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HomeMy WebLinkAbout2022-024 PO 20220303- Colonial Decorators Pir Purchase Order /r `Cavtl U P E COR Fiscal Y ear 20221 F lY�l�A2p�T Z39—.. Page:e: 1 of: 1 o B City of Ashland _ — ATTN: Accounts Payable Purchase L 20 E. Main Order# 20220303 Ashland, OR 97520 T Phone: 541/552-2010 O Email: payable@ashland.or.us• - V H C/O Senior Center ECOLONIAL DECORATORS I 1699 Homes Ave 545 NE WESTBROOK WAY p Ashland, OR 97520 1- GRANTS PASS, OR 97526 Phone: 541/488-5342 R T Fax: 541/488-5314 _ -�6ii3 z =4 l6]�1€[E! — --� =- -- ^- - - --- _- - --- - - - - -- - Isleen Glatt -- �-- • —� - y{E sAW-- �Ia� ®�el I J I i �z=t=li�l!<l' 1 Ia1 1J1 j�51�11 r 1®l@)== 3t f• ib!elf€(� ® 03/29/2022 6333 FOB ASHLAND OR/NET30 Cit Accounts Payable =y t ie[_�i'JE • = --_-1-15,7a: New Flooring Senior Center 1 Remove old flooring and install LVP and rubber baseboard in 1.0 $1,250.00 $1,250.00 Room 113 Computer Room at Senior Center Goods and Services Agreement($35,000 or less) Completion date: May 31, 2022 Project Account: *************** GL SUMMARY*************** 126900-602220 $1,250.00 By, �/ Date: 514-)6? =y Authors e. *nature �� `L a_ 1 a: — $1 250.00 . •• .Xii_4 4-e iie e& e—- C.4.-CM-'--- • — , . ' • . . • • I • . " I FORM #3 • CITY Of • , ! . . / i re R---11 3,2kSI-1 LAN Alt . . A:follogit Igt a:P3,11MI Mt31, OAT ' • • ./• . . REQUISITION Date of request: 031141202 . Required date for delivery: • 1 , . • . • : , .. . . . . Vender Name colonial becoratoro . • •. , Address,City,State,'Zlp 545•VVestbook Ways ;erantsPan,OR 97526 . . ! . . • - . . dontact.Name&Telephone Number Kerry Prulhiero,541•,291,493.07.,mobtlef 541,000-03.57' - I Entail address . . . • coldec5,45@gmall.com ...,..........„, ,..-„....--- . . SOURCING METHOD II Exem ti.ri.)m Competitive Min El invitation to Bid 0 Einergandt, ! . 0 Reason for exemplIon;under•$.5000 Dale approved by Council; . . 'n Form#13,.Written findings and Authorization El AMO 250 . .(Atlach copy of cominilnleellon). Cl Written OA et 000(0 attached . 1 • CI Veen itieto•tir ito•mai attached . . 'Of council approval.required,attach copy of QC) 1 R Small Preeureinent 0 Request-fer•Pronosal. ' • tooperative•Pioaurainent• • , Not exceeding S5,000' ' . Date approved by.COubelb. • [7,1 StateictOregon ' 0 DirectAward, •• .(Altach copy of coUncif conininnicalleri) Contract II . • I . 1 IN.YerbaWiltton tiioN.cir propeSal(s) ' .0 Radoest.for :(Public Works) , El State.otWashington. ' Date approved by•Cotinblir • . . . • Contract# .. • , . (Attach copy&council communication) Cl Other goverrunentageneyeentraa „intermediate Procurement D Sole Source , Agency GOODS&SERVICES. 0 Api511.ostile Form P,.B'i 7 or ii) Coritrant IL. • • I ;Greater than$5,000 and.less than.$400,000 0 Written quote or proposal attached . .interaovernmentat Artreeinent: I ID.(3)Written hids.&-solicitalloo attached' •0 Form#4,Personal Services$5K to.$151<;: •Agency • . , PERSONAL SERVICES Elate approved by Council: .. ... El Annual cost toscitydoes.not exceed$25,000,. • • , Great'ethan;s:060..and les'S than-$75,000 'Valid until ___ Agreement approved by Legal and approved/sighed by , ID .Less:than$35,600;by direct appointment 0 .80ecial•Procureindie . City Administrator,A40250,970(4) fl, (3)Written proposals 1$•S'olicItation attached LI Form#9,Request Approval: El Annual cost to chWeetls.$25,000,!Couripil 1 oForm#4,Personal Services$5K•t0$76K 0 Written quote&,propoSaletteohed approval required,(Attach copy of council communication) Date approved by Council: .Valid WM •' _Pate) .. . Description of ERV.10E$. , Total Cost . . .,. .. . ----- • - • ,' fRaMiteiataiga.M.M.SMENZ Remove old fleeting,OrevlbOlte,,and.lhiali'Lyp and rubber baseboard in Room 113 Computer likagRAISMOlie06.000. Room at Athiand'Spelor Center.Dispose or materials removed. .vI.le, •*:•‘:•1:•44eiz,!:;ta:v.iii.Al.lit,:•;:,A .v.wsititi, g.g50iPth. -1:zt-i';-i!g.:cgi*Wck,.:11:zi'iggwo • • • • ..... • . • Item#. Quantity. Unit pespription.gt:linATERIALS .. . • Unit Price. Total Cost • • . . • . - . * .90 sq ft Xi.,(leering,cola"yeflew knife° • . , . , . •• — . . • Rtib.b.et 13eseboard \ . . , . • • . . — - . . ” . . •• . . . . ,_____ ___ - • . ID .Perattaphect.quat*opOs41: • • :P.110Airdifif9 I ,=4,,,,q,,isfAii-,41,, ,,-,34.•i7z,,,:1,:::1 ay. -1.• 1.t.•-,,,,,,, ;:ir,,,,,e, . . . . ,c4t213.2,3 0 legIvia'W. Project Number__ _ __ _'',L....._ Account NumberJ !!•d :0.r.8. 0,? g '2 0 '2iii&Ue0.iftlaggi. • Accounthutriber• . . . . ..- . . .. A4Cot)nt NOW-___,.-.--••-.-.— -- . . • Txpendifpreipust.bq dI!..Orgedib the appropriate account»umberslorthe financial*,&wieldy reflect thp:a0081 expoifelPtep, .. . . • . , IT Director in collaboration with department to•atipreveAll itarewtit'a and softkiti purchases: IT DItOelet CYO •Supped',Yes]No 13y signing lids regillsliton(pinvi certify MO the Cily's-pob@.'cpritrOlIng iequireh**have boon sallstied . • 4. 1 • Employee • A 1i 51t7..2 Departnent Head . . : • . . I ... Must to orgreatar than%OM • ..Department ManageOuPerviser .City fil'anager. • (Equal to or greater than.