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HomeMy WebLinkAbout2022-079 PO 20230101- Industrial Hearing Service Inc wA Purchase Order Far. ^ ri RECORDER Fiscal Year 2023 Page: 1 of: 1 B City of Ashland `s-- ` -"A 'F _Rri _ �� I ATTN: Accounts Payable - ` � 20 E. Main Purchase 202301 �01 Ashland, OR 97520 Order# T Phone: 541/552-2010 O Email: payable@ashland.or.us • V H C/O Fleet/Shop Division E INDUSTRIAL HEARING SERVICE,INC i 90 North Mountain Ave N 12021 NE SUMNER STREET p Ashland, OR 97520 PORTLAND, OR 97220 Phone: 541/488-5358 R T Fax: 541/552-2304 �� ---_, -- — �-��t.lo�5i8 yc�!=1:'cl8j:!=oiF_�.�I9�E��--'taE9�'e?!E.��� Ec.15'e"�ttfi r- y'•ai�.�+.2��js �_- �_".T=}xs'=- b'l�t tii�'c' - ,4-1e:i��-�—== '_r _ (503) 761-1506 � s H ' �' _- _ i'-';'-' 17 ..-- --; 11.'• Hoadley W adl V- _ 08/10/2022 832 FOB ASHLAND OR/NET30 City Accounts Pa able Employee Audiometric Testing 1 Audiometric testing for approximately 100 each employees 1.0 $1,800.00 $1,800.00 Personal Services Agreement(Less than $25,000) Completion date: 06/30/2023 Project Account: , ***************GL SUMMARY*************** I I '088400-610400 $1,800.00 • ,,..„......... .„,„..._,, J/ Q� nom_ _.„,...„„,, By: . /h Date: f ` ... - $ Authorized `i: atu _ w F_:1 === $1,800.00 FORM #3 • CITY OF A request fora Purchase Orde ## �j 2 /. d ( ASHLAND REQUISITION Date of request: 7/14/2022 Required date for delivery: Vendor Name " Industrial Hearing Service, Inc. Address,City,State,Zip 12021 NE Sumner Street, Portland, OR 97220 • Contact Name&Telephone Number Kyra Webb 503-761-1506 kyraeindhearing.com Email address SOURCING.METHOD ❑ Exempt from Competitive Bidding 0 Emergency ❑ Reason for exemption: ❑. Invitation to Bid 0 Form#13,Written findings and Authorization ❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached ❑ Written quote or proposal attached (Attach copy of council communication) (If council approval required,attach copy of CC) ❑ Small Procurement ❑ Request for Proposal Cooperative Procurement Not exceeding$5,000 Date approved by Council: . ❑ State of Oregon ❑ Direct Award (Attach copy of council communication) Contract# ❑ VerbalfWritten quote(s)or proposal(s) ❑ Request for Qualifications(Public Works) ❑ State of Washington Date approved by Council: Contract# (Attach copy of council communication) ❑ 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 ❑ Written quote or proposal attached Intergovernmental Agreement ❑ (3)Written quotes and solicitation attached ❑ Form#4,Personal Services>$5K&<$75K . Agency PERSONAL SERVICES ❑ Special Procurement ❑ Annual cost to City does not exceed$25,000. Greater than$5,000 and less than$75,000 ❑ Form#9,Request for Approval Agreement approved by Legal and approved/signed by ❑ Direct appointment not to exceed$35,000 ❑ Written quote or proposal attached City Administrator.AMC 2.50.070(4) (3)Written proposals/written solicitation Date approved by Council: ❑ Annual cost to City exceeds$25,000,Council At Form#4,Personal Services>$5K&<$75K Valid until: _(Date) approval required.(Attach copy of council communication) Description of SERVICES • . Total Cost Audiometric Testing for approximately 100 Public Works and City of Ashland employees for FY23 $ 1,800.00 Item # ' Quantity Unit • Description of MATERIALS Unit Price Total Cost • ❑ Per attached quotelproposal TOTAL COST Project Number _ _ Account Number 088400-610400 *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 requi,itio-form,f certify that the City's public contracting requirements have been satisfied. Employee: r Department He.:��;! � g•3•L6L2 , �` (Equ. to or greater than$5,000) Department Manager/Su *�+*t City Administrator: (Equal to or greater than$25,000) Funds appropriated for current fiscal year: / NO ?/i t/rZDep i finance Dire tor-(Equal to or greater than$5,000) Date Comments: Form#3-Requisition • • Industrial ' • Hearing Services Inc. Hearing Conservation Services • City of Ashland 90 N Mountain Avenue Ashland, OR 97520 July 14, 2022 Attention: Nicole Graham RE: Mobile Hearing Testing Dear Nicole, • • Thank you for the opportunity to provide information on our services and we would appreciate your business! Industrial Hearing Service, Inc. has been a mobile audiometric service provider since 1971. We are dedicated to bringing quality Hearing Conservation Services to customers in Oregon, Washington, Idaho, Montana, Nevada and California. . IHS provides comprehensive reports, on the spot test results for each employee and instant notification of Standard Threshold Shifts. Our units have the ability to test 4 staff members every 15 minutes, at your place of business, allowing employees to return to production as quickly as possible. Following OSHA regulation guidelines, a CAOHC Certified Technician will administer a pure-tone, air conduction audiometric test. After the completion of testing one of our Audiologists will review each individual test result for OSHA compliance and reporting. 