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2019-153 20190501 Ashland Construction
• GOODS & SERVICES AGREEMENT PROVIDER: Ashland Construction Inc. CITY OF PROVIDER'S CONTACT: Ron Hobson ASHLAND 20 East Main Street ADDRESS: 102 Pleasant View Ashland,Oregon 97520 Talent,Oregon 97540 Telephone: 541/488-5587 Fax: 541/488-6006 PHONE: 541-488-4571 Cell 541-944-2728 This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and Ashland Construction, Inc, a domestic business corporation ("hereinafter "Provider"), for downtown Plaza sidewalk, curb, gutter, and ADA ramp construction. 1. PROVIDER'S OBLIGATIONS 1.1 Provide downtown Plaza sidewalk, curb, gutter, and ADA ramp construction 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." 12 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 $2,000,000 (two 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 Page 1 of 6: Agreement between the City of Ashland and Ashland Construction,Inc. • • 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. 1.2.3 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. 1.3 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. As evidence of the insurance required by this Agreement,the Provider shall furnish an acceptable insurance certificate prior to commencing any Work under this Agreement. 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 $83,845.00 (eighty-three thousand eight hundred and forty-five dollars) 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$83,845.00 (eighty-three thousand eight hundred and forty-five dollars) 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 Deliveries will be F.O.B destination.Provider shall pay all transportation and handling charges for the Goods.Provider is responsible and liable for loss or damage until final inspection and acceptance of the Goods by the City. Provider remains liable for latent defects,fraud,and warranties. Page 2 of 6: Agreement between the City of Ashland and Ashland Construction,Inc. • � I 3.3 The City may inspect and test the Work.The City may reject non-conforming Work and require Provider to correct it without charge or deliver it at a reduced price,as negotiated.If Provider does not cure any defects within a reasonable time,the City may reject the Work and terminate this Agreement in whole or in part. This paragraph does not affect or limit the City's rights,including its rights under the Uniform Commercial Code,ORS Chapter 72(UCC). 3.4 Provider represents and warrants that any goods are new, current, and fully warranted by the manufacturer. Delivered goods will comply with SUPPORTING DOCUMENTS and be free from defects in labor,material and manufacture. Provider shall transfer all warranties to the City. 3.5 Provider is an independent contractor and not an employee or agent of the.City for any purpose. 3.6 Provider is not entitled to,and expressly waives all claims to City benefits such as health and disability insurance,paid leave,and retirement. 3.7 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. 3.8 This Agreement may be amended only by written instrument executed with the same formalities as this Agreement. 3.9 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 Page 3 of 6: Agreement between the City of Ashland and Ashland Construction,Inc. • 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 request for bids for "CONCRETE INSTALLATION FOR THE CITY OF ASHLAND"dated April 5,2019. • The Provider's amended written quote in the total amount of$82,345.00 by Ron Hobson dated April 12,2019. • 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. 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 October 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. 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—Engineering Department Attn: Brad Barber 20 E.Main Street Ashland,Oregon 97520 Phone: (541)488-5347 Page 4 of 6: Agreement between the City of Ashland and Ashland Construction,Inc. - With a copy to: City of Ashland—Legal Department 20 E.Main Street Ashland,OR 97520 Phone:(541)488-5350 If to Provider: I. . . r•. , Ashland Construction,Inc. Attn:Ron Hobson • 102 Pleasant View Talent,OR 97540 541-944-2728 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: (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. 92 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. Page 5 of 6: Agreement between the City of Ashland and Ashland Construction,Inc. . 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 ASHLAND: ASHLA CO,NSTRUC ON,INC.(PROVIDER): By:) id.a _111 • . By: /" / / %tom`' ---, K-Ily adding,City A. a u-strator Signature i Date Printed Name lzrc Title Purchase Order No. -o / 9 o go / ■/6,//9 Date (W-9 is to be submitted with this signed Agreement) APPROVED AS TO FORM: Assistant City Attorney ._6Y;Lc -5, _�0/ Date • Page 6 of 6: Agreement between the City of Ashland and Ashland Construction,Inc. , C I T Y• • OF • ASHLAND • REQUEST FOR QUOTATIONS • Project located near the intersection of E.Main Street and Oak Street at the.Chautauqua Walkway..Please indicate your quotation for each of the following items as indicated below. City of Ashland will provide Surveying for contractor. Plans and Standard Drawings are attached to this request. y-t _ss'�.�'r l 'b CSL�li 0'713''=' 1,-ra -� ❑ �Y ct '¢n� a .-lam"' ItS -:�sr S'�:£z"s:E�v�«+=..,.. ..i._,.��:r6�� <`rxr�.,..