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HomeMy WebLinkAbout2019-278 20200264 Viking Concrete Cutting Inc I GOODS AND SERVICES AGREEMENT LESS THAN $25,000 PROVIDER: Viking Concrete Cutting Inc. CITY OF PROVIDER'S CONTACT: Bryson Steiner -ASHLAND 20 East Main Street ADDRESS: 186 Ayres Street Ashland, Oregon 97520 K' OR 97524 Telephone: 541/488-5587 E &(Oe- PC)% Fax: 541/488-6006 PHONE: 541-773-2420 This Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and Viking Concrete Cutting Inc., (a domestic business corporation) ("hereinafter "Provider"), for Flat Saw (7) Location of 14" Asphalt and Provide Vacuum Trailer for Slurry Recovery & Haul Off-Site. 1. PROVIDER'S OBLIGATIONS 1.1 Provide Flat Saw (7) Location of 14" Asphalt and Provide Vacuum Trailer for Slurry Recovery & Haul Off-Site as set forth in the "SUPPORTING DOCUMENTS" attached hereto and, by this reference, incorporated herein. Provider expressly acknowledges that time is of the essence of any completion date set forth in the SUPPORTING DOCUMENTS, and that no waiver or extension of such deadline may be authorized except in the same manner as herein provided for authority to exceed the maximum compensation. The services defined and described in the "SUPPORTING DOCUMENTS" shall hereinafter be collectively referred to as "Work." 1.2 Provider shall obtain and maintain during the term of this Agreement and until City's final acceptance of all Work received hereunder, a policy or policies of liability insurance including commercial general liability insurance with a combined single limit, or the equivalent, of not less than $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 • Provider shall supply an endorsement naming the City, its officers, employees and agents as additional insureds by the Effective Date of this Agreement; and Page 1 of 6: Agreement between the City of Ashland and Viking Concrete Cutting Inc. • Be evidenced by a certificate or certificates of such insurance approved by the City. 1.3 Provider shall, at its own expense, maintain Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide workers' compensation coverage for all of its subject workers. 1.4 Provider agrees that no person shall, on the grounds of race, color, religion, creed, sex, marital status, familial status or domestic partnership, national origin, age, mental or physical disability, sexual orientation, gender identity or source of income, suffer discrimination in the performance of this Agreement when employed by Provider. Provider agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. Further, Provider agrees not to discriminate against a disadvantaged business enterprise, minority-owned business, woman-owned business, a business that a service-disabled veteran owns or an emerging small business enterprise certified under ORS 200.055, in awarding subcontracts as required by ORS 279A.I 10. 1.5 In all solicitations either by competitive bidding or negotiation made by Provider for work to be performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Providers of the Provider's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 1.6 Living Wage Requirements: If the amount of this Agreement is $21,507.75 or more, Provider is required to comply with Chapter 3.12 of the Ashland Municipal Code by paying a living wage, as defined in that chapter, to all employees performing Work under this Agreement and to any Subcontractor who performs 50% or more of the Work under this Agreement. Provider is also required to post the notice attached hereto as "Exhibit A" predominantly in areas where it will be seen by all employees. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider the sum of $2,300.00 as provided herein as full compensation for the Work as specified in the SUPPORTING DOCUMENTS. 2.2 In no event shall Provider's total of all compensation and reimbursement under this Agreement exceed the sum of $2,300.00 without express, written approval from the City official whose signature appears below, or such official's successor in office. Provider expressly acknowledges that no other person has authority to order or authorize additional Work which would cause this maximum sum to be exceeded and that any authorization from the responsible official must be in writing. Provider further acknowledges that any Work delivered or expenses incurred without authorization as provided herein is done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement. 3. GENERAL PROVISIONS 3.1 This is a non-exclusive Agreement. City is not obligated to procure any specific amount of Work from Provider and is free to procure similar types of goods and services from other providers in its sole discretion. 3.2 Provider is an independent contractor and not an employee or agent of the City for any purpose. 3.3 Provider is not entitled to, and expressly waives all claims to City benefits such as health and disability insurance, paid leave, and retirement. Page 2 of 6: Agreement between the City of Ashland and Viking Concrete Cutting Inc. / 3.4 This Agreement embodies the full and complete understanding of the parties respecting the subject matter hereof. It supersedes all prior agreements, negotiations, and representations between the parties, whether written or oral. 3.5 This Agreement may be amended only by written instrument executed with the same formalities as this Agreement. 3.6 The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 27913.220, 27913.230 and 27913.235. 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. 3.11 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. 3.12 The City may inspect and test the Goods. The City may reject non-conforming Goods and require Provider to correct them without charge or deliver them at a reduced price, as negotiated. If Provider does not cure any defects within a reasonable time, the City may reject the Goods and cancel 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). 3.13 Provider represents and warrants that the 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. 4. SUPPORTING DOCUMENTS The following documents are, by this reference, expressly incorporated in this Agreement, and are collectively referred to in this Agreement as the "SUPPORTING DOCUMENTS:" Page 3 of 6: Agreement between the City of Ashland and Viking Concrete Cutting Inc. • The Provider's complete written Estimate dated 10/31/2019. 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 Tenn 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 December 15, 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 parry may terminate this Agreement, with cause, by not less than fourteen (14) days' prior written notice if the cause is not cured within that fourteen (14) day period after written notice. Such termination is in addition to and not in lieu of any other remedy at law or equity. 7. NOTICE Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery, by sending via a reputable commercial overnight courier, or by mailing using registered or certified United States mail, return receipt requested, postage prepaid, to the address set forth below: If to the City: City of Ashland - Public Works Department Attn: Steve Walker 20 E. Main Street Ashland, Oregon 97520 Phone: (541) 488-5587 With a copy to: City of Ashland - Legal Department 20 E. Main Street Ashland, OR 97520 Phone: (541) 488-5350 Page 4 of 6: Agreement between the City of Ashland and Viking Concrete Cutting Inc. If to Provider: Viking Concrete Cutting Inc. Attn: Bryson Steiner 186 Ayres Street Eagle Point, OR 97524 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. 9.2 Provider's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Provider's warranty, as set forth in this Article 9, shall constitute a material breach of this Agreement. Any material breach of this Agreement shall entitle the City to terminate this Agreement and to seek damages and any other relief available under this Agreement, at law, or in equity. IN WITNESS WHEREOF the parties have caused this Agreement to be signed in their respective names by their duly authorized representatives as of the dates set forth below. Page 5 of 6: Agreement between the City of Ashland and Viking Concrete Cutting Inc. CITY OF ASHLAND: VIKING CON ETE CUTTING INC. (PROVIDER): By: By: Signature Signature Name Printed Name Printed v - ~l.~ Dim 7~2 r f `(iY CA- q V Title Ti e Date Date (W-9 is to be submitted with this signed Agreement) Purchase Order No.