$36,000), Functs•aptiropriateit for current fiscalyear:. 'YES 61. 01.) • . . — . . Finance Director-Aunt totitilrentartharati:000) Date 1 Comments:.lbls%post WO lie covpre0by ii Tont frpcnAlblaglPalks Nundalfon,Imp fulyisprgioldustidonglid f6rAshiand 8o nloiCentai.A:bedgebneehifreeiMeil be subettee.forApnl, • I , I . , . . ' • • i Fara3.:Requisilion ' . . ' 1 . . 1 - • • 1 . • • • . GOODS AND SERVICES AGREEMENT ($35,000 OR LESS) PROVIDER: Colonial Decorators - • CITY OF PROVIDER'S CONTACT: Kerry Prulhiere ASHLAND 20 East Main Street ADDRESS: 545 Westbook Way, Grants Pass, OR 97526 Ashland, Oregon 97520 • Telephone: 541/488-5587 PHONE: 541-660-0357 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 Colonial Decorators (a domestic business • corporation) ("hereinafter"Provider"), for materials and installation of flooring at Ashland Senior Center. 1. PROVIDER'S OBLIGATIONS • 1.1 Provide materials and install flooring in Room 113 Computer Room at Ashland Senior Center, .1699 Homes Ave,Ashland, OR 97520.Provider will remove and dispose of existing vinyl flooring and rubber baseboards; prepare and level subfloor surface; and install luxury vinyl planking, color yellow knife, and new rubber baseboards 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 suoh 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/conipleted operations coverage; and • Automobile Liability. 1.2.2 Each policy of such insurance shall be on an "occurrence" and not a "claims made" form, and shall: . • Name as additional insured "the City of Ashland, Oregon, its officers, agents and employees" with respect to claims arising out of the provision of Work under this • Agreement; • • Apply to each named and additional named insured as though,a separate policy had been issued to each,provided that the policy limits shall not be increased thereby; • Page 1 of 6: Goods and Services Agreement between the City of Ashland and Colonial Decorators • • 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 $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 relation between the assignee or subcontractor and the City. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider the sum of$1,250 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$1,250 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 • Page 2 of 6: Goods and Services Agreement between the City of Ashland and Colonial Decorators • • • • acknowledges that any Work delivered or expenses incurred without authorization as provided herein is done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement. 3. GENERAL PROVISIONS • 3.1 This is a non-exclusive Agreement. City is not obligated to procure any specific amount of Work from Provider and is free to procure similar types of goods and services from other providers in its sole discretion. 3.2 Provider is an independent contractor and not an employee or agent of the City for any purpose. .3.3 Provider is not entitled to, and expressly waives all claims to City benefits such as health and disability insurance,paid leave,and retirement. . 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 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 6: Goods and Services Agreement between the City of Ashland and Colonial Decorators' • • 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 quote dated March 8,2022. • 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. 6. TERM AND TERNIINATION • 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 May 31, 2022,.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 6: Goods and Services Agreement between the City of Ashland and Colonial Decorators . 1 • 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 otherpartyby 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—Parks and Recreation Department • • Attn: Michael Black 340 S.Pioneer Ashland, OR 97520 Phone: (541)488-5340 . With a copy to: City of Ashland—Legal Department • 20 E.Main Street Ashland, OR 97520 . Phone: (541)488-5350 • . If to Provider: Colonial Decorators Attn:Kerry Prulhiere - 545 Westbrook Way - I Grants Pass, OR 97526 . Phone: 541-660-0357 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: . 9.11..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: . • Page 5 of 6: Goods and Services Agreement between the City of Ashland and Colonial Decorators (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316,317,and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider;and (iii) Any rules, regulations,charter provisions, or ordinances that implement or enforce any of , the foregoing tax laws or provisions. • 9.2 Provider's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Provider's warranty, as set forth in this Article 9, shall constitute a material breach of this Agreement.. Any material breach of this Agreement shall entitle the City to.terminate this Agreement and to seek damages and any other relief available under this Agreement,at law,or in equity. IN WITNESS WHEREOF the parties have caused this Agreement to be signed in their respective names by their duly authorized representatives as of the dates setforth below. Colonial Deco ator ROVIDER : CITY OF ASHLAND: � � By: i%G� 3LiJ c9. 