��x,�r .•�'-.i 1�... ,-1 ���'l...xsa. .�,� _ . irloBD a D' lIDS Mobilization LS 1 6, c) -- Traffic Control LS 1 Erosion& Sediment Control LS 1 Colored Concrete Sidewalk SF 2697 /cr 44-4-ES — Colored Concrete Sidewalk Ramps,ADA EA 4 3QSoj JS•?L7f)m . 12-in Concrete Curb LF 152 6S 98S® I6-in Concrete Curb L£ 74 • $M w� Staking,Layout LS 1 — 110 Vitt Plaza Sidewalk Improvements Bid Total $ 0 I QUOTE MUST BE RECEIVED BY: _ 2:00 PM,Friday, April 12,2019 V• 8' 2 34C p Date: 42'..lc- /e9-% e-7-©/9i 1 `� o snaa S3B4- By ' Sign re N acom Address: /�r� f l//Ef d l Printed Name • 7- OWArr-t-//9e-62. Title 49G(6(4 vo C& Side (.4'7%0 Titre—. a 5/2 - 0.00 Company Phone: r s-4-, -9, .4 -2.7 ZP$ jz) ktBso/s4-,} atj R• .n Fewe Engineering Dcpnrtntent Tel:541/4B8-5347 20 E.Main Street Fax:541/488-6006 Pte. . Ashland,Oregon 97520 TTY:800/735-2900 �� www.ashland.or.ns • Business Registry Business Name Search Page 1 of 3 Business Registry Business Name Search 04-16-2019 New Search Business Entity Data 10:56 Enti Entit Registry Next Renewal Registry Nbr Tvoe Status Jurisdiction Date Renewal Due? Date 134678-16 DBC ACT OREGON 03-01-1979 03-01-2020 Entity Name ASHLAND CONSTRUCTION, INC. Foreign Name New Search Associated Names Type PPB RINCIPAL PLACE OF USINESS Addr 1 102 PLEASANT VIEW Addr 2 CSZ TALENT IOR 197540 1 I Cou ntry1UNITED STA'IES OF AMERICA Please click here for general information about registered agents and service ofprocess. Type AGTREGISTERED AGENT Start Date 03-06- Resign Date 1985 Name RON 1 IFIOBSON Addr 1 102 PLEASANT VW Addr 2 CSZ TALENT (OR 197540 1 ICountry KUNITED STATES OF AMERICA Type MALIMAILING ADDRESS Addr 1 102 PLEASANT VIEW Addr 2 CSZ TALENT IOR 197540 1 ICountry CUNITED STATES OF AMERICA Type PREIPRESIDENT I Resign Date Name RON 1 !HOBSON Addr 1 102 PLEASANT VIEW Addr 2 CSZ TALENT IOR 197540 I ICountrylUNITED STATES OF AMERICA Type SECISECRETARY I I Resign Date Name RON 1 'HOBSON Addr 1 102 PLEASANT VIEW Addr 2 CSZ 'Country http://egov.sos.state.or.us/br/pkg_web_name_srch inq.show detl?p_be_rsn=74696&p_sre... 4/16/2019 Business Registry Business Name Search Page 2 of 3 I ITALENT IOR 197540 I I !UNITED STATES OF AMERICA I. New Search Name History Business Entity Name Name Name Start Date End Date Type Status SHLAND CONSTRUCTION, INC. EN CUR 03-01-1979 Please read before ordering Copies. New Search Summary History Image Action Transaction Effective Status Name/Agent Dissolved By Available Date Date Change a AMENDED ANNUAL 03-01-2019 FI REPORT 8 AMENDED ANNUAL 01-20-2018 FI REPORT 8 AMENDED ANNUAL 02-20-2017 FI REPORT aAMENDED ANNUM 01-30-2016 FI REPORT 0 AMENDED ANNUAL 01-17-2015 FI REPORT aAMENDED ANNUAL 02-28-2014 FI REPORT ANNUAL REPORT 02-12-2013 SYS PAYMENT ANNUAL REPORT 02-14-2012 SYS PAYMENT ANNUAL REPORT 02-16-2011 SYS PAYMENT ANNUAL REPORT 01-20-2010 SYS PAYMENT ANNUAL REPORT 02-16-2009 SYS PAYMENT ANNUAL REPORT 02-05-2008 SYS PAYMENT ANNUAL REPORT 02-07-2007 SYS PAYMENT ANNUAL REPORT 02-10-2006 SYS PAYMENT ANNUAL REPORT 02-25-2005 SYS PAYMENT ANNUAL REPORT 02-13-2004 SYS PAYMENT . 5 http://egov.sos.state.or.us/br/roka web name srch ina.show detl?n be rsn=74696&n arc. . 4/16/2019 6I OZ/91/t7 ••'aIs d28969ft—usa act Hap mous•bup ua.zs am a gam the/aq/sn•ao•alM.s•sos•no o//:d u •panJasal{ s}y611:1 Icy •a121S Jo AJ24anas uo6aJO 6TOZ OO I3 I S 86 I-i T-£0 VrkldMI g2 IHrDIV IIS I3 9861-1E-10 IdrlclgNg2l IHDIVdIIS I3 L861-£0-ZO I�tY1gNg2I IHDIV IIS I3 8 861-£0-ZO I�'�Y1gNg2I IHOIVHIIS Id 6861-LZ-ZO QHUNg➢V I3 0661-0E-10 JYmgN IHrDIVIIIS I I3 1661-171-Z0 vA1gNaH IHrDIVIIIS Id Z661-0£-IO OVA N IHrOIV2IIS I3 £66i-£0-ZO 1VA\gN IHDIV1IIS I3 17661-LZ-i0 T'/A 3NMI IHDIV'2IIS I3 S661-S i-ZO 'IVMNNa 1 IHDIV2IIS IA 9661-9Z-ZO IVtY1gNg2I IHDIV?T I.S I3 L661-£0-£0 `IVA1gN [ J IHOIVILLS I3 866I-£Z-ZO VAVtTM IHDIVHIIS I3 6661-0 i-ZO Z�r1c1gNg2I IHDIV IIS I3 000Z-OZ-IO I�'M Ng2l IHOIVIIIS SAS i 00Z-S i-ZO I NMAiAVd ixod [ I'IV 1NNV SAS ZOOZ-Z I-ZO I NgNAVd ]I IOdg2I JYf1MNF� IN'A IAVd SAS £OO -8I-ZO ixod[I JVIINNV • £Jo £ °Red "lamas auIeN ssautsng kusI oN ssautsng CITY OF ASHLAND April 5,2019 • To All Potential Bidders: RE: CONCRETE INSTALLATION FOR THE CITY OF ASHLAND The City of Ashland is seeking bidders for a concrete work at the Ashland Plaza in Downtown Ashland. Work will consist of the installation of approximately 2697 square feet of colored concrete sidewalk with four handicap ramps. Work will need to be complete before June 1,2019. If you are interested in submitting a bid for this work,please complete and submit the attached Request for Quotations form to the City of Ashland Engineering Department by mail at 20 E.Main Street, Ashland OR 97520 or in person at 51 Winbum Way. Bids must be received by 2:00 PM,Friday April 12,2019. This project will be subject to the enclosed City of Ashland Living Wage Ordinance. The City of Ashland would prefer construction completed by May 31,2019,however the City will be able to adjust phasing to some degree. Please specify a completion date you could achieve. If you have any questions regarding this request,please feel free to call Brad Barber,Project Manager at 488-5347. Sincerely, Brad Barber Project Manager CC: Brad Barber t I Engineering Department Tel:541/488-5347 20 E.Main Street Fax:541/488-6006 Ashland,Oregon 97520 TTY:800/735-2900 www.ashland.or.us G:\pnb-wrks\eng\2019 Project Ycar12019-08 Plaza Sidewalk Improvements\Plaza Sidewalk Improvements Concrete RFQ-04-05-2019.docx CITY OF ASHLAND REQUEST FOR QUOTATIONS Project located near the intersection of E.Main Street and Oak Street at the Cbautauqua_Walkway, Please indicate your quotation for each of the following items as indicated below.City of,Ashland will provide Surveying for contractor. Plans and Standard Drawings are attached to this request. k 71iC ct../c.. CA, eV)• rah' ItbpzDscntoh riVillEhree: Amount 1/4 Oderhirite,f, V. Ogetaktiri:ii317:K::?,7ratf. .itivr:47...tl---;:::.F:77,----..