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HomeMy WebLinkAbout2022-017 PO 20220275- Moises Ramirez Ibarra Jr Purchase Order priprt. noun i, VMSG Fiscal Year 2022 Page: 1 of: 1 BI M_ T�?:`de,-6 a q�3c.`Lj .1NL,t.bs`1[ a 5s I City of Ashland _— _I ATTN: Accounts Payable ' Purchase L 20 E. Main 20220275 Ashland, OR 97520 Order# T Phone: 541/552-2010 , O Email: payable@ashland.or.us ✓ H C/O Facilities Maintenance Div E MOISES RAMIREZ IBARRA, JR I 90 North Mountain Ave N 20258 RIVER VALLEY DRIVE p Ashland, OR 97520 D ANDERSON, CA 96007 Phone: 541/488-5358 R T Fax: 541/552-2304 i'irtiVrli I BIl H3 J ra -i -� ! yr i'_ ?_[, ..-r- .._ -&_ �^ David Arnold :1--70-1 f_=isl>['1=a i�lal4 : :a ` _ _-'- 7.1- ' 1 tt. - "-s .]E=1_r4:. r=� I1r l --_ — SS.i� �. c_ 9. l;S.E-=i'0_ _a�[alt� r "' �$TE'i4, ..: �� E �I:1S a�: Pa 02/16/2022 6715 FOB ASHLAND OR/NET30 City Accounts Payable ..-M-Win'''----:,---:E_-__--:=------ MHP- Do -F_t7itr6: - Ld A M 'Wkiqlif ----Wd:M-__M On-call Crane Repairs - a 1 On-call crane repair services for FY 2022 - 1.0 $5,000.00 $5,000.00 Goods and Services Agreement($35,000 or less) Completion date: June 30, 2022 Project Account: L.P, ***************GL SUMMARY*************** 088400-602400 $5,000.00 • V s:1-, ,-,_44f_p_caT-- --- q .Fi E - - By: Date: f/ �� r&t.4. art Au orized Signature '==° == 5 000.00 1 . . (Afq FORM#3 . CITY OF ASHLAND , I A rot-1)1K : ior ii '1.1)i,.miii) o I 12121/202/ I IC(4�l�DpSpTO®rRil • Dale oirequest . • Required date for delivery: Vendor Name Ibarra Industrial Services • Address,City,State,Zip 70258 River Valley Drive.Anderson.CA 96007 Contact Name&Telephone Number • Elliott address Moises ibarra 530.410-9500 SOURCING METHOD . ❑ Exempt from Comnotitive Blddinq • 0 Invitation to Bid ❑ EmergencV ❑ Reason for exemption: • Date approved by Council: 0 Form 1113,Written findings and Authorization ❑ AMC 2.50 _(Attach copy of council communication) CI Written quote or proposal attached ❑ Written quote or proposal attached ._(If council approval required,attach copy of CC) l Small Procurement ❑ Request for Proposal Cooperative Procurement Not exceeding$5,000 Date approved by Council: ❑ Slate of Oregon II Direct Award _(Attach copy of council communication) Contract it • • ❑ VerballWrilten quote(s)or proposal(s) ❑ Request for Qualifications(Public Works) 0 Slate of Washington Date approved by Council: Contract!! • ______ pyo(Attach cof council communication) . ❑ Other government agency contract Intermediate Procurement 0 Sole Source Agency GOODS&SERVICES ❑ Applicable Form_(115,6,7 or 0) Contract!! • Greater than$5,000 and less than$100,000 0 Written quote or proposal attached intergovernmental Agreement' ❑ (3)Written bids and solicitation attached ❑ Form 114,Personal Services$51(to$75K • Agency • . PERSONAL SERVICES Date approved by Council: ❑ 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 ❑ Special Procurement City Administrator.AMC 2.50970(4) ❑ (3)Written proposals&solicitation attached 0 Form-119,Request for Approval LI'Annual cost to City exceeds$25,000,Council • i D Form 114,Personal Services$SK to$75K 0 Written quote or proposal attached approval required.(Attach copy of council communication) 1 Dale approved by Council: • Valid until: (Date) ' Description of SERVICES Total Cost Crane repalr service for FY22 $5,000.00 ' Item# Quantity Unit Description of MATERIALS Unit Price Total Cost • ' $0 $0.00 .i $0 $0.00. $0 $0.00 • ❑ Per attached quotelproposal TOTAL COST Project Number . •___ Account Number 008400.002400 • $$0.00 'Expenditure must be charged to the appropriate account numbers for lire 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 certify that the City':publi,contracting requirements have been satisfied.