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HomeMy WebLinkAbout2019-269 20200196 Ashland Construction Contract for GOODS AND SERVICES Small Procurement Less than $5,000 CITY OF INDEPENDENT CONTRACTOR: Ashland Construction INC. ASHLAND CONTACT: Rob Hobson 20 East Main Street ADDRESS: 102 Pleasant View Talent OR 97540 Ashland, Oregon 97520 Telephone: 541/488-6002 TELEPHONE: 541-944-2728 FAX: 541-512-0809 Fax: 541/488-5311 EMAIL: Jill Hobson <rhobson541@charter.net> EFFECTIVE DATE: 10-2-2019 COMPLETION DATE: 12-2-2019 TOTAL COMPENSATION: $2,440.00 GOODS AND SERVICES TO BE PROVIDED: Replace 61 feet of curb and gutter per proposal. ADDITIONAL TERMS: In the event of a conflict or discrepancy among the Contract Documents, this City of Ashland Contract will be primary and take precedence, and any exhibits or ancillary agreements having redundant or contrary provisions will be subordinate to and interpreted in a manner that will not conflict with the said primary City of Ashland Contract. NOW THEREFORE, the CITY AND CONTRACTOR HEREBY AGREE as follows: 1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and expense, perform any work described above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance of such work. 2. Qualified Work: Contractor has represented, and by entering into this contract now represents, that any personnel assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are so registered, licensed and bonded. Contractor must also maintain a current City business license. 3. Ownership of Production: All documents, materials or items produced by Contractor pursuant to this contract shall be the property of City. 4. Statutory Requirements: ORS 279B.220, 279B.225, 2798.230, 279B.235, ORS Chapter 244 and ORS 670.600 are made part of this contract. 5. Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless from those losses, expenses, or other damages resulting from injury to any person or damage to property arising out of or incident to the negligent performance of this contract by Contractor its employees, or agents. Contractor shall not be held responsible for any losses, expenses, or other damages, directly, solely, and proximately caused by the negligence of City. 6. Termination: City's Convenience. This contract may be terminated at any time by the City. 7. Independent Contractor Status: Contractor is an independent Contractor and not an employee of the City. Contractor shall have the complete responsibility for the performance of this contract. 8. Non-discrimination Certification: The undersigned certifies that the undersigned Contractor has not discriminated against minority, women or emerging small businesses enterprises in obtaining any required subcontracts. Contractor further certifies that it shall not discriminate in the award of such subcontracts, if any. 9. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an asbestos abatement license. 10. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work. 11. Use of Recyclable Products: Contractor shall use recyclable products to the maximum extent economically feasible in the performance of the contract work set forth in this document. 12. Default. The Contractor shall be in default of this agreement if Contractor commits any material breach or default of any covenant, warranty, certification, or obligation it owes under the Contract. 13. Insurance. Contractor shall at its own expense provide the following insurance: a, a. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide Oregon workers' compensation coverage for all their subject workers. Worker's compensation insurance is required if work is performed by employees, subcontractors, or volunteers. BY INITIALING THIS SENTENCE, CONTRACTOR CERTIFIES UNDER PENALTY OF LAW THAT THE WORK REQUIRED BY THIS CONTRACT SHALL BE PERFORMED SOLELY BY THE UNDERSIGNED: b. General Liability insurance with a combined single limit, or the equivalent, of not less than $1,000,000 for each occurrence for Bodily Injury and Property Damage. C. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than $1,000,000 for each accident for Bodily Injury and Property Damage, including coverage for owned, hired or non-owned vehicles, as applicable. 14. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws of the State of Oregon 15. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. 16. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by reference. 