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HomeMy WebLinkAbout2023-011 PO 20230242 - Inland Potable Services Inc Purchase Order CiTY RECORDER Fiscal.Year 2023 Page: 1 of: 1 B City of Ashland I ATTN: Accounts Payable Purchase 20 E. Main 20230242 L Ashland, OR 97520 Order* T Phone: 541/552-2010 0 Email: payable@ashland.or.us V H C/O Water Division EINLAND POTABLE SERVICES INC. I 90 North Mountaiin Ave 16297 E CRESTLINE LANE p Ashland, OR 97520 O CENTENNIAL, CO 80015 T ,Phone:541/552-2329 53 R O —=`s4Isjsi�i'C£§�h1're e ==z== -_— -- -a 7.1117L;f- .,(.141— Steve _ Steve Walker �'acll=la .�i 5 e e-a_ %.FP7 s—c�—:z= _.=-�vgc._s _ 14.J_.a c3_;[e 02/21/2023 7599 FOB ASHLAND OR/NET30 City Accounts Payable _ Diving Services Reservoirs 1 Diving services for Alsing and Fallon reservoirs 1.0 $8,850.00 $8,850.00 Goods and Services Agreement(Less than $35,000) Completion date: 06/30/2023 Project Account: ***************GL SUMMARY*************** 081800-602400 $8,850.00 I I lI • C L By: Date: .0 �:_ s =R A 'horized Sia ature ` a .8 850.00 - 1.../.._.� -I" (7/t �� CITY OF FORM #3 ,'6 a A request for a Purchase OrderASHLAND REQUISITION Date of request: 02/14/2023 Required date for delivery: Vendor Name Inland Potable Services Address,City,State,Zip 16297 E Crestline Lane Centennial,CO 80015 Contact Name&Telephone Number 844-372-2956 Sam Ireland Email address SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Invitation to Bid 0 Emergency ' O Reason for exemption: Date approved by Council: , ❑ Form#13,Written findings and Authorization ❑ AMC 2.50 _ _(Attach copy of council communication) ❑ Written quote or proposal attached ❑ Written quote or proposal attached (If council approval required,attach copy of CC) O Small Procurement 0 Request for Proposal Cooperative Procurement Not exceeding$5,000 Date approved by Council:_ 0 State of Oregon ' 0 Direct Award _(Attach copy of council communication) Contract# O Verbal/Written bid(s)or proposal(s) 0 Request for Qualifications(Public Works) ❑ State of Washington Date approved by Council: Contract k_ _(Attach copy of council communication) 0 Other government agency contract Intermediate Procurement 0 Sole Source Agency _ GOODS&SERVICES 0 Applicable Form(#5,6,7 or 8) Contract# Greater than$5,000 and less than$100,000 0 Written quote or proposal attached Intergovernmental Agreement It (3)Written bids&solicitation attached 0 Form#4,Personal Services$5K to$75K Agency PERSONAL SERVICES Date approved by Council: 0 Annual cost to City does not exceed$25,000. Greater than$5,000 and less than$75,000 Valid until: (Date) Agreement approved by Legal and approved/signed by O Less than$35,000,by direct appointment 0 Special Procurement City Administrator.AMC 2.50.070(4) ❑ (3)Written proposals&solicitation attached 0 Form#9,Request for Approval ❑ Annual cost to City exceeds$25,000,Council ❑ Form#4,Personal Services$5K to$75K 0 Written quote or proposal attached approval required.(Attach copy of council communication) Date approved by Council:_ Valid until:_ _ ___(Date) Description of SERVICES :TOTAL COST} Diving services for Alsing and Fallon reservoirs '$;`,,8;850:',00,— ' Item# Quantity Unit Description of MATERIALS Unit Price Total Cost E Per attached quote/proposal `''TOTAL COST Project Number Account Number 0 8 1 8 0 0.6 0 2 4 0 0 _:_ 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,I certifytthat the City's public contracting requirements have been satisfied. Employee:\lu�VW tP/IV1 ' Ca1 1115610 Department Head: Eqo Zr a�rtha$000) Department Manager/Supervisor: City k anager /// (Greater than$35, 00) Funds appropriated for current fiscal year: / NO / ()IS an e %t C (Equal!.orgreaterthan$5,000) at • Comments: Form#3-Requisition 1 , Kariann Olson From: Heather Rodriguez' Sent: Tuesday,February 21,2023 11:17 AM To: Kariann Olson Subject: RE:W9 Inland Potable Services All ready for use vendor#7599 Heather Rodriguez,Accounts Payable • City of Ashland Finance Department 20 E Main St,Ashland,Oregon 97520 541-552-2010 I TTY 800.735.2900 Heather.rodriguez@ashland.or.us - Online ashland.or.us; social media (Facebook @CityOfAshlandOregon I Twitter @CityofAshland) This email transmission is official business of the City of Ashland, and it subject to Oregon Public Records Law for disclosure and retention. If you have received this message in error, please contact me at 541-552-2010. Original Message From: Kariann Olson<kari.olson@ashland.or.us> Sent:Wednesday, February 15,2023 10:37 AM To: Heather Rodrigtjez<heather.rodriguez@ashland.or.us>;Accounts Payable<payable@ashland.or.us> Cc: Kariann Olson<kari.olson@ashland.or.us> Subject:W9 Inland Potable Services W9 fora P0. Thank you. Kariann • Kariann (Kari)Olson, Purchasing Specialist City of Ashland Purchasing Office 90 North Mountain Avenue,Ashland,Oregon 97520 541.488.5354 I TTY 800.735.2900 Kari.olson@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.. Original Message From: noreply@ashland.or.us<noreply@ashland.or.us> Sent:Wednesday, February 15, 2023 10:47 AM To: Kariann Olson<kari.olson@ashland.or.us> Subject: Message from "Electric156" 1 [EXTERNAL SENDER] This E-mail was sent from "Electric156" (IM C3000). Scan Date:02.15.2023 10:47:01(-0800) Queries to: noreply@ashland.or.us • • • 2 GOODS AND SERVICES AGREEMENT (LESS THAN $35,000) • PROVIDER: Inland Potable Services CITY OF PROVIDER'S CONTACT: Sam -ASH LAN D 20 East Main Street ADDRESS: 16297 E. Crestline Lane Ashland,Oregon 97520 Centennial, CO 80015 Telephone: 541/488-5587 PHONE: 844-372-2956 Fax: 541/488-6006 This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and Inland Potable Services (a foreign business corporation) ("hereinafter "Provider"), for Diving Services for Potable Water Tank Cleaning and Inspection - "Clean and Inspect Crowson, Alsing and Fallon reservoirs with equipment and methods compliant with ANSI/NSF 61 and all applicable AWWA standards". 1. PROVIDER'S OBLIGATIONS 1.1 Provide Diving Services for Potable Water Tank Cleaning and Inspection-"Clean and Inspect Crowson, Alsing and Fallon reservoirs with equipment and methods compliant with ANSI/NSF 61 and all applicable AWWA standards" 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; and • Workers' Compensation. 