--5--.. :21 Mobilization LS 1 Traffic Control LS Erosion&Sediment Control LS 1 4 . Cdr.:riflr Aralg=2:32:.72;; =7.*IT;l5L:PriT'Sj717;Trf7:7 ,". I Colored Concrete Sidewalk SF 2697 Colored Concrete Sidewalk Ramps,ADA EA - 4 12-in Concrete Curb LF 152 16-in Concrete Curb Lf 74 WitidirazavirC21:::21:::==r;-;;;Lnfrrtcr.IC Staking,Layout LS 1 Plaza Sidewalk Improvements Bid Total _ $ QUOTE MUST BE RECEIVED BY: 2:00 PM,Friday,Anil 12,2019 Date: By: Signature Address: hinted Name Title Company Phone: EngineeringDepaitnent Tel:541/488-5347 20 E.Main Street Fax:541/488-6006 .411 Ashland,Oregon 97520 TTY:8001735-2900 wwwashland or us Int O:\u-rnk\eog\2O19Pmject Year12019-08 Plaza SidewalkImprovementstPlaza BidewalkIroprovements Concrete RFQ-0445-2019 doox • Request for Taxpayer Give Form to the • (Fog.Cactter 2016) Identification Number and Certification requester.Do not boaatearticl the Treatuti. 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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 Brown & Northwest NAME: Susan Wilson 3256 Hillcrest Park Drive PHONE E-MAIL IL ExU: 541494-2658 '(A ,No): 541-494-2758 Medford, OR 97504 ADDRESS: swilsonAbbnw.com INSURER(S)AFFORDING COVERAGE NAIL# www.bbnw.com _INSURER A: Ohio Security Insurance Company 24082 INSURED INSURER B: Developers Surety&Indemnity Company Ashland Construction Inc INSURERC: SAIF Southern Oregon Concrete Pumping 102 Pleasant View INSURERD: Talent OR 97540 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 48270038 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR - POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) LIMITS A I COMMERCIAL GENERAL LIABILITY ✓ ✓ BKS1956059356 3/21/2019 3/21/2020 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE ✓ OCCUR PREMISES(Ea occurrence) $1,000,000 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 ✓ POLICY PEA LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY BAS1956059356 3/21/2019 3/21/2020 COMBINED SINGLE LIMIT , (Ea accident) $1 000 000 ✓ 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) $ A ✓ UMBRELLA LIAB ✓ OCCUR UMB1956059356 4/24/2019 4/24/2020 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED ✓ RETENTION$10.000 $ C WORKERS COMPENSATION 469079 10/1/2018 10/1/2019 ✓ STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE N 1 A E.L.EACH ACCIDENT $500,000 OFFICER/MEMBEREXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500.000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 B CCB Commercial License Bond 274336C 7/1/2018 7/1/2020 Limit: $50,000 B CCB Residential License Bond 274337C 7/1/2017 7/1/2019 Limit: $20,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Re: Plaza Sidewalk Project,Ashland,OR General Liability includes Additional Insured coverage including Primary/Non-contributory and Waiver of Subrogation per attached endorsement CG88100413 when required by written contract. Subject to policy terms,limits,conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Brad Barber ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main Street Ashland OR 97520 AUTHORIZED REPRESENTATIVE I Susan Wilson ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) '1RD name and logo are registered marks of ACORD ... _„ .............. ',I P",a ,n.».nz a*n (onml I oan• 1 of 9 COMMERCIAL GENERAL LIABILITY CG 88100413, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY EXTENSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART INDEX SUBJECT PAGE NON-OWNED AIRCRAFT 2 NON-OWNED WATERCRAFT 2 PROPERTY DAMAGE LIABILITY—ELEVATORS 2 EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) 2 MEDICAL PAYMENTS EXTENSION 3 EXTENSION OF SUPPLEMENTARY PAYMENTS—COVERAGES A AND B 3 - ADDITIONAL INSUREDS—BY CONTRACT,AGREEMENT OR PERMIT 3 PRIMARY AND NON-CONTRIBUTORY—ADDITIONAL INSURED EXTENSION 5 ADDITIONAL INSUREDS—EXTENDED PROTECTION OF YOUR"LIMITS OF INSURANCE" 6 WHO IS AN INSURED—INCIDENTAL MEDICAL ERRORS/MALPRACTICE AND WHO IS AN INSURED— 6 FELLOW EMPLOYEE EXTENSION —MANAGEMENT EMPLOYEES NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES 7 FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES 7 KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT 7 LIBERALIZATION CLAUSE 7 BODILY INJURY REDEFINED 7 EXTENDED PROPERTY DAMAGE 8 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US— 8 WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU ©2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 8 With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. A. NON-OWNED AIRCRAFT Under Paragraph 2. Exclusions of Section I–Coverage A- Bodily Injury And Property Damage Liability, exclusion g. Aircraft, Auto Or Watercraft does not apply to an aircraft provided: 1. It is not owned by any insured; 2. It is hired, chartered or loaned with a trained paid crew; 3. The pilot