23 Signature • Signature/ Michael A. Black Kaeg? �r� 1IA/ e l2e- Printed Name Printed Name . Director, APRC C5GGJGeit /�/i2 `/Ne rL. • Title �Title • p / 3/18/22 / /6 ! 2 Date Date • (W-9 is to be submitted with this signed Agreement) Purchase Order No. �r0 v D • • • Page 6 of 6: Goods and Services Agreement between the City of Ashland and Colonial Decorators • Proposal • • DECORATORS - . 545 WESTBROOK WAY GRANTS PASS, OR 97526 . --.9 I-e,' --...5-'11 -3 63 - 211 3 479-3192 , PROPOSAL BMITTED TO �► PHONE _ DATE 9 • S l �'c e.,„ort Ceiv a .��i'�-019.'- 3'3 4°2 Si' 2 ` 22-- . \ STREET. Z- STREET. JOB NAME . 1 ,2•O /710h-7es -de—. ' . CITY, STATE AND'N/D'ZIP CODE 'JOB JOB LOCATION �F ' r S 1 C JOB PHONE ARCHITECT DATE OF PLANS • We hereby submit specifications and estimates for: l ree0m 'W//.� ci1r!JiQt�L -1— t2 �a0 - gu dde ot her-,,-e G,,,7 — diiligne- .�- /.-,i- 4/i /u(2-1-' . yzi.d66ek 4,1-Ite .4" X L f�0 n.iN) a-,"L0'z-. • • Z 5-`' lot:,✓ i6v/fie. , pi,e-L4.,id-P-4 F/..,,,n pee p. • i!t r Propose hereby to furnish material and labor —complete in accordance with above specifications, for the sum of:/) SO dollars($ 62-51-0 )• Payment to be made as follows: / All material is guaranteed to be as specified.A II work to be completed in a workmanlike Autho lied / • manner according to standard practices.Any alteration or deviation from above specifics• tions involving extra costs will be executed only upon written orders,and will become an Signature extra charge over and above the estimate.All agreements contingent upon strikes,accidents • Note This proposalbe or delays beyond our control.Owner to carry fire,tornado and other necessary insurance. p may • Our workers are fully covered byWorkmen's Compensation Insurance. withdrawn by us if not accepted withindays. Arrrptat re tit Proposal—The above prices,specifications • and conditions are satisfactory and are hereby accepted. You are authorized Signature_ • ' to do the worts as specified,Payment will be made as outlined above. Signature • ) Date of Acceptance: e F _______________ . froptioat , • COLONIAL , • DECORATORS ,. 545 WESTBROOK WAY GRANTS PASS, OR 97526 • .i;Lew -. ii -363 211 3 479-3192 PROPOSALD OMITTEDTOPHONENE /� S h ,,/41 1%/d ail//0._ a g- - 7/ T•,fd'� J 3(i1r2 DATE�� �2 L • STREET JOU NAME j • J 4,e20 /,gip n.i 42..s ,v-. . CITY.STATE AN ZIP CODE JOU LOCATION RSItL�6..� " Sm eller ARCHITECTJ011PHONE DATE OF PLANS • • . • We hereby submit specifications and estimates for: ? . i? /�V r:e1 m u 71e�Z. /24 0�-1 Ou,�t aft"i ova. X d/JP6fe a,1/2/3 "NI"). v"4'' L fLop'el ": ' • -� r�u 66�.� />>a,y.e 6��2c+2s — i$yes „."..s-- /,, /u'� • /2 It IP,t 4,' e . c �"'X L /4.'4°'n i,.•; G a 40 a �} 5-(-3 , . eft c,c.c. ,�w,'Pe. .-- /.i.e..l...i d./.4 F/-4a lz pled eo. • I • . • • . I• . 3Ale, iro}tdiie hereby to furnish material and labor =complete in accordance with above specifications, for the sump of:' dollars($ 1) as O )' Payment to be made as follows: L • • All material Is guaranteed to'be as specified.All work to he completed In a workmanlike y f manner according to standard practices.Any alteration or deviation from above specllica•. SigAunature / lions involving extra costs will be executed only upon written orders.end will become an 8 extra charge over and above Ills estimate.All agreements contingent upon strikes,accidents Note:This o osal mti be or delays beyond our control.Owner to�carry fire,tornado and other necessary Insurance. withdrawn byi1 hrr accepted within days. Our workers are fully covered by Workmen's Compensation Insurance. wrawn us not Act ptunrr of Prnpn,aUl—The above prices,specifications . Signature_ and conditions are satisfactory and are hereby accepted. You are authorized • to do the work as specified.Payment will be ade as outlined above. 3I 1o/vz_ Signature Date,of Acceptance: j \ . . ® AcoRD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) �� 03/25/2022 • 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). PRODUCERCONTACT Hart Insurance,Agency PHONE •Julie,A Maphet FAX •' PO Box 1240 INC.No.Ext): (541) 479-5521 (A/C,No):(541) 474-1209 E-MAIL ADDRESS: imaphet@hartinsurance.com Grants Pass OR 97528 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:MassaChusetts Bay Ins Co 22306 INSURED (541) 479-3192 INSURER B:Hanover American Insurance Co 36064 Colonial Decorators • INSURERC:Allmerica Financial Benefit In 41840 545 Westbrook Way INSURERD: Grants Pass OR 97526 INSURER E: • INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 22078 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 SUER POLICY NUMBER (MMIDD�) (MOD/WW1 LIMITS' LTR INRD WVD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 AMAGE TO RENTED CLAIMS-MADE X OCCUR Y OD2A744404 10/01/2021 10/01/2022 PREM SES Ea occurrence) $ 1,000,000 . MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ AUTOMOBILEUABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) C ANY AUTO Y AW2D399902 10/01/202110/01/2022 BODILYINJURY(Perperson) $ • OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED ) PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) $ • • UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORB ANDEMPL EMPLOYERS' YIN WH2A744407 10/01/2021 10/01/2022 X PER UTE ERH EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVENIA E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? • (MandatorylnNH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes.describe under • DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 $ . $ DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Certificate holder is listed as additional insured where required by written contract per attached • form 391-1006. • Ashland Oregon, its officers, agents and employees are included as Additional Insured per attached endorsement, CA2048 02 99 for the auto and 391-1006 for the General Liability. CERTIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. • 20 E Main St AIITHoRizEDREPRESENTATIVE Ashland OR 97520 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD , Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS LIABILITY SPECIAL BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM • SUMMARY OF COVERAGES Limits Page 1. Additional Insured by Contract,Agreement or Permit Included 1 2. Additional Insured—Broad Form Vendors Included 2 3. Alienated Premises Included 3 4. Broad Form Property Damage—Borrowed Equipment, Customers Included 3 • Goods and Use of Elevators 5. Incidental Malpractice(Employed Nurses, EMT's and Paramedics) Included 3 6. Personal and Advertising Injury—Broad Form Included 4 7. Product Recall Expense Included 4 Product Recall Expense Each Occurrence Limit $25,000 Occurrence 5 Product Recall Expense Aggregate Limit $50,000 Aggregate 5 Product Recall Deductible $500 5 8. Unintentional Failure to Disclose Hazards Included• 6 9. . Unintentional Failure to Notify Included 6 This endorsement amends coverages provided under the Businessowners Coverage Form through new ' coverages and broader coverage grants. This coverage is subject to the provisions applicable to the Businessowners Coverage Form, except as provided below. The following changes are made to SECTION II — (2) Premises you own, rent, lease or occupy; LIABILITY: . or 1. Additional Insured by Contract, Agreement or (3) Your maintenance, operation or use of Permit equipment leased to you. The following is added to SECTION II — b. The insurance afforded to such additional " LIABILITY, C.Who Is An Insured: ' insured described above: • Additional Insured by Contract, Agreement or (1) Only applies to the extent permitted by' Permit law; and a. Any person or organization with whom you (2) Will not be broader than the insurance agreed in a written contract,written agreement which you are required by the contract, or permit to add such person or organization • ,agreement or permit to provide for such as an additional insured on your policy is an additional insured. additional insured only with respect to liability , (3) Applies on a primary basis if that is for "bodily injury", "property damage", or required 'by the written contract, written "personal and advertising injury" caused, in agreement or permit. whole or in part, by your acts or omissions, or the acts or omissions of those acting on your (4) Will not be broader than coverage behalf, but only with respect to: provided to any other insured. (1) "Your work" for the additional insured(s) (5) Does not apply if the "bodily injury", designated in the contract, agreement or . "property damage" or "personal and permit; advertising injury" is otherwise excluded from coverage under this Coverage Part, including any endorsements thereto. 391-1006 0816 Includes copyrighted materials of Insurance Services Offices,Inc.,with its permission. Page 1 of 6 ( c. This provision does not apply: The most we will pay on behalf of the (1) Unless the, written contract or written additional insured for a covered claim is the agreement was executed or permit was lesser of the amount of insurance: ' issued prior to the"bodily injury", "property 1. Required by the contract, agreement or g dama e" or "personalg injury and. permit described in Paragraph a.; or advertising injury". 2. Available under the applicable Limits of (2) To any person or organization included as Insurance shown in the Declarations. an insured by another endorsement This endorsement shall not increase the issued by us and made part of this applicable Limits of 'Insurance shown in the Coverage Part. Declarations (3) To any lessor of equipment: e. All other insuring agreements, exclusions, and (a) After the equipment lease expires; or conditions of the policy apply. (b) If the "bodily injury", "property 2. Additional Insured—Broad Form Vendors damage", "personal and advertising The following is added to SECTION II — injury" arises out of sole negligence of ' LIABILITY,C.Who Is An Insured: the lessor (4).To any: Additional Insured—Broad Form Vendors a. Any person or organization that is a-vendor (a) Owners or other interests from whom with whom you agreed in a written