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HomeMy WebLinkAbout2022-021 PO 20220270- Cut n Break Construction Inc Purchase Order ,apir4& Fiscal Year 2022 Pge: 1 of: 1 i rte_ Ap g1_I� ll� iE`1.�ofi �Ec . B City of Ashland Uri F COR �"�ii r t1�� I ATTN:Accounts Payable - - —^ - L 20 E . Main Purchase 20220270 L Ashland, OR 97520 Order# L T Phone: 541/552-2010 O Email: payable@ashland.or.us S CIO Parks Department ✓ H Admin Office E CUT N BREAK CONSTRUCTION INC I 340 South Pioneer • P DN PO BOX 1455 MEDFORD, OR 97501 • Ashland, OR 97520 O T Phone: 541/488-5340 R o Fax: 541/488-5314 _-�• 35 :3§I61-4=J ®1§§lel e475'1'-16 it E1_� uE 44 ._ t _--2774� 9-��'F i�L�P.._+-.E'i-e�z__ -_- _ - 541) 779-1482 - Michael Black V=Vi=1§]er '®:e1=1ff.-0=f si N7‘24 • ,,,,T__ , -- , --- 6' ,--- -7?) • FORM #3 c1T. v ® IF ' ASHLAND i' ',1tl; .,.• a li . il,' :il•, • • '. ! '/ IEC U Q S l 1101 1 Date of request: , /22/2022 /1(41 • Required date for delive : • Vendor Name Cut N Break. t� /�j ' Address,City,State,Zip PO Box 1455 Medford,OR 97501-0108 e, 4,a �" Contact Name&Telephone Number John Lawton,President , A\ •, Email address _ y 1/V7: . -1 •SOURCING METHOD • GI ❑ Exempt from Competitive Bidding 0 Emergency D Reason for exemption: ❑ Invitation to Bid 0 Form#13,Written findings and A thorization ❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attache, ❑ Written quote or proposal attached - (Attach copy of council communication) _(If council approval required,attach •py of CC) I ❑ Small Procurement • D Request for Proposal . Cooperative Procurement Not exceeding$5,000 Date approved by Council: ❑ State of Oregon ❑ Direct Award _(Attach copy of council communication). Contract 11 , ❑ Verba ilten-bid(s)-arprojiosa Request for Qualifications(Public Works) 0 State of Washington Date aro`:•by Council: Contract 11 i . . Attach('.,of council communication) 0 Other government agency contract • Intermediate Procurement • 40 I.i Source Agency GOODS&SERVICES / ppiicable Form(115,6,7 or 8) Contract ll • Greater than$5,000 and less than$100,0,• ❑ ritlen quote or proposal allached• Intergovernmental Agreement El (3)Written bids&solicitation attached Form 114,Personal Services$51(to$751( Agency pERSONAL SERVICES 0 Special Procurement 0 Annual cost to City does not exceed$25,000. , Greater 11 n$5 000 and , apt$ ;000 .❑ Form 119,Request for Approval Agreement approved by Legal and approved/signed by s n 35,00i •y direct appointment ❑ Written quote or proposal attached City Administrator.AMC 2.50.070(4) ❑ (3)Mille Pr 1,•sals&solicitation attached Date approved by Council: ❑ Annual cost to City exceeds$25,000,Council ❑ Form#4,P= •,.1 Services$5K to$75K Valid until:. (Dale) approval required.(Attach copy of council communication) Desc -,tion.o E'VICES Total Cost ' . co rete work for the Installation of fencing at Lithia Park Pickleball Courts 1 $ 7,500.00 item# Quantity Unit Description of MATERIALS Unit Price . Total Cost • . 1:1 Per attached quotelproposat TOTAL COST • • Project Number Account Number 1 2 1 2 o o.7 o 4 0 01 $7500.00 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,l certify that the City's public contracting requirements have been satisfied. Employee: /a-4-a•A-4:2-wed Department Head: ‘--14^-- 4-1/1,91— (Equal to or greater than$5,000) • Department Manager/Supervisor: • City Administra n (Equal to or greeter then$25,000) i• Funds appropriated for current fiscal year: 'Y /NO ; —1Z—Z.? Finance Director-(Equetfoorgreaferlhan$5000) Da Comments: . • I . Form 113-Requisition • • CUT 'N BREAK CONSTRUCTION INC. • .P.O. Box 1455 • Medford, OR 97501-0108 • CCB License #72046 • 541-779-1482/FAX 541-772-1913. • John Lawton, President September 14,2021 City of Ashland Alt: Jason 541-324-4112 • Jason.minica@ashlarid.or.us Job Site:Lithia Park Tennis Courts • • This proposal is to remove and replace concrete as discussed. • • • 5'x 20' with 2 risers 20' long • Sawcut 0 ❖ Remove rocks,mortar, etc + Install forms • ❖ Install 3/4 minus base rock and compactas needed ❖ Install#3 rebar 2' on center each way ❖ Place and broom finish 4000 psi concrete EQUIPMENT,MATERIAL,AND LABOR: '$7,500.00 When saw cutting, Cut 'N Break Construction, Inc. is not responsible forany damage to anything in or • below the concrete. This includes water lines, electrical line, sprinkler systems, etc. Your signature indicates that you have read this notice and fully understand the limits of Cut'N Break Construction, Inc. • responsibility. . Billing and Payment Procedures: Invoices are presented on completion of work. Invoices are due and payable upon receipt. Delinquent invoices are subject to 1 1/2%monthly on unpaid balance. We accept Visa and MasterCard for your convenience. . . Should you have any questions or need any additional information regarding the above proposal please do not hesitate to contact this office. • • • THIS ESTIMATE IS GOOD FOR 30 DAYS! I . • • • • Signing one copy of this letter and returning it in the enclosed envelope indicates acceptance of this proposal. " Thank you, Travis Lawton Superintendent ACCEPTED By: • Date: • • • • • • • • • • • • • THIS ESTIMATE IS GOOD FOR 30 DAYS! . i • • GOODS AND SERVICES AGREEMENT(LESS THAN'$25,000) s N • PROVIDER: Cut'N Break Construction Inc. to , PROVIDER'S CONTACT: John Lawton,President • 'ADDRESS: PO Box 1455 • • 20 East Main Street • Medford,OR 97501-0108 Ashland,Oregon 97520 '' Telephone: 541/488-5340 PHONE: (541) 779-1482 Fax: 541/552-5314 • This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation(hereinafter"City") and Cut `n Break Inc. ("hereinafter"Provider"), for removal and replacement of concrete at Lithia Park Sports Courts. '} 1. PROVIDER'S OBLIGATIONS. • . . } 1.1 Provide•removal and replacement of•concrete at Litha Park Pickleball Courts 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 maybe 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 becollectively 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: o Comprehensive General or Commercial General Liability, including personal injury, • • contractual liability,and products/completed operations coverage; and o Automobile Liability. 1.2.2 Each policy of such insurance shall be on an"occurrence" and not a"claims made"form,and shall: . ® Name as additional insured "the City.of Ashland, Oregon, its officers, agents and employees" with respect to claims arising out of the provision of Work under this Agreement; . o 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; e Apply as primary coverage for each additional named insured except to the extent that two or more such policiesare intended to "layer" coverage and,taken together,they provide . total coverage from the first dollar of liability; o Provider shall immediately notify the City of any change in insurance coverage o Provider shall supply an endorsement naming the City,its officers, employees and agents as additional insureds by the Effective.Date of this Agreement; and Page 1 of5: Goods and Services Agreement between the City of Ashland and Cut'n Break Construction 1 . 1 I •. Q e 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 p 656.017, which requires subject employers to provide workers' compensation coverage for all of its • subject workers. • 1.4 Provider agrees that noerson shall, on the pgrounds 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 applicablerequirements of federal and state civil rights and rehabilitation statutes,rules and regulations, Further, Provider agrees I 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. if 1.6 Living Wage Requirements: If the amount of this Agreement is $22,002,43 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. 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 t subcontract without written consent of the City shall be void. Provider shall be fully responsible for the 1 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 i or subcontractor and the City. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider the sum of$7,500(seven thousand five-hundreddollars)lump sum as provided 1 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$71500(seven thousand five-hundred dollars)this.is maximum,not to exceed amount of g • ENTIRE Agreement without express,written approval from the City official whose signature appears i 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 I. acknowledges that any Work delivered or expenses incurred without authorization as provided herein is I t. done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement. f r 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, • Page 2 of 5: Goods and Services Agreement between the City of Ashland and Cut'n Break Construction • • 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. 6 .3.4 This Agreement embodies the full and complete understanding of the psi-ties 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 141 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 11 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. 