HomeMy WebLinkAbout2019-140 20190482 Devore Electric and Construction GOODS & SERVICES AGREEMENT ($25,000.00 or less)
PROVIDER DeVore Electric and Construction
CITY O F PROVIDER'S CONTACT: Reginald DeVore
ASHLAND
20 East Main Street ADDRESS: 792 E Dutton Rd
Ashland, Oregon 97520 Eagle Point, OR 97524
Telephone: 541/488-5587 PHONE: (541)944-3380
Fax: 541/488-6006
This Services Agreement(hereinafter"Agreement") is entered into by and between the City of Ashland, an
Oregon municipal corporation(hereinafter"City") and DeVore Electric and Construction, an assumed business
name("hereinafter"Provider"), for removal and replacement of fuel card console at the Ashland Airport.
1. PROVIDER'S OBLIGATIONS
1.1 Provide for removal and replacement of fuel card console at the Ashland Airport 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 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 $1,000,000
million dollars) per occurrence for Bodily Injury and Property Damage.
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
Page 1 of 5: Agreement between the City of Ashland and DeVore Electric and Construction
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• Be evidenced by a certificate or certificates of such insurance approved by the City.
1.3 Provider shall,at its own expense,maintain Worker's Compensation insurance in compliance with ORS
656.017, which requires subject employers to provide workers' compensation coverage for all of its
subject workers.
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.
1.6 Living Wage Requirements: If the amount of this Agreement is $21,127.46 or more, Provider 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 A"predominantly in areas where it will be seen by all employees.
2. CITY'S OBLIGATIONS
2.1 City shall pay Provider the sum of$1,310.00 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$1,310.00 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.
Page 2 of 5: Agreement between the City of Ashland and DeVore Electric and Construction
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 279B.235.
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 Provider's complete written Proposal dated 04/25/2019.
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.
Page 3 of 5: Agreement between the City of Ashland and DeVore Electric and Construction
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 May 31, 2019, unless sooner
terminated as provided in Subsection 6.2.
6.2 Termination
6.2.1 The City and Provider may terminate this Agreement by mutual agreement at any time.
tS' Y gr Y g Y
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 Department
Attn: Chance Metcalf
20 E. Main Street
Ashland, Oregon 97520
Phone: (541) 488-5587
•
l
With a copy to:
City of Ashland—Legal Department
20 E. Main Street
Ashland, OR 97520
Phone: (541)488-5350
If to Provider:
DeVore Electric and Construction
Attn: Reginald DeVore
792 E Dutton Rd
Eagle Point, OR 97524
8. WAIVER OF BREACH
One or more waivers or failures to object bj ect 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
Page 4 of 5: Agreement between the City of Ashland and DeVore Electric and Construction
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:
(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 ARIL • DE VORE ECTRIC CONSTRUCTION
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Signature By: ,✓
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Printed Name (%y • ! /
Printed Name
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Date 05104/20],
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W-9 is to be submitted with this signed Agreement)
Purchase Order No. c l / / 6 9
Page 5 of 5: Agreement between the City of Ashland and DeVore Electric and Construction
Supporting document
1` ; a 3,4ffrannats PROPOSAL
'f
- /� DATE ESTIMATE#
Reginald DeVore°Reggie"
792 E Dutton Rd Eagle Point,OR 97524 4/25/2019 1970
Cell 541-944-3380 Fax 541-879-0563
regdevoreacharter.net CCB#134196
NAME/ADDRESS
City of Ashland
20 East Main St.
Ashland,OR 97520
PROJECT
Ashland airport
ITEM DESCRIPTION TOTAL
Electrical Labor Remove&replace customer supplied fuel card console at the Ashland Airport/LS 1,310.00
i I
Thank you for your business.It is a pleasure to work with you.
TOTAL $1,310.00
•
ACO,R J CERTIFICATE OF LIABILITY INSURANCE DATE(MM7DD1YYYY)
i`„--- 04/29/2019
•
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__-- Debbie D Reed --____
Insurance Marketplace,Inc. IucNNo.Ext); 341)779-0177 __. ,,___.--.LLC No): (541)772-9235
1998 Sky Park Dr AE-MAIL debbie@insmarket,com ___,______ _ •
Medford, OR 97501 _—_ INSURERRAFFORDINO COVERAGE —_ .__ NAICA -.
— ----- -- __--
INSURER A: Allied Insurance Company ---_42$7$7
INSURED INSURER B: Allied insurance Orgsi—. _12.3787
Reginald DeVore
DBA:DeVore Electric&Construction INSURER C: r.��J~-�Qr�?ora#ion T_.,._-._____ __—__ _
INSURER D:
792 E Dutton Rd INSURER E: _..-.-_ ----- ..
Eagle Point,OR 97524-7975 IN$URISRF: ------_. __
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COVERAGES CERTIFICATE NUMBER: 00000000-0 REVISION NUMBER: 12
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. '
INSN -----�--.'._._-.-�— ADD SUER' POLICY EFF POLICY EXP i
TYPE OF INSURANCE 'INK) FIND I POLICY NUMBER JIMMlDD/YYYY1 fMMJDDIYYYYI LWITS
A X'COMMERCIAL GENERAL LIABILITY j Y Y i ACP7555924983 �02117/2019 02/17/2020 EACH OCCURRENCE $ j,d00 000 ,
CLAIMS-MADE I.X I OCCUR I ° $ 100,000_
I. i I i PREMISES(Ea occtrre --_
MED EXP(Any one_person)— $ _-- 10,000
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� `PERSONAL&ADV INJURY I$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: i _GENERAL AGGREGATE $ 2,000,000
X 1 POLICY�^I:Ike,- 1--i LOC I PRODUCTS-COMP/OP AGG $ 2,OOOy000
I OTHER: ! $
B AUTOMOBILE LIABILITY Y TACP7555924983 02/17/2019 02/17/2020 j(eb aBeciNd l)SINGLE LIMIT 1$ 1,000,000
ANY AUTO i �BODILY INJURY(Per person) 1 S
OWNED V l SCHEDULED i j r
BODILY INJURY(Per accitlent)1$ --
_ .AUTOS ONLY :X i AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
X AUTOS ONLY „AUTOS ONLY
� (Per accider ,-.