contract or land has been leased if the "occurrence" , takes place or the written agreement to include as an additional offense is committed after the lease insured under this Coverage Part is an for the land expires; or insured, but only with respect to liability for "bodily injury" or"property damage" arising out (b) Managers or lessors of premises if: of"your products"which are distributed or sold (i) The "occurrence" takes place or in the regular course of the vendor's business. the offense is committed after you • b. The insurance afforded to such vendor cease to be a tenant in that described above: premises; or • (1) Only applies to the extent permitted by (ii) The "bodily Injury", "property law; damage", "personal injury" or (2) Will not be broader than the insurance I "advertising injury" arises out of structural alterations, new con- which you are.required by the contract or struction or demolition operations agreement to provide for such vendor; performed by or on behalf of the (3) Will not be broader than coverage manager or lessor. provided to any other insured; and (5). To "bodily injury", "property damage" or (4) Does not apply if the "bodily injury", "personal and advertising injury" arising "property damage" or "personal. and • out of the rendering of or the failure to advertising injury" is otherwise excluded render any professional services. from coverage under this Coverage;Part, This exclusion applies even if the claims including any endorsements thereto against any insured allege negligence or c.. With .respect to insurance afforded to such other wrongdoing in the supervision, vendors, the following additional exclusions hiring, employment, training or monitoring apply: • of others by that insured, if the The insurance afforded to the vendor does not "occurrence" which caused the "bodily apply to: injury" or"property damage" or the offense (1) "Bodily injury" or "property damage" for which caused the "personal and which the vendor is obligated to pay advertising injury" involved the rendering damages by reasons of the assumption of of or failure to render any professional services by or for you. liability in a contract or agreement. This exclusion does not apply to liability for d. With respect to the insurance afforded to damages that the insured would have in these additional insureds, the following is the absence of the contract or agreement; added to SECTION II — LIABILITY, D. Liability and Medical Expense Limits of (2) Any express warranty unauthorized by Insurance: you; 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices,Inc.,with its permission. Page 2 of 6 (3) Any, physical or chemical change in the . The most we will pay on behalf of the vendor product made intentionally by the vendor; for a covered claim is the lesser of the amount • (4) Repackaging, unless unpacked solely for of insurance: the purpose of inspection, demonstration, 1. •Required by the contract or agreement _ testing, or the substitution of parts under - described in Paragraph a.; or instruction from the manufacturer, and 2. Available under the applicable•Limits of then repackaged in the original container; Insurance shown in the Declarations; , " (5) Any failure to make ,such inspection, This endorsement shall not increase the adjustments, tests or servicing as the applicable Limits of Insurance shown in the vendor has agreed to make or normally Declarations. undertakes to make in the usual course of business in connection with the sale of the 3. Alienated Premises • product; SECTION ll — LIABILITY,, B. Exclusions, 1. (6) Demonstration, installation, servicing or Applicable To Business Liability Coverage k. repair operations, except such operations Damage to Property, paragraph (2) is replaced performed at the vendor's premises in by the following: . connection with the sale of the product; (2) Premises you sell, give away or abandon, if (7) Products which, after distribution or sale the"property damage"arises out of any part of by you, have been labeled or relabeled or those premises and occurred from hazards used as a container, part or ingredient of that were known by you, or should have any,other thing or substance by or for the reasonably been known by-you, at the time the vendor; property was transferred or abandoned. 8 • "Bodilyinjury" or "property dama e" 4. Broad Form Property Damage — Borrowed ( ) ' the Equipment, Customers Goods, Use of • arising out of the sole negligence of vendor for its own acts or omissions or , Elevators • J those of its employees or anyone else a. The following is added to SECTION II actingon its behalf. However, this LIABILITY, B. Exclusions, 1. Applicable To exclusion does'not apply to: Business Liability Coverage,-k. Damage to (a) The exceptions contained within the Property: exclusion in subparagraphs (4) or (6) Paragraph (4)' does not apply to "property above; or damage" to borrowed equipment while at a (b) Such inspections, adjustments, tests jobsite and not being used to perform or servicing as the vendor has agreed operations. to make or normally undertakes to Paragraph (3), (4) and (6) do not apply to make in the usual course of business, "property damage"to "customers goods"while in 'connection with the-distribution or on your premises nor to the use of elevators. sale of the products. b. For the purposes of this endorsement, the (9) "Bodily injury" or "property damage" following definition is added to SECTION II — arising out of an "occurrence" that took LIABILITY, F. Liability and Medical place before you have signed the contract Expenses Definitions: or agreement with the vendor. 