid dated May 23, 2018. • The Provider's complete written Proposal dated May 24, 2018. 5. REMEDIES 5.1 In the event Provider is in default of this Agreement, City may, at its option, pursue any or all of the remedies available to it under this Agreement and at law or in equity, including, but not limited to: 5. 1.1 Termination of this Agreement; 5.1.2 Withholding all monies due for the Work that Provider has failed to deliver within any scheduled completion dates or any Work that have been delivered inadequately or defectively; 5.1.3 Initiation of an action or proceeding for damages, specific performance, or declaratory or injunctive relief, 5.1.4 These remedies are cumulative to the extent the remedies are not inconsistent, and City may pursue any remedy or remedies singly, collectively, successively or in any order whatsoever. 5.2 In no event shall City be liable to Provider for any expenses related to termination of this Agreement or for anticipated profits. If previous amounts paid to Provider exceed the amount due, Provider shall pay immediately any excess to City upon written demand provided. 6. TERM AND TERMINATION 6.1 Term This Agreement shall be effective from the date of execution on behalf of the City as set forth below (the "Effective Date"), and shall continue in full force and effect until 6/30/2019, unless sooner terminated as provided in Subsection 6.2. Page 3 of 5: Agreement between the City of Ashland and Two Dogs Fabricating, LLC 6.2 Termination 6.2.1 The City and Provider may terminate this Agreement by mutual agreement at any time. 6.2.2 The City may, upon not less than thirty (30) days' prior written notice, terminate this Agreement for any reason deemed appropriate in its sole discretion. 6.2.3 Either party may terminate this Agreement, with cause, by not less than fourteen (14) days' prior written notice if the cause is not cured within that fourteen (14) day period after written notice. Such termination is in addition to and not in lieu of any other remedy at law or equity. 7. NOTICE Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery, by sending via a reputable commercial overnight courier, or by mailing using registered or certified United States mail, return receipt requested, postage prepaid, to the address set forth below: If to the City: City of Ashland - Public Works - Fleet Department Attn: Wes Hoadley 20 E. Main Street Ashland, Oregon 97520 Phone: (541) 552-2355 With a copy to: City of Ashland - Legal Department 20 E. Main Street Ashland, OR 97520 Phone: (541) 488-5350 If to Provider: Two Dogs Fabricating, LLC Attn: Anne-Marie Durham (541)826-5200 8. WAIVER OF BREACH One or more waivers or failures to object by either party to the other's breach of any provision, term, condition, or covenant contained in this Agreement shall not be construed as a waiver of any subsequent breach, whether or not of the same nature. 9. PROVIDER'S COMPLIANCE WITH TAX LAWS 9.1 Provider represents and warrants to the City that: 9.1.1 Provider 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 Provider; and (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.1.2 Provider, for a period of no fewer than six (6) calendar years preceding the Effective Date of this Agreement, has faithfully complied with: Page 4 of 5: Agreement between the City of Ashland and Two Dogs Fabricating, LLC (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 Provider; and (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.2 Provider's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Provider's warranty, as set forth in this Article 9, shall constitute a material breach of this Agreement. Any material breach of this Agreement shall entitle the City to terminate this Agreement and to seek damages and any other relief available under this Agreement, at law, or in equity. 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. CITY OF ASULA/N6- Two Dogs Fabric ng, L C (1`1 5411 y - y: /Signa re Signature Printed Name Printed Name Title Title F ~ Date Date (W-9 is to be submitted with this signed Agreement) Purchase Order No. Page 5 of 5: Agreement between the City of Ashland and Two Dogs Fabricating, LLC w i i r 1 i 1 i i i 1 I 1 I I 3 1 1 i 3 { 3 I I ,a►co CERTIFICATE OF LIABILITY INSURANCE DATE YYYY) 06//001/ 1/2018 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 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: HONE Michael Miller Hart Insurance Agency - Medford P FAX PO Box 1240 N o Ext: (541) 779-4232 C No: E-MAIL Grants Pass OR 97528 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: Cincinnati Insurance Company 10677 INSURED INSURER B Two Dogs Fabricating, LLC INSURER C : 684 Brian Way INSURER D Medford OR 97501 INSURER E: INSURER F: I COVERAGES CERTIFICATE NUMBER: Cert ID 7293 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 ADD LTR TYPE OF INSURANCE INSD S VDR POLICY NUMBER MM/DD POLICY /YYYY MM/ODfYYYY LIMITS A X COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 1,000,000 DAMA ED CLAIMS-MADE 1:11 OCCUR ENP 0327413 05/15/2018 05/15/2019 PREM SESOEaoNcu ence $ 100, 000 MED EXP (Any one person) $ 10, 000 PERSONAL BADVINJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO- JECT ❑ LOC PRODUCTS - COMP/OPAGG $ 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 S UMBRELLA LIAB HOCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTIONS $ WORKERS COMPENSATION SPER OTH- AND EMPLOYERS' LIABILITY Y / N TATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ S S DESCRIPTION OF OPERATIONS I 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 City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main Street AUTHORIZED REPRESENTA'T,IVVE Ashland OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 AC`®R® DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06/15/2018 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 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 Kristin Wick Hart Insurance Agency - Medford NAME: PO Box 1240 PHONE No_ Ext) (541) 779-4232 Fq/c No: E-MAIL Grants Pass OR 97528 