~'~ Page 6 of 6: Agreement between the City of Ashland and Viking Concrete Cutting Inc. Viking Concrete Cutting Inc. ESTIMATE "Professional Concrete Sawing & Drilling in Southern Oregon & Northern California" EL - NG - WALL SAWING - BOBCAT - DUMP TRUCKS Date Estimate # Billing Office: 186 Ayres Street 10/31/2019 1609 Eagle Point OR 97524 Klamath Office (541) 884-1399 TERMS., ESTIMATE VALID 90 DAYS Medford Office (541 773-2420 OR LIC #162173 - CA LIC #568236 Job Name /Address Water Line Replacement City of Ashland Water Department Ashland OR 20 E. Main Street Attn: Steve Walker Ashland OR 97520 Email: steve.walker@ashland.or.us Description Total Bid Price Flat Saw (7) Location of 14" Asphalt 2,300.00 Provide Vacuum Trailer for Slurry Recovery & Haul Off-Site Dump and/or Recycle Fee(s) "EXCLUSIONS: 1. Layout 2. Capping, Disconnecting and/or Damage to ANY Type of Utilities 3. Overtime (Before 7:00am and after 3:30pm on any weekdays, any weekends, any holidays) 4. Traffic Control 5. Standby and/or ANY Contractor Delays (Additional Charges Per Person/Per Hour Will Be Billed) 6. More Than (l) Mobilization MemberOfthP CortcretrSaw vlgEr Dr 11 vgtls~or atcow Viking Concrete Cutting Inc. Date Total Bid Price $2,300.00 Accepted By Date VIKING CONCRETE CUTTING INC. will not be responsible for layout or damage to utilties or any object under the surface being cut, cored or excavated. Due to difficult working conditions, heavy reinforced steel, wire or scattered work, VIKING CONCRETE CUTTING INC. reserves the right to bill all jobs on an hourly basis. Prices may vary if the description of work varies (ie: depth of cut, footage, access, water, power, etc.) All invoices for commercial accounts are due in full 30 days after completion of work or they are subject to 1.5% interest per month. All residential invoices are due in full upon completion. In the event of suit to enforce collection of any sums due under this invoice, purchaser agrees to pay attorney fees and all costs of suits. Business Registry Business Name Search New Search Business Entity Data 11-04-2019 09:49 Entity Entity Registry Next Renewal Registry Nbr T pe Status Jurisdiction Date Renewal Due? Date 248212-90 DBC ACT OREGON 10-22-2004 10-22-2020 Entity Name VIKING CONCRETE CUTTING INC. Foreign Name New Search Associated Names Type PPB PRINCIPAL PLACE OF BUSINESS Addr 1 186 AYRES ST Addr 2 CSZ EAGLE OR 97524 Country UNITED STATES OF AMERICA POINT Please click here for general information about registered agents and service of process. Type AGT REGISTERED AGENT Start Date 10-22 Resign Date 12004 Name MORGAN STEINER Addr 1 186 AYRES ST Addr 2 CSZ EAGLE OR 97524 Country UNITED STATES OF AMERICA POINT Type MAL AILING ADDRESS Addr 1 186 AYRES ST Addr 2 CSZ EAGLE OR 97524 Country UNITED STATES OF AMERICA POINT Type PRE PRESIDENT Resign Date "77 1 Name MORGAN STEINER Addr 1 186 AYRES ST Addr 2 CSZ EAGLE OR 97524 Country UNITED STATES OF AMERICA POINT Type SEC SECRETARY Resign Date "77 1 Name ELLEN STEINER Addr 1 186 AYRES ST Addr 2 CSZ EAGLE OR 97524 Country UNITED STATES OF AMERICA POINT New Search Name History Business Entity Name Nam Name Start End Date Type Status Date VIKING CONCRETE CUTTING INC. EN CUR 10-22-2004 Please read before ordering Copies. New Search Summary History Image Transaction Effective Name/Agent Dissolved By Available Action Date Date Status Change ® MENDED ANNUAL 09-29-2019 F1 PORT ® MENDED ANNUAL 09-13-2018 FI PORT ® MENDED ANNUAL 10-02-2017 F1 PORT ® MENDED ANNUAL 10-19-2016 FI PORT MNDMT TO ® ANNUAL RPT/INFO 10-17-2016 FI STATEMENT ® MENDED ANNUAL 10-08-2015 FI PORT MENDED ANNUAL 10-08-2014 F1 PORT ANNUAL REPORT 09-19-2013 SYS PAYMENT ANNUAL REPORT 09-13-2012 SYS PAYMENT ANNUAL REPORT 09-16-2011 SYS PAYMENT ANNUAL REPORT 09-16-2010 SYS PAYMENT ANNUAL REPORT 09-15-2009 SYS PAYMENT 09-18-2008 SYS LY UA L REPORT MENT ANNUAL REPORT 09-11-2007 SYS PAYMENT ANNUAL REPORT 09-14-2006 SYS PAYMENT MENDED ANNUAL 09-22-2005 FI PORT ROF 10-22-2004 FI Agent NCORPORATION © 2019 Oregon Secretary of State. All Rights Reserved. ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) Ill 11/13/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Kim Schnetzk Ward Insurance Agency Inc. PHONE FAX PO Box 10167 N 0. E 541-687-1117 we No): 541-342-8280 Eugene OR 97440 ADDRESS: kim@wardinsurance.net INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Cincinnati Insurance Company 10677 INSURED VIKICON-01 INSURER B : Viking Concrete Cutting, Inc. 186 Ayres St INSURER C : Eagle Point OR 97524 INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 461315204 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DD/YYYY MM LTR IDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y EPP0135156 4/25/2019 4/25/2020 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ~ JERCOT EILOC PRODUCTS - COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y EBA0135156 4/25/2019 4/25/2020 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X XANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ A X UMBRELLALIAB X OCCUR EPP0135156 4/25/2019 4/25/2020 EACH OCCURRENCE $1,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY STATUTE ER Y/N E.L. EACH ACCIDENT $ N CUTIVE F--1 NIA EXCLUDED? DED? OFFICER/MEMBER (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Scheduled Equipment EPP0135156 4/25/2019 4125/2020 Limit: See Schedule Ded: $500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate holder and all entities required by written contract are included as additional insureds on a primary and non-contributory basis with waiver of subrogation as respects to the general liability including completed operations and additional insureds on auto liability as required by written contract per attached endorsements. Subject to policy limits, terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 E Main Street Ashland OR 97520 AUTHORIZE REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. However, any "auto" that is leased, a. Is effective on the date of acquisition hired, rented or borrowed with a driver or formation, and is afforded for 180 not a covered "auto". days after such date: CineiPlus° E. Audio, Visual and Data Electronic E b. Does not apply to "bodily injury" a BUSINESS AUTO Xll ment "property damage" resulting from an "accident" that occurred before you SECTION III - PHYSICAL DAMAGE COV- acquired or formed the organization; (EXPANDED COVERAGE PLUS) ERAGE, C. Limit of Insurance is amended ENDORSEMENT by adding the following: c. Does not apply to any newly acquired 4. The most we will pay for all "loss" to au- or formed organization that is a joint tnic e t venture or partnership; and did, visual or data elec ro This endorsement modifies insurance provided by the following th this ~ and any accessories used with this d. Does not apply to an insured under equipment as a result of any one "acct- any other automobile liability policy, BUSINESS AUTO COVERAGE FORM dent" is the lesser of. or would be an insured under such a a. The actual cash value of the dam- policy but for the termination of such aged or stolen property as of the time policy or the exhaustion of such poli- With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless cy's limits of insurance. modified by this endorsement. of the "accident", I The cost of repairing or replacing the 3. Any of your "employees" while using a damaged or stolen property with nth- vered 'auto" in your business or your A Blanket Waiver of Subrogation This provision does not apply unless the valid personal affairs, provided you do not own. SECTION IV - BUSINESS AUTO CONDI- written contract has been: er property o(like kind and quality; or hire or borrow that "auto". TIOINS, A. Loss Conditions, 5. Transfer of 1. Executed prior to the accident causing c. $2.500. G. Liability Coverage Extensions - Supple. Rights of Recovery Against Others to Us is "bodily injury" or "property damage"; and Provided the equipment, at the time of the mentary Payments - Higher Limits amended by the addition of the following: "loss" is 2. Is still in force at the time of the "accident" SECTION It - LIABILITY COVERAGE, A. We waive any right of recovery we may have causing "bodily injury" or "property dam- a. Permanently installed in or upon the Coverage, 2. Coverage Extensions, a. Sup, agalnst any person or organization because of age'. covered "auto" in a housing, opening plementary Payments is amended by: payments we make for "bodily injury" or or other location that is not normally "property damage" arising out of the operation D. Employee Hired Auto 1. Replacing the $2.000 Limit of Insurance used by the "auto" manufacturer for for bail bonds with $4,000 in (2): and of a covered "auto" when you have assumed 1. Changes in Liability Coverage the installation of such equipment: liability for such "bodily injury" or "property 2. Replacing the $250 Limit of Insurance for damage" under an "insured contract", provid- The following is added to the Section II - h. Removable from a permanently in- reasonable expenses with $500 in (4). ed the "bodily injury" or "property damage" cc- Liability Coverage, A. Coverage, 1. stalled housing unit as described in subsequent to the execution or the "in- Who is an Insured: Paragraph 2.a. above: at H. Amended Fellow Employee Exclusion cured contract". An "employee" of yours is an "insured" c. An integral part of such equipment. SECTION II - LIABILITY COVERAGE, B. Ex- B. Noncontributory Insurance while operating an "auto" hired or rented F. Who is an Insured - Amended clusions, 5. Fellow Employee is modified as SECTION IV - BUSINESS AUTO CONDI- under a contract or agreement in that follows: TIONS, B. General Conditions, 5. Other In- while name. with your permission. SECTION II - LIABILITY COVERAGE, A Exclusion 5. Fellow Employee is deleted. TIONSe is replaced by the following: performing duties elated to the Coverage, 1. Who is an Insured is amended conduct of your business. by adding the following: I. Hired Auto - Physical Damage c. Regardless of the provisions of Par- 2. Changes in General Conditions The following are "insureds": If hired "autos" are covered "autos" for Liability .graph a. above, this 5 overage Coverage. then Comprehensive and Collision Form's Liability Coverage primary SECTION IV - BUSINESS AUTO CON. 1- Any subsidiary which is a legally incorpo- Physical Damage Coverages as provided un- and we will not seek contribution DITIONS, B. General Conditions, 5. rated entity of which you own a financial der SECTION III - PHYSICAL DAMAGE from any other insurance for any lia- Other Insurance is amended by replac- interest of more than 50% of the voting COVERAGE of this Coverage Part are ex- bil'd` assumed under an "insured ing Paragraph 5.b. with the following: stock on the effective date of this cover- tended to ^a urns" you hire, subject to me fol- hat -quires liability to be age form. owing on a primary noncontributo- h. For Hired Auto Physical Damage g basis. Coverage the following are deemed However, the insurance afforded b this Y t. The mast we will pay for "loss" to any to be covered "autos" you own: provision does not apply to any subsidiary hired "auto" is $50.000 or the actual cash C. Additional Insured by Contract that is an "insured" under any other au- value or cost to re hich- SECTION II - LIABILITY COVERAGE, A. (1) hire, covered "auto" you lease, tomobile liability policy, or would be an ever is the least, minus a deductible. , rent or borrow: and ured" under such policy but for term!