17. Consultant's compliance with Oregon Tax Law: (1) Consultant represents and warrants to the City that Consultant shall, throughout the term of this Agreement, including any extensions hereof, comply with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS Chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Consultant; and (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. (2) Consultant represents and warrants that, for a period of no fewer than six (6) calendar years preceding the Effective Date of this Agreement, it has complied with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS Chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Consultant; and (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. Revised 10-28-14 Page 1 of 2 CONTRACT-OR: CITY OF ASHLAND: -W WN I By: By: ~u Sig"n9ture Department Head Z7 OZ?SOSV PAW'(4 c l3.-zo w.✓ Pr i ntName Print Name pg(gE J a c r zoi 4 Title Date (W-9 is to be submitted with the signed contract.) Purchase Order No. EXHIBIT A CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified it that it is no longer subject to backup withholding. Contractor further represents and warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms, (c) the work under the Contract shall be performed in accordance with the highest professional standards, and (d) Contractor is qualified, professionally competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on behalf of the entity designated above and authorized to do business in Oregon or is an independent Contractor as defined in the contract documents, and has checked four or more of the following criteria: _ (1) I carry out the labor or services at a location separate from my residence or is in a specific portion of my residence, set aside as the location of the business. KCA (2) Commercial advertising or business cards or a trade association membership are purchased for the business. eeg, (3) Telephone listing is used for the business separate from the personal residence listing. -g2N_ (4) Labor or services are performed only pursuant to written contracts. (5) Labor or services are performed for two or more different persons within a period of one year. _ (6) I assume financial responsibility for defective workmanship or for service not provided as evidenced by the ownership of performance bonds, warranties, errors and omission insurance or liability insurance relating to the labor or services to be provided. Contractor ~ (Date Revised 10-28-14 Page 2 of 2 't1ff x~xiln4$;i - nFaQ. i~nlnl^?yu 'anfign N'slrino as ay-¢a ariirit 7>.;aut,4ed ;;+Ia{~aAa ea `(3oa. =4? cr tiF" pssJSOy~nplr :w,~vx;dsaaa 6gsdsq o 2 pve ,umaY~cpxsara. cua77;pua3 pux r.:aAxdgpade 'e~aWd. xu3.'- fidSOdbtid d4 30NS',Lc?O~G 5a4oP -r°-y-- vZikvs pa;daxm 3ensn,t~. 'a~n=c',rJl~w'f?x+esduea^j =;.f'1Xa bQ+vm l~n~ur feG. iga V~*' •,cnwDV14* ~9.-M,u lABCU`?~d. tY ; •yr_un.st disfsxr=.:axn rramri'yU duea4rzx.+ry'y~soaaro pvrw{s[.iapa .C4H tlnvpa~==*twsuxatt>slxavai auaw*sAr kN'h+u+n=i:ar?Km cu=nma~aw*mo ninlatdIS =zq 6^ Pu==any unrm umn 14467x' =n r,I aw, Im anz= yp 'a m+a =wn ..v A FU-qyrv flNWl ikSL)C49•~-'t1aHVCN NU.1lIX11Y INJ'aaN"s$W*NI.. Sd kYiNwB~xxYW .f >tiY.+.w.mc . a Wi~?fmm .Q c5 a'Un+. fY -Inp a m ai at aive~rS i A la u.ne aGn =1 •aaonaay~a>ds aea;{; sytx, arrapscaaa z1 2Mdmm - rm n; put IeFrtxvS ga7 ~.quoq S84d0wd ZA z+ 6 ' ud; r-12=44 PUT S~ C1 i ail' '^•ca: s,rvyacr 6080-ZS9-(I") Xr3 , 1. Y s4llll'l;.luC:'_t tIIA'tYd A~R® CERTIFICATE OF LIABILITY INSURANCE 1 DATE (MMIDOA'YYY) 4/23/2019 'PHIS 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 Brown & Brown Northwest NAME °T Susan Wilson 3256 Hillcrest Park Drive PHONE 541-094-2658 ac No: 541-494-2758 Medford, OR 97504 E-MAIL ADDRESS: swilson bbnw.com INSURERS AFFORDING COVERAGE NAIOp www.bt)nw.com INSURERA: Ohio Security Insurance Company 24082 INSURED INSURERS: Developers Surety &Indemnity Company Ashland Construction Inc Southern Oregon Concrete Pumping INSURERC: SAIF 102 Pleasant View INSURERD: Talent OR 97540 INSURER E: 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. LTR TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP INSD D POLICYNUMDER (MMIDDfYYYY) IMMIDDNYYY) LIMITS A COMMERCIAL GENERAL LIABILITY BKS1956059356 3/21/2019 3/21/2020 EACH OCCURRENCE $1000000 -DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES (ED ocumnsel $1,000,000 MED EXP An one person) $ 15,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 ✓ POLICY PECROT - FILOC PRODUCTS - COMPIOPAGG s21000.000 J OTHER: $ A NOMOSILELIABILiTY BAS1956059356 