$
UMBRELLA LIAR - OCCUR EACH OCCURRENCE $
— EXCESS LIAB I I CLAIMS-MADE{ l S ~�
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DED I 1 RETENTION S ii ' 1 S
ri WOREIEtPSCOMPENSATION '769387 03/01/2019 03/01/2020 X STATUTE I .�€RH. i
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ANY PROPRIETOR/PARTNER/EXECUTIVE ! E.L.EACH ACCIDENT $ 500,000
OFFICERIMEMBER EXCLUDED? N I A
)Mandatory In NM i 'E L.DISEASE-EA EMPLOYE $ _ 600,000
If yes,describe under I --
-DESCRIPTION QF OPERATIONS below :E DISEASE-POLICY LIMIT1$ 500,000
DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES(ACORD 101,Additional Rumsrks Schedule,may be attached if more space Is required)
City of Ashland-additional insured-its officers,employees and agents RE:Airport Fuel Console Project
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City of Ashland, Public Works Dept ACCORDANCE WITH THE POLICY PROVISIONS.
20 East Main Street
Ashland,OR 97520 AUTOO (ZED REPRESEeitt41 TATIVE
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@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
Printed by DDR on April 29,2019 at 12:24PM
tERidAL..GENERAL LIABILITY •,
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PARTIES WHEN REQUIRED IN WRITTEN
CONSTRUCTION AGREEMENT•
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COMMERCIAL GENERAL LIABILITY
CG 72 88 12 16
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CONTRACTORS ENHANCEMENT ENDORSEMENT
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INCLUDING MEDICAL. PAYMENTS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Lost Key Coverage C. Non-Owned Watercraft
1, Under Section I - Coverages, Coverage A Under Section I - Coverages, Coverage A
Bodily Injury And Property Damage Bodily Injury And Property Damage Liability,
Liability, coverage is extended to include 2. Exclusions Exclusion g. Aircraft, Auto Or
the following: Watercraft Paragraph(2)(a)is replaced with:
If a customer's master or grand key, (a) Less than 51 feet long;and
excluding electronic key card, is lost, D. Expanded Property Damage Coverage
damaged or stolen while in your care, 1. For the purposes of this endorsement only:
custody or control we will pay the cost of
replacing the keys, including the master lock Section I - Coverages, Coverage A
and all keys used in the same lock, the cost Bodily Injury And Property Damage
of adjusting locks to accept the new keys, or Liability, 2. Exclusions, Exclusion 1.
the cost to replace the locks, whichever is Damage To Property is amended as
less. follows:
2. Limit of insurance- For the purpose of this a. Paragraphs (3), (5), and (6) are deleted
coverage, the most we will pay is $10,000 in their entirety.
per"occurrence". b. Paragraph (4) is deleted in its entirety
B. Voluntary Property Damage and replaced with:
1. Under Section I - Coverages, Coverage A (4) Personal property in the care
Bodily injury And Property Damage Liability, custody, or control of the insured:
coverage is extended to include the following: (a) For storage or sale at premises
At your request, we will pay for "property you own, rent or occupy;or
damage" to property of others caused by you (b) While being transported by any
and while in your possession,arising out of your aircraft, "auto', or watercraft
business operations and occurring during the owned or operated by or rented
policy period. to or loaned to any insured.
2. Limit of Insurance-For the purpose of this c. The coverage provided by this
coverage the most we will pay is$1,500 per endorsement does not apply to
"occurrence". "property damage":
C. Non-Owned Watercraft (1) Arising out of the disappearance or
Under Section 1 - Coverages, Coverage A loss of use of personal property;or
Bodily Injury And Property Damage Liability, (2) Included in the 'products-completed
2. Exclusions Exclusion g. Aircraft, Auto Or operations hazard".
Watercraft Paragraph(2)(a) is replaced with:
(a) Less than 51 feet long;and
CG 72 88 12 16 Includes copyrighted material of Insurance Services Office,Inc., Page 1 of 5
with its permission.
ACP OMA07565924983 LC1H 18354 INSURED COPY 47 0024735
CG 72 88 12 16
2. Limit of Insurance - The most we will pay F. Supplementary Payments
for loss arising out of any one "occurrence" Under Section 1 -Coverages, Supplementary
is$5,000. Payments - Coverages A and B Paragraphs
3. Deductible - Our obligation to pay for a 1.b. and 1.d. are replaced with:
covered loss applies only to the amount of b. Up to $2,500 for cost of bail bonds required
loss in excess of$250. because of accidents or traffic law violations
We will pay the deductible amount 10 effect arising out of the use of any vehicle to which
settlement of any claim or "suit" and upon the Bodily Injury Liability Coverage applies.
notification having been taken you shall We do not have to furnish these bonds.
promptly reimburse us for the deductible as d. All reasonable expenses incurred by the
has been paid by us. insured at our request to assist us in the
This insurance is primary to any expanded investigation or defense of the claim or
damage coverage provided by a separate "suit", including actual loss of earnings up to
endorsement attached to this policy, and it $500 a day because of time off from work.
