Loading...
HomeMy WebLinkAbout2022-053 PO 20230033- Rogue Valley Backflow Services LLC ,�,��,�� Purchase Order Fri �, CITE f; tr�t'til�, Fiscal Year 2023 Page: 1 of: 1 B City of Ashland I ATTN: Accounts Payable 20 E. Main Purchase 20230033 Ashland, OR 97520 Order# T Phone: 541/552-2010 0 Email: payable@ashland.or.us V H CIO Facilities Maintenance Div E ROGUE VALLEY BACKFLOW SERVICES LLC I 90 North Mountain Ave N 10 ALLEN LANE p Ashland, OR'97520 O TALENT, OR 97540 Phone: 541/488-5358 R T Fax: 541/552-2304 S B(37 OrT01:0177Hr t-ssti fll=1 U T1�5 —E 4 — David Arnold --�- DalccOxierisite l pi g_>a- tq.E-g- l g a 5: _. s � a HI.. ;=e 06/10/2022 1770_ FOB ASHLAND OR/NET30 CityAccounts Payable afelf*Backflow Services FY 23 1 Backflow Services for FY 23 1.0 • $4,000.00 $4,000.00 Goods and Services Agreement($35,000 or Less) Completion date: 06/30/2023 Project Account: *************** GL SUMMARY*************** 088400-602400 $4,000.00 • By: AfiL Date: ✓�( ��/� Autho-ze Signaturelir P i .4 000.00 FORM #3 ° CITY OF ASHLAND A request for a Purchase Or Pr' ,— , 6:1—t V REQUISITION • Date of request: 5/24/2022 • Required date for delivery: Vendor Name Rogue Valley Backflow Service • Address,City,State,Zip 10 Allen Lane,Talent, OR 97540 ' Contact Name&Telephone Number Erin Akers 541-482-9464 rvbackflowRgmail.com • Email address SOURCING METHOD . ❑ Exempt from Competitive Bidding 0 Invitation to Bid 0 Emergency ❑ Reason for exemption: Date approved by Council: 0 Form#13,Written findings and Authorization , ❑ AMC 2.50 _(Attach copy of council communication) 0 Written quote or proposal attached ❑ Written quote or proposal attached _(If council approval required,attach copy of CC) ® Small Procurement 0 Request for Proposal Cooperative Procurement Not exceeding$5,000 Date approved by Council: 0 State of Oregon ® Direct Award. (Attach copy of council communication) Contract#. ❑ Verbal/Written quote(s)or proposal(s) 0 Request for Qualifications(Public Works) 0 State of Washington Date approved by Council: Contract# (Attach copy of council communication) 0 Other government agency contract Intermediate Procurement ❑ Sole Source Agency GOODS&SERVICES ❑ Applicable Form(#5,6,7 or 8) Contract# Greater than$5,000 and less than$100,000 0 Written quote or proposal attached Intergovernmental Agreement , ❑ (3)Written bids and solicitation attached 0 Form#4,Personal Services$5K to$75K Agency PERSONAL SERVICES Date approved by Council: 0 Annual cost to City does not exceed$25,000. Greater than$5,000 and less than$75,000 Valid until: (Date) , Agreement approved by Legal and approved/signed by ❑ Less than$35,000,by direct appointment ❑ Special Procurement City Administrator.AMC 2.50.070(4) ❑ (3)Written proposals&solicitation attached 0 Form#9,Request for Approval i 0 Annual cost to City exceeds$25,000,Council ❑ Form#4,Personal Services$5K to$75K 0 Written quote or proposal attached approval required.(Attach copy of council communication) Date approved by Council: , Valid until: (Date) Description of SERVICES Total Cost Backflow services for FY23 $4,000.00 Item # Quantity Unit Description of MATERIALS Unit Price Total Cost 1. $0 $0.00 • . $0 $0.00 $0 $0.00 ❑ Per attached quotelproposal 'TOTAL,COST • Project Number: _ _ Account Number: 088400-602400 $$0.00 • *Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaborationwith department t pprovy all hardware and software purchases: IT Director. Date Support-Yes/No By signing this regui ,;;;_orco edify that th City's public ntracting requirements have been satisfied. Employee: v Y�j—.' Department He • `a1z4zZ" (Eq I to or greater than$5,000) Department Manager/Supervisor: • •City Ma ager: r (Greater than$35, 00) Funds appropriated for current fiscal year: Y� / NO 6q-f/f'-� Fi nce rector-(Equal to or greater than$5,000) Date Comments: Form#3-Requisition • • GOODS AND SERVICES AGREEMENT ($35,000.OR LESS) PROVIDER: Rogue Valley Backflow Service CITY OF PROVIDER'S AS H LAN D CONTACT: • Erin Akers • • 20 East Main Street Ashland,Oregon 97520 ADDRESS: 10 Allen Lane Telephone: 541/488-5587 Talent,OR 97540 °Fax: 541/488-6006 PHONE: 541-482-9464 This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and Rogue Valley Backflow Service, (a domestic/foreign business corporation)("hereinafter"Provider"), for backflow services. 1. PROVIDER'S OBLIGATIONS 1.1 Provide backflow services for FY23 as set forth in the"SUPPORTING DOCUMENTS"attached hereto and,by this reference, incorporated herein. Provider expressly acknowledges that time is of the essence of any completion date set forth in the SUPPORTING DOCUMENTS,and that no waiver or extension of such deadline may be authorized except in the same manner as herein provided for authority to exceed the maximum compensation. The services defined and described in the "SUPPORTING DOCUMENTS" shall hereinafter be collectively referred to as"Work." 1.2 Provider shall obtain and maintain during the term of this Agreement and until City's final acceptance of all Work received hereunder, a policy or policies of liability insurance including commercial general liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 (two million dollars)per occurrence for Bodily Injury and Property Damage. 