312112019 3/2112020 COMBINED SING LE LIMIT $ Ee eccitlen[ 1 BOB 000 ANYAUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accltlenq $ AUTOSONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accitlent $ A ✓ UMBRELLALIAB OCCUR UMB1956059355 4124/2019 4/2412020 EACH OCCURRENCE $1000000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED ✓ RETENTION$10,000 $ G WORKERS COMPENSATION 469079 10/1/2018 10/1/2019 ✓ STATUTE ~a AND EMPLOYERS' LIABILITY _ ANYPROPRIETORIPARTNERIEXECUTIVE V~ N/A E.L. EACH ACCIDENT $500000 OFFICERIMEMBEREXC W CEDP (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $500000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE-POLICY LIMIT $500000 B COB Commercial License Bond 274336C 711/2018 7/112020 Limit: $50,000 B COB Residential License Bond 274337C 7/1/2017 7/1/2019 Limit: $20,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe allaehed 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 Susan Wilson - , ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) ~RD name and logo are registered marks of ACORD 98270038 1 00012132 1 19-20 GL/A1TTO/' '23/2019 10:37:03 AM (PDT) I Page 1 of 9 COMMERCIAL GENERAL LIA61LITY CG 88 10 0413 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 40270038 00012132 19-20 GL/AV70/B0NUS I Susan Wilson 1 4/23/2019 10:37:03 AM (PDT) I Page 2 of 9 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: j (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 98200038 100012132 1 19-20 G /ADT0/BONDS I Susan Wilson 1 9/23/2019 10:39:03 AM (PDT) I 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 111- 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 A AND 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 40270030 00012132 1 19-20 GL/AUTO/BONDS I Sooon Wilson 14/23/2019 10:37:03 AM (PDT) I Page 4 of 9 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 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: (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. 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 48270030 1 00012132 1 19-20 GL/AUT0/P0N05 i Susan Wilson i 4/23/2019 30:37:03 AM (PDT) i 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 111- 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 1 19-20 cc/AUTO/BONDS I Susan Wilson 1 4/23/2019 10:37:03 AN (PDT) I Page 6 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. 1. 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 11 - 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 "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 90290030 1 00012132 1 19-20 GL/AUTO/BONDS I Susan Wilson 1 9/23/2019 10:37:03 AM (POT) I Page 7 of 9 Paragraphs (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 11- 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 11- 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. 0. 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 48270036 1 00012132 1 19-20 GL/AUT0/B0M19 I Susan Nilson 14/23/2019 10:37:03 AM I Page 8 of 9 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 we may have against a person or organization 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 48270038 1 00012132 1 19-20 GL/A=O/BONDS I Susan Wilson 1 4/13/2019 10:37:03 AM (PDT) I Page 9 of 9 Please Mail Payment To: Brown & Brown Northwest PO Box 29018 Customer Ashland Construction Inc _ Portland, OR 97296-9018 t.. Acct# 12132 Overnight Payment To: Date 04/26!2019 Brown & Brown Northwest 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 Transaction Description Amount Policy#USO56059356 0412412019-04/24/2020 Liberty Mutual Insurance Companies / Ohio Security Insurance Co 987608 04/2412019 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 04/2612019 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: C~ ~a~S ` S~v ✓/cP2 /~p~~ G~~~s~ lcizto~is~ ~r c~i (Include names ofparfies to the document) Type of Document: Contract Lease ❑ Easement ❑ Deed ❑ IGA ❑ Other (Specif3~ Dept Contact: / Q AP1 / ~S ACTION REQUESTED: Dept: FLU Phone: Ext ❑ Review Draft Date submitted to Legal: ~1-• / 7 / 9 ❑ Approve final and forward to: Draft due by: (rT 1= indicates{ Legal will rehmn document to yan) 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 DateReceivedby_Iegal Date L4 f1 , By USE ONLY Rehuned to Dept- foralRevision Date By: Received foi addition review byL-gal „ .Date By Retuined to Dept. for Revision - Date By Received.foi'additionalrevtewbyLegal ` "Date _ By 'R tt - to Dept for Revision Date = By.: _e ned Received for Additional Review by Legal Date: 7 By - ' Retained to Dept for Revision = Date = By- Final Logged.ont by Leg81 Date: , . 