- to C-11 includge e, as an sW I h nosur ur a ednaIny nsur pe ed rson o Is ar amended 2 An covered "auto" hired or nation of such policy or the exhaustion of 2. The deductible will be equal to the largest "auto" written with which you have agreed in a a valid O id rented by your "employee" under such policy's limits of insurance. deductible applicable to any owned written contract to ovide insurance as is af- a contract in that individual "em_ for that coverage, or $1,000, whichever is pr 2. Any organization that newly acquired or s forded by this policy. ployee's" name, with your per- formed by you and over which you main- les. mission, while performing duties tain majority ownership. The insurance 3. Hired Auto - Ph This provision is limited to the scope of the elated to the conduct of your Physical Damage coverage valid written contract. business. provided by this in rovisio n : excess over any y other collectiblemsur- ance. Includes copyrighted material of ISO Includes copyrighted material of ISO AA 288 01 16 Properties. Inc.. with its permission. Page 1 of 4 AA 288 01 16 Properties, Inc., with its permission. Page 2 of 4 4. Subject to the above limit, deductible, and I Transportation Expense- Higher Limits 2. SECTION V - DEFINITIONS Is amended P. Unintentional Failure to Disclose Hazards excess provisions we will provide cover- by adding the following, but only for the age equal to the broadest coverage app SECTION III - PHYSICAL DAMAGE COV- purposes of this Loan or Lease Gap SECTION IV - BUSINESS AUTO CONDI- i- cable to any covered "auto" you own in- ERAGE, A. Coverage, 4. Coverage Exten- Coverage: TIONS, M General Conditions, 2. Conceal- ended by replacing $20 per day ent. Misrepresentation or Fraud is sion, is sured under this s poll policy. with $50 per day, and $600 maximum with "Total loss" means a "loss" in which the amended by adding the following: Coverage includes loss of use of that hired au- $1.500 maximum in Extension a. Transpor- cost of repairs plus the salvage value ex- However, I you unintentionally fail to disclose to, provided it results from an 'accident" for lotion Expenses. ceeds the actual cash value. any hazards existing on the effective date of which you are legally liable d as a result of L. Airbag Coverage N. Glass Repair of Deductible this Coverage Form, we will not deny cover- which a monetary loss is sustained by the g - age under this Coverage Form because of leasing or rental concern. The most we will SECTION III - PHYSICAL DAMAGE COV- SECTION III - PHYSICAL DAMAGE COV- such failure. pay for any one "accident" Is $3,000. ERAGE, B. Exclusions, 3.a. is amended by ERAGE, D. Deductible Is amended by adding If a limit for Hired Auto - Physical Damage is adding the following: the following: Q. Mental Anguish Resulting from Bodily Inju- shown in the Schedule, then that limit replac- However. the mechanical and electrical N. deductible applies to glass damage if the ry es, and is not added to, the $50,000 limit iri breakdown portion of this exclusion does not glass is repaired in a manner acceptable to us SECTION V - DEFINITIONS, C. "Bodily inju- cated above. apply to the accidental discharge of an alrbag. rather than replaced. ry" is deleted in its entirety and replaced by J. Rental Reimbursement This coverage for airbags is excess over any O. Duties in the Event of an Accident, Claim, the fallowing: other collectible insurance or warranty. SECTION III - PHYSICAL DAMAGE is Suit or Loss - Amended "Bodily injury" means bodily injury, sickness or amended by adding the following: M. Loan or Lease Gap Coverage SECTION IV - BUSINESS AUTO CONDI. disease sustained a person, including men- tal anguish and death sustained by the same ame 1. We will pay for rental reimbursement ex- 1. SECTION III - PHYSICAL DAMAGE TIONS, A. Loss Conditions, 2. Duties in the person that results from such bodily injury, penses Incurred by you for the rental of COVERAGE, C. Limit of Insurance is Event of Accident, Claim, Suit or Loss, a. is sickness or disease. "Bodily injury" does at an "auto" because of a "loss" to a covered deleted in its entirety and replaced by the amended by adding the following: include mental anguish or death that does not "auto". Payment applies in addition .the following, but only for private passenger This condition applies only when the "acci- result from bodily injury. sickness or disease. n otherwise applicable amount of each cov- type "autos" with an original loan or lease. dent" or "loss" is known to: erage you have on a covered "auto'. No and y in the event of a "total loss" to R. Coverage for Certain Operations in Con- deductible applies to this coverage. such a private passenger type "auto": 1. You, if you are an individual; nection with Railroads 2. We will for those ex a. The most we will pay for "loss" in any 2. A Partner. rf you area partnershlp With respect to the use of a covered "auto" in pay y penses in- greater g a railroad. timed duringon the policy period beginning one "accident" is the of operations for or affecting 24 hours after [he "loss" and ending, re- 3. An executive officer or insurance I-I 24 ho of the p olicy's expiration, with (1) The amount due under the terms er. if you are a corporation: or 1. Section V - Definitions, H. "Insured con- s of the lease or loan to which tract". 1.c. is amended to read: the lesser of the following number of your covered private passenger 4. A member or manager, if you are a lim- days: type "auto" is subject, but will not tied Ili company. c. An easement or license agreement: a. The number of days reasonably re- include: 2. Section V - Definitions, H. "Insured con- quired to repair the covered "auto". If (a) Overdue lease or loan pay- tract". 2.a. is deleted. "loss" is caused by theft, this number ments; of days is added to the number of days it takes to locate the covered (b) Financial penalties imposed 'auto' and return it to you; or under the lease due to high mileage. excessive u e or b. 30 days. abnormal wear and tear 3. Our payment is limited to the lesser of the (c) Security deposits not re following amounts: funded by the lessor; a. Necessary and actual expenses in- (d) Casts for extended warran- curred; or ties, Credit Life Insurance - b. $50 per day. Health. Accident or Dlsabil. Ity Insurance purchased 4. This coverage does not apply while there with the loan or lease; and are spare or reserve "autos" available to (e) Carry-over balances from you for your operations. previous loans or leases, or 5. We will pay under this coverage only that tint of your rental reimbursement ex- (2) Actual cash value of the stolen penses which is not already provided for or damaged property. under SECTION III - PHYSICAL DAM- b. An adjustment for depreciation and AGE COVERAGE, A. Coverage, 4. physical condition will be made in de- Coverage Extensions. tem ining actual cash value at the time of "loss". Includes copyrighted material of ISO Includes copyrighted material of ISO AA 288 01 16 Praperties. Inc.. with its permission. Page 3 of 4 AA 288 01 16 Properties, Inc., with its permission. Page 4 of 4 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 6. Voluntary Property Damage (coverage a.) and Care, Custody or Control Liability Coverage (Coverage b.) OREGON CONTRACTORS' COMMERCIAL GENERAL LIABILITY Limits of Insurance (Each OO-„rrenee) BROADENED ENDORSEMENT Coverage a.$000 Coverage b. $55,000 unless otherwise stated $ Deductibles (Each Occurrence) This endorsement modifies insurance provided under the following. Coverage a.$250 COMMERCIAL GENERAL LIABILITY COVERAGE PART Coverage h. $250 unless otherwise stated $ A. Endorsement - Table of Contents: COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM Coverage : Begins on Pace: (h Pea (For Limits in Excess of (For Limits in Excess of sales $5.000) $5,000) (c) G,... Sales 1. Employee Benefit Liability Coverage..__...._ _..._......_.__.2 (d) Units 2. Unintentenal Failure to Disclose Hazards 8 a Other 3. Damage to Premises Rented to You....._ 8 b. Care, Custody 4. Supplementary Payments 9 or Control $ 5. Medical Payments ....................._...........................10 6. Voluntary Property Damage (Coverage a.) and Care, Custody or Control TOTAL ANNUAL PREMIUM Liablfly Coverage (Coverage b.) 10 11. Property Damage to Borrowed Equipment 7. 180 Day Coverage for Newly Formed or Acquired Organizations., 10 8. Waiverof Subrogation......