11 3.10 If any provision of this Agreement is found by a court of competent jurisdiction to be unenforceable,' such provision shall not affect the other provisions,but such unenforceable provision shall be deemed modified to the extent necessary to render it enforceable,preserving to the fullest extent permitted the intent of Provider and the City set forth in this Agreement. 3.11 Deliveries will be F.O.B destination.Provider shall pay all transportation and handling charges for the Goods.Provider is responsible and liable for loss or damage until final inspection and acceptance of the Goods by the City. Provider remains liable for latent defects,fraud,and warranties. • 3.12 The City may inspect and test the Goods. The City may reject non-conforming Goods and require Provider to correct them without charge or deliver them at a reduced price, as negotiated.If Provider • • does not cure any defects within a reasonable time, the City may reject the Goods and cancel this • Agreement in whole or in part. This paragraph does not affect or limit the City's rights, including its rights under the Uniform Commercial Code,ORS Chapter 72 (UCC). • • Page 3 of 5: Goods and Services Agreement between the City of Ashland and Cut`n Break Construction • 1 r I • 1 gg 7 3.13 Provider represents and warrants that the Goods are new, current, and. fully warranted by the • manufacturer. Delivered Goods will comply with 1 p Y SUPPORTING DOCUMENTS and be free from defects in labor,material and manufacture.Provider shall transfer all warranties to the City. c 4. SUPPORTING DOCUMENTS The following documents are,by this reference,expressly incorporated in this Agreement,and are collectively referred to in this Agreement as the"SUPPORTING DOCUMENTS:" ® ' The Provider's complete written quote dated September 14,2021. f 5. REMEDIES t 5.1 In the event Provider is in default of this Agreement, City may, at its option, pursue any or all of the 1 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 . 1 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. i 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 E 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 April 30, 2022, unless sooner . terminated as provided in Subsection 6,2. E 6.2 Termination 6.2.1 The City and Provider may terminate this Agreement by mutual agreement at any time. 6.2.2 The City may,upon not less than thirty(30)days' prior written notice,terminate this Agreement for any reason deemed appropriate in its sole discretion. 6,2.3 Either party may terminate this Agreement,with cause,by not less than fourteen(14)days'prior written notice if the cause is not cured within that fourteen(14) day period after written notice. Stich termination is in addition to and not in lieu of any other remedy at law or equity. • • E 7. NOTICE Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in • t 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: 0 • If to the City: Ashland Parks and Recreation Commission 1 Attu: Michael Black 340 S.Pioneer St. . Ashland, Oregon 97520 . • Pagc 4 of 5: Goods and Services Agreement between the City of Ashland and Cut'n Break Construction • • • Phone: (541)488-5340 1 • With a copy to: ' City of Ashland—Legal Department • 20 E.Main Street , Ashland,OR 97520 ' . • Phone: (541)488-5350r N If to Provider: • . h Cut'n Break Construction Inc. Attn: John Lawton,President PO Box 1455 • Medford,OR 97501-0108 1. l; Phone: (541)779-1482 8. WAIVER OF BREACH - rl 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, `1F 9. PROVIDER'S COMPLIANCE WITH TAX LAWS 1 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 5 Provider; and • . (iii) Any rules,regulations,charter provisions, or ordinances that implement or enforce any of ii the foregoing tax laws or provisions. N 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 i chapters 316,317,and 318; • i (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 t •• 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 i I Agreement and to seek damages and any other relief available under this Agreement,at law,drill equity, , • . 's 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, . i • - i Page 5 of 5: Goods and Services Agreement between the City of Ashland and Coit`n Break Construction • iji CITY OF ASHLAND: Cut'n Break Construction Inc. (PROVIDER): By: Signature Si uIture M? €--e-4 n et-t.4_ `ter / Printed Name Printed Name Title Title ).9- /,9-- 0?