will supplant any deductible in said G. Newly Formed And Acquired Organizations
endorsement. Under Section II -- Who Is An Insured
E. Damage To Premises Rented To You Paragraph 3.a.is replaced with:
1. Under Section I-Coverages, Coverage A a. Coverage under this provision is afforded
Bodily Injury And Property Damage only until the 180t' day after you acquire or
Liability, the last paragraph of 2. form the organization or the end of the policy
Exclusions is replaced with:
period, whichever is earlier;
If Damage To Premises Rented To You is H. Additional Insured - Automatic Status When
not otherwise excluded, Exclusions C. Required In An Agreement Or Contract With
through n. do not apply to damage by fire, You
lightning, explosion, smoke, or sprinkler Section W - Who Is An Insured is amended to
leakage to premises while rented to you or include:
temporarily occupied by you with permission
of the owner. A separate limit of insurance 4. Any person(s) or organizaiion(s) described
applies to this coverage as described in in Paragraphs a. - d. below with whom you
Section III-Limits Of Insurance. have agreed in writing in a contract or
2. Under Section III -- w Of Insurance, w en agreement that such person or
Paragraph 6, is replaced with: organization be added as an additional
insured on your policy during the policy
6. Subject to 5. above, the Damage To period shown in the Declarations.
Premises Rented To You Limit is the The person or organization added as an
most we will pay under Coverage A for insured by this endorsement is an insured
damages because of "property damage"
for liability fab Irt due to:
to any one premises, while rented to
only Y
you, or in the case of damage by fire, a. Lessors of Leased Equipment with
lightning, explosion, smoke or sprinkler respect to their liability for"bodily injury",
leakage, while rented to you or "property damage", or "personal and
temporarily occupied by you with advertising injury", caused in whole or in
permission of the owner. The limit ie part by your maintenance, operation or
increased to$1,000,000. use of equipment leased to you by such
3. Under Section IV - Commercial General person(s) or organization(s). This
Liability Conditions, Condition 4. Other insurance does not apply to any
Insurance, b. Excess Insurance (1)(a)01) "occurrence which takes place after the
is replaced with: lease expires.
(ti) That is Fire, Lightning, Explosion, However, their status as additional
Smoke, or Sprinkler leakage insured under this policy ends when
insurance for premises rented to their lease, contract, or agreement with
you or temporarily occupied by you you for such leased equipment expires.
with permission of the owner.
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1
CG 72 88 12 16
b. Managers or Lessors of Premises d. Owners, Lessees, or Contractors with
with respect to liability arising out of the respect to liability for "bodily injury,
ownership, maintenance, or use of that "property damage", or "personal and
part of the premises you own, rent, advertising injury"caused, in whole or in
lease, or occupy. part, by:
This insurance does not apply to: (1) Your acts or omissions;or
(1) Any "occurrence" which takes place (2) The acts or omissions of those
after you cease to be a 'tenant in acting on your behalf;
that premises. in the
2 Structural alterations, new con- performance of your ongoing
{ ) operations performed for that
struction or demolition operations additional insured, whether the work
performed by or on behalf of the is performed by you or on your
person or organization. behalf.
However, their status as additional The insurance does not apply to:
insured under this policy ends when you (1) "Bodily injury", "property damage",
cease to be a tenant of such premises. or "personal and advertising injury"
c. State or Political Subdivision -- arising out of the rendering of or the
Permits Relating to Premises with failure to render any professional
respect to the following hazards for architectural, engineering, or survey
which the state or political subdivision services, including:
has issued a permit or authorization in
connection with premises you own, rent (a) The preparing, approving, or
failing to prepare or approve
or control and to which this insurance maps, shop drawings, opinions,
apple reports, survey, field orders,
(1) The existence, maintenance, repair, change orders, or drawings and
construction, erection, or removal of specifications: or I
advertising signs, awnings, (b) Supervisory, inspection, archi-
canopies, cellar entrances, coat tectural, or engineering activ-
holes, driveways, manholes, hies
marquees, hoist away openings,
sidewalk vaults, street banners, or (2) "Bodily injury or "property damage"
decorations and similar exposures; occurring after:
or (a) All work, including materials,
parts, or equipment furnished in
(2) The construction, erection, or connection with such work, on
removal of elevators;or the project (other than service,
The ownership, maintenance, or use of maintenance or repairs) to be
any elevators covered by this insurance. performed by or on behalf of the
This insurance does not apply to: additional insured(s) at the
(1) "Bodily injury" or "property damage" location of the covered
or "personal or advertising injury" operations has been completed;
arising out of operations performed or
for the state or municipality;or (b) Thal portion of "your work" out
(2) `Bodily injury" or "property damage" of which the injury or damage
arises has been put to its
included within the "products-
intended use by any person or
completed operations hazard". organization other than another
However, such stale or political contractor or subcontractor
subdivision's status as additional engaged in performing
insured under this policy ends when the operations for a principal as a
permit ends. part of the same project.
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72 8812 16
However, a person or organization's This coverage does not apply if Coverage C -
status as additional insured under Medical Payments is excluded either by the
this policy ends when your provisions of any coverage forms attached to the
operations for that additional insured policy or by endorsement,
are completed. K. Knowledge Of An Occurrence
With respect to the insurance afforded to Under Section IV - Commercial General
such additional insureds a. - d. described Liability Conditions, the following is added to
above the following is added to the Section Condition 2. Duties In The Event Of
ill-Limits Of Insurance: Occurrence, Offense,Claim Or Suit:
If coverage provided to the additional e. Knowledge of an occurrence, offense, claim
insured is required by a contract or or suit by an agent or employee of any
agreement, the most we wilt pay on behalf of insured shall not in itself constitute
the additional insured is the amount of knowledge of the insured unless you, a
insurance: partner, if you are a partnership; or an
1. Required by the contract or agreement: executive officer, or insurance manager, if
or you are a corporation receives such notice
2. Available under the applicable Limits of of an occurrence, offense, claim, or suit from
Insurance shown in the Declarations; the agent or employee.
whichever is less. f. The requirements in Paragraph b. will not be
This endorsement shall not increase the considered breathed unless there is
applicable Limits of Insurance shown in the Paragraph of occurrence as outlined in
aph e. above.
ge
Declarations.