�,� ,,1 . Employee: / % Department Head: �' ='!lt �►� Z 7 Z0 / � ✓ greater than x,000) =DepartmentMana.erlSupervisor: City Manag r: %I ►i-r= ! • / :17 al toorgroalp(lian$35,000) Funds appropriated for current fiscalyear ENO ‘--"\-... '2—"1-1 --z •Finance Director-Aug to orgreaterthan$5,000) Dale Comments: Form 113-Requlsiton i • • memo TO: Joseph Lessard FROM: Tami De Mille-Campos(Public Works) DATE: 2/7/22 RE: City Manager Signature Needed for Ibarra Industrial Services Background: - The City of Ashland has several indoor stationary overhead cranes(not on vehicles) at various locations that require annual inspection, scheduled preventive maintenance as well as Occasional repairs.All of which must be performed by certified technicians. Council Action: Other Relevant Information: Insurance waived or reduced?Yes Who to return to if different from sender? Are all other Signatures required collected?Yes If no,please collect before sending them to the City Manager. Are all attachments listed included?Yes If no,please include all attachments before sending to the City Manager. CITY OF ASHLAND 20 East Main Street Tel:541-488-6002 Ashland,Oregon 97520 Fax:541-488-5311 www.ashland.or.us TTY:800-735-2900 ,ata IBARRA INDUSTRIAL SERVICES s i 20258 River Valley Drive I Anderson,CA 96007 er 'C+1 tt, (530)410-9500 I lbarralndustrialSVCS@outlook.com xeeltImg yam uralrGry are Cate at a acre/ ' . ?.a"f • • ' I February 7, 2022 . I To: City of Ashland To Whom It May Concern: Regarding the City of Ashland's Service Agreement General Liability Insurance requirement, I am requesting an exception. - As the owner of Ibarra Industrial Services, my company currently carries $1,000,000 worth of Liability Insurance while providing industrial,repair and services. During the process of performing these repairs or services, incidents are extremely rare and personal injury or property damage is almost unheard of. • Please contact me if you have any questions or would like more information as you consider my request, - Thank you, /MP) Moises R. lbarr I,Jr. - a Owner Operator Ibarra Industrial Services I - I • • • • j I GOODS AND SERVICES AGREEMENT(535,000 OR LESS) PROVIDER: Ibarra Industrial Services CITY of PROVIDER'S • ASHLANDCONTACT: Moises Marra 20 East Main Street Ashland,Oregon 97520 ADDRESS: 2025$River Valley Drive • Telephone: 541/458-5537 Anderson,CA 96007 • • Fax: 541/488-6006 ' PHONE: • 530-410-9500' • i A • -= I • This Goods and Services Agreement (hereinafter "Agreement") is entered into by end between the City of Ashland,an Oregon municipal corporation(hereinafter"City")and Ibarra Industrial Services,(a domestic/foreign • business corporation)("hereinafter"Provider"),for crane repair. 1. PROVIDER'S OBLIGATIONS • 1.1 Provide crane repair services for FY22 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 090;080-(two— million dollars)per occurrence for Bodily Injury and Property Damage. 1,000i MO(DrIc i I 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 en"decurrence"and not a"claims made"form,and • shall: • Name as additional-insured "the City of Ashland, Oregon, its officers, agents and i 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 ? j 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 I j 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. Page 1 of 6: Goods and Services Agreement between the City of Ashland and Ibarra Industrial Services • • • • • • • • 1,3 Provider shall,at its own expense,maintain Worker's Compensation Insurance in compliance with QRS 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 $22,310.46 or more,Provider.is . required to comply with Chapter 3.12 of the Ashland Municipal Code by paying a living wage,as defined in that chapter,to all employees performing Work under this Agreement and to any Subcontractor who performs 50%or more of the Work under this Agreement. '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 relalion between the assignee or subcontractor and the City. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider the hourly rates effective 12/16/2021 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$5,000(this is maximum,not to exceed amount of ENTIRE Agreement)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 fr'oni other providers in its sole discretion. •. Page 2 of 6: Goods and Services Agreement between the City of Ashland and Ibarra Industrial Services • . • • • • 3.2 Provider is an independent contractor and not an employee or agent of the City for any impose.. 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 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 3f 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 nrarmfactuue.Provider shall transfer all warranties to the City. Page 3 of 6: Goods and Services Agreement between the City of Ashland and Marra Industrial Services • • • • • • • 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 Rate Sheet dated December 2021. 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 SUPPORTINGDOCUIvIENTS,the several supporting documents shall be given precedence in the order lis ted in Article 4.1. S. REMEDIES 5.1 In the event Provider is in default of this Agreement,City may,at its option,pursue any or all of the remedies available to it under this Agreement and at law or in equity,including,but not limited to: 5.1.1 Termination of this Agreement; 5.1.2 Withholding all monies due for the Work that Provider has failed to deliver within any scheduled completion dates or any Work that have been delivered inadequately or defectively; 5.1.3 Initiation of an action or proceeding for damages, specific performance, or declaratory or injunctive relief, 5.1.4 These remedies are cumulative to the extent the remedies are not inconsistent,and City may pursue • any remedy or remedies singly,collectively,successively or in any order whatsoever. 5.2 In no event shall City be liable to Provider for any expenses related to termination of this Agreement or for anticipated profits,If previous amounts paid to Provider exceed the amount due,Provider shall pay immediately any excess to City upon written demand provided. 6. TERM AND TERMINATION 6.1' Term This Agreement shall be effective from the date of execution on behalf of the City as set forth below (the"Effective Date"), and shall continue in fill force and effect until June 30,2022,unless sooner terminated as provided in Subsection 6.2. • 6.2 Termination 6.2.1 The City and Provider may terminate this Agreenient 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 pasty 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 atter 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: Page 4 of 6: Goods and Services Agreement between the City of Ashland and Ibarm Industrial Services • • • If to the City: City of Ashland—Facilities Maintenance Department • ' Attn: David Arnold 20 E.Main Street Ashland,Oregon 97520 Phone:(541)552-2292 With a copy to: City of Ashland—Legal Depaitment 20 E.Main Street Ashland,OR 97520 • Phone:(541)488-5350 If to Provider: • Ibarra Industrial Services Attn:Moises Ibarra • 530-410-9500 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 jaws 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 3.13; (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. • Pegs 5 of 6: Goods and Services Agreement between the City of Ashland and Ibarra Industrial Services • • • 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: Ibarra In U.trl1 micas(PROVIDER): By: ��''� �By IiI�1�v� 41W3 Signature Reorr R..gUity • 171S•ds • Printed Name 1 Printed Name • 1 , PU( 4c_ oupyt•e,v, , oiP•evo-fog Title Title 2.fr2(322 IZ17,v �zn� • Date Date (W-9 is to be submitted with this signed Agreement) • Purchase Order No. • ' • • ' Page 6 of 6: Goods and Services Agreement between the City of Ashland and Ibarra Industrial Services • 5--tiet1,1 ( BARBA INDUSTRIAL SERVICES 20258 River ValleyDrive Anderson,CA 96007 9\,1 ; (530)410-9500 I IbarralndustrialSVCS@outlook.com i<ceAGr9 you 1r4aria9.orre&de at a bore/ 'I` 'aa1[ lC; T r;' 6 t gi 1- E�*�-;.»�'�'..�,���.1(gt 'yt. .�'.*.4 tib` 1... 3 ..__ t .� :+.