1.2.1 The insurance required in this Article shall include the following coverages: . ▪ Comprehensive General or Commercial General Liability, including personal injury, contractual liability,and products/completed operations coverage; and • • Automobile Liability. 1.2.2 Each policy of such insurance shall be on an "occurrence" and not a"claims made" form,and shall: • Name as additional insured "the City of Ashland, Oregon, its officers, agents and employees" with respect to claims arising out of the provision of Work under this Agreement; • Apply to each named and additional named insured as though a separate policy had been issued to each,provided that the policy limits shall not be increased thereby; • • Apply as primary coverage for each additional named insured except to the extent that two or more such policies are intended to "layer" coverage and, taken together, they provide total coverage from the first dollar of liability; • Provider shall immediately notify the City of any change in insurance coverage • Provider shall supply an endorsement naming the City, its officers, employees and agents as additional insureds by the Effective Date of this Agreement; and • • Be evidenced by a certificate or certificates of such insurance approved by the City. Page 1 of 6: Goods and Services Agreement between the City of Ashland and Rogue Valley Backflow Service • • • 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 Prov.ider. 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 befully 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 hourly rates effective 4/13/2022 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$4,000 (this is maximum, not to exceed amount of ENTIRE Agreement) without express, written approval from the City official whose signature appears below, or such official's successor in office. Provider expressly. acknowledges that no other person has authority to order or authorize additional Work which would cause this maximum sum to be exceeded and that any authorization from the responsible official must be in writing. Provider further acknowledges that any Work delivered or expenses incurred without authorization as provided herein is done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement. 3. GENERAL-PROVISIONS 3.1 This is a.non-exclusive Agreement. City-is not obligated to procure any specific amount of Work from Provider and is free, to procure similar types of goods and services from other providers in its sole discretion. • Page 2 of 6: Goods and Services Agreement between the City of Ashland and Rogue Valley Backflow Service • 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 thedistrict of,Oregon. Each party expressly waives any and all rights to maintain an action under this Agreement in any other venue, and expressly consents that, upon motion of the other party, any case may be dismissed or its venue transferred, as appropriate, so as to effectuate this choice of venue. 3.8 Provider shall defend,save,hold harmless and indemnify the City and its officers,employees and agents from and against any and all claims, suits, actions, losses, damages, liabilities, costs, and expenses of any nature resulting from, arising out of, or relating to the activities of Provider or its officers, employees, contractors,or agents under this Agreement. 3.9 Neither party to this Agreement shall hold the other responsible for damages or delay in performance caused by acts of God, strikes,lockouts,accidents,or other events beyond the control of the other or the other's officers,employees or agents. ' 3.10 If any provision of this Agreement is found by a court of competent jurisdiction to be unenforceable, such provision shall not affect the other provisions, but such unenforceable provision shall be deemed modified to the extent necessary to render it enforceable,preserving to the fullest extent permitted the intent of Provider and the City set forth in this Agreement. 3.11 Deliveries will be F.O.B destination. Provider shall pay all transportation and handling charges for the Goods.Provider is responsible and liable for loss or damage until final inspection and acceptance of the Goods by the City. Provider remains liable for latent defects, fraud, and warranties. 3.12 The City may inspect and test the Goods. The City may reject non-conforming Goods and require Provider to correct them without charge or deliver them at a reduced price, as negotiated_ If Provider does not cure any defects within a reasonable time, the City may reject the Goods and cancel this Agreement in whole or in part. This paragraph does not affect or limit the City's rights, including its rights under the Uniform Commercial Code,.ORS Chapter 72 (UCC). 