P
However, the insurance afforded to such L. Unintentional Failure To Disclose Hazard
additional insureds a.-d. described above: Under Section IV - Commercial General
1. Only applies to the extent permitted #3y Liability Conditions, Condition 6.
law;and Representations the following paragraph is
added:
2. Will not be broader than that which you d. Your failure to disclose all hazards or prior
are required by the contract or "occurrences" or offenses existing as of the
agreement to provide such additional inception date of the policy shall not
insured, prejudice the coverage afforded by this
Aggregate Limit Per Protect policy provided such failure to disclose all
Under Section Hi - Limits Of Insurance The hazards or prior"occurrences" or offenses is
following paragraph is added to Paragraph 2: not intentional. This provision does not
The General Aggregate Limit under Section III affect our right to collect additional premium
Limits Of Insurance applies separately to each or exercise our right of cancellation or non-
of your construction projects away from renewal_
premises owned by or rented to you M. Waiver Of Subrogation
J. Medical Payments Under Section iV - Commercial General
Under Section Iii - Limits Of insurance, Liability Conditions, 8.Transfer Of Rights Of
Paragraph 7. is replaced with: Recovery Against Others To Us the following
7. Subject to 5.above, the higher of: paragraph is added:
a. $1 t)OQO;or If required by a written contract executed prior to
loss, we waive any right of subrogation we may
b. The amount shown in the Declarations have against the contracting person or
for Medical Expense Limit is the most organization because of payments we make for
we will pay under Coverage C for all injury or damage arising out of your ongoing
medical expenses because of "bodily operations or "your work" done under a contract
injury"sustained by one person. with that person or organization and included in
the"products-completed operations hazard".
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CG 72 8812 16
N. Liberalization O. Broadened Bodily Injury Definition (Mental
Under Section IV — Commercial General Anguish)
Liability Conditions, the following condition is Under Section V -- Definitions Definition 3.
added: "Bodily Injury"is replaced with:
10. Liberalization 3. "Bodily injury" means physical injury,
If we revise this coverage form to provide sickness, or disease to a person and if
more coverage without additional premium arising out of the foregoing, mental anguish,
charge, your policy will automatically provide mental injury, shock, or humiliation,
the additional coverage as of the day the including death at any time resulting
therefrom.
revision is effective in your slate.
All terms and conditions of this policy apply unless modified by this endorsement.
CO 72 88 12 16 Includes copyrighted material of Insurance Services Office,Inc., Page 5 of 5
with its permission.
ACP OLA076559249e3 LCIH 15354 INSURED COPY 47 0024739
COMMERCIAL AUTO
AC 70 05 03 16
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESS AUTO PROTECTION .. GOLD
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
SUMMARY OF COVERAGES
A, Effect of This Endorsement
B. Newly Acquired or Formed Entities
C. Employees as insureds—Nonowned Autos
D. Additional Insured by Contract,Permit or Agreement
E. Supplementary Payments—Bail Bonds
F. Supplementary Payments—Loss of Earnings
G. Personal Effects and Property of Others Extension
H. Prejudgment interest Coverage
I. Fellow Employee—Officer, Managers and Supervisors
J. Hired Auto Physical Damage
K Temporary Substitute Autos—Physical Damage Coverage
L. Expanded Towing Coverage
M. Auto Loan or Lease Coverage
N. Original Equipment Manufacturer Parts—Leased Private Passenger Types
O. Deductible Amendments
P. Rental Reimbursement Coverage
Q. Expanded Transportation Expense
R. Extra Expense—Stolen Autos
S. Physical Damage Limit of Insurance
T. New Vehicle Replacement Cost
U. Physical Damage Coverage Extension
V. Transfer of Rights of Recovery Against Others To Us
W. Section IV—Business Auto Conditions—Notice of and Knowledge of Occurrence
X. Hired Car Coverage Territory
Y. Emergency Lock Out
Z. Cancellation Condition
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COMMERCIAL AUTO
AC 70 05 03 15
A. EFFECT OF THIS ENDORSEMENT If specifically required by the written contract or
Coverage provided under this policy is modified agreement referenced in the paragraph above,
the provisions of this endorsement. If there any coverage provided by this endorsement to
by P h an additional insured shall be primary and
is any conflict between the provisions of this i
any other valid and collectible insurance avail-
endorsement endorsement and the provision(s)of any state- able to the additional insured shall be non-
specific endorsement also attached to this poll- contributory with this Insurance. If the written
cy, then the provision(s) of the state-specific contract does not require this coverage to be
endorsement shall apply Instead of the provi- primary and the additional insured's coverage to
sions of this endorsement that are In conflict, be non-contributory, then this insurance will be
but only to the extent of the conflict,and only to excess over any other valid and collectible Insur-
the extent necessary to bring such provisions ance available to the additional insured.
into conformance with the state requirement(s)
contained in the provision(s)of the state-specific
endorsement. E. SUPPLEMENTARY PAYMENTS — BAIL
B. NEWLY ACQUIRED OR FORMED ENTITIES BONDS
The Named Insured shown in the Declarations is Supplementary Payments of SECTION II —
amended to include any organization you newly COVERED AUTOS LIABILITY COVERAGE is
acquire or form, other than a partnership, joint revised as follows:
venture, or limited liability company, and over (2) Up to$2,500 for cost of bail bonds(including
which you maintain ownership or majority (more bonds for related traffic law violations)
than 50%) interest; if there is no other similar In- required because of an "accident"we cover.