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,providedthat the policy limits shall not be increased thereby; Page 1 of 7: Goods and Services Agreement between the City of Ashland and Inland Potable Services • Apply as primary coverage for each additional named insured except to the extent that two or more such policies are intended to "layer" coverage and, taken together; they provide total coverage from the first dollar of liability; • Provider shall immediately notify the City of any change in insurance coverage • Provider shall supply an endorsement naming the City, its officers, employees and agents as additional insureds by the.Effective Date of this Agreement; and • Be evidenced by a certificate or certificates of such insurance approved by the City. 1.3 Provider shall,at its own expense,maintain Worker's Compensation Insurance in compliance with ORS 656.017, which requires subject employers to provide workers' compensation coverage for all of its subject workers. 1.4 Provider agrees that no person shall, on the grounds of race, color, religion, creed, sex, marital status, familial status or domestic partnership, national origin, age, mental or physical disability, sexual orientation, gender identity or source of income, suffer discrimination in the performance of this Agreement when employed by Provider. Provider agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. Further, Provider agrees not to discriminate against a disadvantaged business enterprise,minority-owned business,woman-owned business, *a business that a service-disabled veteran owns or an emerging small business enterprise certified under ORS 200.055, in awarding subcontracts as required by ORS 279A.110. 1.5 In all solicitations either by competitive bidding or negotiation made by Provider for work to be performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Providers of the Provider's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 1.6 Living Wage Requirements: If the amount of this Agreement is $24,050.68 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. 1.7 Assignment: Provider shall not assign this Agreement or subcontract any portion of the Work to be provided hereunder without the prior written consent of the City. Any attempted assignment or subcontract without written consent of the City shall be void. Provider shall be fully responsible for the acts or omissions of any,assigns or subcontractors and of all persons employed by them,and the approval by the City of any assignment or subcontract shall not create any contractual relation between the assignee or subcontractor and the City. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider the sum of$8,850.00 (eight thousand eight hundred fifty dollars) as provided herein as full compensation for the Work as specified in the SUPPORTING DOCUMENTS. 2.2 In no event shall Provider's total of all compensation and reimbursement under this Agreement exceed the sum of$8,850.00(eight thousand eight hundred fifty dollars)without express,written approval from the City official whose signature appears below,or such official's successor in office. Provider expressly acknowledges that no other person has authority to order or authorize additional Work which would cause this maximum sum to be exceeded and that any authorization from the responsible official must be in writing. Provider further acknowledges that any Work delivered or expenses incurred without Page 2 of 7: Goods and Services Agreement between the City of Ashland and Inland Potable Services authorization as provided herein is done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement.- 3. GENERAL PROVISIONS 3.1 This is a non-exclusive Agreement. City is not obligated to procure any specific amount of Work from Provider and is free,to procure similar types of goods and services from other providers in its sole discretion. 3.2 Provider is an independent contractor and not an employee or agent of the City for any purpose. 3.3 Provider is not entitled to, and expressly waives all claims to City benefits such as health and disability insurance,paid leave, and retirement. 3.4 This Agreement embodies the full and complete understanding of the parties respecting the subject. matter hereof. It supersedes all prior agreements,negotiations, and representations between the parties, whether written or oral. 3.5 This Agreement may be amended only by written instrument executed with the same formalities as this Agreement. 3.6 The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220,279B.230 and 279B.235. 3.7 This Agreement shall be governed by the laws of the State of Oregon without regard to conflict of laws principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is in federal court, in which case exclusive venue shall be in the federal district court for the district of Oregon. Each party expressly waives any and all rights to maintain an action under this Agreement in any other venue, and expressly consents that, upon motionof 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. Page 3 of 7: Goods and Services Agreement between the City of Ashland and'Inland Potable Services • 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 4.1 The following documents are, by this reference, expressly incorporated in this Agreement, and are collectively referred to in this Agreement as the "SUPPORTING DOCUMENTS:" • The Provider's complete written Proposal 1/27/2023. 4.2 This Agreement and the SUPPORTING DOCUMENTS shall be construed to be mutually complimentary and supplementary wherever possible. In the event of a conflict which cannot be so resolved,the provisions of this Agreement itself shall control over any conflicting provisions in any of the SUPPORTING DOCUMENTS. In the event of conflict between provisions of two of the SUPPORTING DOCUMENTS,the several supporting documents shall be given precedence in the order listed in Article 4.1. 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. r 6. TERM AND TERMINATION 6.1 Term This Agreement shall be effective from the date of execution on behalf of the City as set forth below (the "Effective Date"), and shall continue in full force and effect until June 30, 2023 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. Page 4 of 7: Goods and Services Agreement between the City of Ashland and Inland Potable Services • 6.2.3 Either party may terminate this Agreement, with cause, by not less than fourteen (14) days' prior written notice if the cause is not cured within that fourteen (14) day period after written notice. Such termination is in addition to and not in lieu of any other remedy at law or equity. 