3.13 Provider represents and warrants that the Goods are new, current, and fully warranted by the manufacturer. Delivered Goods will comply with SUPPORTING DOCUMENTS and be free from •• defects in labor, material and manufacture.Provider shall transfer all warranties to the City. Page 3 of 6:, Goods and Services Agreement between the City of Ashland and Rogue Valley Backflow Service 4. SUPPORTING DOCUMENTS 4.1 The following documents are, by this reference, expressly incorporated in this Agreement, and are collectively referred to in this Agreement as the "SUPPORTING DOCUMENTS:" • The Provider's complete written Rate Sheet dated April 13,2022. • 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.L•1 Termination of this Agreement; 5.1.2 Withholding all monies due for the Work that Provider has failed to deliver within any scheduled completion dates or any Work that have been delivered inadequately or defectively; 5.1.3 Initiation of an action or proceeding for damages, specific performance, or declaratory or injunctive relief; 5.1.4 These remedies are cumulative to the extent the remedies are not inconsistent,and City may pursue any remedy or remedies singly,collectively, successively or in any order whatsoever. 5.2 In no event shall City be liable to Provider for any expenses related to termination of this Agreement or for anticipated profits. If previous amounts paid to Provider exceed the amount due,Provider shall pay immediately any excess to City upon written demand provided. 6. TERM AND TERMINATION 6.1 Term This Agreement shall be effective from the date of execution on behalf of the City asset forth below (the "Effective Date"), and shall continue in full force and effect until June 30, 2023, unless sooner terminated as provided in Subsection 6.2. 6.2 Termination 6.2.1 The City and Provider may terminate this Agreement by mutual agreement at any time. 6.2.2 The City may,upon not less than thirty(30) days' prior written notice,terminate this Agreement for any reason deemed appropriate in its sole discretion. 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 lawor equity. 7. NOTICE •Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery, by sending via a reputable commercial overnight courier, or by mailing using registered or certified United States mail, return receipt requested, postage prepaid, to the address set forth below: If to the City: • Page 4 of 6: Goods and Services Agreement between the City of Ashland and Rogue Valley Backflow Service • City of Ashland—Facilities Maintenance Department Attn: David Arnold 20 E. Main Street Ashland, Oregon 97520 Phone: (541)552-2292 ' With a copy to: City of Ashland—Legal Department 20 E. Main Street Ashland,OR 97520 Phone: (541)488-5350 If to Provider: • Rogue Valley Backflow Service Attn: Erin Akers 541-482-9464 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 anysubsequent breach,whether or not of the same nature. 9. PROVIDER'S COMPLIANCE WITH TAX LAWS 9.1 Provider represents and warrants to the City that: 9.1.1 Provider shall, throughout the term of this Agreement, including any extensions hereof, comply with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider; and (iii) Any rules,regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. - 9.1.2 Provider, for a period of no fewer than six (6) calendar years preceding the Effective Date of this Agreement, has faithfully complied with: (i) ' All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317,and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider; and (iii) Any rules,regulations, charter provisions,or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.2 Provider's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Provider's warranty, as set forth in this Article 9, shall constitute a material breach of this Agreement. Any material breach of this Agreement shall entitle the City to terminate this Agreement and to seek damages and any other relief available under this Agreement,at law,or in equity. Page 5.of 6: Goods and Services Agreement between the City of Ashland and Rogue Valley Backflow Service • • IN WITNESS WHEREOF the parties have caused this Agreement to be signed in their respective names by their duly authorized representatives as of the dates set forth below, CITY OF ASHLAND: • Rogue Valley Backflow Service(PROVIDER): By: ( By: /i natur Signature Sccs r Buz- J vj C.Qi12- Printed.Nafne Printed Name pu .iL. t.�tts Meg LAX_ Q 1J (1.1-42-, . Title Title (*Lt. ? C) Date Date (W-9 is to be submitted with this signed Agreement) • Purchase Order No. D� • • • i Page 6 of 6: Goods and Services Agreement between the City of Ashland and Rogue Valley Backflow Service • Rogue Valley Backflow Service Erin Akers LCB#15844 OHD#5438 10 Allen Ln Talent,OR 97540 (541)482-9464 e-mail: rvbackflow@gmail.com • April 13, 2022 To: City of Ashland To whom it concerns, The charge for a backflow assembly test is $27.50 per assembly. As a general rule we do not charge a repair labor fee-for `typical' repairs when done at the time of testing. The cost of the average repair part is included with the invoice: The most common parts are valued at around $14.00-$50.00. In addition, service calls outside of the testing schedule will be charged at a rate of$40.00 flat or $50.00 per hour when time spent exceeds 1(one) hour. If, in testing and/or repair, the cost'exceeds the usual, an authorizing representative of the city is contacted before incurring such expense for approval and direction to proceed. Please