3 4 By:_ } Comments f6ju LEGAL toMEPARTMENT:' Comments from DEPARTMENT to LE AL. ❑ ; See Attached':/ I ,Return original executed document to City- Does this document need to be recorded? Recorder for safekeeping? " ❑ No',' Yes_ No ❑ Yes CITY AD- TRATOR 1 DEPARTMENT HEAD Please do not sign the attached document until this form Been coved by the Legal Dept below: FINAL LEGAL DEPARTMENT APPROVAL: X& Date: I li CERTIFICATE OF LIABILITY INSURANCE DAo]/zolns ) 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 r R 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(les) 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 Brown & Brown Northwest NAMEAOT Susan Wilson 3256 Hillcrest Park Drive PHONE FAX Medford, OR 97504 541-494-2658 ac No : 541-494-2758 ADDRIESS, t Swilson bbnw.com INSURE S AFFORDING COVERAGE NAIC0 www.bbnw.com INSURERA: Ohio Securi Insurance Company 24082 INSURED INSURER B: Developers Sure & Indemnity Company Ashland Construction Inc Southern Oregon Concrete Pumping INSURER C: SAIF 102 Pleasant View INSURER D: i Talent OR 97540 INSURER E: INSGRER F COVERAGES CERTIFICATE NUMBER: 51679183 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 ADOL SUER POLICYEFF POUCYEFP LTR TYPE OF INSURANCE POLICYNUMBER MWDDIYYYY MM/DDIYYYY LIMITS J= Mn A COMMERCIAL GENERAL LIABILITY BKS1956059356 312112019 3121/2020 EACH OCCURRENCE $1000000 CIAIMS-MADE F✓ OCCUR PREMISES Ea occurrence $1,000,006 MED EXP (Any one person) $ 15,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE 52,000,000 ✓ POLICY JERCT FILOC PRODUCTS -COMPIOPAGG s2,000,000 OTHER: $ A AUTOMOBILELIABIDTY BAS1956059356 312112019 3/21/2020 Eoa~d D SINGLE LIMIT $1000000 ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS - ( ) HIRED NON-0WNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ A ✓ UMBRELLA IJAB ✓ OCCUR US056059356 4/24!2019 4/2412020 EACHOCCURRENCE $1,000,000 EXCESS LUIS CLAIMS-MADE AGGREGATE $1000000 DED ✓ RETENTION 810,000 $ C WORKERS COMPENSATION 469079 101172016 10/112019 PER RR YIN STATUTE ER ANYPROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $500000 OFFICERIMEMBEREXCLUDED? El NIA (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $500000 If yes, describe under DESCRIPTION OF OPERATIONSW. E. L. DIGEASE-POLICY LIMIT $500000 B CCB Commercial License Bond 274336C 7/112018 7/112020 Limit: $50,000 B CCB Residential License Bond 274337C 7/1/2017 7/1/2019 Limit: $20,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may ba attached if more space Is required) Re: All Operations & Projects by Named Insured. 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 Street eet THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E of Main S eet ACCORDANCE WITH THE POLICY PROVISIONS. OR 97520 AUTHORIZEDREPRESENTATIVE Susan Wilson ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 51679183 1 00012132 119-20 GL/AUTO/BONDS I SUean Nilson 1 10/7/2019 1:55:07 PM (PDT) I Page 1 Of 9 COMMERCIAL GENERAL LIABILITY CG 8810 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABII,.ITY EXTENSION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART i 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 E~TENSION 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 8810 0413 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 8 51679183 09012132 119-20 cc/AVm/POwos I Susan wilson 10/7/2019 1:55:07 PM )PDT) I Page 2 of 9 e. 4 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 - Lodily 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 c'- him a commercial or airline pilot; and 4. It is not being used to carry persons or property for a cl•arge. 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 the loss covered under this provision. B. NON-OWNED WATERCRAFT Under Paragraph 2. Exclusions of Section I - Coverage A - `r 3odily 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 endors( ment is excess over any property insurance, whether primary, excess, contingent or on any other be3is. D. EXTENDED DAMAGE TO PROPERTY RENTED TO YOU (Te iant'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 51679183 1 00012132 1 19-20 GL/AUTO/BONDS I Susan Wilson 1 10/7/2019 1:55:07 PM (PDT) I Page 3 of 9 Y. i 1 J A 1 i b. The last paragraph of subsection 2. Exclusion, 3 is replaced by the following: Exclusions c. through n. do not apply to damac a by fire, lightning, explosion, smoke or leakage from automatic fire protection systems to prerr, ses while rented to you or temporarily occupied by you with permission of the owner. A separate 1,nit of insurance applies to Damage To Premises Rented To You as described in Section III - L:rits Of Insurance. 