surance available to that organization. Coverage We do not have to furnish these bonds.
under this provision is afforded until the 180"' F. SUPPLEMENTARY PAYMENTS — LOSS OF
day after you acquire or form the organization or EARNINGS
the end of the policy period,whichever is later. Supplementary Payments of the SECTION II —
C. EMPLOYEES AS INSUREDS — NONOWNED COVERED AUTOS LIABILITY COVERAGE is
AUTOS revised as follows:
The following is added to paragraph A.1. Who is (4) All reasonable expenses incurred by the In-
An insured of SECTION II—COVERED AUTOS sured" at our request, including actual loss
LIABILITY COVERAGE: of earnings up to $500 a day because of
d. Arty "employee" of yours is an "insured" time oft from work.
while using a covered "auto" you don't own, G. PERSONAL EFFECTS AND PROPERTY OF
hire or borrow in your business or your per- OTHERS EXTENSION
sone!affairs. 1. The. Care, Custody or Control Exclusion of
D. ADDITIONAL INSURED BY CONTRACT, SECTION II — COVERED AUTOS
PERMIT OR AGREEMENT LIABILITY COVERAGE, does not apply to
The following is added to A.1. Who Is An In- "property damage" to property, other than
1 sured of SECTION II — COVERED AUTOS your property, up to an amount not exceed-
LIABILITY COVERAGE: ing $250 in any one "accident", Coverage
Any person or organization that you are re- is excess over any other valid and collectible
quired to name as an additional insured in a insurance.
written contract or agreement that is executed 2. The following paragraph is added to A.4.
or signed by you prior to a "bodily injury" or Coverage Extensions of SECTION III
9 Y
"property damage" occurrence is an "insured" PHYSICAL DAMAGE COVERAGE:
for Covered Auto Liability coverage. How- c. We will pay up to$500 for your property
ever, with respect to covered "autos", such that is lost or damaged as a result of a
p erson or organization is an insured only to covered loss", without applying
a de-
file extent that person or organization qualifies ductible, Coverage is excess over any
as an "insured"under A.1. Who is an Insured of other valid and collectible insurance.
SECTION II -- COVERED AUTOS LIABILITY
COVERAGE:
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AC 70050316
H, PREJUDGMENT INTEREST COVERAGE substitute for a covered"auto"you own that
The following paragraph Is added to SECTION II is out of service because of its:
— COVERED AUTOS LIABILITY COVERAGE, a. Breakdown;
2. Coverage Extensions, a. Supplementary b. Repair;
Payments: c. Servicing;
(7) Prejudgment Interest awarded against the d. 'Loss';or
"insured" on that part of the judgment we
pay. If we make an offer to pay the appli- e. Destruction
cable limit of insurance, we wig not pay The coverage that applies is the same as
any prejudgment interest based on that the coverage provided for the vehicle being
period of time after the offer. raped. .
1. FELLOW EMPLOYEE — OFFICERS,
MANAGERS, AND SUPERVISORS L, EXPANDED TOWING COVERAGE
The Fellow Employee Exclusion in SECTION II 1. We will pay up to:
—COVERED AUTOS LIABILITY COVERAGE Is a $100 for a covered "auto' you own of
replaced as follows; the rivate
A. "Bodily injury" to any fellow "employee" of P passengertype,or
the"insured'arising out of and in the course b. $500 for a covered "auto" you own that
of the fellow "employee's" employment or Is not of the private passenger type,
while performing duties related to the con- for towing and labor costs Incurred each
duct of your business. This exclusion does time the covered"auto" Is disabled. Noway-
not apply to an Insured" who occupies a er,the labor must be performed at the place
position as an officer, manager, or supervi- of disablement.
sor. 2. This coverage applies only for an "auto"
J. HIRED AUTO PHYSICAL DAMAGE covered on this policy for Comprehensive or
If covered'auto"designation symbols 1 or 8 ap- Specified Causes of Loss Coverage and
ply to Liability Coverage and if at least one"au- Collision Coverages
to' you own is covered by this policy for Corn- 3. Payment applies in addition to the otherwise
prehenslve,Specified Causes of Loss, or Colli- applicable amount of each coverage you
sion coverages, then the Physical Damage have on a covered"auto°.
coverages provided are extended to'autos"you M. AUTO LOAN OR LEASE COVERAGE
lease,hire, rent or borrow without a driver; and 1. In the event of a total "loss" to a covered
provisions in the Business Auto Coverage Form 'auto", we will pay any unpaid amount due
applicable to Hired Auto Physical Damage apply on the loan or lease,including up to a max-
up to a limit of$100,000. The deductible will be imum of $500 for early termination fees or
equal to the largest deductible applicable to any penalties,for your covered"auto"less:
owned "auto for that coverage. My Comore-
a. The amount paid under SECTION III — -
hensive deductible does not apply to fire or PHYSICAL DAMAGE COVERAGE of
lightning, this policy;and
- K. TEMPORARY SUBSTITUTE AUTOS —
PHYSICAL DAMAGE COVERAGE b. My:
The following is added to paragraph C. Certain 1) Overdue lease/loan payments at the
Trailers, Mobile Equipment And Temporary time of the"loss';
Substitute Autos of SECTION I - COVERED 2) Financial penalties imposed under a
AUTOS: lease for excessive use, abnormal
If Physical Damage Coverage is provided by wear and tear or high mileage;
this Coverage Form, the following types of 3) Security deposits not refunded by a
vehicles are also covered'autos" for Physi- lessor;
cal Damage Coverage: 4) Costs of extended warranties,Credit
Any "auto" you do not own while used with Life insurance, Health, Accident, or
the permission of its owner as a temporary Disability insurance purchased with
the lease;and
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AC 70 05 031 6
5) Carry-over balances from previous No deductible applies to glass if the glass is re-
leases, paired,in a manner acceptable to us,rather than
2. This coverage only applies to a "loss"which replaced.
is also covered under this policy for Corn- P. RENTAL REIMBURSEMENT COVERAGE
prehensive, Specified Causes of Loss, or 1. This coverage applies only to a covered"au-
Collision coverage. to" for which Physical Damage Coverage is
3. Coverage does not apply to any unpaid provided on this policy.
amount due on a loan for which the covered 2. We will pay for rental reimbursement ex-