_ 10 Ea di Occurrence Limit. $ 10.000 9. Automate Additional Insured- Specified Relationships. .....__.__._11 Deductible: $ 250 Managers or Lessors of Premises; Lessor of Leased Equipment; Vendors; C. Coverages: 2) Our right and duty to State or Political Subdivisions - Permits Relating to Premises; x State or Pohfinl Subdivisions- Permits, and 1. Employee Benefit Liability Coverage defend ends when we x Contractors' Operations - have used up the ce 10. Broadened Contradual Liability - Work Within 50' of Railroad Property a. The following is added to SECTION I cable limit of insurance 16 11. Property Damage to Borrowed Equipment 16 -COVERAGES: Empbyee Benefit in n the payment of 12. Employees as Insureds- Specified Heats Care Services 16 Liability Coverage. judgments or settle- EmergencyMedcalTehnicians,and (1) Insuring Agreement menu. x Paramedics (a) We will paythose sums that No other obligation or haml- 13. Broadened Notice of Ocarrren ce 16 the insured becomes legally ity to pay sums or perform obligated to pay as dart, ads or servces is cwered ages caused by any gel, err ur lessexpllcity provided for ror or ss n of the in- unetler Suppl 8. Limits ofInsurance: ementary Pay ved, ornof any other Per- ts. The Commercial General Liability Limits of Insurance applyto the insurance provided by this endorsement, sm for wfiose ads the in- (b) This insurance applies to exce of as provided below'. sraed is legally liable, to damages only if the ad, wfiid, thi er- 1. Employee Benefit Liability Coverage this insurance ap- ror or omission, plies. We will have the night omission, is I and duty to defend the in gently committed inn the a Employee Limit: $ 1,000.000 - "administration' of your your E dr Aggregate Limit $ 3,000.000 sued gait[ "s. empmplooye,e benefit program"-, Deductible: $ 1,000 seeking in ose damages. and 3. Damage to Promises Rented to You However we l aga nst no an ge duty [o defend y 11 Occurs during the pol- "suit" seeking damages to icy period;d; o or The lesser of not apthis insurance does a. The Each Occurrence Limit shown in the Declarations; or not aply. We may, at our 2) Ocwrred prior the discretion, investigate any ffectve data of f this error endorsement provided: b. $500,000 unless otherwise stated $ report of a `1' and ettleany a) You did not have 4. Supplementary Payments claim ort suit" that may re- kmowdedge of a. Ball bonds: $ 1,000 sJl. But. claim o suit" c h. Loss of earnings: $ 350 i) The amount we will pay fectef date of this for damages s limited 5. Medical Payments as described in SEC- endorsement. T,ON Medical Expense Limit: $ 10,000 INSURANCE. anddS OF You will he deemed to have Includes copyrighted material of Insurance Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., win its permission. Page 1 of 16 GA 233 OR 09 10 Services Office, Inc., with its permission. Page 2 of 16 knoWedge of a 1) Failure of any invest- (3) Coercion, demotion, tors are insureds, but only claim wit" ment to perform; valuation, sign- with respect to their duties Wish any "author- ment, discipline defa- as your oRcem or directors. zed represenla- 2) Errors in providing in- motion, harassment, your stockholders a also five; formation on past per- humiliation, riscnmina- wreds, but only with re- formance of investment tion o other employ- spact to their liability as i) Reports all, o vehicles; or ant-related practices, stoddiolders. as part, or of the or 3) Advice en to any ads or onamions,o giv r (e) A trust, you are an insured. on to us person with respect to (4) Consequential h billy Your I ustees are also in- any other that person's decision a rewft of (1). (2) or surede, but only with respect inwr to participate o not to (3) above, to their duties as trustees. participate in any plan ii) Receeves included in the 'em This exclusion applies (2) Each of the following is also an written o - ployee benefit pro- whether the insured may be insured: bat demand or gram'. held liable as an employer claim for darn orlany other capacity and (a) Each of your "employees" ages because (F) Workers' Compensation to orry obligation to share who is or was authorized to of the act, error and Similar Laws damages with repay administer your employee omission, Any claim arising out of your else w. must benefit program". and pay edamages beuw of failure to comply with the (b) Any persons, organizations b) There is no other mandatory provisions of any the injury or employees" having Icable msur- workers' mmpensation, un- (3 Supplementary Payments proper temporary authonm- appai 1 a empoyment mmpensason son to administer your ^err, dal seaaity or SECTION I - COVERAGES, ployee benefit program" if uranoa, (2) Exclusions disability bee fins law or any SUPPLEMENTARY PAY- you die, but only until your similar law. MENTS - COVERAGES A AND legal representative is ap- This insurance does not apply te: (q) ERISA B also apply to this Coverage. pointed. (a) Bodily Injury, Property b. Who is an Insured (c) Your legal but representative if Damage or Personal and Damages for which any in- you die, but only ly with h re- Advertlsing Injury sued is liable because of It- As respects Employee Benefit LiabiF sped to duties as soda. I 'Bodily injury' "property ability imposed on a fiduci- ity Coverage. SECTION R - WHO IS That representative will ary by the Employee Re- AN INSURED is deleted in its entirety have all your rights and du- damagz' or "personal and firemen' Income Secumty and replaced by the following. ties under this Coverage advertisng nary Act of 1974, as now or b Dishonest, Fraudulent, hereafter amended, or by (1) Ifyou are designated in the Dec- Pan' ( ) larations as Criminal or Malicious Act any similar federal, state or (3) Any organization you newly ac- lacal laws. quire, r form, other than a Part- Damages risng out of any (a) An spouse are are re you insureds, your nersHp, joint venture or limited a intentional , di shonest, (h) Available Benefits on liability company, and over which fraudulent, criminal or mall- only with respell to tc the con- you maintain ownership o - r or omission Any claim for benefits to the duct of a business of which jonty interest, WII qualify ra cious act, matted by error insured extent that such benefits are you are the sole owner. Named Insured if no other sma available, with reasonable indutling the wilful or rack- effort and cooperation ofthe (b) A partnership or joint van- lar insurance applies to that or- less vitiation of anystatute. insured. from the applicable tore, you are an insured. g-i-It,n. However, coverage (c) Failure to Perform a Con- funds amued or other cal- heYour rs, and theirs, your part- under thisprovsion. (a) Is afforded any until the tract lectideinsurance. also insureds but only with Dam, - out of tail- (i) Taxes, Fines or Penalties respect to the conduct of 180thmday after you acquire gas arising ou your business. or for the orgy n lZatim or of performance of art- Taxes, fines or penalties, the end of the pohcy period, trod by arty Insurer. including those imposed (c) A limited liability company, whichever is earlier, and (d) Insuflieiency of Funds under the Internal Revenue you are an nwred. Your (b Does not apply to any act, Code or any similar state or members are also insureds, ) Damages arising out of an lace] law. but only with respect to the mr or reson that was sufhciency of funds to con duct of your business. comitted before you ac- 'neet any obligations under (J) Employment-Related Vour managers are inuur- qulretl or formed the organi- any plan in ciuded t the Practices ads, but only with rasped to zahm. employee benefit program'. Any liad]ily arising out of their duties as your manag- c. Limits of Insurance (e) Inadequacy of Perform- any ors. once of Investment I Ad- (d) An organization other than a As respects Employee Benefit Llabll- vice Given Wth Respect 11) Refusal to employ; partnership, joint venture or ty Coverage, SECTION III - LIMITS OF INSURANCE Is deleted in its on- to Participation (2) Termination of em limited liability d. Your 'You rarely and replaced by the following: Any based u Pllo ymen Y Pon: eMive officers" and direc- Includes copyrighted material of Insurance Includes copyrighted me eral of Insurance GA 233 OR 09 10 Services Office, Inc., W in its permission. Page 3 of 16 GA 233 OR 09 10 Services Office, Inc., Wm I6 permisson. Page 4 of 16 (1) The Limits of Insurance shown in amount stated in the Deda- may result in a daim. may also Section B. Limits of Insurance. rations applicable to To the extent possible, apply 1. Employee Benefit Liability Each Employee. The limits notice Should neutle: d. No inapt will, exc t Coverage and the rules below of insurance shall not be re- ap fix the mast we will pay regard- duced by the amount of this (1) What the act, error at that ineured's own less of the number of deductible, =nit cs, voluntarily make a andom payment a any (a) Insureds; (b) The deductible amount cured; and obligation, or incur any stated in the Declarations expense without our (b) Claims made or suits" applies to all damages sus- (2) The names and consent brought; rained by any one "em andressesof any, who ay suf- (2) Item 5. Other Insurance is de- ptoyee", including suds o e n (c) Persons or oror brin ns fer damages as a leted in its entirety and replaced suits'; making loi ns or bringing and benefiaemployees"ari s because dependents result of the ad, by the following "e or omis- error or omi ssion of all acts. , errors r 5. Other insurance d Acts, errors or omissions; or 61Os to whi h this incur- ( ) h. If a claim is made or an e Benefit. intlUded in your ce applies. is brought a gains' IF Other valid and collectible assurance is vailable to the employee benefit program". (c) The terms of this insurance, any insured, you must: a induding those with respect ( insured for a loss we cover 1) Immediately re- under this Coverage Part, (2) The Aggregate Limit shown in 10 cad the spe.fics or obligations are limned Section B. Limits of Insurance. of the claim or as flows 1. Employee Benefit Liability 1) Our right and duty to Coverage ofths endorsement is defend the aural 'sun' antl the date the most we will pay for all darn- against any suits' received; and a. Primary Insurance ages because of ads, errors or eeldng those dam (2) Notify us as n This in once is pri- as sin nary except when c. negligently committed ages; and nmthe0nadministrati or" of your practicable. below applies. If this In- I'employeebenefit program". 