2. Paragraph 6. under Section III - Limits Of Insurance"s 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. EXT =NDED DAMAGE TO PROPERTY RENTED TO YOU (Tenant's Property Damage) - Paragraph 9.a. o; Definitions is replaced with the following: 9.a. A contract for a lease of premises. However, tt at 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 system;' 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 lea a 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 17 Coverage C - Medical Payments, Subparagraph (b) of Paragraph a. is replaced by the fo,lowing: (b) The expenses are incurred and reported within, three years of the date of the accident; and F. EXTENSION OF SUPPLEMENTARY PAYMENTS - COVERA3ES A AND B 1. Under Supplementary Payments - Coverages A anc B, Paragraph 1.b. is replaced by the following: b. Up to $3,000 for cost of bail bonds required be ;ause of accidents or traffic law violations arising out of the use of any vehicle to which the Bodil ~ 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 insure 1A at our request to assist us in the investigation or defense of the claim or "suit", including actual toss of earnings up to $500 a day because of time off from work. G. ADDITIONAL INSUREDS - BY CONTRACT, AGREEMENT 0;2 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 addit onal 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 :hat the "bodily injury" or "property damage" occurs, or the "personal and advertising injury" is comriitted, subsequent to the signing of such written contract or written agreement; or I © 2013 Liberty Mutual InSL. ance CG 88 10 04 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 8 51679183 1 00012132 1 19-20 GL/AUTO/BONDS I Susan Wilson 10/7/2019 1:55:07 PM (PDT) Page of 9 a E s t) a 8 b. Premises or facilities rented by you or used by you; or c. The maintenance, operation or use by you of E auipment rented or leased to you by such person or organization; or d. Operations performed by you or on your behah for which the state or political subdivision has issued a permit subject to the following additional provisions: (1) This insurance does not apply to " bodi'-y injury", "property damage", or "personal and advertising injury" arising out of the op,-rations performed for the state or political subdivision; (2) This insurance does not apply to "bodi`ly 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 expos Tres; or (b) The construction, erection, or emoval of elevators; or (c) The ownership, maintenance, :)r 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 1. ian 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: (1) All work, including materials, parts or E juipment 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 whic 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 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 rim apply to any "occurrence" which takes place after the equipment rental or lease agreement has expired or you ha;ie 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 Conditi n 2. Duties In the Event Of Occurrence, Offense, Claim Or Suit under Section IV - Commercial Genr:ral 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 51679183 1 00012132 1 19-20 GL/AUTO/BONDS I Susan Wilson 1 10/7/2019 1:55:07 PM (PDT) Page of 9 1 i 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 frorl the sole negligence of the additional insured. b. "Bodily injury" or "property damage" that occur;; prior to you commencing operations at the location where such "bodily injury' or "property damage" occurs. C. "Bodily injury', "property damage" or "personal6nd 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 ;irepare 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 in?ured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring bf 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. I 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 1 (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 organiz<'ttion other than another contractor or subcontractor engaged in performing operations for w principal as a part of the same project. e. Any person or organization specifically desigriked 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 require`i 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 