— 2 —*a? —Date Date • (W-9 is to be submitted with this signed Agreement) • • • Purchase Order No. s' ' 7 ) •• . . • • • • Page 6 of S: Goods and Services Agreement between the City of Ashland and Cut'n Break Construction . 4 CERTIFICATE OF LIABILITY INSURANCE DA 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 Ileu of such endorsement(s). PRODUCER NAME: CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY PHONEFAX HOME OFFICE:P.O.BOX 328 , IA/C,No,Est):888-333-4949 IA/C,No1:507,446-4664 OWATONNA,MN 55060ADDRE SS:CLIENTCONTACTCENTER(EIFEDINS.COM • INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:FEDERATED MUTUAL INSURANCE.COMPANY 13935 • INSURED 171-997'0 INSURER B: • 0 CUT'N BREAK CONSTRUCTION,INC, INSURER C: PO BOX 1455 INSURER D: MEDFORD,OR 97501-0108 • INSURER E:• , INSURER F: COVERAGES CERTIFICATE NUMBER:110 REVISION NUMBER:3 • 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. • INSRTYPE OF INSURANCE INSR SWVD LTR MMIDPOLICY NUMBER ( D YVY(I (MMIDD' ) LIMITS X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $1,000,000 • CLAIMS-MADE n OCCUR ' DAMAGE RENTED $100,000 ( PREMISES(Ea occurrence) • MED EXP(My one person) . EXCLUDED I A — Y N 9829854 04/13/2021 04/13/2022 PERSONAL&ADV INJURY $1,000,000 GEI.AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 XPOUCY PRO LOC. PRODUCTS•COMP/OP AGO $2,000,000 riga n. OTHER: AUTOMOBILE LIABILITY CO BINEDtSINGLE LIMIT _ $1,000,060. X ANY AUTO BODILY.INJURY(Per person) —OWNED AUTOS ONLY SCHEDULED A _ACHED Y N 9829854 04/13!2021 04/13/2022 BODILY INJURY(Por accldenE NON-OWNED • FROPERZ •DAMAGE .. • HIRED AUTOS ONLY AUTOS ONLY IPer aeeidenA • X UMBRELLA LIAR X OCCUR . . EACH OCCURRENCE $4,000,000 A EXCESS LIAR CLAIMS-MADE Y N - 9829855 . 04/13/2021 - 04/13/2022 AGGREGATE $4,000,000 DED 1 RETENTION - WORKERS COMPENSATIONPER STATUTE ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE , E.L EACH ACCIDENT • OFFICER/MEMBER EXCLUDED? —N I A . EL DISEASE•EA EMPLOYEE (Mandatory in NH) If yes,describe under EL DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below • DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remelts Schedule,mey be attached II more space Is required) SEE ATTACHED PAGE • • • CERTIFICATE HOLDER CANCELLATION • , 171-997-0' 110 3 ' ASHLAND PARKS&RECREATION COMMISSION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 340 S PIONEER ST • THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND,OR 97520-2729 ACCORDANCE WITH THE POLICY PROVISIONS. • AUTHORIZED REPRESENTATIVE " / `/o` - I O 1988.2015 ACORD CORPORATION.Ail rights reserved. • ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ' • / J • • AGENCY CUSTOMER ID: 171-997-0 LOC##: A ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AOENCY NAMED INSURED • FEDERATED MUTUAL INSURANCE COMPANY CUT'N BREAK CONSTRUCTION,INC. POLICY NUMBER PO,BOX 1455 SEE CERTIFICATE#110.3 MEDFORD,OR 97501-0108 CARRIER NAIC CODE SEE CERTIFICATE##110.3 EFFECTIVE DATE:SEE CERTIFICATE##110.3 ADDITIONAL REMARKS • THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE ADDITIONAL INSURED ALSO INCLUDES THE CITY OF ASHLAND, OREGON, ITS OFFICERS, AGENTS AND EMPLOYEES THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT • ENDORSEMENT FOR BUSINESS AUTO LIABILITY. INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. • INSURANCE PROVIDED BY THE BUSINESS AUTO LIABILITY IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. COMMERCIAL UMBRELLA FOLLOWS FORM ACCORDINGTO THE TERMS, CONDITIONS, AND ENDORSEMENTS FOUND IN THE COMMERCIAL UMBRELLA POLICY. • • • • • • • • • • ACORD 101(2008/01) O 2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD • • COMMERCIAL AUTO CA 04 49 11 16 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM • MOTOR CARRIER COVERAGE FORM With respect t6 coverage provided by this endorsement, the provisions of the Coverage Form apply unless . • modified by the endorsement. • A. The•following is added to the Other Insurance ' B. The following is added to the Other Insurance Condition in the Business Auto Coverage Form Condition in the Auto Dealers Coverage Form and • and the Other Insurance - Primary And Excess supersedes any provision to the contrary: Insurance Provisions in the Motor Carrier This Coverage Form's Covered Autos Liability Coverage Form and supersedes any provision to Coverage and General Liability Coverages are the contrary: primary to and will not seek contribution from any This Coverage Form's Covered Autos Liability other insurance available to an "insured" under Coverage is primary to and will not seek your policy provided that: contribution from any