21 Your duties, and the You must see to it that surance is primary, our duties of any other we receive written no- obligations are not at- (3) Subject to the Ii,it described in voNed insured , in the tice of the claim o fatted unless any of the (2) above, the Each Employee even' of an ad, error or "suit" as Soon as other insurance is also Limit shown m Sad— B. Limits omission, or daim, prat of Insurance, 1. Em to cable. primary. Then, will P Yce share with all that t other Benefit Liability Coverage 01 aPPIY irrespective deducible ap- 0. You and any other in- insurance by the this endorsement is the mast we pliration of f the deductible voNed assured must. wit pay for all damages sus- amount. be shod described in h. tamed by ray e "employee", (1) Immediately send low. induding damages sustained by (d) of We the may day edu pay cti ableny a part or mount all 11 pies of any h. Method of Sharing demand st h "employee's' dependents effect settlement of any summonses net ces, laim or "suit" and, upon no- es le- If all of the other insur- and boner-les, as a result of. c sum tifiratim of the action taken, gal papers re- once yer a mntr- (a) An act, error or omission; or _ ved connec- Hon b shares, you shall promptly r lion win the claim yell folhw this (b) A series of related ads, er- burse us for sudt part of the or suit,I method also. Under this regard- deductible amount s we a less of the amount of time have paid. (2) Authorize us to ob- canproach sach insurer that lapses between suds taro records antl aqua acts, emme or emoss it s, d. Add Non al Conditions other information; amounts until it has paid its applicable limit negligently committ ed in the As aspects Employ- Benefit Li- (3) Cooperate wth us of insurance or none of "administration" of your "em ability Coverage. SECTION FV - in the investigation the loss remain ployee benefit program". COMMERCIAL GENERAL LIABIL- or settlement of whichever comes firsts IM CONDITIONS Is amended as fd- the daim or de- However, the amount paid under . fence against the If any of the other in- However, endorsement shall not ex- r ram does not per- ceed, and will be subject to the (1) Item 2. Duties in the Event of "suit"; and mita contribution by lints and restrictions that apply Occurrence, Offense, Claim or (d) Assist us, upon equal shares, we veil to the payment of benefits In any Suit is deleted in its enmety and r request, in the cmmbule by limits. plan included io the "employee reo..dby the fdlovnng: enforcement of Under this method, benefit program". 2. Duties in the Event of an any right against each insurers share is Act, Error or Omission, or any person m aasedceon the ratio ofi ts (L) Deductible Amount ganizatoo which ppl ble li Claim or Suit may be liable to sur ca to thmite t0o,l tal n- (a) Our obin bah to pay dam plicable limits of in sur- behalf of the in- a. You must see to it that the -neured he- ages o - noted as Soon cause of an ad, once stall insurers. ad amount damages aot d onemages in t ex are acableo of an ad, error - is omisI c. No Coverage cess of the deductible error o which I. fo wfiidi this n- Indudes copyrighted material of Insurance Includes copyrighted material of Ins rance, GA 233 OR 09 10 Services Office, Inc., with its permisson. Page 5 of 16 GA 233 OR 09 10 Services Office, Inc., win In permiss,- Page 6 of 16 I This inwrance shall not providing some or all of the ages are claimed and The exdusens under SECTION any loss far following benefits to to wfiidh the insured I - COVERAGES, COVERAGE wthidh the insured is en- ployses', whether proviMd must submit or does A. BODILY INJURY AND titled to recovery under through a "cafeteria plan" or submit Win our cm- PROPERTY DAMAGE LIABIL- any other insurance in otherwise. sent; ITY, 2. Exclusions, other than I. force previous to the ef- alte rnative War and the Nuclear Energy festive date of the a. Group life ~tlewl ran b. tli Anytotheer all Liability Exclusion, are deleted Coverage Part. group or spu e r pro- and the fidl ing are added. health inw es ; den- ceedng in vvmch such e. Additional Definitions fair vion and hearing damages a claimed This insurance does not apply to As respects Employee Benefit Li- spank, rig and ~flembl once to the in- 2b a 'Property ility Coverage, SECTION V - ts, co d wwhidh bm its with our damage'. DEFINITIONS is amended as fol- orhvidetl that n rrsent or 1) Assumed in any conlows. they thras o "em c, An tract; or plo appeal of a civil pro- (1) The following definitions are to w may such bene sufusbs d ceedng. 2) Lass caused by or re- sudh benefits are madae s:ng from any of the added . general avty ailable to 8. a %ly byse' ern a pens y P fortnerl following' - 1. "Adminlstralion" means: those "employees" who d ire employed , on leave of ab- a) Wear and tear, disabled, o a. Providing Information to bility ngre4ritheremenfie or plan'•eligi- sence o r re- ) employees'', including tired. "Employee" induces a h) Rust corrosion, their dependents and b. Profit sharing plans, 'leased worker" .'Em ploy!!" fungus, decay, de- thcm dmes, with n e_ employee vings does not in dude a tempo- terioration, hidden sped to eligiblrty for or plan employe eslodc vary worker". or latent defect or rope of "employee :ion plans, pen- 2, Unintentional Failure to Disclose Hai- any quality in benefit programs'; on plans and stock ards c usesit to da that ulascaption plans, pro- m b, Interpreting the vided that no one other SECTION IV -COMMERCIAL GENERAL age or destroy a- play- benefit pro- than employee' LIABILITY CONDITIONS. 7. Represen- self, grams", may sub-be to such tatlons is hereby amended by the addi- e) Smog; c. Handling f !cords in benefits and such lion ofthe following nedian with the benefits are made gen- d) Mechanical break- "m: "employee benefit !rally available to all Based on our dependence upon your rep- dorm including pro- who are estimations as to eh bmg h-ds, if un- apt nit or burst grams"; or employees" intentionally you should fail to disdase all arg eligible der the plan c it by c - d. terminati rn continuing r for such benefits; such hazards al the inception date of your tnugal farce; terminating any "em policy, we will not reject erage under dsolely on such e) Stinting, cracking, ployee's" partidpatlon c. Unemployment sun- this Coverage Part base se in any benefit induced an-. soda, secuailure. shnnking or ex in the 'employee ben!- benefits, workers' co: m pan..n; or - pensation and disability 3. Damage to Premises Rented to You fit program". benefits, and Nesting or infesla- However, "administration" a. The last Subparagraph Paragraph lion, or disdharge does not induce: d. Vacation plans, indud- 2. SECTION I - COVERAGES, or release of waste ing buy and sell pro- COVERAGE A. - BODILY INJURY products or seoe- a. Handling payroll deduc- grams, leave of ab- AND PROPERTY DAMAGE. 2. LI- lions, by insects, lions; or once programs, in- ABILITY Exclusions is hereby de- birds, rodents or h. The failure to effect or chiding military, mater- leted and reels cal bythe following-. other animals. nr, aintain any insurance leave tuititon ass Sonic! Exdusens c. through q, do not appy (b) Loss caused directly or indi- adequate limits of plans; transportation to damage by fire explosion. IigM- redly by any of the folkxv- ,.adequate th club subsi- ning, lee o of to premises ing 0 of insurance. and heal e vvhile rented to tem including but not limited dies. yw or pommy oc- to u employment in- cupied by you with permission of the 1) Earthquake, volcanic n dal wwr'ay (2) The following definitions are de- owner, eruption, landslide o benefits, workers' corn leted in their entirely and re- It. The insurance provided under SEC- alny other earth move- pencatlon and disability placed bylhe Following: t• TION I-COVERAGES. COVERAGE benefits 21. Suit" means A. BODILY INJURY AND PROP- 2) Water that backs up or ' a civil Pro- 2. "Cafeteria plans" reeding in which money ERTY DAMAGE LIABILTY applies overflows from a sewer, plan authorized by appl- damages because of ad, tm "property damage' arising out M drain or sump; or in on to which water damage to premises that are ble law to allow "employees" error to elect to pay for certain this i applies are both rented to and oavpied by you. 3) Water under the ground benefits with pre-tax dollars. allegeds'Suit reWdes: surface prsng on, (1) As respects Water Damage Le- Bowing or seeping g 3. 