1. "Customers goods" means property of (10)To any person or organization included as your customer on your premises for the an insured .by another endorsement purpose of being: issued by us and made part of this a. Worked on; or Coverage Part. (11)Any insured person or organization,.from b. Used in your manufacturing process. whom you have acquired such products, c. The insurance afforded under this provision is or any ingredient, part or container, excess over any other valid and collectible entering into, accompanying or containing property insurance (including deductible) such products. available to the insured whether primary, d. With .respect to' the insurance afforded to excess, contingent or on any other basis. these vendors, the following is added to 5. Incidental Malpractice — Employed Nurses, SECTION II LIABILITY, D. Liability.and _ EMT's and Paramedics Medical Expense Limits of Insurance: SECTION ll —LIABILITY, C.Who Is An Insured, paragraph 2.a.(1)(d) does not apply to a nurse, .391-1006 08 16 Includes copyrighted materials of Insurance Services Offices,Inc.,with its permission. Page 3 of 6 emergency medical technician. or paramedic o. Recall of Products, Work or Impaired employed by you if you are not engaged in the Property is replaced by the following: • business or occupation of providing medical, o. Recall of Products, Work or Impaired paramedical, surgical, dental, x-ray or nursing Property services. 6. Personal Injury—Broad Form Damages claimed for any loss, cost or, expense incurred by you or others for the a. SECTION II — LIABILITY, B. Exclusions, 2. loss of use, withdrawal, recall, inspection, Additional Exclusions Applicable only to repair, replacement, adjustment, removal "Personal and Advertising Injury", or disposal of:' paragraph e. is deleted. (1) "Your product"; b. SECTION II — LIABILITY, F. Liability and (2) "Your work"; or Medical Expenses.Definitions, 14. "Personal and advertising injury", paragraph b. is (3) "Impaired property"; replaced'by the following: . If such product, work or property is b. Malicious prosecution or abuse of withdrawn or recalled from the market or process. from use by any person or organization c. The following is added to SECTION II — because of a known or suspected defect, LIABILITY, F. Liability and Medical • deficiency, inadequacy or. dangerous . 14. condition in it, but this exclusion does not Expenses Definitions, Definition "Personal and advertising injury": . apply to"product recall expenses"that you incur for the "covered recall" of "your "Discrimination" (unless insurance thereof is product". prohibited by law) that results in 'injury to the However, the exception to the exclusion feelings or reputation of a natural person, but does not apply to "product recall only if such"discrimination" is: ` expenses" resulting from: (1) Not done intentionally by or at the (4) Failure of any products to accomplish direction of: their intended'purpose; (a) The insured; (5) Breach of warranties of fitness, • (b) Any officer of the corporation, director, quality, durability or performance; stockholder, partner/or member of the (6) Loss of customer approval, or any insured; and cost incurred to regain customer (2) Not directly or indirectly related to an approval; • "employee", not to the employment, (7) Redistribution or replacement of"your prospective employment or termination of product" which has been recalled by any person or persons by an insured. like products or substitutes; d. For purposes of , this endorsement, the following definition is added to SECTION II — (8) Caprice or whim of the insured; LIABILITY, F. Liability and Medical (9) A condition likely to cause loss of Expenses Definitions: ' which.any insured knew or had reason 1. "Discrimination" means the . unlawful to know at the inception of this • treatment of individuals based upon race, insurance; color, ethnic origin, gender, religion, age, (10)Asbestos, including loss, damage or or sexual preference. "Discrimination" clean up resulting from asbestos or does not include the unlawful treatment of asbestos containing materials; or individuals based upon developmental, , (11)Recall of"your products" that have no physical, cognitive, mental, 'sensory or known or suspected defect' solely emotional impairment or any combination because a known or suspected defect . of these. in another of"your products" has been e. This coverage does not apply if liability found. coverage for "personal and advertising injury" b'. The following is added to SECTION II — - is excluded either by the provisions of the LIABILITY, C.Who Is An Insured, paragraph Coverage Form or any endorsement.thereto. 