7. NOTICE Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery, by sending via a reputable commercial overnight courier, or by mailing using registered or certified United States mail, return receipt requested, postage prepaid, to the address set forth below: If to the City: City of Ashland—Water 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 If to Provider: Inland Potable Services Attn: Sam 16297 E. Crestline Lane Centennial, CO 80015 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; Page 5 of 7: Goods and Services Agreement between the City of Ashland and Inland Potable Services (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider; and (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.2 Provider's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Provider's warranty, as set forth in this Article 9, shall constitute a material breach of this Agreement. Any material breach of this Agreement shall entitle the City to terminate this Agreement and to seek damages and any other relief available under this Agreement,at law,or in equity. IN WITNESS WHEREOF the parties have caused this Agreement to be signed in their respective names by their duly authorized representatives as of the dates set forth below. CITY OF ASHLAND: INLAND POTABLE SERVICES (PROVIDER): s. By: —.me g By: 7/// ' 4 Signature ,amu¢. Tania Roberts Printed Name Printed Name pu2m . woccs IeE crv—_. CFO Title Title 7. %4.2o7 3 2/9/2023 Date Date (W-9 is to be submitted with this signed Agreement) g 42-- Purchase Order No. • Page 6 of 7: Goods and Services Agreement between the City of Ashland and Inland Potable Services EXHIBIT A CITY OF ASHLAND, OREGON City of Ashland LIVING ALL employers.dais ibed WAGE below must comply with City €4 Ashland laws regulating payment of a living wage. $17'.°0" . per hours effective June 30 2022. The Living Wage is adjusted annuality°everyrwows . June 30by the Consumer Price Index. Employees must be paid a portion oftheholnessof ofhealth care,retirestraent, their employer,ifthe 1111 andDRS Ile living wage: employer Inas tent or mare moria plans(in& g eemplctfeeS,arid has received obildcareli benells to the Fur all haws wed under a IFtnancial assisrince for the employee's.amount of wages. service contract hrn theirJ or iiosiatess$r�rorro the emplayer and the City of City of k[ nd o > Nott: 1=or temporary and ,awl'aero if the onautsaet $24,650.68; t:fcmoe employees,the exceeds 4O5t1_i„'ca.more Living Wage eines net apply r [Ether,a rropfoy>er ms the to Ike mit 11340 imam%larked i For...Il ire in a ,Menai,irothading the Parks in any,ca en. r year_ Fcar month, dm employand Recreation Department more uiett ils„please see spends:50%.or mare of the 4slrtd Municipal Code earrplayee°s time in a month [ru calculating!the faring wage, SeEticurc 3.12.0211 working on a project or employersmay a,1 the value For additional iinfor-rrsation: Gail the Ashland City Manager's craw at 541-488-6082 or write to the City Manager, City Hail,20 East Main Street,Ashland,OR 97520,entail the City website at w w_ash[and_or•_us_ Notice to Employers: This notice most be posted in areas where it can be seen by aq employees. CITY OF ASHLAND Page 7 of 7: Goods and Services Agreement between the City of Ashland and Inland Potable Services otable 16297 E.Crestline Lane oy Centennial,Colorado 80015 Office Phone: 303-400-4220 �, ; • Toll Free: 1-844-372-2956 , f Office Fax: 303-400-4215 Email: Sam@inlandpotableservices.com City of Ashland Date:01/27/2023 Steve Walker Phone: 541-488-5345 90 North Mountain Ave. Email: steve.walker@ashland.or.u: Ashland, OR 97520 Diving Services for Potable Water Tank Cleaning and Inspection Tanks Tank Description Additional Information Scope of Work Includes Crowson Tank Discharge water WILL require de- 2.1 MG, Below-Grade, Tank chlorination. 1 has an oval shape with cross sectional area of All Discharge water and sediment 13,813 Sq Must go through a Sediment bag. Clean and inspect. 'Up to three (3) inches of Discharge water WILL require de- sediment removal from Alsing Tank chlorination. the tank floor. 1 2.1 MG, On-Grade, Concrete, 107' Dia x 31' Discharge water and sediment will Visual inspection of the Deep be released onto the ground in the interior and exterior direction specified by the of the tank. on-site company representative All Discharge water does not Written report(PDF format) Fallon Tank require de-chlorination. with photos. 0.5MG, On-Grade, and a digital recording of the 1 Concrete, 58' Dia x 25' All Discharge water and sediment dive. Deep will only need to be diffused where it will soak into the ground on a hill side Proposal Total: $8,850.00 Proposals signed and returned to Inland Potable Services are valid for one year from date of acceptance. Payment terms: 1%Ten Days, Net 30 Days. 1.5% interest will be charged on all accounts past 30 days. This contract is based on a total price which includes time and mobilization to and from the project site, set- up and breakdown of equipment, and the preparation for the dive and diving services. Diving services will include sediment removal up to 3 inches from the floor, a video inspection and written report for your records (still photos included). During the initial dive, sediment depths will be measured by the diver and documented on video. If removal of sediment of an abnormal consistency (clay, calcium, rocks, pebbles, mud, etc.), additional sediment removal (over 3 inches from the floor), wall cleaning or epoxy repairs is requested and approved by designated on-site representative, each of these services will be performed at a rate of$369.00 per hour. Inland Potable Services, Inc. will provide all personnel and equipment necessary to provide diving services in the above referenced tank(s) or reservoir(s). We will provide your utility with a written report as well as a narrated color video for the services performed. The tank(s) or reservoir(s) will be inspected according to American Water Works Association (AWWA), NACE, SSPC,ASNT,ACI and AWS standards. • All divers employed by Inland\Potable Services are.certified Commercial Divers. • Inland Potable Services is fully bondable and insured. • All equipment entering the tanks will be disinfected with a minimum of 200 ppm Chlorine. • Schedule dates are tentative and are subject to change. • If Inland Potable Services dive team is required to stop working or is delayed working due to unforeseen circumstances or any reasons beyond our control(i.e. no utility personnel onsite, inability to access designated work site, low water level, etc.) a down-time charge of$369.00 per hour will be charged. • A fee based on $369.00 per hour will be charged if we are unable to get our