'Employee benefit pro- a. An arbitration proceed- gal Liability, as provided in Paa- through: grams" means a program ing in wfiidh wdh dam graph 3.b. above: Induces copyrighted material of Insurance Includes copyrighted material of Insurance GA 233 OR 09 10 Services Office, Inc., Win its permission. Page 7 of 16 GA 233 OR 09 10 Services Office, Inc., with its permission. Page 8 of 16 i i a) Foundations, 'ocarrreace' to which b. Care, Custody or Control Liability it dudide amount as has been one walls, floor or tmsmsurance applies. Coverage paid byus. paved surfaces; (3) The amodntwa will pay is limited SECTION 1 - COVERAGES, COV- 1. 180 Day Coverage for Newly Formed or b) Basements, as described in Section B. Lim- ERAGE A. BODILY INJURY AND Acquired Organizations whether paved or its of Insurance, 3. Damage to PROPERTY DAMAGE LIABILITY, 2. SECTION II - WHO IS AN INSURED is not; or Premises Rented to You of this Exclusions. I. Da ge to Proerty. , windows or endorsement. Suboaragrap hs (3). (4) and (5) p do not amended as follows t Doors : apply to prooehy damage" to the Subparag is other openings. 4. Supplementary Payments property of others desolbed therein. raeletl ph and o replaced by [he lot- Law caused by or resulting Under SECTION I - COVERAGE. Si With respect to the insurance provided by lowng from water that leaks or PLEMENTARY PAYMENTS - COVER- this section of the endorsement, the fol- flowe from plumbing, heat- AGES A AND B lowing additional provisions apply a. Insurance under this provision is er ing, air conditioning, or fire forded any until the 180th day after protection systems oust a. Paragaph 2, Is replaced by the fd- a. The Limits of Insurance sho.vn In the you acquire or farm the organization by or resulting ham freezing, ION"'ng Declarations are replaced by the fm- or the end of the policy period, c unless'. Up to the limit shown in Section B. its designated in Section B. Limits of whihever is earlier. 1) You did your best to Limits of Insurance, 4.a. Bail Bonds Insurance, 6. Voluntary Property 8, Waiver of Subrogation of this endorsement for -9 of bail Damage and Care, Custody or aiding or stheatmdinure; th or the bonds re - ed because of accidents Control Liability Coverage of this SECTION IV -COMMERCIAL GENERAL building or traffic law violations arising out of endorsement with respell to cover- LIABILITY CONDITIONS, 9. Transfer of 2) You drained the equip- the use of any vehicle to which the age provided by this endorsement. Rights of ReooveryAgainst Others to tint and shut off the Badly In]ury Liability Coverage ali These limits are indusrva of and not Us is hereby amended by the addition of water sappy if the heat plies We do not have to furnish in add Rion to the Lmits being re- th._ fdlawng was not-biined. these bond. placed- The Limns of Insurance N,'e waiv any right of recovery we may shown in Section B. Limits of Insur- have beceuse of payments we make for (d) Lossto ordamage lo'. b. Paragraph 4. is replaced by the fel- ante, 6. Voluntary Property Dam- he or damage arising out wyour exi 1) Plu m make I r bing, h eating, a loving: L and C. Custody nont.ol hjury ' em fix Coverage of f this s ain any ing operat =or your work" done under written contras requiring such wa onh."`sg, fire prof All reasonable expenses incurred by 4tiant fix the most we volt pay any em the insured at our request to defer assist us one e enc." regardless of the with that person o organization a ra other syst- o[he equipment or apr in the investlgatien o or r defense of the number r of of chided in the "produriscompleted opepera- pliances; or claim or "suit, including actual loss of lions hazard". However, o rights may mings up to the Imitshawnin Sec- (1) Insureds, only be waived prior to the"oodarreace" 2) The inlenor of any bon B. Limits of Insurance, 4.6. giving rise to the votary or damage for building or structure, or Loss of Eamings of this endorsement (2) Claims made or "suits" brought; winch we make payment on der this Cov- to personal property in per day because of time off from or erage Part. The insured must do nothing the building or structure work. after a loss to impair rights. At our re- (3) Persons or organizations making quest, the insured will bring "suit"or trans- ad by or ....king ortr from rain snow, Sect 5. Medical Payments claims mgmg "suits . fief those rights to us and help us enforce or ice, whether cinven The Medical Expense Limit of Any One b. Deductible Clause those rights. by wool or not. person as stated in the Dedararons is Limit of Insurance amended to the limit shown in Section B. (1) Our on to pay damages 9, Automatic Add itbnal Insured - Speci- c. an you, ur behbehalfapplies only tthe fied Relationships The Damage to Premises Rented to Limits of Insurance, 5. Medical Pry- mount of damages for each You Limit as shown in the Declare- merits of this erxlorsement. bCCUrta de, which are in excess a. The lallow ION 11ng H hereby added to tions is amended as follows: 6. Voluntary Property Damage and Care, of the deductible amount stated SECTION II • WHO IS AN INSURED: Custody or Control Liability Coverage in Section B. Limits of Insur- (1) Any person or organizabon de- (2) Paragraph 6. of SECTION III - ante, 6. Voluntary property sashed in Paragraph 9.a.(2) be- LIMITS OF INSURANCE a. Voluntary Property Damage Cov- Damage and Care. Custody or low (hereinafter referred to as hereby deleted and replaced by .rage Control Liability Coverage .1 additional insureds whom you are the following this and., semen[. The limits of e etl to add as as additional We wil pay for "property damage" to insurance will not he reduced by nslure der thi s 6. Sri to 5. above, the property of others ansng out of op- he application of such deducts- b tl un Coverage Pan Damage to Premises eratians incidental to the insureds ble amount. by reason of j Rented to You Limit is the husinesswhen: most we will pay under (2) Condition 2. Duties in the Event (a) mentttor contract or agree- COVERAGE A. BODILY (1) Damage is caused by the in- of Occurrence, Offense, Claim INJURY AND PROPERTY ..red. or or Suit applies to each d1mm or (b) An oral agreement or can- DAMAGE LIABILITY, far (2) Damage occurs wlido in the tin- wilt" vrespeRlhe of the amount. troll where a certificate of damages because of "prop- s inwra ce showing that per- ured's possession. (3) We may pay any part or all of the erty damage" to premises deduRige amount to effect set- cen or organization an while rented to you a to - With your mnsent, we will make adomenal insured has been porarily otsupied by you these payments regardless of fault. tlnd ment of any claim or suit" Issued, on of the ac- with permission of the a, upon notificati - owner, ansog out of any ti.n taken, you shall promptly re is an insured, provided: imburse us for such part of the Includes copyrighted material of Insurance Includes copyrighted material of Insurance GA 233 OR 09 10 Services office, Inc., with Is permission. Page 9 of 16 GA 213 OR 0110 Services Office, Inc., with its permission. Page 10 of 16 (a) The wittier, o oral contract use of equipment leased e) Any failure to Part with respect or agreement is to you by suds person(s) or make such inspec- to such pro tluCs. crganlzations(s). However, tans, adjustments, 1) Currently in effect or this insurance does not ap- tests or servicing (d) Any state or political subdi- becomes effective due- ply to any "occurrence" as the vendor has vision with which you have Ing the policy Period, which takes place after the agreed to make or agreed per Paragraph and equipment lease expires. normally under- above to provide in- takes make in subject to the tol- 2) Executed prior to a in- long additional provision: r offense (o) Any person or organization the usual course of vi (referred to below you ave as wen- nuesness, in to wri ch this insuranm con- This insurance applies only would apply, and adar) greedm perom Paraglraph distribubontor sale Wth respect to the following (b) They a not specifically su ((nceabove to In wov,de in- ith re of the produ ts, orzpolttl to sub is ithe shoe coed as an additional in- spet to "bodily injuy' or f) Demonstration, in- issued a permit in connec- uren under aney1 other pro- bon win premises you own, of or endorsement "property damage" arising stallation, servidng 1 or control and to which added to, this Coverage out of'your products" which or repair opera- Part. are distributed or sold in the tons, except sudh this insurance applies: regular course of wen- operations per- 1) nhe existence, inte- (2) Only the follovAng persons un or- doe's business, subject to farmed the von- once. repair, ns - ganizaions ns are are additional inr- the follow rig additional ex- tlors premises in lion, erectionT , or or re re- eds under this endorsement and clusons: connection with movat c advertising insurance coverage provided to the sale of the w ~~no- suchadditinal sureds Ilm 1) The insurance afforded product: signs, a cogs, a, helm, entrances, iced a s provided herein'. the vendor does not cool holes apply to: g) Products Witch, I . ys (a) The manager or lessor of a after distribution or manholes, maquees, premises leased to you with a) 'Bodily injury' or sale by you, have host away openings, wfiom you have agreed per 'property damage" keen labeled or re- sidewalk vaults, street Paragraph 9.a.