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA:Cincinnati Insurance Company 10677 INSURED Two Dogs Fabricating LLC INSURERS: INSURER C : 684 Brian Way INSURER D: Medford OR 97501 INSURER E: I INSURER F: COVERAGES CERTIFICATE -NUMBER:Cert ID 7834 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 ADOD SUER POLICY NUMBER MM/DDY/YYEFF YY MMIDDY/YYEXP YY LIMITS INS A X COMMERCIALGENERALLIABILITY 1,000,000 EACH OCCURRENCE $ CLAIMS-MADE OCCUR Y ENP 0327413 05/15/2018 05/15/2019 pREMSESOE,RENTED occcurrrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL& ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICY PRO ❑ LOC PRODUCTS -COMP/OP AGG $ 2,000,000 X JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 A ANY AUTO EBA 0327413 05/15/2018 05/15/2019 BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY IX AUTOS ONLY Per accident $ $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y/ N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) E.L. DISEASE- EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ $ IT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Ashland is an additional insured per attached form GA2010. 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 20 E Main St AUTHORIZED REPRESENTATIVE Ashland OR 97520 J~- ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Page 1 of 1 i I 3 3 3 i 7 7 14 i j4 i 1 II I f i H 1 t S 1 I~ j~# J 3 j 1 i 3 f 3 J 3 3 i ® DATE (MM/DDIYYYY) pcc~® ty® CERTIFICATE OF LIABILITY INSURANCE 06/14/2018 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 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: Michael Miller Hart Insurance Agency - Medford PHOFAX PO Box 1240 A'C%. E t: (541) 779-4232 AIC No: E-MAIL ADDRESS: Grants Pass OR 97528 INSURERS AFFORDING COVERAGE NAIC # INSURERA:Cincinnati Insurance Company 10677 INSURED INSURER B : Two Dogs Fabricating, LLC INSURER C : 684 Brian Way INSURER D: Medford OR 97501 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: Cert ID 7293 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 EFF POLICY EXP LIMITS LTR IN SD WVO POLICYNUMBER MMIDD/YYYY MM/DDIYYYY A X COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE ~ OCCUR y ENP 0327413 05/15/2018 05/15/2019 PREMISES Eaoccurrence $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL aADVINJURY $ 1,000,000 MGE N GENERAL AGGREGATE $ 2,000,000 POLICY ❑ PRO ❑ LOC PRODUCTS -COMP/OP AGG $ 2,000,000 JECT T 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 LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUIIVE ❑ NIA E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (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, Additional Remarks Schedule, may be attached if more space is required) The City of Ashland is an additional insured per attached form GA2010. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520~r/! ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 i i E 2 t t i p~ g Z 1 1 S f t i f E 1 1 E THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A Endorsement - Table of Contents: overage: Begins on Page: 1. Employee Benefit Liability Coverage ..................................................................................................2 2. Unintentional Failure to Disclose Hazards .........................................................................................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 Political Subdivisions - Permits Relating to Premises 9. Property Damage to Borrowed Equipment ......................................................................................12 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. Supplementary Payments a. Bail bonds: $ 1,000 b. Loss of earnings: $ 350 5. Medical Payments Medical Expense Limit: $ 10,000 9. Property Damage to Borrowed Equipment Each Occurrence Limit: $ 10,000 Deductible: $ 250- GA 210 02 07 Page 1 of 12 a) You did not have C. Coverages knowledge of a 1. Employee Benefit Liability Coverage claim or "suit" 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 knowledge of a (a) We will pay those sums that claim or "suit' the insured becomes legally when any "author- obligated to pay as damages ized representa- caused by any act, error or tive"; omission of the insured, or of any other person for i) Reports all, or whose ads the insured is le- any part, of the gally liable, to which this in- ad, 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" seeking those damages. However, we will ii) Receives a have no duty to defend written or ver- against any "suit" seeking bal demand or damages to which this in- claim for dam- surance does not apply. We ages because may, at our discretion, inves- of the act, er- tigate any report of an ad, ror or omis- error or omission and settle sion; and any claim or "suit" that may result. But: b) There is no other applicable insur- 1) The amount we will pay anoe. for damages is limited as described in SEC- (2) Exclusions TION III - LIMITS OF This insurance does not apply to. INSURANCE; and 2) Our right and duty to de- (a) Bodily Injury, Property fend ends when we Damage or Personal and have used up the appli- Advertising Injury cable limit of insurance "Bodily inyury", "property in the payment of judg- damage" or "personal and ments or settlements. advertising injury'. No other obligation or liability (b) Dishonest, Fraudulent, to pay sums or perform acts Criminal or Malicious Act or services is covered unless explicitly provided for Damages arising out of any under Supplementary Pay- intentional, dishonest, ments. fraudulent, criminal or mali- cious act, error or omission, (b) This insurance applies to committed by any insured, damages only if the ad, er- inciuding the willful or reck- ror or omission, is negb- less violation of any statute. gently committed in the "administration" of your "em- (c) Failure to Perform a Con- ployee benefit program"; and tract 1) Occurs during the policy Damages arising out of fail- period; or ure of performance of con- trad by any insurer. 