truck and trailer . to a tank location.We will use portable dive gear and cleaning equipment to complete the job. Please understand that use of utility vehicles or equipment may be necessary to get our equipment to a tank. • Inland Potable Services makes every attempt to obtain complete information from customers, prior to the presentation of bids concerning fees required for municipal licenses, registration fees,Sales Tax or Use Taxes in your area. These items are identified on your contract. In the event that additional fees are discovered or charged,after the bid has been submitted,these charges will be added to the stated contract amount when billed. Sam Ireland, Regional Account Manager Date: Important Information Hatch Size -The entry hatch on top of the tank must be at least 20 inches in diameter or square with no obstructions that would prevent entry. A futile trip charge of$500.00 will be levied if the team is unable to enter the tank due to the hatch size being too small or objects are blocking the entry. Water Level—Please understand, the water level within the tank must be within ten (10)feet or less of the hatch opening prior to the dive team's arrival. If the air gap is more than 10 feet, a fee of$369.00 per hour will be charged until the waterreaches the appropriate level. Tank Information — Please verify the type of tank, dimensions or'information listed in the proposal is accurate. If the tank dimensions or information is not accurate as listed then additional costs may be added. Completion Date — With'acceptance this work will be completed at a mutually acceptable date within one year. If money budgeted for this work must be used by a specific date, please indicate the date on this line and every attempt will be made to meet the given date: Option — If an hatch gasket($50.00), a#24 mesh vent screen ($75) and/or a lock for the hatch ($25) is needed, would you like the dive team to install while on-site? Yes_ No If a hard bound copy of the inspection report is.needed ($125.00)Yes_ No_ To accept, please sign and date the proposal. Please fax both pages to 303-400-4215 or scan and email them to me at Sam@inlandpotableservices.com. Printed Name and Title Signature Date: Reservoir Cleaning Contact Log Inland Potable Returned my call on 12-20-22 and has been in contact since Liquivision I E-mailed on 12/12/22 and made several phone calls, no return contact at anytime Marine Industrial Tank I called and left a message on 11/30/22 I emailed through their re captcha contact us Email on 12/20/22 I called and left a message on 1-4-23 No return contact at anytime. Potable Diver Inc. I called and E-mailed through their re captcha contact us email on 12/20/23 E-mailed through their re captcha contact us email on 1/4/23 No return contact at anytime. • Kariann Olson From: Tami Campos ,Sent: Monday,February 27,2023 12:07 PM To: Kariann Olson Cc: Steve Walker Taina Glick Subject RE:Insurance Certificate Attachments: . Certificate.pdf Good morning, • I am not sure how this would have been missing from the contract packet but at any rate, here you go. Thanks! Tami DeMille-Campos,Administrative Analyst • ' 1 AVA Or • • City of Ashland Public Works 20 East Main Street,Ashland,Oregon 97520 541-552-2420 I TTY 800.735.2900 Tami.campos@ashland.or.us Online ashland.or.us I Social media Facebook @CityOfAshlandOregon I Twitter @CityofAshland 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. From:Steve Walker steve.walker@ashland.or.us Sent: Monday, February 27, 2023 11:55 AM To:Tami Campos tami.camposPashland.or.us Subject: FW: Insurance Certificate Good morning! See below, We have this for the divers, Steve Walker,Water Quality and Distribution Supervisor 1 fira,‘44kA City of Ashland Water Distribution 90 N Mountain Ave,Ashland,Oregon 97520 541-552-2326 I TTY 800.735.2900 Steve.walker@ashland.or.us • Online abl Lncior.us;social media(Facebook @CityOfAshlandOregon I Twitter @CityofAshland) 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 541-552-2326. From: Kariann Olson<kari.olson@ashland.or.us> Sent: Monday, February 27, 2023 11:50 AM To:Steve Walker<steve.walker@ashland.or.us>;Taina Glick<taina.gIick@ashland.or.us> Cc: Kariann Olson<kari.olson@ashland.or.us> Subject: Insurance Certificate Hello, I do not see an.insurance certificate with the contract for Inland Potable Services. Here is"my understanding" of what the City requires. If you want,you can also use this verbiage to request insurance certificate from contractor. The City's contract requires a Certificate of Insurance for General Liability,Automobile and Workers'Compensation, including the City of Ashland(20 E.Main,Ashland, OR 97520)named as the additional insured. The additional insured boxes will need to be checked on the certificate and actual copies of the additional insured endorsements for General Liability and Automobile will need to be provided with the Certificate of Insurance. Thank you. • Kariann Kariann(Kari) Olson,Purchasing Specialist 17�d R n, '' ^' 'x,`fl, vhf.. rkf3 r l,dl,,:;gid 1 ;.� . 2 • / DATE(MM/DDNYYY) ACCORD CERTIFICATE OF'LIABILITY.INSURANCE 2,102023 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 CRS Insurance Brokerage PHONE Scott Anderson,CIC, IC FAX 9780 S Meridian Blvd Suite 400 INC.ANo.Ext): 303-996-7800 INC.No):303-757-7719 Englewood CO 80112 - ADDRESS: sanderson@crsdenver.com . INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Travelers Prop Casualty of AM 25674 INSURED INLAN-1 INSURER B:Selective Ins.Co.of America . 12572 Inland Potable Services, Inc. INSURER c:United Specialty Insurance Co " 12537 Inland Marine Service 13780 E. Rice Place#201 INSURER D:Navigators.Specialty Insurance Company 36056 Aurora CO 80015 INSURER E:AmTrust Insurance Company 15954 INSURER F: -- COVERAGES CERTIFICATE NUMBER:50635036 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 NSD ADDL SUER WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) D X COMMERCIAL GENERAL UABILITY Y SF22CGL144807IC 10/30/2022 10/30/2023 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE 70 RENTED PREMISES(Ea occurrence) $50,000 . MED EXP(Any one person) _ $5,000 — 1 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. - GENERAL AGGREGATE $2,000,000 POLICY XECT n LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY ' Y S 2500829 10/30/2022 10/30/2023 COMB aacdINEdent)D SINGLE LIMIT $1,000,000 (E X ANY 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) $ C UMBRELLA LIAB X OCCUR BTN2229415 10/30/2022 10/30/2023 EACH OCCURRENCE $2,000,000 X