���.yk,,�r. < .v .,. _ '-� Install,Service, and Repair of Bridge Cranes,Overhead Cranes,Jib Boom Hoists and $175.00 Hour Ground Vehicle Lifts Service and Repair of Industrial Machinery,including Press Brake,Shear,Roll $150.00 Hour Former,and Drill Press Service and Repair of Forklift and Pallet Lift(gas,liquid propane, diesel, or electric) $145.00 Hour $275.00- Hoist Inspection (price varies by size,location installed, and accessibility) Each $1,000.00 Small Machinery Inspection $275.00 Each • Large Machinery Inspection $375.00 Each After Hours Call(after 8 hours or after 5 p.m.on Monday-Friday) 1.5 times hourly rate Emergency Callout(applies to same day calls*,calls on Saturday or Sunday,after 2 times hourly rate 4 p.m. on Monday-Thursday,or after 3 p.m. on Friday) Mileage(starting at25 miles outside of Redding,California) - Federal GSA Rate Meals(for job sites located 25 miles away from Redding, California) Federal GSA Rate *Emergency Callout rate will apply to same day service requests when 11S technician is scheduled for or is already onsite at another project but can accommodate the emergency callout request. • • is IG / ' ® DATE(MIAlDDIYYYY) A 3 o CERTIFICATE OF LIABILITY INSURANCE 12/17/2021 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(les)must 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 CONTACTNAME: Melissa Fredrickson-Grace Shaw Insurance ServicesPHONE (530)365-2576 FAX(A1C,No): (5301365-0520 ' IAIC,No.Exl1: P 0 BOX 729 Rgamnissy@shawinsservices.com pussy@shawinsservices.com • 2275 NORTH STREET INSURER(S)AFFORDING COVERAGE NAIC/1 ANDERSON CA 96007 INSURERA:BURLINGTON INSURANCE COMPANY. INSURED INSURER B: MOISES & VALERIE IBARRA, DEA: IBARRA INDUSTRIAL, SERVICES INSURERC: • 20258 RIVER VALLEY DR. INSURER D: - - • INSURER E: ANDERSON CA 96007 - INSURER COVERAGES CERTIFICATE NUMBER:CL2162406312 ,. 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 MAYBE 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. INSRAODL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE VD - LIMITS 'LTR IN5D WPOLICY NUMBER (MMNDTYYYYI (MMIDDIYYYYI - I . X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 I , DAMAGETO RENTED A CLAIMS-MADE n OCCUR PREMISES(Ea occurrence) $ • 100,000 X 9745003564 6/10/2021 6/10/2022 EXCLUDED. MED EXP(Any one person) S ) . PERSONAL&ADV INJURY S 1,000,000 GEN'LAGGREGATEUMITAPPLIES PER: GENERALAGGREGATE $ 2,000,000 h I POLICY n J O n LOC PRODUCTS-COMP/OPAGG $ 2,000,000 I S AUTOMOBILE LIABILITY " COMBINED SINGLE LIMIT $ _ (Ea accident) - ' ANYAUTO BODILY INJURY(Per person) $ ALL OWNED —SCHEDULED BODILY INJURY(Per accident) $ AUTOS • _AUTOSNON.O� - HIRED AUTOS _AUTOSEO PROPERTY DAMAGE - :$ (Per accident)t) ! S UMBRELLALIABOCCUREACH OCCURRENCE S — EXCESS LIAB CLAIMS-MAGE • AGGREGATE S II DED RETENTION S S !' WORI(ERS COMPENSATIONI PER' DTH- STATUTE ER AND EMPLOYERS'LIABILITY Y/N • ANY PROPRIETOR/PARTNER/EXECUTIVE n N f A E.L.EACH ACCIDENT S. OFFICER/MEMBER EXCLUDED? - s. • (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S • II yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S • DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER IS REFLECTED AS AN ADDITIONAL INSURED WHEN REQUIRED BY WRITTEN CONTRACT, PER ATTACHED . CARRIER FORM. , CERTIFICATE HOLDER CANCELLATION . nicole.graham@ashland.or.us . SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CITY OF ASHLAND THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 90 N MOUNTAIN AVE ASHLAND, OR 97520-2014 AUTHORIZED REPRESENTATIVE • M Fredrickson-Grace/Mrd1�Qfeta. I ©1988-2014 ACORD CORPORATION. All rights reserved. is ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) • COMMERCIAL GENERAL LIABILITY CG 20 33 04 13 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS -- AUTOMATIC. STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU 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 these include as an additional insured any person or additional insureds, the following additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to: organization have agreed in writing in a contract or agreement that.such person or organization