in command holds a currently effective certificate, issued by the duly constituted authority of the United States of America or Canada, designating her or him a commercial or airline pilot; and 4. It is not being used to carry persons or property for a charge. However, the insurance afforded by this provision does not apply if there is available to the insured other valid and collectible insurance, whether primary, excess (other than insurance written to apply specifically in excess of this policy), contingent or on any other basis, that would also apply to the loss covered under this provision. B. NON-OWNED WATERCRAFT Under Paragraph 2. Exclusions of Section I–Coverage A–Bodily Injury And Property Damage Liability, Subparagraph (2) of exclusion g. Aircraft, Auto Or Watercraft is replaced by the following: This exclusion does not apply to: (2) A watercraft you do not own that is: (a) Less than 52 feet long; and (b) Not being used to carry persons or property for a charge. C. PROPERTY DAMAGE LIABILITY–ELEVATORS 1. Under Paragraph 2. Exclusions of Section I–Coverage A–Bodily Injury And Property Damage Liability, Subparagraphs (3), (4) and (6) of exclusion j. Damage To Property do not apply if such "property damage" results from the use of elevators. For the purpose of this provision, elevators do not include vehicle lifts. Vehicle lifts are lifts or hoists used in automobile service or repair operations. 2. The following is added to Section IV–Commercial General Liability Conditions, Condition 4. Other Insurance, Paragraph b. Excess Insurance: The insurance afforded by this provision of this endorsement is excess over any property insurance, whether primary, excess, contingent or on any other basis. D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) If Damage To Premises Rented To You is not otherwise excluded from this Coverage Part: 1. Under Paragraph 2. Exclusions of Section I -Coverage A-Bodily Injury and Property Damage Liability: a. The fourth from the last paragraph of exclusion j. Damage To Property is replaced by the following: Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" (other than damage by fire, lightning, explosion, smoke, or leakage from an automatic fire protection system) to: (i) Premises rented to you for a period of 7 or fewer consecutive days; or (ii) Contents that you rent or lease as part of a premises rental or lease agreement for a period of more than 7 days. Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage"to contents of premises rented to you for a period of 7 or fewer consecutive days. A separate limit of insurance applies to this coverage as described in Section III– Limits of Insurance. ©2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 2 of 8 Aoo— I nnn1,11, I :s_•n n,./LrrTn/noNns I Susan Wilson 1 4/23/2019 10:37:03 AM (PDT) 1 Page 3 of 9 b. The last paragraph of subsection 2. Exclusions is replaced by the following: • Exclusions c.through n. do not apply to damage by fire, lightning, explosion, smoke or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to Damage To Premises Rented To You as described in Section III—Limits Of Insurance. 2. Paragraph 6. under Section III—Limits Of Insurance is replaced by the following: 6. Subject to Paragraph 5. above,the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of"property damage"to: a. Any one premise: (1) While rented to you; or (2) While rented to you or temporarily occupied by you with permission of the owner for damage by fire, lightning, explosion, smoke or leakage from automatic protection systems; or b. Contents that you rent or lease as part of a premises rental or lease agreement. 3. As regards coverage provided by this provision D. EXTENDED DAMAGE TO PROPERTY RENTED TO . YOU (Tenant's Property Damage) - Paragraph 9.a. of Definitions is replaced with the following: 9.a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke, or leakage from automatic fire protection systems to premises while rented to you or temporarily occupied by you with the permission of the owner, or for damage to contents of such premises that are included in your premises rental or lease agreement, is not an "insured contract". E. MEDICAL PAYMENTS EXTENSION If Coverage C Medical Payments is not otherwise excluded,the Medical Payments provided by this policy are amended as follows: Under Paragraph 1. Insuring Agreement of Section I—Coverage C—Medical Payments, Subparagraph (b) of Paragraph a. is replaced by the following: (b) The expenses are incurred and reported within three years of the date of the accident; and F. EXTENSION OF SUPPLEMENTARY PAYMENTS—COVERAGES AAND B 1. Under Supplementary Payments —Coverages A and B, Paragraph 1.b. is replaced by the following: b. Up to$3,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 2. Paragraph 1.d. is replaced by the following: d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or"suit", including actual loss of earnings up to$500 a day because of time off from work. G. ADDITIONAL INSUREDS -BY CONTRACT, AGREEMENT OR PERMIT 1. Paragraph 2. under Section II—Who Is An Insured is amended to include as an insured any person or organization whom you have agreed to add as an additional insured in a written contract, written agreement or permit. Such person or organization is an additional insured but only with respect to liability for"bodily injury", "property damage" or"personal and advertising injury" caused in whole or in part by: a. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your on going operations for the additional insured that are the subject of the written contract or written agreement provided that the"bodily injury" or"property damage" occurs, or the"personal and advertising injury" is committed, subsequent to the signing of such written contract or written agreement; or ©2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 3 of 8 48270038 1 00012132 119-20 GL/AITTO/BONGS I S"nnn Wilcnn I a/>a/>mo in.ni.nn nv ,om, I n...... n _� .. b. Premises or facilities rented by you or used by you; or c. The maintenance, operation or use by you of equipment rented or leased to you by such person or organization; or d. Operations performed by you or on your behalf for which the state or political subdivision has issued a permit subject to the following additional provisions: (1) This insurance does not apply to"bodily injury", "property damage", or"personal ersonal and advertising injury" arising out of the operations performed for the state or political subdivision; (2) This insurance does not apply to "bodily injury" or"property damage" included within the "completed operations hazard". (3) Insurance applies to premises you own, rent, or control but only with respect to the following hazards: a) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar exposures; or (b) The construction, erection, or removal of elevators; or (c) The ownership, maintenance, or use of any elevators covered by this insurance. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. With respect to Paragraph 1.a. above, a person's or organization's status as an additional insured under this endorsement ends when: parts or equipment(1) All work, including materials, ment furnished in connection with such work,p q p on the project(other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (2) That portion of"your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. With respect to Paragraph 1.b. above, a person's or organization's status as an additional insured under this endorsement ends when their written contract or written agreement with you for such premises or facilities ends. With respects to Paragraph 1.c. above, this insurance does not apply to any"occurrence"which takes place after the equipment rental or lease agreement has expired or you have returned such equipment to the lessor. The insurance provided by this endorsement applies only if the written contract or written agreement is signed prior to the "bodily injury" or"property damage". We have no duty to defend an additional insured under this endorsement until we receive written notice of a"suit" by the additional insured as required in Paragraph b. of Condition 2. Duties In the Event Of Occurrence, Offense, Claim Or Suit under Section IV—Commercial General Liability Conditions. ©2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 4 of 8 48270038 1 00012132 119-20 GL/AUTO/BONDS 1 Susan Wilson 1 4/23/2019 10:37:03 AM (PDT) 1 Page 5 of 9 2. With respect to the insurance provided by this endorsement, the following are added to Paragraph 2: Exclusions under Section I -Coverage A-Bodily Injury And Property Damage Liability: This insurance does not apply to: a. "Bodily injury" or"property damage" arising from the sole negligence of the additional insured. b. "Bodily injury" or"property damage"that occurs prior to you commencing operations at the location where such "bodily injury" or"property damage" occurs. c. "Bodily injury", "property damage" or"personal and advertising injury" arising out of the rendering of, or the failure to render;any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the"occurrence"which caused the"bodily injury"or"property damage", or the offense which caused the"personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. d. "Bodily injury"or"property damage" occurring after (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. e. Any person or organization specifically designated as an additional insured for ongoing operations by a separate ADDITIONAL INSURED—OWNERS, LESSEES OR CONTRACTORS endorsement issued by us and made a part of this policy. 3. With respect to the insurance afforded to these additional insureds, the following is added to Section III— Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. H. PRIMARY AND NON-CONTRIBUTORY ADDITIONAL INSURED EXTENSION This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy. Condition 4. Other Insurance of SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: a. The following is added to Paragraph a. Primary Insurance: If an additional insured's policy has an Other Insurance provision making its policy excess, and you have agreed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis, this policy shall be primary and we will not seek contribution from the additional insured's policy for damages we cover. ©2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 5 of 8 40270030 1 00012132 119-20 GL/AUTO/BONDS 1 Susan Wilson 1 4/23/2019 10,37,53 AM MUTT I vans a of 9 b. The following is added to Paragraph b. Excess Insurance: • When a written contract or written agreement, other than a premises lease,facilities rental contract or agreement, an equipment rental or lease contract or agreement, or permit issued by a state or political subdivision between you and an additional insured does not require this insurance to be primary or primary and non-contributory, this insurance is excess over any other insurance for which the additional insured is designated as a Named Insured. Regardless of the written agreement between you and an additional insured, this insurance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional insured has been added as an additional insured on other policies. ADDITIONAL INSUREDS - EXTENDED PROTECTION OF YOUR"LIMITS OF INSURANCE" This provision applies to any person or organization who qualifies as an additional insured under any form or endorsement under this policy. 