3.b.: 7. Product Recall Expense "Product recall expense" arising out• ofany a. SECTION II — LIABILITY, B. Exclusions, 1. withdrawal or recall that occurred before you Applicable To Business Liability Coverage, acquired or formed the organization. 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices,Inc.,with its permission. Page 4 of 6 c. The following is added to SECTION II — a deductible amount, you shall promptly LIABILITY, D. Liability and Medical reimburse us for the part of the deductible Expenses Limits of Insurance: amount we paid. Product Recall Expense Limits, of The Product Recall Expense Limits of Insurance _Insurance apply separately to each a. The Limits of Insurance shown in the consecutive annual , period and to any SUMMARY OF COVERAGES of this remaining period of less than 12 .months, endorsement and the rules stated below starting with the beginning of the policy period fix the most that we will pay under this shown in the Declarations, unless the policy Product Recall Expense Coverage ' period is extended after issuance for an regardless of the number of: additional period of less than 12 months. In that case; the additional period will be deemed (1) Insureds; part of the last preceding period for the (2) "Covered Recalls initiated; or purposes ' of determining the Limits of (3) Number of"your products"withdrawn. Insurance. b. The Product Recall Expense Aggregate d. The following is added to SECTION II — Limit is the most that we will reimburse LIABILITY, E. Liability and Medical you for the sum of all "product recall Expense General Conditions, 2. Duties in expenses" incurred for all"covered recalls" the Event of Occurrence, Offense, Claim or , initiated during the policy period. Suit: c. The Product Recall Each Occurrence Limit You must see to it that the following are done is the most we will pay in connection with in the event of an actual or anticipated any one defect or deficiency. "covered recall" that may result in "product. recall expense": d. All"product recall expenses" in connection (1)"Give us prompt notice of any discovery or with substantially the same general notification that "your product" must be harmful condition will be deemed to arise withdrawn or recalled. Include a out of the same defect or deficiency and considered one"occurrence". description of "your product" and the reason for the withdrawal or recall; e. Any amount reimbursed for"product recall (2) Cease any further release, shipment, expenses" in connection with any one consignment or any other method of "occurrence"will reduce the amount of the distribution of like or similar products until Product Recall Expense Aggregate Limit it has been determined that all such available for reimbursement of "product products are free from defects that could recall expenses" in connection with any be a cause of loss under this insurance. other defect or deficiency. f. If the Product Recall Expense Aggregate e. For the purposs of this endorsement, the Limit has been reduced by reimbursement ;following definitions are added to SECTION II of"product recall expenses" to an amount — LIABILITY, F. Liability and Medical that is less than the Product Recall Expenses Definitions: , Expense Each Occurrence .Limit, the 1. "Covered recall" means a recall made remaining Aggregate Limit is the most that necessary because you or a government will be available for reimbursement of • body has determined that a known or "product recall expenses" in connection suspected defect, deficiency, inadequacy, with any other defect or deficiency. . or dangerous condition in "your product" has resulted or,will result in "bodily injury" g. Product Recall Deductible or"property damage". We will only pay for the amount of 2. "Product recall expense(s)"means: "product recall expenses" which are in excess of the $500 Product Recall a. Necessary and reasonable expenses Deductible.The Product Recall Deductible "' for: applies separately to each "covered (1) Communications,, including radio recall". The limits of insurance will not be or television announcements. or reduced by the amount of this deductible. printed advertisements including We may, or will if required by law, pay all 1 stationary, envelopes and or any part of any deductible amount, if postage; • applicable. Upon notice of our payment of 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices,Inc.,with its permission. Page 5 of 6 (2) Shipping the recalled products (1) If the "products — completed operations from any purchaser, distributor or hazard" is excluded from coverage under user to the place or places this Coverage Part including any designated by you; endorsement thereto; or (3) Remuneration paid to your regular (2) To "product recall expense" arising out of "employees" for necessary any of "your products" that are otherwise overtime; excluded from coverage under this (4) Hiring additional persons, other Coverage Part