be 1. "Bodily injury", "property damage"or"personal added as an additional insured on your policy.Such and advertising injury" arising out of the person or organization is an additional insured only rendering of, or the failure to render, any with respect to liability for"bodily injury", "property professional architectural, engineering or damage" or "personal and advertising injury" surveying services, including: caused, in whole or in part,by: a. The preparing, approving, or failing to 1. Your acts or omissions;or prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, 2. The acts or omissions of those acting on your change orders or drawings and behalf; • specifications; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. However,the insurance afforded to such additional This exclusion applies even if the claims against insured: any insured allege negligence or other wrongdoing 1. Only applies to the extent permitted by law;and in the supervision, hiring, employment, training or 2. Will not be broader than that which you are monitoring of others by that insured, if the • required by the contract or agreement to provide "occurrence" which caused the "bodily injury" or for such additional insured. "property damage",or the offense which caused the "personal and advertising injury", involved the A person's or organization's status as an additional rendering of or the failure to render any professional insured under this endorsement ends when your architectural,engineering or surveying services. • operations for that additional insured are completed. • CG 20 33 04 13 ©Insurance Services Office,Inc.,2012 Page 1 of 2 2. "Bodily injury" or"property damage" occurring C. With respect to the insurance afforded to these after: additional insureds, the following is added to a. All work, including materials, parts or Section III—Limits Of Insurance: equipment furnished in connection with such The most we will pay on behalf of the additional work, on the project (other than service, insured is the amount of insurance: maintenance or repairs)to be performed by 1. Required by the contract or agreement you have or on behalf of the additional insured(s) at entered into with the additional insured;or the location of the covered,operations has been completed;or 2. Available under the applicable Limits of b. That portion of"your work"out of which the Insurance shown in the Declarations; injury or damage arises has been put to its , whichever is less. intended use by any person or organization This endorsement shall not increase the applicable other than another contractor or Limits of Insurance shown in the Declarations. subcontractor engaged in performing operations for a principal as a part of the same project. ` • • • • • • • • I Page 2 of 2 ©Insurance'Services Office,Inc.,2012 • CG 20 33 04 13 • • • GEICO GOVERNMENT EMPLOYEES INSURANCE COMPANY Washington DC VERIFICATION OF COVERAGE (SEE BELOW UNDER CAUTIONARY NOTE) MAILING ADDRESS Policy Number:4522686221 MOISES R IBARRA AND VALERIE T Effective Date: 12-19-21 IBARRA Expiration Date:06-19-22 20258 RIVER VALLEY DR Registered State:CALIFORNIA ANDERSON CA•96007-8405 To whom It may concern: • This letter is to verify that we have issued coverage under the above policy number for the dates Indicated in the effective and expiration date fields for the vehicle listed.This should serve as proof that the below mentioned vehicle • meets or exceeds the financial responsibility requirement for your state. This verification of coverage does not amend,extend or alter the coverage afforded by this policy. Vehicle Year: 2012 Make: GMC Model: SIERRA VIN: 1 GT121 E89CF108380 II COVERAGES LIMITS DEDUCTIBLES Bodily Injury Liability Each Person/Each Occurrence State Minimum$15,000/$30,000 $300,000!$300,000 Property Damage Liability State Minimum$5,000 $100,000 • Uninsured&Underinsured Motorists Each Person/Each Occurrence $300,000/$300,000 • Uninsured Motorists Property Damage Insured Rejects Comprehensive(Excluding Collision) $500 Ded Collision $500 Ded/Waiver Emergency Road Service Full Rental Reimbursement $35 Per Day!