feel free to contact me with any questions or if further information is needed. Thanks, • • Erin Akers, Owner/Operator Rogue Valley Backflow Service • • • www.saif.com • • saifr : . Oregon Workers' Compensation Certificate of Insurance Certificate holder: • CITY OF ASHLAND, FLEET SERVICES/FACILITIES MAINTENANCE 0 ATTN:NICOLE GRAHAM 90 NORTH MOUNTAIN AVENUE • ASHLAND,OR 97520 • The policy of insurance listed below has been issued to the insured named below.for the policy period indicated.The insurance afforded by this policy is subject to all the terms,exclusions and conditions of such policy;this policy is subject to change or cancellation at any time. Insured • Producer/contact • • Rogue Valley Backflow Service LLC - United Insurance Agencies, • Rogue Valley Backflow Service United Insurance Agencies 10 Allen Ln 541.242.6464 workerscomp@uiaoregon.com • Talent,.Or 97540-9739 Issued ' 04/28/2022 Limits of liability Policy 875425 Bodily Injury by Accident $500,000 each accident Period 09/01/2021 to 09/01/2022 Bodily Injury by Disease $500,000 each employee Body Injury by Disease $500,000 policy limit Description of operations/locations/special items , ' All operations • Important . • This certificate is issued as a matter of information only and confers no rights to the certificate holder.This certificate • does not amend,extend or alter the coverage afforded by the policies above.This • certificate does not constitute a contract between the issuing insurer,authorized representative or producer and the certificate holder. • • CANCELLATION: • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED TO THE POLICYHOLDER AND CERTIFICATE HOLDER IN ACCORDANCE WITH THE POLICY PROVISIONS AND OREGON LAW.SAIF WILL ENDEAVOR TO PROVIDE WRITTEN NOTICE WITHIN 30 DAYS WHENEVER POSSIBLE. Authorized representative • CAt- R. • • Chip Terhune 0 - President and CEO , • • 400 High Street SE• . • Salem,OR 97312 P:800.285.8525 Policy_OLCA Certificate0flnsurance F:503.584.9812 • • •ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/29/2022 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 Focus/ Insurance Group, Inc NAME: Teri Triem 720 E Jackson St AHCC,N,Ext): 541-772-3120 FAX No):541-772-7900 Medford, OR 97504 E-MAIL . E-MAILADDRESS: teri@focus1ins.com License#: NPN: 16192192&CA INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Accredited Surety and Casualty Company.Inc • INSURED ROGUE VALLEY BACKFLOW SERVICE LLC INSURER B: Ohio Security Insurance Company 24082 DBA ROGUE VALLEY BACKFLOW SERVICE INSURERC: 10 Allen Ln INSURERD: Talent, OR 97540 INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER: 00015497-0 REVISION NUMBER: 8 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 POLICY EFF POLICY EXP LIMITS (MMIDD/YYl'Y) (MMIDD/YYYY) A �( COMMERCIAL GENERAL LIABILITY Y 1ABPOR05127372000 08/28/2021 08/28/2022 EACH OCCURRENCE $ 1,000,000. DAMAGE RENTED CLAIMS-MADE X OCCUR PREMISESO(Ea occurrence) $ 100,000 MED EXP(Any one person) _ $ 5,000 PERSONAL&ADV INJURY $ Included GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ • 2,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 • OTHER: $ B AUTOMOBILE LIABILITY BAS58217718 12/14/2021 12/14/2022 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 ANY AUTO, BODILY INJURY(Per person) $ OWNEDSCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY. X AUTOS HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE• $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y,/N STATUTE - ER '_ ANY PROPRIETOR/PARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under • DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF-OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached If more space Is required) Certificate Holder is also Additional Insured in regards to the general liability per attached Form B10101020. • • 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 _ Ashland, OR 97520 • AUTHO IZED REPRESENTATIVE • (TTI) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by TT1 on 04/29/2022 at 09:49AM • / 1 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM . The following is added to SECTION II—LIABILITY, C.Who Is An Insured: Additional Insured by Contract,Agreement or Permit • a. Any person or organization with whom you agreed in a written contract, written agreement or permit to add such person or organization as an additional insured on your policy is an additional insured only with respect to liability for"bodily injury","property damage", or"personal and advertising injury" caused, in whole-or in part, by your acts oromissions, or the acts or omissions of those acting on your behalf, but only with respect to: (1)"Your work"for the additional insured(s) designated in the contract, agreement or permit; (2) Premises you own, rent, lease or occupy; or (3)Your maintenance, operation or use of equipment leased to you, other than aircraft, "auto"or watercraft. b. The insurance afforded to such additional insured described above: (1) Only applies to the extent permitted by law; and (2) Will not be broader than the insurance which you are required by the contract, agreement or permit to provide for such additional