2) Occurred prior to the ef- fective 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 meet any obligations under U) Employment-Related Prac- any plan included in the tices "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, defa- 2) Errors in providing in- mation, harassment, formation on past per- humiliation, discrimina- formance of investment tion or other employ- vehicles; or ment-related practices, 3)- Advice- given to any ads or omissions; or 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) Workers' Compensation in any other capacity and to and Similar Laws any obligation to share dam- Any claim arising out of your ages with or repay someone 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 insurance, social security or SECTION I - COVERAGES, disability benefits law or any SUPPLEMENTARY PAYMENTS similar law. - COVERAGES A AND B also apply to this Coverage. (g) ERISA b. Who is an Insured Damages for which any in- sured is liable because of li- As respects Employee Benefit Liability ability imposed on a fiduciary Coverage, SECTION If - 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 (1) If you are designated in the Dec- amended, or by any similar larations as: federal, state or local laws. (h) Available Benefits (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 ture, you are an insured. funds accrued or other coi- Your members, your part- lectible insurance. ners, and their spouses are (1) Taxes, Fines or Penalties also insureds but only with respect to the conduct of Taxes, fines or penalties, in- your business. cluding those imposed under the Internal Revenue Code (c) A 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 c. Limits of Insurance their duties as your manag- ers. As respects Employee Benefit Liability Coverage, SECTION 111 - LIMITS OF (d) An organization other than a INSURANCE is deleted in its entirety partnership, joint venture or and replaced by the following: limited liability company, you are an insured. Your "ex- (1) The Limits of Insurance shown in ecutive officers" and direc- Section B. Limits of Insurance, tors are insureds, but only 1. Employee Benefit Liability with respect to their duties Coverage and the rules below fix as your officers or directors. the most we will pay regardless Your stockholders are also of the number of: insureds, but only with re- (a) Insureds; sped to their liability as stockholders. (b) Claims 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. "suits"; (2) Each of the following is also an (d) Acts, errors or omissions; or insured: (e) Benefits included in your (a) Each of your "employees" "employee benefit program". who is or was authorized to administer your "employee (2) The Aggregate Limit shown in benefit program". Section B. Limits of Insurance, 1. Employee Benefit Liability (b) Any persons, organizations Coverage of this endorsement is or "employees" having the most we will pay for all dam- proper temporary authoriza- ages because of acts, errors or tion to administer your "em- omissions negligently committed ployee benefit program" if in the "administration" of your you die, but only until your "employee benefit program". legal representative is ap- pointed. (3) Subject to the limit described in (2) above, the Each Employee (c) Your legal representative if Limit shown in Section B. Limits you die, but only with respect of Insurance, 1. Employee to duties as such. That rep- Benefit Liability Coverage of resentative will have all your this endorsement is the most we rights and duties under this will pay for all damages sus- Coverage Part. tained by any one "employee", sustained by (3) Any organization you newly ac- including such "employee's" " dependents quire or form, other than a part- nership, joint venture or limited and beneficiaries, as a result of: 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 acts, er- Named Insured if no other similar rors or omissions, regard- insurance applies to that organi- less of the amount of time zation. However, coverage un- that lapses between such der this provision: ads, errors or omissions, (a) Is afforded only until the negligently committed in the 180th day after you acquire "administration" of your "em- or form the organization or ployee benefit program". the end of the policy period, However, the amount paid under whichever is earlier; and this endorsement shall not ex- (b) Does not apply to any act, ceed, and will 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 organi- plan included in the "employee zation. benefit program". GA 210 02 07 Page 4 of 12 (4) Deductible Amount a. You must see to it that (a) Our obligation to pay dam- we are notified as soon as practicable of an ad, ages on behalf of the in- error or omission which sured applies only to the may result in a claim. amount of damages in ex- To the extent possible, cess of the deductible notice should include: amount stated in the Decla- 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 ductible. (2) The names and (b) The deductible amount addresses of any- 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", including such "em- ror or omission. ployee's" dependents and beneficiaries, because of all b. If a claim is made or ads, errors or omissions to "suit" is brought against which this insurance applies. any insured, you must: (C) The terms 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 ties 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 amount. (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- ceived 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 ob- ductible amount as we have tain records and paid. other information; d. Additional Conditions (3) Cooperate with us As respects Employee Benefit Li- in the investigation ability Coverage, SECTION IV - or settlement of the COMMERCIAL GENERAL LIABIL- claim or defense ITY CONDITIONS is arnended as fol- against the "suit; lows and (1) Item 2. Duties in the Event of (4) Assist us, upon our Occurrence, Offense, Claim or request, in the en- Suit is deleted in its entirety and forcement of any replaced by the following right against any