other insurance available to 1. Such "insured"'is a Named Insured under an "insured" under your policy provided that: such other insurance; and 1. Such '"insured" 'is,a Named Insured under 2. You have agreed in writing in a contract or such other insurance; and agreement that this insurance would be primary and would not seek contribution from 2. You have agreed in writing in a contract or any • other insurance available to such agreement that this insurance would be "insured". primary and would,not seek contribution from any other insurance available to such "insured". • • • . CA 04 4911 16 © Insurance Services Office, Inc., 2016 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART . r With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. WHO IS AN INSURED for"bodily injury" and "property damage" liability is amended to include: Any person or organization other than a joint venture, for which you have agreed by written contract to procure bodily injury or property damage "auto" liability insurance arising out of operation of a covered "auto"with your permission. However, this additional insurance does not apply to: (1) The owner or anyone else from whom you hire or borrow a covered "auto". This exception does not apply if the covered "auto" is a "trailer"connected to a covered "auto"you own. (2) Your "employee" if the covered "auto" is owned by that."employee" or a member of his or her household. (3) Someone using a covered "auto" while he or she is working in a business of selling, servicing,. repairing, parking or storing "autos" unless that business is yours. (4) Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees", while moving property to or from a covered "auto". • (5) A partner (if you are a partnership), or a member (if you are a limited liability company) for a covered "auto"owned by him or her or a member of his or her household. • B. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached. In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any insured, or to procure insurance. C. The limits of insurance applicable to such insurance shall be the lesser of the limits required by the agreement between the parties, or the limits provided by this policy. • ;1 D. Additional exclusions. The insurance afforded to any person or organization as an insured under this endorsement does not apply: 1. To"loss"which occurs prior to the date of your contract with such person or organization; 2. To "loss" arising out of the sole negligence of any person or organization that would not be an insured except for this endorsement. 3. To "loss" for any leased or rented "auto" when the lessor or his or her agent takes possession of the leased or rented "auto"or the policy period ends, whichever occurs first. • • Includes copyrighted material of Insurance Services Office, Inc. with its permission. CA-F-127 (03-03) Policy Number: 9829854 Transaction Effective Date:04-13-2021 • • • COMMERCIAL GENERAL LIABILITY . CG 20 01 12 19 • • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION • This endorsement modifies insurance provided under the following: ' • COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART • The following is added to the Other Insurance (2) You have agreed in writing in a contract • Condition and supersedes any provision to the oragreement that this insurance would be contrary: • primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the • This insurance is primary to and will not seek additional insured. contribution from any other insurance available to an additional insured under your policy provided that: . - (1) The additional insured is a Named Insured . under such other insurance; and • ' • • • • • • • • • • • • • • • © Insurance Services Office, Inc., 2018 Page 1 of 1. CG 20 01 12 19 Policy Number: 9829854 Transaction Effective Date: 04-13-2021 • • • • • COMMERCIAL GENERAL LIABILITY CG 20 33 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ `IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU • This endorsement modifies insurance provided under the following: - COMMERCIAL GENERAL LIABILITY.COVERAGE PART A. Section II - Who.. Is An Insured isamended 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 added as an additional insured on your policy. "personal and advertising injury" arising out Such person or organization is an additional of the rendering of, Or the failure to render, insured only with respect to liability for "bodily any professional architectural, engineering