I 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. i 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 polio!, for damages we cover. © 2013 Liberty Mutual Insclance CG 88 10 0413 Includes copyrighted material of Insurance Services bite, Inc., with its permission. Page 5 of 8 ( i 51679183 I D0012132 1 19-20 GL/A=/BONDS I Sucan W1160R 1 10/7/2019 1:55:07 PM (PDT) 1 Pdge G Of 9 1 i b. The following is added to Paragraph b. Excess. Insurance: When a written contract or written agreement, :.ther than a premises lease, facilities rental contract or agreement, an equipment rental or ease contract or agreement, or permit issued by a state or political subdivision between you and i additional insured does not require this insurance to be primary or primary and non-contributory, his insurance is excess over any other insurance for which the additional insured is designated z'i a Named Insured. Regardless of the written agreement between ou and an additional insured, this insurance is excess over any other insurance whether prim ry, excess, contingent or on any other basis for which the additional insured has been added as an additional insured on other policies. 1. ADDITIONAL INSUREDS - EXTENDED PROTECTION OF YC"UR "LIMITS OF INSURANCE" This provision applies to any person or organization who qualifi~-s 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 sc on as practicable: a. Give written notice of an "occurrence" or an offnse 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 w'iich the additional insured has for a loss we cover under this Coverage Part. d. We have no duty to defend or indemnify an aduitional insured under this endorsement until we receive written notice of a "suit" by the addition it insured. 2. The limits of insurance applicable to the additional insu,ed are those specified in a written contract or written agreement or the limits of insurance as stated it the Declarations of this policy and defined in Section III - Limits of Insurance of this policy, which6er 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 / h ALPRACTICE WHO IS AN INSURED - FELLOW EMPLOYEE EXTENSION - MANAGEMENT EMPLOYEES Paragraph 2.a.(1) of Section II - Who Is An Insured is replace i with the following: (1) "Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you arc a partnership or joint venture), to your members (if you are a limited liability company), to a co";mployee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other '.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 I ; (d) Arising out of his or her providing or failing to p`~ovide 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 InsC, ante CG 88 10 04 13 Includes copyrighted material of Insurance Services Office Inc. with its permission. Page 6 of 8 51679183 1 00012132 1 19-20 GL/AUTO/BONDS I Susan Wilson 1 10/7/2019 1:55:07 PM (PDT) I Page r Of 9 9 Paragraphs (a) and (b) above do not apply to "bodily injury" or ";aersonal and advertising injury' caused by an "employee" who is acting in a supervisory capacity for you. Sup.:rvisory 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 wil `ul intent to cause "bodily injury" or "personal and advertising injury", or caused in whole or in part by their intoxic,;tion by liquor or controlled substances. The coverage provided by provision J. is excess over any othe,_ valid and collectable insurance available to your ,.employee". K. NEWLY FORMED OR ADDITIONALLY ACQUIRED ENTITIE: Paragraph 3. of Section II - Who Is An Insured is replaced by. he following: 3. Any organization you newly acquire or form and over w Lich you maintain ownership or majority interest, will qualify as a Named Insured if there is no other simi .3r 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 t'~ maintained by the first Named Insured. No person or organization is an insured with respect to the con:'uct of any current or past partnership, joint venture or limited liability company that is not shown as a Named lnsur('ld in the Declarations or qualifies as an insured under this provision. L. FAILURE TO DISCLOSE HAZARDS AND PRIOR OCCURRE ICES Under Section IV - Commercial General Liability Condition'", the following is added to Condition 6. Representations: Your failure to disclose all hazards or prior "occurrence existing as of the inception date of the policy shall not prejudice the coverage afforded by this policy )rovided such failure to disclose all hazards or prior "occurrences" is not intentional. M. KNOWLEDGE OF OCCURRENCE, OFFENSE, CLAIM OR SL' IT Under Section IV - Commercial General Liability Condition,;, 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 ur less an insured listed under Paragraph 1. of Section II - Who Is An Insured or a person who has t een 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 cove, age as of the day the revision is effective in your state. ; 0. 