person or organi- 2. Duties in the Event of an zation which may Act, Error or Omission, or be liable to the in- Claim or Suit sured because of GA 210 02 07 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 insured's own other insurance in force cost, 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 5. Other Insurance is de- As ability respects Coverage, Employee SECTION Benefit V Li- - ' leted in its entirety and replaced by the following: DEFINITIONS is amended as follows: 5. Other Insurance (1) The following definitions are added;. If other valid and collectible insurance is available to the 1. "Administration" means: insured for a loss we cover under this Coverage Part, a. Providing information to "employees", including our obligations are limited as their dependents and follows: beneficiaries, with re- a. Primary Insurance spect to eligibility for or scope of employee This insurance is pri- benefit programs"; mary except when c. below applies. If this ire b. Interpreting the "em- surance is primary, our ployee benefit pro- obligations are not af- grams"; fected unless any of the c. Handling records in other insurance is also connection with the primary. Then, we will "employee benefit pro- share with all that other grams"; or insurance by the method described in b. d. Effecting, continuing or below. terminating any "em- b. Method of Sharing ployeeV' participation in any benefit included in If all of the other insur- the "employee benefit ance permits contribu- program". tion by equal shares, we However, "administration" will 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 surance 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- ance does not permit ance, social security contribution by equal benefits, workers' com- shares, we will contrib- pensation and disability ute by limits. Under this benefits. method, each insurer's share is based on the 2. "Cafeteria plans" means ratio of its applicable plans authorized by applica- limit of insurance to the ble law to allow "erployeee total applicable limits of to elect to pay for certain insurance of all insur- benefits with pretax dollars, ers. GA 210 02 07 Page 6 of 12 1 i 3. "Employee benefit pro- ages are claimed and to grarrs" means a program which the insured must pinviding some or all of the submit or does submit following benefits to "ern- with our consent; plowed', Mether provided through a "cafeteria plan" 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 g. "Employee" means a person to such benefits and such benefits are made actively fo~~ generally available a employed, on leave of ab- "employees" who sense or disabled, or retired. those Employee satisfy the plan's eligibil- includes a ity requirements; 'leased worms' ployee" does not include a b. Profit sharing plans, "Wri4orary employee savings 2. Unintentional. Failure to Disdose Haz- plans, employee stock aryls 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 amended 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 ees" 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 Premises Rented to You benefits, workers' com- a. The last Subparagraph of SECTION I pensation and disability _ COVERAGES, COVERAGE A benefits; and BODILY INJURY AMID PROPEF Y d. Vacation plans, indud- BlAN AGE LIABILITY, 2 Exclusions ing buy and sell pro- is hereby deleted and replaced by the grams; leave of ab- following: sense programs, indud- Exclusions c. through q. do not apply ing military, maternity, to damage by fire, explosion, light- family, and civil leave; Wing, smoke or soot to premises while tuition assistance plans; transportation and rented to you or temporarily occupied health dub subsidies. by you with permission of the owner. (2) The following definitions are de- b. The insurance provided under SEC- leted in their entirety and re- TION I - COVERAGES, CO ERAGE PROP- 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 darn- water damage to premises that are ages because of an act, er- both rented to and occupied by you. rnr or omission to which this (1) As respects Water Damage Le- insurance applies are al- gal Liability, as provided in Para- leged. Suit 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 I. War b) Basements, and the Nuclear Energy Liabil- whether paved or ity Exclusion, are deleted and not; or the folowing are added: c) Doors, windows or This insurance does not apply to: other openings. (a) „Property daToge": (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 b protection systems caused by or re- by or resulting from freezing, sulting from any of the unless: following: a Wear and tear; 1) You did your best to 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 latent defect or water supply if the heat any quality in prop- was not maintained. erty that causes it to damage or de- (d) Loss to or damage to: stroy itself; 1) Plumbing, heating, air c) Smog; conditioning, fire protec- tion systems, or other equipment or appli- down including rup- ances; or ture or bursting caused by cen- 2) The interior of any build- trifugal force; ing or structure, or to Settling, cracking, personal property in the e building or structure shrinking or ex- caused by or resulting pansion; or from rain, snow, sleet or f) Nesting or infesta- ice, whether driven by tion, or discharge wind or not. or release of waste c. Limit of Insurance products or secre- tions, by insects, The Damage to Premises Rented to birds, rodents or You Limit as shown in the Declara- other animals. tions is amended as follows: (b) Loss caused directly or indi- (2) Paragraph 6. of SECTION III - re tly by any of the following: LIMITS OF INSURANCE is 1) Earthquake, volcanic t~ cted and replaced by followingc eruption, landslide or any other earth move- 6. Subject to 5. above, the ment; Damage to Premises Rented to You Limit is the 2) Water that backs up or most we will pay under overflows from a sewer, COVERAGE A. BODILY IN- drain or sump; JURY AND PROPERTY 3) Water under the ground DAMAGE LIABILITY for surface pressing on, or damages because of "prop- flowing or seeping erty damage" to premises through: while rented to you or tem- porarily occupied by you with permission of the owner, arising out of any one "oc- GA 210 02 07 Page 8 of 12 currence" to which this in- Us is hereby amended by the addition of suran a applies. the following: (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 er niejed openinducted in 4. Supplementary Payments t that rson he "pp rod cots-cop Aand ations haz- Under SECTION I - COVERAGE SUP- and". However, our rights may only be PLEMENTARY PAYMENTS - COVER- waived prior to the "occurrence" giving rise AGES A AND B: to the injury or damage for which we make payment under this Coverage Part. The a. Paragraph 2. is replaced by the fol- insured must do nothing after a loss to im- lo%Mng pair our rights. At our request, the insured will bring "suit" or transfer those rights to Up to the limit shown in Section B. us and help us enforce those rights. Limits of Insurance, 4.a. Bail Bonds of this endorsement for cost of bail 8. Automatic Additional Insured - Specii- bonds required because of accidents fied 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) be- b. Paragraph 4. is replaced by the foil- low (hereinafter referred to as IcWng additional insured) whom you are required to add as an additional All reasonable expenses incurred by insured under this 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- claim up to the limit shown in Sec- 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 Expense Limit of Any One is an insured Person as stated in the Declarations is , provided: amended to the limit shown in Section B. (a) The written or oral contract Limits of Insurance, 5. Medical Pay- or ment of this endorsement. agreement is: 6. 180 Day Coverage a for Newly Formed or 1) Currents in effect or y g y becomes effective dur- Acquired Organizations ing the policy period; SECTION II - 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 until the 180th day after (b) They are not specifically you acquire or form the organization named as an additional in- or the end of the policy period, which- sured under any other provi- 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 ganizations are additional insur- Rights of Recovery Against Others to eds under this endorsement, and insurance coverage provided to GA 210 02 07 Page 9 of 12 such additional insureds is lim- a) "Bodily injury" or ited as provided herein: "property carnage' for which the ver - (a) The manager or lessor of a dor is obligated to premises leased to you with pay damages by whom you have agreed per reason of the as- Paragraph 8.a.(1) above to sumption of liability provide insurance, but only in a contract or with respect to liability aris- agreement. This ing out of the ownership, exclusion does not maintenance or use of that apply to liability for part of a premises leased to damages that the you, subject to the following vendor mould have additional exclusions: in the absence of This insurance does not ap- the contract or ply to: 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; half of such additional d) Repackaging, un- insured. less unpacked (b) Any person or organization solely for the pur- from which you lease 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 organization(s) are insureds from the manufac- solely with respect to their li- turer, and then re- ability arising out of the packaged in the maintenance, operation or original container; use by you of equipment e) Any failure to make leased to you by such per- such inspections, son(s) or organization(s). adjustments, tests However, this insurance or servicing as the does not apply to any oc, vendor has agreed currence" which takes place to make or nor- after the equipment lease mally 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 nection with the per Paragraph 8.a.(1) above distribution or sale to provide insurance, but of the products; only with respect to "bodily fl Demonstration, in- injury" or "property damage" stallation, servicing arising out of "your products" which are distributed or sold tionsrepair opera- in the regular course of the , except such vendor's business, subject to operations per- - the following additional ex- formed does at the premises venin elusions: connection with the 1) The insurance afforded sale of the product; the vendor does not ap- g) Products which, af- ply to: ter distribution or sale by you, have GA 210 02 07 Page 10 of 12 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 2 This insurance does not apply to "bodily injury". "property apply to any insured damage" or "personal and actver- tising injury arising out of the person or organization: sole negligence or willful miscon- duct of the additional insured or a) From whom you their agents, "employees" or any have acquired other representative of the add- such products, or tional insured. any ingredient, part or container, enter- b. SECTION IV - COMMERCIAL. GEN- ing into, accompa- ERAL LIABILITY CONDITIONS is nying or containing hereby amended as follows: such products; or Condition 5. Other Insurance is b) When liability in- amended 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.a.