EXCESS LIAB CLAIMS-MADE _ AGGREGATE $2,000,000 DED •X RETENTION$n ' $ E WORKERS COMPENSATION Y TWC4168981 11/1/2022 11/1/2023 X ST TUTE ETH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE �( N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? I I - • . (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Inland Marine 6608F327572 10/30/2022 10/30/2023 Rent/Leased Equip 200,000 Equipment/ACV/Special Deductible 1,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Ashland is included as additional insured for ongoing operations on the General Liability and included as additional insured on the Auto Liability with respect to operations of the named insured for the certificate holder as required by written contract. Workers Compensation coverage includes a waiver of subrogation. . • 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 East Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 /7zeirt...t._ ' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ElitePac® • Commercial Automobile Extension POLICY NUMBER:S2500829 - COMMERCIAL AUTO CA 78 09 11 17 THIS ENDORSEMENT CHANGES/ME POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM •With respect to coverage provided by this endorsement,the provisions of the Business Auto Coverage Form apply unless modified by the endorsement. AMENDMENTS TO SECTION II - LIABILITY COVER- EMPLOYEE INDEMNIFICATION AND EMPLOY- AGE ER'S LIABILITY AMENDMENT A. If this policy provides Auto Liability coverage for , The following' is added to SECTION II, B.4. - • Owned Autos, the following extensions are applica- - Exclusions: ble accordingly: _ This exclusion does not apply to a "volunteer work- NEWLY ACQUIRED OR FORMED ORGANIZA- er" who is not entitled to workers"compensation, TIONS disability or unemployment compensation benefits. • The following is added to SECTION II, A.1. -Who Is FELLOW EMPLOYEE COVERAGE An Insured: ' The Fellow Employee Exclusion, SECTION •II, Any organization you newly acquire or form, other B.5.-is deleted in its entirety. than a partnership, joint venture or limited liability • CARE, CUSTODY OR CONTROL AMENDMENT company.over which you maintain ownership or majority interest, will qualify as a Named Insured if The. following is added to SECTION II,. B.6. - there is no similar insurance available to that organi- Exclusions: zation. However: This exclusion does not apply to property owned by 1. Coverage under this provision is afforded only anyone other than an"insured",subject to the follow- until the 180th day after you acquire or form the ing: organization or the end_ of the policy period, 1.' The most we will pay under this exception for whichever is earlier; ,- any one"accident" is the Limit of Insurance stat- • 2. Coverage does not apply to "bodily injury" or ed in the ElitePac Schedule; and "property damage" resulting from an "accident" 2. A per "accident" deductible as stated in the that occurred before you acquired or formed the ElitePac Schedule applies to this exception. • organization. B. If this policy provides Auto Liability coverage for No person or organization is an "insured" with re- Owned Autos or Non-Owned Autos, the following spect to the conduct of any current or past partner- . extension is applicable accordingly: ship,joint venture or limited liability company that is not shown as a Named Insured,in the Declarations. LIMITED LIABILITY COMPANIES EXPENSES FOR BAIL BONDS AND LOSS OF The following is added to SECTION II, A.1. -Who Is EARNINGS An Insured: • Paragraphs (2) and (4) of SECTION II, A.2.a. - If you are a limited liability company, your members Supplementary Payments are deleted in their and managers are "insureds" while using a covered - entirety and replaced with the following: "auto" you don't own, hire or borrow during the course of their duties for you. (2) Up to the Limit of Insurance shown on the BLANKET ADDITIONAL INSUREDS - As ElitePac Schedule for the cost of bail bonds (in- Required By Contract ' cluding bonds for related traffic'law violations) required because of an "accident"covered under The following iscadded to SECTION II, A.1. -Who Is this policy. We do not have to furnish these An Insured: bonds. (4) All reasonable -expenses incurred by the "insured" at our request. This includes actual loss of earnings because of time off from work, which-we will pay up to the Limit of Insurance shown on the ElitePac Schedule. " Copyright,2017 Selective Insurance Company of America.All rights reserved. CA 78 09 11 17' Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 1 of 5 " • Any person or organization whom you have agreed For labor charges to be eligible for reimbursement the in a written contract, written agreement or written labor must be performed at the place of disablement. permit that such person or organization be added as • This coverage extension does not apply to Emergency an additional "insured" on your policy. Such person Services Organizations and Governmental Entities. or organization is an additional "insured" only with respect to liability for "bodily injury" or "property GLASS BREAKAGE DEDUCTIBLE damage" caused, in whole or in part,by your owner- The following is added to SECTION III, A.3. - Glass ship, maintenance or use of a covered "auto", This Breakage -Hitting A Bird Or Animal-Falling Objects coverage shall be primary and non-contributory with or Missiles: respect to the additional "insured". This provision , If damaged glass is repaired rather than replaced, no only applies if: deductible will apply for such repair. This extension does 1. It is required in the written contract, written not apply to Emergency Services Organizations and agreement or written permit identified in this sec- Governmental Entities. tion; • ADDITIONAL TRANSPORTATION EXPENSES SEC- 2. It is permitted by law; and TION III, A.4.a. - Transportation Expenses is deleted 3. The written contract or written agreement has in its entirety and replaced with the following: been executed (executed means signed by a We will pay up to the maximum Limit of Insurance shown named insured) or written permit issued prior to on the ElitePac Schedule for temporary transportation the"bodily injury"or"property damage". expenses that you incur because of any"loss" to a cov- C. If this policy provides Auto Liability coverage for Non- ered "auto", but only if the covered "auto" carries the 'Owned Autos, the following extension is applicable coverages and meets the requirements described in 1.. accordingly: or 2. below: EMPLOYEES AS INSUREDS 1. We will pay temporary transportation expenses for total theft of a covered "auto". We will only pay for If this policy provides Auto Liability coverage for such expenses incurred during the period beginning Non-Owned Autos, the following is added to 24 hours after thetheft and ending, regardless of the SECTION II,A.1.