2023-24 Audiometric Pricing Includes: • On Site Mobile Testing Unit Set Up, Calibration at each location and Take Down.. • CAOHC Certified Technician Audiometric Testing • • OSHA required Audiologist Review and Recommendations for°Individual Test Results • OSHA compliant DVD training shown on the day of testing • Management Report for,Records Maintenance Compliance • • Rate Includes Mileage and Travel Expenses when scheduling in a designated route to the area. For special datesand time requests additional mileage rate of $ 2.00 per mile from Portland, OR and overnight per diems applies when scheduling out of a route to the area. Minimum Per Site/Visit Rate: $ 675.00 Mobile Audiometric Testing Unit, rate also includes up to two hours of testing. Testing up to 32 employees (four every 15 minutes). Half Day Per Site/Visit Rate: $ 950.00 Mobile Audiometric Testing Unit, rate,includes up to four consecutivehours of testing (including Technician break). Testing up to 60 employees (four every'15 minutes). Daily Rate Per Site/Visit•Rate: $ 1,500.00Mobile Audiometric Testing Unit, rate includes up to eight consecutive hours of testing. Testing up to 112 employees (four every 15 minutes). Includes two 15 minute breaks and one 30 minute lunch for Technician. Ten hour daily maximum. Additional Hourly Rate: $ 200.00 per hour Industrial HEARING Service, Inc. -Serving COMPANIES since 1971 • T(503)761-1506. F.(503)761-1508 • NHcA. t+ Member BBB. Member ITalu Ela I • insHearing riuice, IInc. Hearing Conservation Services Mobile Hearing Testing - Continued Same Day Site Return Rate: $ 250.00 - $ 650.00 rate varies based on location and time scheduled. Records Maintenance Service: (Separate from mobile services.) Processing and reviewing audiograms from sources other than Industrial Hearing Service for OSHA compliance. $ 25.00 per audiogram. Price is disclosed up front, with no hidden costs. Industrial Hearing Service values each and every customer and would greatly appreciate your business. Price quote is valid for 90 days. For additional information please visit our website: • www.indhearing.com. Thank you again for this opportunity. Respectfully, • Kyra Webb Operations Manager . . Industrial Hearing Service, Inc. T: 503.761.1506 - EM: Kyra@iindhearing.com • • www.indhearing.com • • • • • • Industrial HEARING Service, Inc. -Serving COMPANIES.since 1971 �� T(503)761-1506 F(503)761-1508 MICAMember Member • BBB_ Member ' 9 • • • . PERSONAL SERVICES AGREEMENT (LESS THAN $25,000) • CONSULTANT: Industrial Hearing Service,Inc. • CITY OF CONTACT: Kyra Webb ASHLAND 20 East Main Street ADDRESS: 1201 NE Sunnier Street Ashland,Oregon 97520 Portland,OR 97220 Telephone: 541/488-6002 Fax:.541/552-5311 TELEPHONE: 503-761-1506 EMAIL: kyra@indhearing.com This Personal Services Agreement(hereinafter"Agreement") is entered into by and between the City of • Ashland,an Oregon municipal corporation(hereinafter"City")and Industrial Hearing Service, Inc,("hereinafter "Consultant"),for Audiometric Testing for approximately 100 employees. NOW THEREFORE,in consideration of the mutual covenants contained herein,the City and Consultant hereby agree as follows: 1. Effective Date and Duration: This Agreement shall become effective on the date of execution on behalf of the City,as forth below(the"Effective Date"),and unless sooner terminated as specifically provided herein,shall terminate upon the City's affirmative acceptance of Consultant's Work as • 'complete and Consultant's acceptance of the City's final payment therefore,but not later than 6/30/2023. 2. Scope of Work: Consultant will provide Audiometric Testing for approximately 100 employees as more fully set forth in the Consultant's Proposal dated July 14,2022,which is attached hereto as "Exhibit A"and incorporated herein by this reference. Consultant's services are collectively referred to herein as the"Work." 3. Supporting Documents/Conflicting Provisions: This Agreement and any exhibits or other supporting documents shall be construed to be muttially complementary 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 exhibits or supporting documents. 