(1) above to for which the van- labeled or used as banners, or decorations provide insurance, but only dor is obligated to container, pan or and similar exposures, with respect to liability arts- pay damages by ingredle nl of any or ing out of the o emNp, re on of the as- other thing or sub- , antenance or u oaf that suin ption of liability stance by or for 2) The at removal mval of f ele- ele- pan of a premises leased to in a contract or the vendor; or Von, a or re you, subject to the following eagreement. This attire; or additional exclusions: xclusion does not h) 'Bodily injury" or 3) The ownehip, main- apply to liability for 'property damage" [.ranee, 0;,._ of any This insurance does not ap- damages that the sng out of the elevators ctired by ply to vendor ,.that have negligence. acts or this insurance. in the absence of l of the 1) Any "occurrence" whid, the contract or vendor, its (e) Any slate or political subdi-em, takes place after you agreement; ployees or anyone v with which you have se to be a tenant in else acting on its agree per that premises. b) Any express war- behalf. 9.a(1) above to prowdean- ranty unauthoroed surance, subject to the fd- 2 Structural alterations. ctionerations, by you; 2) This insurance does not low[ rig provisions: new demolitionretra operations or apply c) Any physical person f or orga_ator 1) This insurance applies performed by or on be- chemical charge only with respect to op- half of such additional the product a) From whom you erations performed by insured. made intentionally have acquired you o n your behalf (b) Any person or by the vendor, any fir inucts, entr for which the state or from whi h r organization lease d) Repackaging, e - political subdivision has issued a permit. equipment with who you cep[ when - ep.rt or ntering ~tu, ac- hake greed per Paragraph packed solely u far o ri or 9.a.(1) above to provide in- the purpose of in- oniai t,l rung g suds 2) This insurance apply o b di does not ' ce . Such person(s) or Inaction, demon- products, or "property damage or organization(s) are insureds, stration, testing, or 'personal and adverbi but only to the extent that the substitution of b) When liability in- ing injury " arising out of the liability for'bodlly injury", pans under in- eluded within the 'property damage" or "per- structions hom the 'produts- for the state or political anal and advertising injury" manufacturer, antl completed opera- subdivision. is ca used by your negli- than repackaged lions hazard" has gence, acts or omissions in in the original em- been excluded un- (f) For "your work" performed the maintenance, operation father; der this Coverage in Oregon, any person or Induces copyrighted material of Insurance Includes opyrighed material of Insurance GA 233 OR 09 10 Services Office, Inc., with is Permission. Page 11 of 16 GA 233 OR 09 10 Services Office, Inc., with its permission. page 12 of 16 organization with which you (a) Subparagraphs (e). (f) and chitectural or engi- primary to other insurance have agreed per Paragraph (g) do not apply to "bodly 'm- neering activities available to the additional 9.a.(1) above to provide in- jury' or "properly damage" insured except surance but ony to the ex- included within the "prod- 3) Professional _ tent abut t the liabilit y is uds-completed operations do not include services 1) As otherwise provided used by 'your work" per- hazard'; within construction in SECTION IV - formed forthatacl itional in- means, methods, ledh- COMMERCIAL GEN- ured and only to the extent (b) Subparagraphs (a), (d), (e) niques, sequences and ERAL LIABILITY that such liabilry is used ari do not apply to"bod- procedures employed CONDITIONS, 5. by your negligence or the ily injury"" , 'property darn by you in mmectbr Other Insurance, b. negligence of those acting age" or personal and ad- with construcnan work Excess In sunned; air . on your behalf. A person or veetisng inju a among out you perform 2) oranization'a status as an of the side gligence o For any other valid on ce e red under this provision willful miscondud of the ad- (d) Subpara graphs (f) and (g) cdlecbbl inur of this endorsement mnW- ditional insured or its "em do not apply to °bodiy in- available to the addi- s for only the period of ployees'; or jury' or "property damage" Banal insured as an ad- [ime required by the written arising out o('ypur worK' for ditional insured by st- cmtrad or agreement, but (c) Subparagraph (f) and (g) do whitlh a consolidated (wrap tachment of an en- in no vent beyond the exp- net apply to "bodily injury", upl insurance program has dorsement to another Coverage "property damage" or per- been provided by the prime suranm policy that is ration vdate of ent beyois no n . If there this written n sonal and advertising injury" contractor / project manager written on an excess Part Pan If or agreement, or s sing out of or owner of the coretruction bans. In such case, the d ranee req. d 1 The rendering of o i ject in which you are in- coverage provided un no peno ire ) 8 i der this endorsement by the written contract or failure to render, any shall also be excess. agreement, a person or or- professional services b. Only with regard m In ce pro- ganizafionS status as an in- by you or on you be- vided I. an additional sured desig- (2) Condition 11. Conformance to ured under this endorse- half, but only with re nated under Paragraph 9.a.(2) Sub- Specific Written Contract or ment ends when your cp- sped to either or both paragraphs (f) and ~p) above, SEC- Agreement is herebyadded. em ions for that insured are of the following opera- TION III - LIMITS O I SURANCE is 11 Confortnanee to Specific completed. tiens: amended to include'. Written Contact or (g) For "your work" performed a) ProNding engi- The limits applicable to the additional Agreement in the "coverage territory" neering, archrec- insured arme those specified in the in ract o agreement or in a. With respect to addi- but not Oregon, any per- tural w:o surveying written on e or organization wth es to others ; the Declarations of this Coverage Donal uretls de- whh you have agreed per and Part , whichever are less. If no limits scribed in Paragraph Paragraph 9.a.(1) above to re spedfied m the written contract m 9a.(2Nf) above only. provide insurance , but only b) Providing, or hiring agreement, or if there is no written If a r with respedlo liability aril- independent pro- contract or agreement, the limits ap agreement contract o ing out of 'your work" per- fessionals to pro- pGnble to the amilional insured are eement between formed for that additional in- vide engi neerng, those specified in the Declarations of you and the additional ured by you or on your be- architectural or this Coverage Part. The limits of in- insured specifies that half. A person organza- rveying services suran- are inclusive of and not in coverage for the addi- lional insured tion 's statu . an l s a ured connection wrath addtion to the limits of insurance under this provision of this mnslrudion work shown in the Declarations. (1) Be provided bythe endorsement continues for you perform. Insurance Ser- only the period of time re- c. SECTION IV - COMMERCIAL GEN- v -S ORlce addl- qulred by the wdtlen con- 2) Subject to Paragraph 3) ERAL LIABILITY CONDITIONS is be, I insured form tract or agreement, but in no below, professional hereby amended as follows: include umber CG 32 61, event beyond the expiration : CG 32 62 or CG date of this Coverage Part. a) Preparing, appre - (1) Cme Ided to include unonce is 3263; or 1(there isnownton contract ing, or failing to a n or agreement, or if no period prepare or ap- (a) Where required by a wntem (2) Include coverage of time I. required by the prove, maps, shop contract or agreement, this for completed op- written contract or agree- drawings, of ra Sprimaryand/or eraticns; or int. a person or organ- ns, reports, sur- noncontributory as respects lion's status as an insured veys, field orders, any ther in a policy (3) Include coverage under this endorsement change orders, o issued to the additional in- (or'your work'; antls when you operations drawings and sued, and Such other in- and vA)ere the limits or for that insured are cm~ spetlfications; and ce policy shall bee - overage provided to pleted. _ cessn and / or noncontribut the additional insured is An insurance to a b) Supervs.y or sh- Ing, whchever applies, with =e spec rend- than (3) Any provided an spedim adivi es this insurance. firally re- andtional Insured designated performed as part under Paragraph 9.2.(2). of any related - (b) Any Insu ce prowded by culled the On tectrms of etl in thaat written this mdorsement shall be tra or oddment, Pan , Intludes copyrighted material of Insurance Includes copyriginted material of Insurance GA 233 OR 09 10 Services Office, Inc., with its permission. Page 13 of 16 GA 233 OR 09 10 Services Office, Inc., with its permission. Page 14 of 16 graphs 9.a.(3)(u) or 9.b. agreement specifies (2) Deductible Clause a. Nurses; above, or any mmblna- the Insurance Services lion thereof, shall be in- Office additonal (a) Our obligation to pay dam- b. Emergency Medical Technicians, or mrpreted is providing sured form number CG ages on your behalf applies c the limits o coverage 20 10 but does not only to the amount of dam- . Paramedics, required by the terms of spedfywhich edition, or ages for each "occurrence in the jurisdiction where an "occurrence" the written contract or specfies an edition that which are in excess of [he or offense to which this insurance applies agreement, but only to does not exist, Para- Deductible amount stated in takes place. the eMent that such fm- graphs 9.a.3.b. and section B. Limits of Insur- its or coverage 9.b. of this endorse- oe, 11. of this endorse- 13. Broadened Notice of Occurrence eluded within the terms merit shall nor ment. The limits of insur- of the Coverage Pan to and Paragrap~ once will not be reduced by Paragraph a. of Condition 2. Duties in the application of such De- the Event of Occurrence, Offense, which this endorsement 9.a.