(1) above to provide in- (2) Any insurance be provided this surance, subject to the fol- endorsement shall primary lowing additional provision: other insurance available to the additional insured except: This insurance applies only with respect to the following (a) As otherwise provided in hazards for which the state SECTION IV - COMMER- or political subdivision has CIAL GENERAL LIABILITY issued a permit in comec- CONDITIONS, 5. Other In- tion with premises you own, surance, b. Excess Insur- rent or control and to which ance; or . this insurance applies: (b) For any other valid and col- 1) The existence, mainte- lectible insurance available nance, repair, construc- to the additional insured as tion, erection, or re- an additional insured by at- moval of advertising tachment of an endorsement signs, awnings, cano- to another insurance policy pies, cellar entrances, that is written on an excess coal holes, driveways, basis. In such case, the manholes, marquees, coverage provided under hoist away openings, this endorsement shall also sidewalk vaults, street be excess. banners, or decorations and similar exposures; 9. Property Damage to Borrowed Equip- and or 2) The construction, erec- a. The following is hereby added to Ex- tion, or removal of ele- clusion j. Darnage to Property of Paragraph 2., Exclusions of SEC- TION 1 - COVERAGES, COVE]r?AiGE 3) The ownership, mainte- A BODILY INJURY AND PROP- nance, or use of any ERTY DAMAGE LIABILITY. GA 210 02 07 Page 11 of 12 i Paragraphs (3) and (4) of this exclu- effect settlement of any sion do not apply to tools or equip- claim or "suit" and, upon no- ment loaned to you, provided they are tification of the action taken, not being used to perform operations you shall promptly reimburse at the time of loss. us for such part of the de- ductible amount as has been b. With respect to the insurance pro- paid by us. 1 vided by this section of the endorse- ment, the following additional provi- 10. Employees as Insureds - Specified sions apply. Health Care Services (1) The Limits of Insurance shown in It is hereby agreed that Paragraph the Declarations are replaced by 2.a.(1)(d) of SECTION II - WHO IS AN the limits designated in Section INSURED, does not apply to your "em- B. Limits of Insurance, 9. playees' who provide professional health Property Damage to Borrowed care servioes on your behalf as duty li- Equipment of this endorsement censed: with respect to coverage pro- vided by this endorsement, a. Nurses; These limits are inclusive of and b. Emergency Medical Technicians; or not in addition to the limits being replaced. The Limits of Insur- c. Paramedics, ante shown in Section B. Limits of Insurance, 9. Property Dam- in the jurisdiction where an "occurrence" age to Borrowed Equipment of or offense to which this insurance applies this endorsement fix the most we takes place. will pay in any one "occurrence" 11. Broadened Notice of Occurrence regardless of the number of: (a) Insureds; Paragraph a. of SECTION N - 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 that we are notified "suits". as soon as practicable of an "occur- rence" or an offense which may result (2) Deductible Clause in a claim. To the extent possible, no- tice should include: i (a) Our obligation to pay dam- ages on your behalf applies (1) How, when and where the "oc- a 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 stated in injured persons and witnesses; Section B. Limits of Insur- and ance, 9. Property Damage (3) The nature and location of any in- to Borrowed Equipment of jury or damage arising out of the this endorsement. The limits "occurrence" or offense. of insurance will not be re- duoed by the application of This requirement applies only when such deductible amount. the "occurrence" or offense is known (b) SECTION IV - COMMER- to an "authorized representative". CIAL GENERAL LIABILITY CONDITIONS, 2. Duties in the Event of Occurrence, Offence, Claim or Suit, ap- plies to each claim or "suit" irrespective of the amount. (c) We may pay any part or all of the deductible amount to GA 210 02 07 Page 12 of 12 CERTIFICATION OF EXEMPTION FROM W® ERS' C® ENSATION INSURANCE REQUIREMENTS Contractor is exempt from the requirement to obtain workers compensation insurance under ORS Chapter 656 for the following reason. Contractor is to initial the appropriate boa as follows: SOLE PROPRIETOR (Initials) ® 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 (Initials) ® Contractor's business is incorporated; and m All employees of the corporation are officers and directors and have a substantial ownership interest* in the corporation, and ® All work will be performed by the officers and directors; Contractor will not hire other employees or subcontractors to perform this contract. CORPORATION - NONPROFIT (Initials) ® 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. PARTNERSMP (Initials) ® 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.** L TEID LIABILITY COMPANY (initials) ® 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 ® If Contractor has more than one member, Contractor is not engaged in work performed in direct connection with the onstructio ation, repair, improvement, moving or demolition of an improvement to real property or a ' ces there s (Signature Authorize igner) (Date) 0 (Signer'sTit *NOTE: Under OAR436-50-050 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. i 3 E i i s i I i E } E State Farm Mutual Automobile Insurance Company PO Box 853922 Richardson, TX 75085-3922 AT1 A-9C9E A GUINN, MATT & DURHAM, ANNE-MARIE AUTO RENEWAL 684 BRIAN WAY MEDFORD OR 97501 - PREMIUM PAID: $605.31 DO NOT PAY. Your premium is billed through the State Farm Payment Plan State Farm Payment Plan Number: 1279346315 Your State Farm Agent BRAD LINNELL Policy Number: 350 4214-C28-37C Office: 541-535-5505 Policy Period: March 28, 2018 to September 28, 2018 Address: PO BOX 216 Vehicle: TALENT, OR 97540-0216 2017 FORD F250 SD Ifyouhaveaneworddferentcar,have added anyd»vers,orhavemoved, Principal Driver: please contact youragent. MATT GUINN Thank you for choosing State Farm. Location used to determine rate charged-966 information from your check to make an electronic fund HIGHBURY DR, MEDFORD OR 97501. transfer, funds may be withdrawn from your account as soon When you provide a check as payment, you authorize us as the same day we receive your payment, and you will not either to use information from your check to make a receive your check back from your financial institution. one-time electronic fund transfer from your account or to process the payment as a check transaction. When we use Policy Number: 350 4214-C28-37C Page number 1 of 4 Prepared February 21, 2018 1004583 143562 202 01-15-2018 I 7 7 -You Know, Your auto insurance premium is $605.31. x_l Did you know you may qualify fora discount? I Call State Farm° Agent BRAD LINNELL at 541-535-5505 to see how much you