1. The following is added to Condition 2. Duties In The Event Of Occurrence, Offense, Claim or Suit: An additional insured under this endorsement will as soon as practicable: a. Give written notice of an "occurrence" or an offense that may result in a claim or"suit" under this insurance to us; b. Tender the defense and indemnity of any claim or"suit"to all insurers whom also have insurance available to the additional insured; and c. Agree to make available any other insurance which the additional insured has for a loss we cover under this Coverage Part. d. We have no duty to defend or indemnify an additional insured under this endorsement until we receive written notice of a "suit" by the additional insured. 2. The limits of insurance applicable to the additional insured are those specified in a written contract or written agreement or the limits of insurance as stated in the Declarations of this policy and defined in Section III—Limits of Insurance of this policy, whichever are less.These limits are inclusive of and not in addition to the limits of insurance available under this policy. J. WHO IS AN INSURED -INCIDENTAL MEDICAL ERRORS/ MALPRACTICE WHO IS AN INSURED - FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES Paragraph 2.a.(1) of Section II -Who Is An Insured is replaced with the following: (1) "Bodily injury" or"personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co-"employee"while in the course of his or her employment or performing duties related to the conduct of your business, or to your other P 9 Y "volunteer workers"while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co-"employee"or"volunteer worker" as a consequence of Paragraph (1) (a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1) (a) or(b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. However, if you are not in the business of providing professional health care services or providing professional health care personnel to others, or if coverage for providing professional health care services is not otherwise excluded by separate endorsement, this provision (Paragraph (d))does not apply. ©2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 6 of 8 48270038 1 00012132 1 19-20 GL/AUTO/BONDS 1 Susan Wilson 1 4/23/2019 10:37:03 AM (PDT) 1 Page 7 of 9 Paragraphs g aphs (a) and (b) above do not apply to"bodily injury" or"personal and advertising injury" caused by an "employee"who is acting in a supervisory capacity for you. Supervisory capacity as used herein means the . "employee's"job responsibilities assigned by you, includes the direct supervision of other"employees" of yours. However, none of these "employees" are insureds for"bodily injury" or"personal and advertising injury" arising out of their willful conduct, which is defined as the purposeful or willful intent to cause"bodily injury" or"personal and advertising injury", or caused in whole or in part by their intoxication by liquor or controlled substances. The coverage provided by provision J. is excess over any other valid and collectable insurance available to your "employee". K. NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIES Paragraph 3. of Section II-Who Is An Insured is replaced by the following: 3; Any organization you newly acquire or form and over which you maintain ownership or majority interest, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only until the expiration of the policy period in which the entity was acquired or formed by you; b. Coverage A does not apply to"bodily injury"or"property damage"that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. d. Records and descriptions of operations must be maintained by the first Named Insured. No person or organization is an insured with respect to the conduct of any current or past partnership,joint venture or limited liability company that is not shown as a Named Insured in the Declarations or qualifies as an insured under this provision. L. FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRENCES Under Section IV—Commercial General Liability Conditions, the following is added to Condition 6. Representations: Your failure to disclose all hazards or prior"occurrences" existing as of the inception date of the policy shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or prior"occurrences" is not intentional. M. KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SUIT Under Section IV—Commercial General Liability Conditions,the following is added to Condition 2. Duties In The Event of Occurrence, Offense, Claim Or Suit: Knowledge of an "occurrence", offense, claim