"auto"is not the sole collateral. penses Incurred by you for the rental of an
N. ORIGINAL EQUIPMENT MANUFACTURER "auto"because of"loss"to a covered"auto".
PARTS — LEASED PRIVATE PASSENGER Payment applies in addition to the otherwise
TYPES applicable amount of each coverage you
Under Paragraph C. Limit of Insurance of have on a covered "auto." No deductibles
SECTION III -- PHYSICAL DAMAGE apply to this coverage.
COVERAGE, Section 4 is added as follows: 3. We will pay only for those expenses incurred
4. We will use new original equipment vehicle during the policy period beginning 24 hours
manufacturer parts for any private passen- after the "loss"and ending,regardless of the
ger type covered "auto" where required by policy's expiration, with the lesser of the
the lease agreement which has a term of at following number of days:
least six months. If a new original equip- a. The number of days reasonably
ment vehicle manufacturer part is not in pro- required to repair or replace the covered
duction or distribution we may use a like, "auto". If "loss" is caused by theft, this
kind and quality replacement part number of days is added to the number
O. DEDUCTIBLE AMENDMENTS of days it takes to locate the covered
The following are added to the Deductible provi "auto"and return it to you.
sion of SECTION III -- PHYSICAL DAMAGE b. The number of days shown In the
COVERAGE: Schedule.
If another policy or coverage form that is not an 4. Our payment is limited to the lesser of the
automobile policy or coverage form issued by following amounts:
this company applies to the same"accident",the a. Necessary and actual expenses
following applies: incurred.
1. If the deductible under this coverage is the b. $75 for any one day or for a maximum
smaller (or smallest) deductible, it will be of 30 days.
waived: 5. This coverage does not apply while there
2. If the deductible under this coverage is not are spare or reserve"autos"available to you
the smaller(or smallest) deductible,it will be for your operations.
reduced by the amount of the smaller (or 6. If "loss" results from the total theft of a cav-
smallest)deductible. ered "auto" of the private passenger type,
If a Comprehensive or Specified Causes of Loss we will pay under this coverage only that
Coverage "loss" from one "accident" Involves amount of your rental reimbursement ex-
two or more covered "autos", only the highest penses which is not already provided for un-
deductible applicable to those coverages will be der SECTION III — PHYSICAL DAMAGE
applied to the"accident,"if the cause of the loss COVERAGE Coverage Extension.
is covered for those vehicles. This provision only Q. EXPANDED TRANSPORTATION EXPENSE
applies if you carry Comprehensive or Specified Paragraph A.4,a. of SECTION III -- PHYSICAL
Causes of Loss Coverage for those vehicles, DAMAGE COVERAGE is replaced by the follow-
and does not extend coverage to any covered
"autos" for which you do not carry such ing'
coverage. We will pay up to $50 per day to a maximum of
$1500 for temporary transportation expense in-
curred by you because of the total theft of a
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• COMMERCIAL AUTO
AC 70 0503 16
covered "auto" of the private passenger type. merit manufacturer or other sources In-
We will only pay for those covered "autos" for chiding non"original equipment menu-
which you carry Comprehensive or Specified facturers and
Causes of Loss Coverage.We will pay for tern- b. if a repair or replacement results in bet-
porary transportation expenses incurred during ter than like kind or quality, we will not
the period beginning 24 hours after the theft and pay for the amount of the net improve-
ending, regardless of"the policy's expiration, ment
when the covered"auto"is returned to use or we
pay for its 'loss". 5. If we offer to pay the actual cash value of
the R. EXTRA EXPENSE—STOLEN AUTOS value damaged or stolen property, we will
value auto advertising wraps,paint customi-
The following paragraph is added to Coverage zation,and similar business related advertis-
Extensions of SECTION III — PHYSICAL ing modifications, in addition to the actual
DAMAGE COVERAGE: cash value of the property. Auto advertising
a. We will pay for up to$6,000 for the expense wraps, paint customization, and similar
of returning a stolen covered"auto" to you. business related advertising modifications
We will pay only for those covered "autos" will be valued at the cost to replace them
for which you carry Comprehensive or Spec- with an adjustment made for depreciation
Iliad Causes of Loss Coverage and physical condition.
S. PHYSICAL DAMAGE LIMIT OF INSURANCE T. NEW VEHICLE REPLACEMENT COST .
Under SECTION III — PHYSICAL DAMAGE The following is added to the Limit of Insurance
COVERAGE, Paragraph C., Limit of Insurance provision of SECTION III — PHYSICAL
is replaced by the following: DAMAGE COVERAGE:
C.Limit Of Insurance 5. The provisions of paragraphs 1. and 3. do
1. The most we will pay for loss" in any one not apply to a covered"auto" o! the private
"accident°is the lesser of: passenger type or a vehicle with a gross
vehicle weight rating of 20,000 pounds or
a. The actual cash value of the damaged less which is a"new vehicle."