can save! *Not all discounts are available in every state, and discount _ amounts may vary by state. t1 -e 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. j Vehicle Identification Vehicle Description Number (VIN) Who principally drives this vehicle? How is this vehicle normally used? I 2017 FORD F250 SD 1 FWX2B66HEC63860 MATT GUINN, a married male, who will be Business. age 59 as of March 28, 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: a 2016 FORD FOCUS 2004 DAMON CHALLENGER 2003 HONDA CHF50 2003 HONDA CHF50 The premium for this renewal was determined using an the vehicle safety discount that is applied to each make and annual mileage this vehicle is expected to be driven that model. In addition, we review the comprehensive, collision, was developed from information we obtained or was bodily injury and property damage claim experience provided by you. Please contact us if you expect your annually to determine which makes and models have annual mileage to change over the next year. earned decreases or increases from State Farm's standard Premium Adjustment rates. If any changes result from our reviews, adjustments Each year, we review our medical payments and personal are reflected in the rates shown on this renewal notice. injury protection coverages claim experience to determine DRIVER INFORMATION Assigned Driver(s) The following driver(s) are assigned to the vehicle(s) on this policy. Age as of Marital Name March 28, 2018 Gender Status ANNE-MARIE DURHAM 55 Female Married MATT GUINN 59 Male Married 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 ofthese coverages. ,A Liability Bodily Injury 250,000/500,000 Property Damage 100,000 P1 Personal Injury Protection (continued on next page) Policy Number: 350 4214-C28-37C Page number 2 of 4 Prepared February 21, 2018 t ~ COVERAGE AND LIMITS continued Includes Medical 15,000 Income Loss 3000/molyr $309.25 D 250 Deductible Comprehensive $58.06 G 250 Deductible Collision $189.58 U1 Uninsured Motor Vehicle Bodily Injury 250,000/500,000 Property Damage 20,000 $48.42 Total Premium $605.31 The claim experience on your make and model of vehicle bodily injury, property damage, and personal injury has resulted in an increase to your vehicle rating group for protection coverages. comprehensive coverage. If any coverage you carry is changed to give broader The claim experience on your make and model of vehicle protection with no additional premium charge, we will give has resulted in a reduction to your vehicle rating group for you the broader protection without issuing a new policy, collision coverage. starting on the date we adopt the broader protection. The claim experience on your make and model of vehicle has resulted in a reduction to your liability rating group for DISCOUNTS These adjustments have already been applied to your premium, _ Multiple Line ✓ Multicar ✓ Vehicle Safety ✓ total Discounts $166.71 SURCHARGES AND DISCOUNTS AUTOMOBILE RATING PLAN - Applies to private damage to any property. For renewal business, an accident passenger cars only, is chargeable as of the date State Farm pays at least $750 Accident-Free Discount - Once your policy has been in (for accidents occurring on or after April 1, 1999) under force for at least three years with no chargeable accidents, property damage liability and collision coverages for an you may qualify for our Accident-Free Discount. Once you at-fault accident. qualify, this discount applies as long as there are no Surcharges - If there are chargeable accidents, you may chargeable accidents, and may even increase over time. lose your Good Driving Discount or Accident-Free Discount Good Driving Discount - Newer policyholders who do not and receive accident surcharges. But if the accident is the yet qualify for our Accident-Free Discount (available after first to become chargeable in nine years and this policy has three years with no chargeable accidents) may already be been in force for at least that long, the Accident-Free receiving a Good Driving Discount. This discount continues Discount will continue and no surcharge will apply. The to apply until your policy qualifies for the Accident-Free surcharge for each accident depends upon the number and Discount as long as there are no chargeable accidents and timing of the accidents, and each accident surcharge will no new drivers. If you add new drivers, they must also remain in effect up to three years. qualify in order for your Good Driving Discount to continue. Surcharges will be removed if the company is given Chargeable Accidents - For new business rating, an satisfactory evidence that the driver involved is no longer a accident is chargeable if it results in $750 or more of member of the household or will not be driving the car in the future. If that driver is insured on another State Farm policy, (continued on next page) Policy Number: 350 4214-C28-37C Page number 3 of 4 Prepared February 21, 2018 { J i his or her driving record will be considered in the rating of These discounts and surcharges do not apply to all the other policy. coverages. For complete details, see your State Farm agent. ADDITIONAL INFORMATION If any information on this renewal notice is incomplete or information regarding discounts or coverages, see your inaccurate, or if you want to confirm the information we have State Farm agent or visit statefarm.com®. in our records, please contact your agent. For additional Important Notice Regarding Your Premium State Farm works hard to offer you the best combination of price, service, and protection. The amount you pay for automobile insurance is determined by many factors including: j • The coverage you have • Where you live • The kind of car you drive j • How the car is used ! • Who drives the car Any premium adjustment is reflected on this Auto Renewal. If you have any questions, please contact your agent. i Buying a new car? Remember to contact your agent! When you buy an additional car or one that replaces a car already on your policy, you need to report the change to