(3)(u) of ' en- Claim Event Su it (SECTION IV - COMMER- is attached. dorsement shall apply. audible amount. CIAL GENERAL LIABILITY CONDI- b. With respect to addi- 10. Broadened Contractual Liability -Work (b) Condition 2. Duties in the TIONS) is hereby deleted and replaced by Clonal ureds tle- Within 50 of Railroad Property Event of Occurrence Of. the f.11-g: ec.ed rln Paragraph tense. Claim or Sul . ap- it [hat vre are notified 9.a.(2)(g) above only It is hereby agreed that Paragraph f.(1) of plies to each claim or "sun' a' You must see to it Mat of are -In- Definition 12. "Insured contract" (SEC- mespeciive of the amount. o as prat If a written wntract or TION V -DEFINITIONS) is deleted. or an offense which may result agreement between (e) We may pay any pan .r all in acclaim To the a#ent possible, no- you and the additional 11. Property Damage to Borrowed Equip- of the deductible amount to flee should include: insured specifies that meet effect settlement of a erage for the addi- claim or "suit" and, upon _ (1) How, when and where the "oC Clona1 insured a. The fallowing Is hereby added to Ex- ti currence ' or offense took place. elusion t.P,.P.rty Pro of fication of the Er action taken. 1 e of SEC- you shall promptly r a. Be provided by the Paragraph 2.. Exclusions f SEC- bursa us for suit pan .(the (2) one names and addresses of Insurance S., TION I - COVERAGES, COVERAGE deducible a curl as has y injured persons and wit- s Office addi- A. BODILY INJURY AND PROP- been paid by us. nesses; and atone] insured form ERTV DAMAGE LIABILITY. (3) The nature and location of any umber CG 20 10 12. Employees as Insureds - Specified injury or damage arising out of Paragraphs (3) and (4) of this exdu- Health Care Services CG 20 77 n do not apply to tools or equip- the "occurrence" or offense. (where edition en[ loaned to you, provided they are It hereby agreed that Paragraph spedfied); or of being used to perform operations 2.a.(1)(d) of SECTION II - WHO IS AN This requirement applies only when atm. time.(l.ss. INSURED. does not apply to your "em- to the an "authorized "authtrren~'orized r re e offense is known b. Include coverage presentative for completed op- b. With respect to the insurance pro- ployeservACes ornvide pro(esdonal health erations; or vided by this sectch of the end.rse- censed your behalf as duly I, e. Include coverage ent, the following additional provi- for 'Sourwork"; sions apply and where the limits or (1) The Li nits of insurance shown in coverage provided to the Declarations are replaced by the additional insured is the limit designated in Section resridiee than B. Limits of Insurance, 11. of more spe dfi tally - this endorsement vwth respect to was quired in that written c erage provided by this en- contmct or agreement, dorsement These limits are ii the terms of Para- cIusve of and not in addition to graphs 9A.(3)(a), the limits being replaced- The 9.a.(3)(b)or9.b.above, Limits of Insurance shown in any combination Sedion B. Limits of Insurance. thereof, shall be inter- 11. of this endorsement fx the prated as providing the most we volt pay in any one "oc- limns er coverage re- ence" regardless of the q, rd by the terms of number of I:ne written contract or (a) Insureds; _ .nE but only ro -ent that su h em (b) Claims made or suits" it' or Coverage Is in brought, or eluded within the terms of the Coverage Part to (e) Persons o -,an,,ations which this endorsement making claims or bring is atahed. If, however, suits". the written contract or Includes copyrighted material of Insurance Indudes cvpyrighred material of Insurance GA 233 OR 09 10 Services Office, Inc., w tit i6 permission. Page 15 of 16 GA 233 OR 09 10 Services Office, Inc., wth its permission. Page 16 of 16 www.saif.com Oregon Workers' Compensation ■ Work. Life. Certificate of Insurance say O regon. Certificate holder: CITY OF ASHLAND PARKS & RECREATION DEPT. 340 S PIONEER ST. ASHLAND, OR 97520 The policy of insurance listed below has been issued to the insured named below for the policy period indicated. The insurance afforded by this policy is subject to all the terms, exclusions and conditions of such policy; this policy is subject to change or cancellation at any time. Insured Producer/contact Viking Concrete Cutting Inc Ward Insurance Agency Inc 186 Ayres Rd Chris Christensen Eagle Point, Or 97524-6526 541.687.1117 chris@wardinsurance.net Issued 11/13/2019 Limits of liability Policy 912438 Bodily Injury by Accident $1,000,000 each accident Period 10/01/2019 to 10/01/2020 Bodily Injury by Disease $1,000,000 each employee Body Injury by Disease $1,000,000 policy limit Description of operations/locations/special items Re: All operations of the named insured in accordance to the policy terms and conditions. Important This certificate is issued as a matter of information only and confers no rights to the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policies above. This certificate does not constitute a contract between the issuing insurer, authorized representative or producer and the certificate holder. CANCELLATION: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED TO THE POLICYHOLDER AND CERTIFICATE HOLDER IN ACCORDANCE WITH THE POLICY PROVISIONS AND OREGON LAW. SAIF WILL ENDEAVOR TO PROVIDE WRITTEN NOTICE WITHIN 30 DAYS WHENEVER POSSIBLE. Authorized represenative ~4~- r Kerry Barnett President and CEO 400 High Street SE Salem, OR 97312 P: 800.285.8525 F. 503.584.9812 Policy_OLCA_ Certificate OfInsurance Purchase Order Fiscal Year 2020 Page 1 of: 1 TH1b PO NUMBER MUST /APPEAR ON ALL INVOICES AND SHIPPING DOCUMENTS. B City of Ashland ATTN: Accounts Payable L Purchase 20200264 L 20 E. Main Ashland, OR 97520 Order # T Phone: 541/552-2010 O Email: payable@ashland.or.us V H C/O Public Works - Operations E VIKING CONCRETE CUTTING INC 1 90 North Mountain Ave. N 186 AYRES STREET P Ashland, OR 97520 D EAGLE POINT, OR 97524 Phone: 541/488-5353 O O Fax: 541/552-2329 R Paula Brown 11/20/2019 5072 FOB ASHLAND OR/NET30 Cit Accounts Pa able Flat Saw Asphalt 1 Flat saw location of 14" asphalt and provide vacuum trailer for 1 $2,300.0000 $2,300.00 slurry Goods and Services Agreement (Less than $25,000) Completion date: 12/15/2019 Project Account: GL SUMMARY 081800 - 602400 $2,300.00 By: c' 3A-t'-it LI) Date: (Ci Authorized Signature $2,300.00 I FORM #3 G~~l CITY OF -ASHLAND 4t-- REQUISITION 4!5p e of request: I I I'--4 1 Required date for delivery: Vendor Name Viking Concrete Cutting, Inc. Address, City, State, Zip 186 Ayres Street Klamath Falls, OR 97524 Contact Name & Telephone Number Bryson Steiner 541-773-2420 Email address SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: ❑ Invitation to Bid ❑ Form #13, Written findings and Authorization ❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached ❑ Written quote or proposal attached -(Attach co of council communication -(If council approval required, attach co of CC ❑ Small Procurement ❑ Request for Proposal Cooperative Procurement Not exceeding $5,000 Date approved by Council: ❑ State of Oregon ❑ Direct Award -(Attach copy of council communication) Contract # ❑ Verbal/Written bid(s) or proposal(s) ❑ Request for Qualifications (Public Works) ❑ State of Washington Date approved by Council: Contract # _(Attach co of council communication ❑ Other government agency contract Intermediate Procurement ❑ Sole Source Agency GOODS & SERVICES ❑ Applicable Form (#5, 6, 7 or 8) Contract # Greater than $5,000 and less than $100,000 ❑ Written quote or proposal attached Intergovernmental Agreement ❑ (3) Written bids & solicitation attached ❑ Form #4, Personal Services $5K to $75K Agency PERSONAL SERVICES ❑ Special Procurement ❑ Annual cost to City does not exceed $25,000. Greater than $5,000 and less than $75,000 ❑ Form #9, Request for Approval Agreement approved by Legal and approved/signed by ❑ Less than $35,000, by direct appointment ❑ Written quote or proposal attached City Administrator. AMC 2.50.070(4) ❑ (3) Written proposals & solicitation attached Date approved by Council: ❑ Annual cost to City exceeds $25,000, Council ❑ Form #4, Personal Services $5K to $75K Valid until: Date approval required. (Attach copy of council communication) Description of SERVICES Total Cost Flat saw location of 14" asphalt and provide vacuum trailer for slurry $ 2300,00 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost 0 Per attached quote/proposal TOTAL COST _ _ _ _ _ _ 081800 602400 Project Number Account Number Account Number Account Number 'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: IT Director Date Support -Yes/ No By signing this requisition form, t certify that the City's public contracting requirements have been satisfied. Employee:] _T I Department Head: x. 201 (Equal to or greater than $5,000) Department Manager/Supervisor: City Administrator: (Equal to or greater than $25,000) Funds appropriated for current fiscal year YES / NO Deputy Finance Director- (Equal to or greater than $5,000) Date Comments: Form #3 - Requisition