including endorsements than your regular"employees"; thereto. (5) Expenses incurred by 8. Unintentional Failure to Disclose Hazards "employees" including The following is added to SECTION II — transportation and LIABILITY, E Liability and Medical Expenses accommodations; General Conditions: (6) Expenses to rent additional Representations warehouse or storage space; We will not disclaim coverage under this Coverage (7) Disposal of "your product", but Part if you fail to disclose all hazards existing as of only to the extent that specific the inception date of the policy provided such methods of destruction other than failure is not intentional. those employed for trash 9, Unintentional Failure to Notify discarding or disposals are required to avoid "bodily injury" or The following is added to SECTION II — "property damage" as a result of LIABILITY, E. Liability and Medical Expenses such disposal, General Conditions, 2. Duties in the Event of you incur exclusively for the purpose Occurrence, Offense,Claim or Suit: of recalling"your product"; and Your rights afforded under this Coverage Part b. Your lost profit resulting from such shall not be prejudiced if you fail to give us notice "covered recall". of an "occurrence", offense, claim or "suit", solely due to your reasonable and documented belief f. This Product Recall Expense Coverage does that the "bodily injury", "property damage" or not apply: "personal and advertising injury" is not covered under this Policy. • ALL OTHER TERMS, CONDITIONS,AND EXCLUSIONS REMAIN UNCHANGED. • 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices,Inc.,with its permission. Page 6 of 6 Hanover • Insurance Group_ AW2D399902 0901601 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED • This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM. GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE•FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: Countersigned By: Named Insured: (Authorized Representative) SCHEDULE Name of Person(s) or Organization(s): CITY OF ASHLAND 1699 HOMES AVENUE ASHLAND, OR 97520 • (If no entry appears above, information required to complete this endorsement will be shown in the Decla- rations as applicable to the endorsement) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision con- tained in Section II of the Coverage Form. • • CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 R® ACCPRE) - CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 03/14/2022 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 ' CONTACT NAME: Julie A Maphet Hart Insurance Agency PHONE 541) 479-5521 • FAX A C,NoI:(541) 474-1209 PO Box 1240 (AIC.No,Extl: E-MAIL ADDRESS: imaphet@hartinsurance.com / Grants Pass OR 97528 • INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Massachusetts Bay Ins Co 22306 INSURED (541) 479-3192 INSURER B:Hanover American Insurance Co 36064 Colonial Decorators INSURER C:Allmerica Financial Benefit In 41840 545 Westbrook Way INSURERD: Grants Pass OR 97526 INSURER E: , INSURER F: COVERAGES CERTIFICATE NUMBER...cert ID 22078 ' REVISION NU /: R: ' • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ': E FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUME WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE.ISSUED OR MAY PERTAIN, HE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HE— IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. I IMITS SHOWN.MAY HAVE BEEN REDUCED BY PAID CLAIMS: INSR - ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 • DAMAGE TO RENTED CLAIMS-MADE X OCCUR Y Y OD'A744404 10/01/202110/' /2022 PREMISES(Ea occurrence) $ 1,000,000 MED EXP(Any one person) ' $ 10,000 . PERSONAL&ADV INJURY $ 2,000,000 GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PRO- JECT LOC I PRODUCTS-COMP/OPAGG $ 4,000,000 • OTHER: • AUTOMOBILE LIABILITY (Ea acccidentSINGLE LIMIT $ 1,000,000 C ANY AUTO AW2D399902 ' 10/01/202110/01/2022 BODILYINJURY(Perperson) $ OWNED -.• SCHEDULED BODILY INJURY(Per accident) .$ AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED (Per accident) • $ • X AUTOS ONLY X AUTOS ONLY UMBRELLA LIAB OCCUR • EACH OCCURRENCE $ • EXCESS UAB CLAIMS-MADE • AGGREGATE $ DED ' RETENTION$' $ WOR KERS COMPENSATION , WH2A74• 07 10/01/2021 10/01/2022 X PEATUTE 0TH B AND EMPLOYERS'LIABILITY Y IN ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBEREXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 $ DESCRIPTION OF OPERATIONS/LOCATIONS/11E, CLES(ACORD 101,Additional Remarks Schedule,may be attached If mo-space Is required) • Certificate holder is listed -s additional insured where required by writt= contract per attached form 391-1006Ashland Oregon its officers, agents and employees are include. as Additional Insured per attached. • CERTIFICATE HOLDER CANCELLATION -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 'ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland_. 20 E Main St AUTHORIZED REPRESENTATIVE Ashland OR 97520 I • • ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) - The ACORD name and logo are registered marks of ACORD Page 1 of 1 ' '