or"suit" by an agent, servant or"employee" of any insured shall not in itself constitute knowledge of the insured unless an insured listed under Paragraph 1. of Section II—Who Is An Insured or a person who has been designated by them to receive reports of "occurrences", offenses, claims or"suits"shall have received such notice from the agent, servant or "employee". N. LIBERALIZATION CLAUSE If we revise this Commercial General Liability Extension Endorsement to provide more coverage without additional premium charge, your policy will automatically provide the coverage as of the day the revision is effective in your state. O. BODILY INJURY REDEFINED Under Section V—Definitions, Definition 3. is replaced by the following: 3. "Bodily Injury" means physical injury, sickness or disease sustained by a person. This includes mental anguish, mental injury, shock, fright or death that results from such physical injury, sickness or disease. ©2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 7 of 8 48270038 1 00012112 114-20 C.L/MTTO/RMITIS I .0,,,,p., Wilnnn I £/71/7010 10.11.01 1. ,0nv■ 10_,._ a ... 0 P. EXTENDED PROPERTY DAMAGE Exclusion a. of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY is replaced by the following: a. Expected Or Intended Injury "Bodily injury"or"property damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or"property damage" resulting from the use of reasonable force to protect persons or property. Q. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US—WHEN REQUIRED IN A CONTRACT OR AGREEMENT WITH YOU Under Section IV — Commercial General Liability Conditions, the following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us: We waive any right of recovery ry we may have against a person or or anization because of payments we make for injury or damage arising out of your ongoing operations or"your work" done under a contract with that person or organization and included in the "products-completed operations hazard" provided: 1. You and that person or organization have agreed in writing in a contract or agreement that you waive such rights against that person or organization; and 2. The injury or damage occurs subsequent to the execution of the written contract or written agreement. ©2013 Liberty Mutual Insurance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 8 of 8 Please Mail Payment To: Brown&Brown Northwest PO Box 29018 Customer Ashland Construction Inc Portland,OR 97296-9018 Acct# 12132 Overnight Payment To: Brown&Brown Northwest Date 04/26/2019 2701 NW Vaughn St.,Suite 340 Customer (503)274-6511 Portland,OR 97210 Service Page 1 of 1 Payment Information Invoice Summary $ 4,476.00 Ashland Construction Inc Payment Amount Southern Oregon Concrete Pumping Payment for: Invoice#987608 102 Pleasant View US056059356 Talent,OR 97540 Customer:Ashland Construction Inc Invoice Effective I Transaction I Description Amount Policy#US056059356 04/24/2019-04/24/2020 Liberty Mutual Insurance Companies/Ohio Security rty P Insurance Co 987608 04/24/2019 New business New Umbrella 2019-2020 4,476.00 Due Date: 4/24/2019 Total $ 4,476.00 Brown&Brown Northwest (503)274-6511 Date 2701 NW Vaughn St., Suite 340 PO Box 29018 04/26/2019 Portland,OR 97296-9018 bbnwmail @bbnw.com Legal Department Review DOCUMENT TRANSMITTAL AND CONTROL This form will accompany the document through the drafting, review,and signature processes,and will be kept with the City's final executed copy of the document. Required fields are indicated in gray scale. Document: 6 ' 1s 't-S,,v //c � �eiu- G�/ L/ J 57/'u c-Li`l�'C- (Include names ofparties to the document) Type of Document: Contract IA Lease ❑ Easement ❑ Deed ❑ IGA ❑ Other(Specify) Dept Contact: /— a vn i 0 S ACTION REQUESTED: Dept: "6-4-.)G-U Phone: Ext ❑ Review Draft Date submitted to Legal: 1-77-/ 9 ❑ Approve final and forward to: Draft due by: (Unless indicated Legal will riiurn document to you) Return Requested by: Complete this section ONLY the first time this form is filled out: Has this document been previously worked on by the Legal Dept Staff? ❑ No ❑ Yes If yes,by whom? LEGAL DEPT First Date Received by Legal Date: Lt 1 in t to By: USE ONLY Returned to Dept. for Revision Date: By: _' 0 Received for additional review by Legal Date: By Returned to Dept. for Revision Date: By: Received for additional review by Legal Date: By: Returned to Dept.for Revision Date: By: Received for Additional Review by Legal Date: By: Returned to Dept for Revision Date: By: Find Logged out by Legal Date: © k' By: Comments from LEGAL to DEPARTMENT: Comments from DEPARTMENT to LE ❑ See Attached. � , hisP ,e�r 4-" f et-c' � 1 --,, '62) w S`'//9. Return original executed document to qty Does this document need to be recorded? Recorder for safekeeping? ❑ No Yes No ❑ Yes CITY ADM STRATOR/DEPARTMENT'WAD Please do not sign the attached document until this form jbeenzawroved by the Legal Dept below: FINAL LEGAL DEPARTMENT APPROVAL: ,. ' Date: s--7-/- ',A Purchase Order Oral Fiscal Year 2019 Page: 1 of: 1 —THIS-PO NUMBER MUS-TAPPE4R'ON ALL`- B City of Ashland INVOICES,AND SHIPPING DOCUMENTS. iATTN: Accounts Payable Purchase L 20 E. Main 20190501 Ashland, OR 97520 Order# T Phone: 541/552-2010 O Email: payable @ashland.or.us V H C/O Purchasing Division E ASHLAND CONSTRUCTION I 90 North Mountain Ave p 102 PLEASANT VIEW p Ashland, OR 97520 O TALENT, OR 97540 Phone: 541/488-5354 R T Fax: 541/488-5320 Paula Brown 05/22/201• 1508 FOB ASHLAND OR/NET30 Ci _ . •. able y y Plaza Sidwalk Curb and Gutter 1 Downtown plaza sidewalk, curb and gutter and ADA ramp 1 $83,845.0000 $83,845.00 construction Goods &Services Agreement Completion date: 10731/2019 Project Account: ............... GL SUMMARY ............... 