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 0413 Includes copyrighted material of Insurance Services Jffice, Inc., with its permission. Page 7 of 8 51679183 1 00012132 1 19-20 GL/AUTO/BONDS I Susan Wilson 1 10/7/2019 1:55:07 PM (PDT) I Page of 9 P. EXTENDED PROPERTY DAMAGE Exclusion a. of COVERAGE A. BODILY INJURY AND PROP RTY DAMAGE LIABILITY is replaced by the following: a. Expected Or Intended Injury "Bodily injury" or "property damage" expected (,r intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "p: operty damage" resulting from the use of reasonable force to protect persons or propert, Q. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAR ST 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 we may have against a person )r organization because of payments we make for injury or damage arising out of your ongoing operations or "you, work" done under a contract with that person or organization and included in the "products-completed operatior ; hazard" provided: 1. You and that person or organization have agreed in wr ing 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 execut on of the written contract or written agreement. i © 2013 Liberty Mutual Ins; ance CG 88 10 04 13 Includes copyrighted material of Insurance Services 7ffice, Inc., with its permission. Page 8 of 8 51679183 100012132 19-20 GL/AUTO/BONDS I Susan Wilson 110/7/2019 1:55:07 PM (PCT( Page of 9 i Kariann Olson From: Kariann Olson Sent: Monday, October 07, 2019 2:27 PM To: KOLJESKY John * DAS Cc: Kariann Olson Subject: RE: Fundamentals of Procurement John, Thank you for taking my call. Please transfer enrollment to the 4-day webinar. It is too bad all the trainings were cancelled in Medford. O Thank You. Kariann 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, pease contact me at (541) 488-5354. Thank you. Y From: KOUESKY John * DAS <John.KOUESKY@oregon.gov> Sent: Monday, October 07, 2019 1:21 PM To: Kariann Olson <kari.olson@ashland.or.us> Subject: RE: Fundamentals of Procurement It is via live webinar over 4 days, 8:30 to 12:00 John Koljesky Statewide Training Coordinator DAS Procurement Services 503-378-2497 http://www.oregon.gov/das/Procurement/Pages/Training.aspx Data Classification Level 1 - Limited From: Kariann Olson [mailto:kari.olson@ashland.or.us] Sent: Thursday, October 03, 2019 9:09 AM To: KOUESKY John * DAS <John.KOUESKY@oregon.gov> 1 Cc: Kariann Olson <kari.olson@ashland.or.us> Subject: RE: Fundamentals of Procurement Hello John, Is the Medford class (Fundamentals of Procurement) now a Webinar? Prefer classroom 10/22 and 10/23 at the Medford Marriott, but will make webinar work. How many recertification points will this class provide? 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@nashland.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: KOUESKY John * DAS <John.KOUESKY@oregon.gov> Sent: Wednesday, October 02, 2019 1:40 PM To: BACHELLER Noel * OPRD <Noel.Bache Iler@oregon.gov>; BERKLEY Andrea * OPRD <Andrea.Berkley@oregon.gov>; tfindley@bendoregon.gov; LEBO Celeste * OPRD <Celeste.Lebo@oreg.on.gov>; MCBETH Brian * OPRD <Brian.MCBeth@oregon.gov>; Kariann Olson <kari.olson@ashland.or. as>; PELLISSIER John D * ODF <John.D.PELLISSIER@oregon.gov> Subject: Fundamentals of Procurement We're going to schedule a live WEBINAR version for 22 ,24, 29, 31 Oc0ber 8:30 to 12:00 each day. I can give priority registration for you for this convening if you wish Will this work for y'all John Koljesky Statewide Training Coordinator DAS Procurement Services 503-378-2497 http://www.oregon.gov/das/Procurement/Pages/Training.aspx Data Classification Level 1- Limited John Koljesky Statewide Training Coordinator DAS Procurement Services 503-378-2497 http://www.oregon.gov/dalProcurement/Papes/Training.aspx 2 Kariann Olson From: Tami Campos Sent: Monday, October 07, 2019 2:10 PM To: Avram Biondo Cc: Kariann Olson Subject: RE: Cert No. 51679183 - Certificate of Liability: Ashland Construction Inc - City of Ashland Attachments: 51679183. pdf Thank you!!! Kari- could you please update what I sent