your agent promptly. Even though the dealership you purchased the car from may offer to notify your agent or insurance company, you, as the named insured, are responsible for reporting all changes to your auto policy. By contacting your agent, you can help: • avoid any complications or lack of coverage in the event of an accident or loss, • avoid insurance verification problems with a lienholder, the police, or the department of motor vehicles, and • ensure that you receive any new discounts you may be entitled to. Your current State Farm policy automatically provides certain coverages for a new or replacement car for up to a specified, limited number of days after you take possession of the car. Please refer to your policy for the number of days that applies in your state. If you have any questions about coverage for a newly acquired car, please contact your State Farm agent. Disclaimer. This message is provided for informational purposes only and does not grant any insurance coverage. The terms and conditions of coverage are set forth in your State Farm Car Policy booklet, the most recently issued Declarations Page, and any applicable endorsements. Policy Number: 350 4214-C28-37C Page number 4 of 4 Prepared February 21, 2018 Purchase Order D~ Fiscal Year 2019 Page: 1 of: 1 JFII~ P~T~l7MB~R-Mt~~:1-AP2EAR=9N A(aL._ B City of Ashland =yc~~ ar7~ se ~~i~FINo~MEnLT ATTN: Accounts Payable - - _ ~ L 20 E. Main Purchas L e 20190026 Ashland, OR 97520 Order # T Phone: 541/552-2010 O Email: payable@ashland.or.us V H C/O Fleet/Shop Division E TWO DOGS FABRICATING 1 90 North Mountain Ave N 2630 AVENUE G p Ashland, OR 97520 D WHITE CITY, OR 97503 Phone: 541/488-5358 O O Fax: 541/552-2304 R d = 4n um = _ - ~t« _ - g 541 826-5200 _ Wes Hoadle D 2-M-0 = vm = e - - it - rare _ a t1 = R : men = - - 06/15/2018 245 FOB ASHLAND OR Cit Accounts Pa abl _ - E-xt~r1 e - Crane Body - Vehicle #1075 1 Supply and install CRANE BODY on VEHICLE #1075 per 1 EACH $24,637.0000 $24,637.00 attached Estimate #1494 Goods and Services Agreement Termination date: 06/30/2019 Project Account: GL SUMMARY 081000 - 703000 $24,637.00 By: Date: ! Authorized Sign ture $24,637.00 i i f FORM #3 C IT Y OF ASHLAND REQUISITION Date of request: 05/31/201E Vendor Name Two Dogs Fabricating, LLC Address, City, State, Zip 684 Brian Way, Medford, OR 97501 _ Contact Name Anne-Marie Durham 1 Telephone Number (541) 826-5200 Email address am a()twodogsfab.com 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 uote or prop osal 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) ❑ Direct Award Date approved by Council: ❑ State of Oregon . Contract # [:1 Verbal/Written quote(s) orproposal(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 ❑ Agency ❑ Form #9, Request for Approval ❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached Date original contract approved by Council: ❑ (3) Written proposals/written solicitation Date approved by Council: (Date) ❑ Form #4, Personal Services $5K to $75K Valid until: Date - (Attach copy of council communication) Description of SERVICES Total Cost supply and install crane body as per attached quote for vehicle #1075 $ 24,637,00 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost Q Per attached quote/proposal TOTJkL COST Expenditure must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately. Project Number. _ Account Number 0 8 1 0 0 0.7 0 3 0 0 0 $ _ 2 4 6 3 7' 0 0 Project Number- _ _ - - - - Account Number Project Number- - - _ _ - - Account Number IT Director in collaboration with department to approve all hardware and software purchases: By signing this req isifio form, l certi It the City's pdblic contracting requirements have been satisfied. IT Director Date Support -Yes/ No Employee: Department Head: V ( al to or greater than $5,000) Department Manager/Supervisor: City Administrator( (Equal to or greater than 25,000) Funds appropriated for current fiscal year ES / o l nce Dire (Equal to or greater than $5,000) Date Comments: Form #3 - Requisition . I Two Dogs Fabricating, LLC Estimate 684 Brian Way Date Estimate # Medford, Or. 97501 5/24/2018 1494 Name /Address City of Ashland 90 N Mountain Ave. Ashland Or. 97520 541-552-2355 Attn: Wes TWO DOGS FABRICATING, LLC TRUCK EQUIPMENT COMPANY P.O. No. Terms Date Rep Job COD 5/24/2018 MG Description Qty Cost Total 2 Each Whelen L32 LAF Class 1 LED Beacons Mounted on Top Corners of Headache Rack. Receiver Hitch, Tail Plate, D-Rings, Tow Package. LINE-X Spray in Bed Liner or Equivalent. Paint Body Single Stage WHITE to Match Cab. 24,637.00 24,637.00 ******DELIVERY FOB 90 N Mountain Ave. Ashland Oregon 97520 We appreciate your business and the confidence you have placed in us. Total $24,637.00 Phone # Fax # E-mail Web Site (541) 826-5200 (541) 826-5200 am@twodogsfab.com twodogsfab.com Page 2 Two Dogs Fabricating, LLC Estimate 684 Brian Way Date Estimate # Medford, Or. 97501 5/24/2018 1494 Name /Address City of Ashland 90 N Mountain Ave. Ashland Or. 97520 541-552-2355 Attn: Wes TWO DOGS FABRICATING, LLC TRUCK EQUIPMENT COMPANY P.O. No. Terms Date Rep Job COD 5/24/2018 MG Description Qty Cost Total Two Dogs fabricating LLC 541-826-5200 Contact: Matt Guinn RE: Service Body and Crane to fit 2018 F-450 1 Each Pacific Service Body. Crane Reinforcement Curb Rear. Vertical Compartments Both SIdes. Flip Lid Street Side. T-Handle Latches. Rear Step Bumper. Front Curb Side Compartment to have AG Drawers 3" Whole Height of Bin. Powder Coated WHITE. 1 Each Verta Max Pure Sine Wave 3000W (6000W Surge) Inverter. 1 Each Venturo ET8K(X) 3200LB Crane. Boom Length 6'- 14', 65' of 7/32" Air Craft-Quality Wire Rope. 12 V DC Power Remote Control Pendant, 20' Cord and Quick Disconnect. 360 Degree Continuous Rotation Power Elevation and Telescope Function. 1 Each Headache Rack with Full Bar Window Opening. LED Back Up and Tail Lights. Front LED Warning Strobes. We appreciate your business and the confidence you have placed in us. Total Phone # Fax # E-mail Web Site (541) 826-5200 (541) 826-5200 am@twodogsfab.com twodogsfab.com Page 1