or stolen property as of the time of the
In the event of a total loss"to your new ve-
loss°,or Y
hide to which this coverage applies,we will
b. The cost of repairing or replacing the pay at your option:
damaged or stolen property. a. The verifiable "new vehicle' purchase
2. $1600 is the most we will pay for loss" in price you paid for your damaged vehi-
'any one "accident" to all electronic equip- de, not including any insurance or war-
ment that reproduces,receives or transmits rarities purchased;
audio, visual or data signals which, at the b. If it Is available, the purchase price, as
time of"loss",is: P P
negotiated by us, of a "new vehicle" of
a. Permanently installed in or upon the the same make, model, and equipment
covered "auto"in a housing, opening or or the most similar model available,not
other location that is not normally used including any furnishings, parts, or
by the "auto manufacturer for the in- equipment not installed by the manufac-
stallatlon of such equipment. turer or manufacturers'dealership;or.
b. Removable from a permanently installed c. The market value of your damaged ye-
housing unit as described in Paragraph hie, not Including any furnishings,
2.a. above or is an integral part of that parts, or equipment not Installed by the
equipment;or manufacturer or manufacturer's dealer-
c. An integral part of such equipment ship. ,
3. An adjustment for depreciation and physical We will not pay for initiation or set up costs
condition will be made in determining actual associated with loans or leases
cash value in the event of a total loss°. As used in this endorsement, a "new
4. The cost of repairing or replacing may: vehicle' means an auto" of which you are
a. Be based on an estimate which includes the original owner that has not been previ-
parts furnished by the original .equip-
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AC 70 05 03 16
ously titled and which you purchased less a. Your obligation in the Duties in the Event
than 365 days before the date of the"foss". of Accident, Claim, Suit or Loss Condi-
tion relative to notification requirements
U. PHYSICAL DAMAGE COVERAGE applies only when the "accident" or
Under r SECTION III — PHYSICAL DAMAGE
loss"is known to:
EXTENSIONS (1) You,if you are an Individual;
S
COVERAGE, A. Coverage, Coverage Exten- (2) A partner,If you are a partnership;
sloes, b. Loss of Use Expenses is replaced by (3) A member, if you are a limited liability
, the following: company;or
b. Loss of Use Expenses (4) An executive officer or insurance
For Hired Auto Physical Damage,'we will manager,if you are a corporation.
pay expenses for which an "insured" be- b. Your obligation in the. Duties in the Event
comes legally responsible to pay for loss of of Accident,Claim, Suit or Loss Condition
use of a vehicle rented or hired without a relative to providing us with documents
driver, under a written rental contract or concerning a claim or "suit° will not be
agreement. We will pay for loss of use ex- considered breached unless the breach
penses if caused by: occurs after such claim or"suit" is known
(1) Other than collision if the Declarations to:
Indicate that Comprehensive Coverage (1) You,if you are an individual;
Is provided for any covered"auto"; (2) A partner,if you are a partnership;
(2) Specified Causes of Loss only if the (3) A member, if you are a limited
Declarations Indicate that Specified liability company;or
Causes of Loss Coverage is provided (4) An executive officer or insurance
for any covered"auto";or manager,if you are a corporation,
(3) Collision only if the Declarations indicate
that Collision Coverage is provided for
any covered"auto." X. HIRED CAR—COVERAGE TERRITORY
However, the most we will pay for any Item (5) of the Policy Period,Coverage Ter itory
expenses for loss of use is $50 per day,to a Generaconditionds replaced by the following:
maximum of$1,500.The Insurance provided (5) Anywheren theworidif a covered"auto"is
by this provision Is excess over any other leased, hired, rented or borrowed without a
collectible Insurance. driver for a period of 30 days or less;and
V. TRANSFER OF RIGHTS OF RECOVERY Y. EMERGENCY LOCKOUT
AGAINST OTHERS TO US We will reimburse you up to$100 for reasonable
The following is added to the Transfer Of Rights expense incurred for the services of a locksmith
Of Recovery Against Others To Us Condition: to gain entry Into your covered "auto"subject to
We waive any right of recovery we may these provisions:
have against any person or organization to 1. Your door key, electronic key or key entry
the extent required of you by a written con- pad has been lost, stolen or locked in your
tract executed prior to any "ardent"be- covered "auto°and you are unable to enter
cause of payments we make for damages such"auto°,or
under this coverage form. 2. Your keyless entry device battery dies and
W. NOTICE OF AND KNOWLEDGE OF you are unable to enter such "auto"as a re-
OCCURRENCE suit,
SECTION IV—BUSINESS AUTO 3. Your key, electronic key or key entry pad
CONDITIONS, Paragraph A is amended as has been lost or stolen and you have
follows: changed the lock to prevent an unauthorized
entry;and
6. NOTICE OF AND KNOWLEDGE OF
OCCURRENCE
Page 6 of 7- includes copyrighted material of Insurance Services Office, inc AC 70 05 0316
with its permission. ,
ACP BAPD965-6f249113 WIN 18363 INSURED COPY Ara D viow OM 47
••
COMMERCIAL AUTO
AC 70 05 0316
4. Original copies of receipts for services of a If we cancel for any reason other than non-
locksmith must be provided before reim- payment of premium, we will mail or deliver
bursementis payable. to the First Named Insured written notice of
Z. CANCELLATION CONDITION cancellation at least 60 days before the et-
Peragraph k2. of the COMMON POLICY festive date of cancellation. This provision
does not apply in those states that require
CONDITION — CANCELLATION applies
except as follows: more than 60 days prior notice of cancella-
tion.
AC 70 05 0316 Includes copyrighted material of Insurance Services Office,Inc., Page 7 of 7
with Its permission
ACP BAPD76-64024903 SIIH 18353 INSURED COPY AC7005031600 0081 47 0024789
CITY OF
ASHLAND
Memo
DATE: May 1, 2019
TO: Paula Brown, Director of Public Works ,
FROM: Chance Metcalf, Project Manager
RE: Low Risk, Less Stringent Insurance Co erage
RI
L.,..