-Who Is An Insured: .policy's expiration, when the covered "auto" is re- Any"employee" of yours is an "insured" while using turned to use or we pay-for its"loss". a covered "auto" you don't own, hire or borrow in 2. For "loss" other than total theft of a covered "auto" your business or your personal affairs. under Comprehensive or Specified Causes of Loss An "employee" of yours is an "insured" while.operat- . Coverage, or for any"loss"under Collision Coverage ing an "auto" hired or rented under a contract or to a covered "auto", we will only pay for those tern- agreement in that"employee's" name with your per- porary transportation expenses incurred during the mission, while performing duties related to the con- policy period beginning 24 hours after the "loss" and duct of your business. ending, regardless of the policy's expiration,with the AMENDMENTS TO SECTION III - PHYSICAL lesser of the number of days reasonably required to DAMAGE COVERAGE repair or replace the covered"auto"or 30 days. If this policy provides Comprehensive, Specified Causes Paragraph 2: of this extension does not apply while of Loss or Collision coverage, the following extensions there are spare or reserve "autos" available to you are applicable for those "autos". for which Comprehen- for your operations. sive, Specified Causes of Loss or Collision coverage is This coverage extension does not apply to Emergency purchased: • Services Organizations and Governmental Entities. TOWING AND LABOR HIRED AUTO PHYSICAL DAMAGE COVERAGE SECTION III, A.2. -Towing is deleted in its entirety and The following is added to SECTION III, A.4. -Coverage replaced with the following: Extensions: We will pay all reasonable towing and labor costs up to Physical Damage coverage is hereby extended to apply- the pplythe maximum Limit of Insurance shown on the ElitePac to Physical Damage "loss" to "autos" leased, hired, rent- Schedule per tow each time a covered,"Private Passen- . ed or borrowed without a driver. We will provide cover- ger Auto", "Social Service Van or Bus" or"Light Truck"is age equal to the broadest coverage available to any disabled and up to the maximum Limit of Insurance per covered "auto" shown in the Declarations. But, the most tow each time a covered "Medium Truck", "Heavy Truck" we will pay for"loss" to each "auto" under this coverage or"Extra Heavy Truck"is disabled. extension is the lesser of: Copyright, 2017 Selective Insurance Company of America.All rights reserved. CA 78 09 11 17 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 2 of 5 1. The Limit of Insurance stated in the ElitePac Sched- , AUTO LOAN/LEASE GAP COVERAGE (Not Applica- ule; or ble in New York) 2. The actual cash value of the damaged or stolen ' The following is added to SECTION III, A.4. -Coverage property as of the time of the"loss"; or Extensions: 3.' The actual cost of repairing or replacing the dam- In the event of a total "loss" to a covered "auto" we will aged or stolen property with other property of like pay any unpaid amount due on the lease or loan for a kind and quality. A part is of like kind and quality covered"auto", less: when it is of equal or better condition than the pre- 1. The amount paid under the Physical Damage Cover- accident part. We will use the original equipment age Section of the policy; and from the manufacturer when: (a) The operational safety of the vehicle might . 2. Any: otherwise be impaired; a. Overdue lease/loan payments at the time of (b) Reasonable and diligent efforts to locate the "loss"; appropriate rebuilt, aftermarket or used part b. Financial penalties imposed under a lease for have been unsuccessful;or excessive use, abnormal wear and tear, high (c) A new original equipment part.of like kind mileage or similar charges; and quality is available and will result in the . c. Security deposits not refunded by the lessor or lowest overall repair cost. financial institution; For each leased, hired, rented or borrowed "auto" our d: Costs for extended warranties, credit life, health, obligation to pay"losses"will be reduced by a deductible ' accident, or disability insurance purchased with equal to the highest deductible applicable to any owned the loan or lease; and "auto"for that coverage. No deductible will be applied to e.: Carry-over balances from previous leases or "losses"caused by fire or lightning. . loans. SECTION IV, B.5. Other Insurance Condition, Para- You are responsible for the deductible applicable to the graph 5.b. is deleted in its entirety and replaced by the "loss"for the covered"auto". following: PERSONAL EFFECTS For Hired Auto Physical Damage Coverage, the follow- The following is added to SECTION III, A.4. -Coverage ing are deemed to be covered"autos'you own: Extensions: 1. Any covered "auto" you lease, hire, rent, or borrow; If this policy provides Comprehensive Coverage for a and covered "auto" you own and that covered "auto" is 2. Any covered "auto" hired or rented by your "em- . stolen, we will pay up to the Limit of Insurance shown on ployee" under a contract or agreement in that the ElitePac Schedule, without application of a deducti- "employee's" name, with your permission, while ble, for lost personal effects that were in the covered performing duties related to the conduct of your "auto"at the time of theft. Personal effects do not include business. jewelry, tools, money, or securities. This coverage is However, any "auto" that is leased, hired, rented or excess over any other collectible insurance. borrowed with a driver is not a covered"auto". AIRBAG COVERAGE This coverage extension does not apply to Emergency The following is added to SECTION III, B.3.a. - Exclu- Services Organizations and Governmental Entities. sions: HIRED AUTO LOSS OF USE COVERAGE Mechanical breakdown does not include the accidental The following is added to SECTION III, A.4: -Coverage , discharge of an airbag. Extensions: This coverage extension does not apply to Emergency We will pay expenses for which you are legally responsi- Services Organizations and Governmental Entities. ble to pay up to the Limit of Insurance shown on the ' EXPANDED AUDIO, VISUAL, AND DATA ELEC- _ ElitePac Schedule per "accident" for loss of use of a TRONIC EQUIPMENT COVERAGE leased, hired, rented or borrowed "auto" if it results from SECTION III, B.4. -Exclusions an"accident". This coverage extension does not apply to Emergency This exclusion does not apply to the followirig: Services Organizations, Governmental Entities, and . 