or injury", "property damage" or "personal and surveying services, including: advertising injury" 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, 2. The acts or omissions of those acting on your opinions, reports, surveys, field orders, behalf; change orders or drawings and 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 ' This exclusion applies even if the claims additional insured: against any insured allege negligence'or other - 1. Only applies to the extent permitted by law; wrongdoing in the supervision, hiring, and employment, training or monitoring of others • • 2. Will not be broader than that which you are by that insured, if the "occurrence" which required by the contract or agreement to caused the "bodily injury" or "property provide for such additional insured. damage", or the offense which caused the A person's or organization's status as an "personal and advertising injury", involved the • • additional insured under this endorsement ends rendering of or the failure to render any ' when your operations for that additional insured professional architectural; engineering or are completed. surveying services. • • • • • • © Insurance Services Office, Inc., 2018 0 Page 1 of 2 CG 20 33 12 19' Policy Number: 9829854 . Transaction Effective Date:04-13-2021 2. "Bodily injury" or "property damage" C. With respect to the insurance afforded to these occurring 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 The most we will pay on behalf of the additional such work, on the project (other than insured is the amount of insurance: service, maintenance or repairs)•to be 1. Required by the contract or agreement you performed by or on behalf of the additional have entered into with the additional insured; insured(s) at the location of the covered or operations has been completed; or 2. Available under the applicable limits of b. That portion of "your work" out of which ( insurance; the injury or damage arises has been put • to its intended use by any person or whichever is less. organization other than another contractor This endorsement shall not increase the or subcontractor engaged in performing applicable limits of insurance. operations for a principal as a part of the ' same project. • ' • • • s. • • • • • • • Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 33 12 19 Policy Number: 9829854 Transaction Effective Date:04-13-2021 ' Ac � ® DATE(MMIDD/YYYY) �( ,-D CERTIFICATE OF LIABILITY INSURANCE 3/9/2022 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 Brown&Brown NorthwestCONCONTACT Susan Wilson 3256 Hillcrest Park Drive PHONEIAIC.No.Ext): 541-494-2658 (NC, No): 541-772-3785 Medford, OR 97504 ADDRESS: Susan.Wilson(a)bbrown.com INSURER(S)AFFORDING COVERAGE NAIC# • www.bbnw.com INSURERA: SAIF Corporation 36196 ' INSURED INSURER B: Cut N Break Construction Inc INSURERC: • PO Box 1455 Medford OR 97501-0108 INSURER D: INSURER E: INSURER F: • COVERAGES CERTIFICATE NUMBER: 67132253 REVISION NUMBER: THIS IS TO CERTIFY THAT.THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY.PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER IMMIDDIIYYYYY) (MM/DD/Y Yl) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ • • DAMAGE RENTED CLAIMS-MADE OCCUR PREM SESO(Ea occurrence) $ MED EXP(Arty one person) $ PERSONAL&ADV INJURY $ . GEN'LAGGREGATE LIMIT APPLIES PER: " GENERAL AGGREGATE $ POLICY JECT PRC I I LOC PRODUCTS-COMP• /OPAGG $ OTHER: ' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS • HIRED NON-OWNEDPROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION H- PER ✓ti Exceeds Statute AND EMPLOYERS'LIABILITY YIN 48900310/1/2021 10f1/2022 ANYPROPRIETOR/PARTNER/EXECUTIVE pi N/A E.L.EACH ACCIDENT $1000000 OFFICERIM EM B ER EXCLU D ED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1000000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $1000000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached It more space Is required) • Verification Only This form is subject to policy terms,conditions,and exclusions. • CERTIFICATE HOLDER CANCELLATION , SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ashland Parks&Recreation Commission THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 340 S Pioneer St ACCORDANCE WITH THE POLICY PROVISIONS: Ashland OR 97520 AUTHORIZED REPRESENTATIVE 1 I Kaitlin Higgins " ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) ' The ACORD name and logo are registered marks of ACORD 67132253 I 21-22 WC I Susan Wilson 13/9/2022 11:04:02 AM (PST) I Page 1 of 1 '