° I yis my intention to hire Reggie Devore, owner of Devore Electric and Construction, to provide
�`q 4W1 ctrical services to remove and replace the fuel card console at the Ashland Airport. Devore Electric
h and Construction carries insurance limits that are lower than the City's standards, including$1M
general liability(City requires $2M), and$1M automobile liability(City requires $2M). I believe the
City's requirements are not necessary for this project based on the reasons provided below.
General Liability
It is my opinion that the risk associated with the services requested is sufficiently low to justify
waiving the City's higher general liability insurance requirements. There are multiple factors that
contribute to my opinion of low risk such as: Minimal scope (reroute conduits,rewire the console), all
work will be completed in less than one day, work area is designated to one location on the Airport,
and lastly because we are supplying all the materials for this project.
Automobile Liability
Other than parking lot access and egress, this project will not require the operation of a vehicle on
City-owned property. As with general liability insurance, I believe that the type of driving,the spatial
extent of where an automobile will be operated, and the duration of automobile operations do not
necessitate the City's requirement for$2M in coverage.
Past Performance
Mr. Devore has worked with me on multiple projects in the past displaying exceptional expertise in his
field. He has been fair and delivers on his projects.
•
Page 1 of 1
WIIS
pirtm
Purchase Order
Vaal Fiscal Year 2019 Page: 1 of: 1
B City of Ashland
ATTN: Accounts Payable Purchase
L Ashland, OR 97520 Order# 20190482
T Phone: 541/552-2010
O Email: payable @ashland.or.us
V H C/O Public Works Department
E DEVORE ELECTRIC AND CONSTRUCTION I 51 Wnburn Way
N 792 E DUTTON RD p Ashland, OR 97520
O EAGLE POINT, OR 97524 Phone: 541/488-5347
R T Fax: 541/488-6006
Paula Brown
05/15/2019 4431 FOB ASHLAND OR/NET30 Ci Accounts Pa able
Fuel Card Console Airport
1 Removal and replacement of fuel card console at the Ashland 1 $1,310.0000 $1,310.00
Municipal Airport
Goods & Services Agreement
Completion date: 05/31/2019
Project Account:
GL SUMMARY
085700-704100 $1,310.00 I
By l -Z--Date: 1.1 )1
Au ••rized Signature _ $1,310.00
• 7---6 ( 6 (,V(? Ye-e-1 -
, 17/ -).,/t1
6Z c-e--Z 4( r
FORM #3 �- CITY
H LA
�8 AS N D
A request for a Purchase Or .- e5 ,-
REQUISITION Date of request: 04/29/2019
Vendor Name DeVore Electric and Construction
Address,City,State,Zip 792 E Dutton Road Eagle Point,OR 97524
Contact Name Reginald DeVore
Telephone Number 541-944-3380
Email address
SOURCING METHOD
❑ Exempt from Competitive Bidding ❑ Invitation to Bid ❑ Emergency
❑ Reason for exemption:_ Date approved by Council: ❑ Form#13,Written findings and Authorization
❑ AMC 2.50 _(Attach copy of council communication) El Written quote or proposal attached
❑ Written quote or proposal attached _(If council approval required,attach copy of CC)
❑ Small Procurement ❑ Request for Proposal Cooperative Procurement
Not exceeding$5,000 Date approved by Council: ❑ State of Oregon
❑ Direct Award (Attach copy of council communication) Contract#
❑ Verbal/Written quote(s)or proposal(s) ❑ Request for Qualifications(Public Works) ❑ State of Washington
Intermediate Procurement Date approved by Council: Contract#
GOODS&SERVICES (Attach copy of council communication) ❑ Other government agency contract
Greater than$5,000 and less than$100,000 ❑ Sole Source Agency
❑ (3)Written quotes and solicitation attached ❑Applicable Form(#5,6,7 or 8) Contract#
PERSONAL SERVICES ❑Written quote or proposal attached Form Intergovernmental Agreement
Greater than$5,000 and less than$75,000 ❑ Form#4, Personal Services>$5K&<$75K Agency
❑Direct appointment not to exceed$35,000 0 Annual cost to City does not exceed$25,000.
❑ Special Procurement
0(3)Written proposals/written solicitation Agreement approved by Legal and approved/signed by
❑Form#4,Personal Services>$5K&<$75K CI Form#9,Request for Approval City Administrator.AMC 2.50.070(4)
❑ Written quote or proposal attached
Date approved by Council: ❑Annual cost to City exceeds$25,000,Council
Valid until: (Date) approval required.(Attach copy of council communication)
Description of SERVICES Total Cost
Removal and replacement of fuel card console at the Ashland Municipal Airport. $ 1,310.00
Item# Quantity Unit Description of MATERIALS Unit Price Total Cost
0 Per attached quote/proposal TOTAL COST
Expenditure must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately.
Project Number -_ _ Account Number 085700 - 704100 $ 1,310.00,— — _ — —
Project Number _ Account Number - $ I 1 .
Project Number — — Account Number - $ .
IT Director in collaboration with department to approve all hardware and software purchases:
By signing this re uisition form,I certify that the City's public contracting requirements have been satisfied. IT Director Date Support-Yes/No
i
Employee: f Department Head: //. � � Cr ' Z40/
/Wm 1 (Equ. to o'r great-than$5,0'0)
Department Manager/Supervisor: City Administrator. � l /�,
(Equal to orgreaterth. $2 000)
Funds appropriated for current fiscal year: NO r 11 f
Fin e Director-(Equal to or greater than$5,000) Date
Comments:
Form#3-Requisition