1. Global positioning systems; Schools. . . " 2.. "Telematic devices";or • 3. Electronic equipment that reproduces, receives or transmits visual or data signals and accessories used with such equipment, provided such equipment is: . Copyright, 2017 Selective Insurance Company of America.All rights reserved. CA 78 09 11 17 . Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 3 of 5 • a. Permanently installed in or upon the covered 3. An executive officer or insurance manager, if you "auto"at the time of the"loss"; are a corporation; b. Removable from a housing unit that is perma- 4. Your members, managers or insurance manager, if nently installed in the covered "auto" at the time you are a limited liability company; of the"loss"; 5. Your elected or appointed officials, trustees, board c. Designed to be solely operated by use of power members or your insurance manager, if you are an from the"auto's"electrical system; or organization other than a partnership, joint venture d. Designed to be used solely in orupon the or limited liability company.• covered"auto". But, this section does not amend the provisions relating For each covered "loss"to such equipment, a deductible to notification of police or protection or examination'of of$50 shall apply, unless the deductible otherwise appli- the property that was subject to the"loss". cable to such equipment is less than $50, at which point WAIVER OF SUBROGATION the lower deductible, if any,will apply.' • SECTION IV, A.5. - Transfer Of Rights Of Recovery COMPREHENSIVE DEDUCTIBLE (- LOCATION ,Against Others To.Us is deleted in its entirety and TRACKING DEVICE replaced with the following: The following is added to SECTION III, D.-Deductible: We waive any right of recovery we may have against Any Comprehensive Coverage Deductible shown in the any person or organizationbecause of payments we Declarations will be reduced by 50% for any "loss" make for "bodily injury" or "property damage" resulting caused by theft if the covered "auto" is equipped with a from the ownership, maintenance or use of a covered "auto" but only when you have assumed liability for such location tracking device and that device was the sole "bodily injury" or "property damage" in an "insured con- method used to recover the"auto". tract". In all other circumstances, if a person or organiza- PHYSICAL DAMAGE LIMIT OF INSURANCE tion to or for whom we make payment under this Cover- SECTION III, C. - Limit Of Insurance is deleted in its age.Form has rights to recover damages from another, entirety and replaced with the following: those rights are transferred to us. The most we will pay for a "loss" in any one"accident" is . MULTIPLE DEDUCTIBLES the lesser of: The following is added to SECTION IV, A. - Loss 1. The actual cash value of the damaged or stolen Conditions: property as of the time of the"loss"; or If a "loss" from one event involves two or more covered 2. The cost of repairing or replacing the damaged or "autos"and coverage under Comprehensive or Specified stolen property with other property of like kind and Causes of Loss applies, only the highest applicable quality. deductible will be•applied. This coverage extension doesnot apply to Emergency CONCEALMENT, MISREPRESENTATION OR FRAUD Services Organizations and Governmental Entities. The following is added to SECTION IV, B.2. - Conceal- AMENDMENTS TO SECTION IV - BUSINESS AUTO ment, Misrepresentation Or Fraud: CONDITIONS If you should unintentionally fail to disclose any existing DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT hazards in your representations to us prior to the incep- OR LOSS tion date of the policy or during the policy period in The following is added to SECTION IV, A.2.a. - Duties , connection with any newly discovered hazards, we will In The Event Of Accident,Claim,Suit Or Loss: not deny coverage under this Coverage Form based upon such failure. The notice requirements for reporting "accident" claim, "suit" or "loss" information to us, including provisions POLICY PERIOD, COVERAGE TERRITORY related to the subsequent investigation of such "acci- SECTION IV, B.7. - Policy Period, Coverage Territory dent", -claim, "suit" or "loss" do not apply until the is deleted in its entirety and replaced with the following: "accident", claim,"suit"or"loss"is known to: Under this Coverage Form, we cover "accidents" and 1. You, if you are an individual; "losses"occurring: 2. A partner, if you are a partnership; a. During the policy period shown in the Declarations; and b. Within the"Coverage Territory". Copyright, 2017 Selective Insurance Company of America.All rights reserved. CA 78 09 11 17 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 4 of 5 • • • We also cover "loss—to or "accidents" involving a coy- EXTRA HEAVY TRUCK ered "auto" while being transported between any of "Extra Heavy Truck" means a truck with a gross vehicle these places. weight rating of 45,001 pounds or more. TWO OR MORE COVERAGE FORMS OR POLICIES HEAVY TRUCK • ISSUED BY US-DEDUCTIBLES • The following is added to SECTION IV, B.8. - Two Or "Heavy Truck" means a truck with a gross vehicle weight More Coverage Forms Or Policies Issued By Us: rating of 20,001 pounds to 45,000 pounds. If a "loss" covered under this Coverage Form also•in- LIGHT TRUCK volves a "loss"to other property resulting from the same "Light Truck" means a truck with a gross vehicle weight "accident" that is covered under this policy or another rating of 10,000 pounds or less. policy issued by us or any member company of ours, MEDIUM TRUCK ' only the highest applicable deductible will be applied. "Medium Truck" means a.truck with a gross vehicle AMENDMENTS TO SECTION V-DEFINITIONS weight rating of 10,001 pounds to 20,000 pounds. BODILY INJURY INCLUDING MENTAL ANGUISH (Not PRIVATE PASSENGER AUTO Applicable in New York) -"Private Passenger Auto" means a four-wheel "auto" of The definition of bodily injury is deleted in its entirety and the private passenger or station wagon type. A pickup, replaced by the following: panel truck or van not used for business is included "Bodily injury" means bodily injury, sickness, or disease within the definition of a"private passenger auto". sustained by a person, including death resulting