you on, I think it was Friday? Thank you Ta*yt il De, M%l,>LPi-Cc~mpo- 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! "Like 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: Avram Biondo <avram.biondo@ashland.or.us> Sent: Monday, October 07, 2019 1:57 PM To: Tami Campos <tami.campos@ashland.or.us> Subject: Fwd: Cert No. 51679183 - Certificate of Liability: Ashland Construction Inc - City of Ashland Avram Biondo Street Supervisor Public Works Street Division City Of Ashland 90 N. Mountain Ave. Ashland, Oregon 97520 (541) 488-5313 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) 552-2345 . Thank you Begin forwarded message: From: "notification@ecertsonline.com" <notification@ecertsonline.com> Date: October 7, 2019 at 1:55:10 PM PDT To: City of Ashland <avram.biondo@ashland.or.us> Subject: Cert No. 51679183 - Certificate of Liability: Ashland Construction Inc - City of Ashland 1 This ACORD 25 (03/16) Certificate of Liability has been sent to you by Susan Wilson of Brown & Brown Northwest . This is an automated email do not reply. Send reply to: swilson@bbnw.com. The following document (PDF Attachment) contains certificaton of insurance coverage; your company is listed as the organization requesting receipt of this document. z Purchase Order Fiscal Year 2020 Page: 1 of: 1 1 ^fHIS O NUMBER 'MUST APPEAR ON ALL B City of Ashland INVOICES, AND SHIPPING DOCUMENTS. I ATTN: Accounts Payable L 20 E. Main F U r~;i, 202,00196 L Ashland, OR 97520 Order # T Phone: 541/552-2010 O Email: payable@ashland.or.us V S C/O Street Division E ASHLAND CONSTRUCTION H 90 North Mountain Ave N 102 PLEASANT VIEW P Ashland, OR 97520 OD TALENT, OR 97540 Phone: 541/488-5313 R T Fax: 541/552-2304 O Avram Biondo ~wrecf== 10/08/2019 1508 FOB ASHLAND OR/NET30 Cit Accounts Pa able Replace curb and gutter 1 Replace curb and gutter per attached contract and proposal - 1 $2,440.0000 $2,440.00 Voris Street Contract for Goods and Services Small Procurement Less than $5,000 Completion date: 12/02/2019 Project Account: GL SUMMARY 081200 - 602400 $2,440.00 By: (2~_ lkla y l ie Date: Authorized Signature 1 PO i otal $2,440.00 FORM #3 CITY OF -ASH LAN D REQUISITION ecI2 ~Z-e " t,2 Date of request: Vendor Name Ashland Construction INC. Address, City, State, Zip 102 Pleasant View, Talent, OR, 97540 Contact Name Ron Hobson Telephone Number 541-944-2728 Email address Jill Hobson <rhobson541(a.charter.net> SOURCING METHOD ~SvR~4MD~L` ❑ Exempt from Competitive Biddii d T ❑ Emergency ❑ Reason for exemption: in file) ❑ Form #13, Written findings and Authorization ❑ AMC 2.50 ❑ Written quote or proposal attached ❑ Written quote or proposal attached s t 0 iunication If council approval required, attach co of CC X Small Procurement q , ,9¢ Cooperative Procurement Less than $5,000 )ies on file) ❑ State of Oregon Direct Award C Contract # VerbalMritten quote(s) or proposal(s 0 Ve ez.•~ 3 -clurus`v nication) ❑ State of Washington Intermediate Procurement d To %&A ILA IV PO Contract # GOODS & SERVICES _ nppncable Form (#5,6, 7 or 8) ❑ Other government agency contract $5,000 to $100,000 ❑ Written quote or proposal attached Agency ❑ (3) Written quotes and solicitation attached ❑ Form #4, Personal Services $5K to $75K Contract # PERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement $5,000 to $75,000 ❑ Agency ❑ Form #9, Request for Approval ❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached Date original contract approved by Council: ❑ (3) Written proposals/written solicitation Date approved by Council: (Date) ❑ Form #4, Personal Services $5K to $75K Valid until: Date - (Attach copy of council communication) Description of SERVICES Total Cost Replace curb and gutter per attached contract and proposal $ 2,440.00 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST ❑ Per attached quotelproposal $ Project Number - Account Number o s, z 0 0- B o z 4 0 0 2 4 4 0 0 0 2440.00 Project Number Account Number Project Number Account Number 'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: IT Director Date Support -Yes / No I By signing this requisition form, / certify that the City's public contracting requirements have been satisfied. Employee: mil (_~t 7G//y Department Head: OCT ~o (Equal to or greater than $5,000) Department Manager/Supervisor: City Administrator: (Equal to orgreaterthan $25,000) Funds appropriated for current fiscal year: YES / NO Deputy Finance Director- (Equal to orgreaterthan $5,000) Date Comments: Form #3 - Requisition