insured. (3) Applies on a primary basis if that is required by the written contract, written agreement or permit. (4) Will not be broader than coverage provided to any other insured. (5) Does not apply if the"bodily injury", "property damage"or"personal and advertising injury" is otherwise excluded from coverage under this Coverage Part, including any endorsements thereto. c. This Additional Insured provision does not apply, and none of the persons or organizations described in a. above will qualify as additional insureds:' (1) Unless the written contract or written agreement was executed or permit was issued prior to the"bodily injury", "property damage", or"personal injury and advertising injury". • (2) If the person or organization is included as an insured by another endorsement issued by us and made part of this Coverage Part. (3) If the person or organization is a lessor of equipment: (a)After the equipment•lease expires; or • (b) If the"bodily injury", "property damage", "personal and advertising injury"arises out of sole negligence of the lessor. • B10 1 01 10 20 Includes copyrighted material of Insurance Services Office, Inc.,with Page 1 of 2 its permission. ©2020 Accredited Surety and Casualty Company, Inc. Alf Rights Reserved. May not be copied without permission. • (4) With respect to"bodily Injury" or"property damage".arising out of"your products"which are distributed or sold in the regular course of that person's or organization's business the insurance afforded that person or organization does not apply to: •a)."Bodily injury"or"property damage"for which that person or organization is obligated to pay •damages by reason of the assumption of liability in a contract or agreement; however,this exclusion does not apply to liability for damages that person or organization would have in the absence of the contract or agreement; b) Any express warranty unauthorized by you; • c) Any physical or chemical change in the product made intentionally by that person or organization; d) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instruction from the manufacturer, and then repackaged in the original container; e) Any failure to make such inspections, adjustments, tests or servicing as that person or organization has agreed to make or normally undertakes to make in the usual course of business in connection with the sale of the product; or f) Products which, after distribution or sale by you, have been labeled or re-labeled or used as a container, part of ingredient of any other thing or substance by or for that person or organization; however this insurance does not apply to any insured person or organization, from who you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. • (5) To any: (a) Owners or other interests from whom land has been leased if the "occurrence"takes place or the offense is committed after the lease for the land expires; or(b) Managers or lessors of premises if: (i)The"occurrence"takes place or the offense is committed after you cease to be a tenant in that premises; or(ii)The"bodily injury", "property damage", "personal injury"or"advertising injury"arises out of structural alterations, new construction.or demolition operations performed by or on behalf of the manager or lessor. • • (6) To"bodily injury", "property damage" or"personal and advertising injury" arising out of the rendering of or the failure to render any professional services. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment,training or monitoring of others by that insured, if the"occurrence"which caused the"bodily injury" or"property damage"or the offense which caused the"personal and .advertising injury" involved the rendering of or failure to render any professional services by or for you. (7) To any architects, engineers, or surveyors with respect to any injury or damage arising out of the. rendering or failure to render any professional services by or for you, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) Supervisory, inspection, architectural or engineering activities. All other terms and conditions of the policy remain unchanged. • • • B10 1 01 10 20 Includes copyrighted material of Insurance Services Office, Inc.,with Page 2 of 2 its permission. ©2020 Accredited Surety and Casualty Company, Inc. • All Rights Reserved. May not be copied without permission. a i Rogue Valley Backflow Service Erin Akers LCB#15844 OHD#5438 10 Allen Ln Talent,OR 97540 (541)482-9464 e-mail: rvbackflow@gmail.com May 27, 2022 To: City of Ashland To whom it concerns, Regarding the City of Ashland's Service Agreement General Liability Insurance requirement, I would like to request an exception. As the owner of Rogue Valley Backflow Service LLC, my company currently carries $1,000,000 worth of Liability Insurance while providing backflow testing and repair. During the process of performing these tests and repairs, incidents are extremely rare and personal injury or property damage is almost unheard of. Please contact me if you have any questions or would like more, information as you consider my request, Thank you, COW- Erin Akers, Owner/Operator Rogue Valley Backflow Service LLC