from SOCIAL SERVICE VAN OR BUS any of these. "Bodily injury" includes mental anguish "Social Service Van or Bus"means a van or bus used by resulting from bodily injury, sickness or disease sus- a government entity, civic, charitable or social service tained by a person. • organization to provide transportation to clients inci- ADDITIONS TO SECTION V DEFINITIONS dental to the social services sponsored by the organiza- COVERAGE TERRITORY tion, including special trips and outings. "Coverage Territory"means: TELEMATIC DEVICE 1. The United States of America (including its territories "Telematic Device" includes devices designed for the and possessions), Canada and Puerto Rico; and collection and dissemination of data for the purpose of Anywhere in the world, except for any country or monitoring vehicle and/or driver performance. This in- 2. jurisdiction that is subject to trade or other economic eludes Global Positioning System technology, wireless jurisdiction or embargo by the Unitedr other States of safety communications and automatic driving assistance corn- America,sanctif a covered "auto" is leased, hired, rented, munsystems, all integrated with computers and mobile or borrowed without a driver for a period of 30 days ms. tions technology in automotive navigation sys- or less, and the insured's responsibility to pay"dam- ages" terns. is determined in a "suit" on the merits in and VOLUNTEER WORKER under the substantive law of the United States of "Volunteer.worker" means a person who performs busi- America (including its territories and possessions), ness duties for you, for no financial or other compensa- Puerto Rico, or Canada, or in a settlement we agree tion. to. If we are prevented by law, or otherwise, from defending the "insured" in a "suit"brought in a location described in Paragraph 2. above, the insured will conduct a defense of that"suit".We will reimburse the "insured"for the rea- sonable and necessary expenses incurred for the de- fense of any such "suit" seeking damages to which this insurance applies, and that we would have paid had we been able to exercise our rightand duty to defend. • . Copyright,2017 Selective Insurance Company of America.All rights reserved. CA 78 09 11 17 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 5 of 5 POLICY NUMBER: SF22CGL1448071C COMMERCIAL GENERAL LIABILITY CG 20 38 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • ADDITIONAL INSURED - OWNERS, LESSEES OR- CONTRACTORS AUTOMATIC STATUS FOR OTHER - PARTIES WHEN REQUIRED IN WRITTEN CONSTRUCTION AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II ,Who Is An Insured is amended to B. With respect to the insurance afforded to include as an additional insured: these additional insureds, the following 1. Any person or organization for whom you additional exclusions apply: are performing operations when you and This insurance does not apply to: such person or organization have agreed in .1. "Bodily injury", "property damage" or writing in a contract or agreement that such "personal and advertising injury"arising person or organization be added as an out of the rendering of,or the failure to additional insured on your policy;and render, any professional architectural, 2. Any other person or organization you are engineering or surveying services, required to add as an additional insured including: under the contract or agreement described a. The preparing,approving,or failing ' in Paragraph 1.above. to prepare or approve, maps,shop drawings, opinions,reports, Such person(s) or organization(s) is an surveys, field orders,change orders additional insured only with respect to liability or drawings and specifications;or for"bodily injury", "property damage" or b. Supervisory, inspection, "personal and advertising Injury" caused, In architectural or engineering whole or in part, by: activities. a. Your acts or omissions;or . This exclusion applies even if the claims b. The acts or omissions of those acting against any insured allege negligence or on your behalf; other wrongdoing in the supervision, hiring, in the performance of your ongoing operations employment, training or monitoring of others for the additional insured. by that insured, if the"occurrence"which However,the insurance afforded to such caused the"bodily injury"or "property damage",or the offense which caused the , additional insured described above: "personal and advertising injury", involved the a. Only applies to the extent permitted by rendering of, or the failure to render, any law;and professional architectural, engineering or b. Will not be broader than that which you surveying services. are required by the contract or 2. "Bodily injury"or "property damage" • agreement to provide for such additional occurring after: • insured. a. All work, including materials, parts or A person's or organization's status as an equipment furnished in connection additional insured under this endorsement with such work,on the project(other ends when your operations for the person or than service, maintenance or repairs) organization described in Paragraph 1. above to be performed by or on behalf of the are completed. additional insured(s) at the location of the covered operations has been • completed;or • CG 20 33 0413 ©Insurance Services Office, Inc.,2012 Paae 1 of 2 b. That portion of"your work"out of which 2.' Available under the applicable Limits of the injury or damage arises has been Insurance shown in the Declarations; put to its intended use by any person or whichever is less. organization other than another contractor or subcontractor engaged in This endorsement shall not increase the performing operations for a principal'as applicable Limits of Insurance shown in the ,a part of the same project. Declarations. C. With respect to the insurance afforded to these additional insureds, the following is added to - Section III - Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance:/ 1. Required by the contract or agreement described in Paragraph A.1.;or •• • • • • • • • • • CG 20 38 0413 © Insurance Services Office, Inc.,2012 Paae 2 of 2 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 (Ed.04-84) • • WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Any person or organization as required by written contract . • • • This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 11/1/2022 Policy No. TWC4168981 Endorsement No. 0 Insured Inland Potable Services Inc Premium$ Insurance Company Technology Insurance Company, Inc. Countersigned by • WC000313 (Ed. 04-84) •