$1,050 Max X Lienholder _Additional Insured _interested Party el= • Additional Information: • Issue Date:2021-12-21 If you have any additional questions,please call 1-800-841-3000. CAUTIONARY NOTE:THE CURRENT COVERAGES,LIMITS,AND DEDUCTIBLES MAY DIFFER FROM THE COVERAGES,LIMITS AND DEDUCTIBLES IN EFFECT AT OTHER TIMES DURING THE POLICY PERIOD.THIS VERIFICATION OF COVERAGE REFLECTS THE COVERAGES,LIMITS,AND DEDUCTIBLES AS OF THE ISSUED DATE OF THIS DOCUMENT WHICH IS SHOWN UNDER"ADDITIONAL INFORMATION"OR IF AN ISSUED DATE IS NOT SHOWN,THE DATE OF THIS FACSIMILE OR EMAIL U3312-17 ' F I i Ii • Fp IBARRA INDUSTRIAL SERVICES 20258 River Valley Drive I Anderson,CA 96007 .1.4.4g• ,, r •U (530)410-9500 IbarralndustrialSVCS@outloolc.com cept9!MC autm&t9 Otte COft ata rue/ 'i 1� • December 21,2021 •City of Ashland 20 E. Main Street Ashland, OR 97520 To whom it may concern: • Regarding the City of Ashland's Service Agreement Workers'Compensation Insurance requirement,I would like to request an exception on the bases that I am the only employee. Please contact me if you have any questions or would like more information as you consider my request, Thank you, M ises Ibarra,Jr. Owner/Operator • • • CERTIFICATION OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCEREQUIREMENTS , Contractor is exempt from the requirement to obtain workers compensationinsurance under ORS Chap er 656 for the following reason.Contractor is to initial the appropriate box as follows: 1. " SOLE PROPRIETOR (initials) ■ Contractor is a sole proprietor,and ■ Contractor has no employees,and ■ Contractor will not hire employees or subcontractors to perform this contract. CORPORATION—FOR PROFIT (Initials) ■ Contractor's business is incorporated;and • All employees of the corporation are officers and directors and have a substantial ownership interest*in the corporation,and • All work will be performed by the officers and directors;Contractor will not hire other employees or subcontractors to perform this contract. CORPORATION-NONPROFIT (Initials)• • Contractor's business is incorporated as a nonprofit corporation,and ■ Contractor has no employees;all work is performed by volunteers,and • Contractor will not hire employees or subcontractors to perform this contract. • PARTNERSHIP (Initials) • Contractor is a partnership,and • • Contractor has no employees,and ■ All work will be performed by the partners;Contractor will not hire employees or subcontractors to perform this contract,and • Contractor is not engaged in work performed in direct connection with the construction,alteration,repair, improvement,moving or demolition of an improvement to real property or appurtenances thereto.** • LIMITED LIABILITY COMPANY (Initials) • Contractor is a limited liability company,and • Contractor has no employees,and • All work will be performed by the members;Contractor will not hire employees or subcontractors to perforin this contract,and o If Contractor has more than one member,Contractor is not engaged in work performed in direct connection with the construction,alteration,repair,improvement,moving or demolition of an improvement to real property or .ppurtenances thereto.** • ignatur- of Authorized )Si ner J g (Date) ( LAY1\Cv' I n(kW\ (Signer'sTitle *NOTE: Under OAR436-50-050 a shareholder has a"substantial ownership"interesrif the shareholder owns 10%of the corporation,or if less than 10%is owned,the shareholder has ownership that is at least equal to or greater than the average percentage of ownership of all shareholders. **NOTE: Under certain circumstances partnerships and limited liability companies can claim an exemption even when performing construction work. The requirements for this exemption are complicated. Consult with City Attorney's Office before an exemption request is accepted from a contractor who will perform construction work. •