1 081200-602400 $83,845.00 1 I �/l CI-, A , c - By: !mil/ Date: Auk ized Signature $83 845.00 ie_L Ci /7 (i2-VYNCe) FORM #3 CITY OF A request fora Purchase Order U d 1 ASH LAN D REQUISITION " Date of req uest: 04/16/2019 Vendor Name Ashland Construction Inc. Address,City,State,Zip 102 Pleasant View Talent,OR 97540 Contact Name Ron Hobson Telephone Number 541-488-4571 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) CI Written quote or proposal attached ❑ Written quote or proposal attached _- (If council approval required,attach copy of CC) ❑ Small Procurement ❑ --•L;st for Pro•osal Cooperative Procurement Not exceeding$5,000 Date a''roved by Council: ❑ State of Oregon ❑ Direct Award r (Attach .•y of council communication) Contract# ❑ Verbal/Writte •u• -s)or prop al(s R -=..erst or Qualifications(Public Works) ❑ State of Washington Intermediate P�,�1 �'� ' , bate approv d by Council: Contract# GOODS&S or ES ' et- r!i (Attac• copy of council communication) ❑ Other government agency contract Greater than;. r00 and less NJ 1000 • e Source Agency ID (3)Writte It uotes and,.:a it'on attached O Applicable Form(#5,6,7 or 8) Contract# PERSONAL SE-VICES ❑Written quote or proposal attached Form Intergovernmental Agreement Greater than$5,100 and less than i r 1 ❑ Form#4, Personal Services>$5K&<$75K Agency ❑Direct appointme toted$35,000 ❑Annual cost to City does not exceed$25,000. ❑ Special Procurement Agreement A approved by Legal approved/signed Written proposals/written solicitation ❑ Form#9,Request for Approval g pp y al and a pp g ned b y ❑Form#4,Personal Services>$5K&<$75K 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 Downtown Plaza sidewalk,curb and gutter and ADA ramp construction $ 83,845.00 Item # Quantity Unit , Des ' tion of MATERIALS Unit Price Total Cost �l� f1 • �.IT1*�^ 417A,'1 ( � ►W/ TOT�iTST: 0 Per attached- ( , !J` •• ditu- �us b�harg-•to t , ;pp• 'ate account numbers for t r nanaals to reflect the.•Sal expenditures accurately. _. Projec Number - 8 -_ Account Number - 081200 $ 83,:45.00_ Project umber_ _ _ -_ _ _ Account ' mber - Project Number -_ _ Account Nu , -r - IT Director in collaboration with department to approve all hardware and software purchases: By signing this requisition form,I certify that the City's public contracting requirements have been satisfied. IT Director Date Support Yes/No Employee: /�,ii, i 1 �KA„. A,/i 44,11 epartment Head: /._.. ___� i 1 ; Zo/ ATali�3 I to or greater t'a •,000) Department Manager/Supervisor: City Administrator: A to , /`� / (Equal to ,r greater ha $ 5,000) Funds appropriated for current fiscal year: NO ' S 1 c'k i ante Dire "•r(Equal to or greater than$5,000) Date Comments: Form#3-Requisition Kariann bison From: Tami Campos Sent: Tuesday, May 21, 2019 11:36 AM To: Kariann Olson; Miranda Iwamoto Subject: RE: Unable to enter Project#201°-!: We really messed that one up! No project#, sor abou hat. 081200.602400 Tame De/M CU,"-Campers, Administrative Analyst City of Ashland, Public Works Department 20 East Main Street,Ashland,OR 97520 541-552-2420 Fax: 541-488-6006,TTY: 1-800-735-2900 Like Public Works on Facebook for updates and information! lii1Like Ashland Water Conservation on Facebook for updates and information! This email transmission is official business of the City of Ashland, and it is subject to Oregon Public Records law for disclosure and retention. If you have received this message in error,please contact me at 541-552-2420. Thank you. From: Kariann Olson Sent:Tuesday, May 21, 2019 10:09 AM To:Tami Campos<tami.campos @ashland.or.us>; Miranda Iwamoto<miranda.iwamoto@ashland.or.us> Subject: RE: Unable to enter Project#2019-08 Only partial a c#on requisition uisition 081200/ q Kariann Olson Purchasing Representative City of Ashland 90 N. Mountain Ave. Ashland, Oregon 97520 Tel 541-488-5354 Fax 541-488-5320 TTY 800-735-2900 kari.olson @ashland.or.us Visit the City's web site at: www.ashland.or.us This email transmission is official business of the City of Ashland, and it is subject to Oregon Public Records law for disclosure and retention. If you have received this message in error, please contact me at(541)488-5354.Thank you. From: Kariann Olson Sent:Tuesday, May 21, 2019 10:02 AM To:Tami Campos<tami.campos @ashland.or.us>; Miranda Iwamoto<miranda.iwamoto @ashland.or.us> Cc: Kariann Olson<kari.olson @ashland.or.us> Subject: Unable to enter Project#2019-08 Hello, 1 Please advise. . . . Downtown plaza sidewalk, curb and gutter project. Thank you. Kariann Olson Purchasing Representative City of Ashland 90 N. Mountain Ave. Ashland, Oregon 97520 Tel 541-488-5354 Fax 541-488-5320 TTY 800-735-2900 kari.olson @ashland.or.us Visit the City's web site at: www.ashland.or.us This email transmission is official business of the City of Ashland, and it is subject to Oregon Public Records law for disclosure and retention. If you have received this message in error, please contact me at (541)488-5354.Thank you. 2