4. All Costs Borne by Consultant: Consultant shall,at its own risk,perform the Work described above and,unless otherwise specified in this Agreement,furnish all labor,equipment,and materials required for the proper performance of such Work. ' 5. Qualified Work: Consultant has represented,and by entering into this Agreement now represents,that all personnel assigned to the Work to be performed under this Agreement are fully qualified to perform the service to which they will be assigned in a skilled and worker-like manner and,if required to be registered,licensed or bonded by the State of Oregon,arc so registered,licensed and bonded. I - Page 1 of 6: Personal Services Agreement with Industrial Hearing Service,Inc. • • • 6. Compensation: City shall pay Consultant the sum of$1,800.00 as full compensation for Consultant's performance of all Work under this Agreement. In no event shall Consultant's total of all compensation and reimbursement under this Agreement exceed the sum of$1,800.00 without the express,written approval from the City official whose signature appears below,or such official's successor in office. Payments shall be made within thirty(30)days of the date of receipt by the City of Consultant's invoice. Should this Agreement be terminated prior to completion of all Work,payments will be made for any phase of the Work completed and accepted as of the date of termination. 7. Ownership of Work/Documents: All Work,work product,or other documents produced in furtherance of this Agreement belong to the City,and any copyright,patent,trademark proprietary or • any other protected intellectual property right shall vest in and is hereby assigned to the City. 8. Statutory Requirements: The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220,279B.230 and 279B.235. I. 9. Living Wage Requirements: If the amount of this Agreement is$21,507.75 or more,Consultant 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. Consultant is also required to post the notice attached hereto as"Exhibit B"predominantly in areas where it will be seen • by all employees. 10. • Indemnification: Consultant hereby agrees to defend,indemnify,save,and hold City,its officers, • employees,and agents harmless from any and all losses,claims,actions,costs,expenses,judgments,or other damages resulting from injury to any person(including injury resulting in death),or damage (including loss or destruction)to property,of whatsoever nature arising out of or incident to the • performance of this Agreement by Consultant(including but not limited to,Consultant's employees, agents,and others designated by Consultant to perform Work or services attendant to this Agreement). However,Consultant shall not be held responsible for any losses,expenses,claims,subrogations, actions,costs,judgments,or other damages,caused solely by the negligence of City. 11. Termination: a. Mutual Consent. This Agreement may be terminated at any time by the mutual consent of both parties. b. City's Convenience. This Agreement may be terminated by City at any time upon not less than thirty(30)days'prior written notice delivered by certified mail or in person. c. For Cause. City may terminate or modify this Agreement,in whole or in part,effective upon .. delivery of written notice to Consultant,or at such later date as may be established by City under . any of the following conditions: i. If City funding from federal,state,county or other sources is not obtained and continued at levels sufficient to allow for the purchase of the indicated quantity of services; • • ii. If federal or state regulations or guidelines are modified,changed,or interpreted in such a • way that the services are no longer allowable or appropriate for purchase under this Agreement or are no longer eligible for the funding proposed for payments authorized by this Agreement;or iii.'If any license or certificate required by law or regulation to be held by Consultant to provide • the services required by this Agreement is for any reason denied,revoked,suspended,or not renewed. Page 2 of 6: Personal Services Agreement with Industrial Hearing Service,Inc. • d. For.Default or Breach. • i. Either City or Consultant may terminate this Agreement in the event of a breach of the Agreement by the other. Prior to such termination the party seeking termination shall give to the other party written notice of the breach and its intent to terminate. If the party committing the breach has not entirely cured the breach within fifteen(15)days of the date of ' the notice,or within such other period as the party giving the notice may authorize in writing, then the Agreement may be terminated at any time thereafter by a written notice of termination by the party giving notice. ii. Time is of the essence for Consultant's performance of each and every obligation and duty under this Agreement. City,by written notice to Consultant of default or breach,may at any time terminate the whole or any part of this Agreement if Consultant fails to provide the Work called for by this Agreement within the time specified herein or within any extension thereof. iii. The rights and remedies of City provided in this subsection(d)are not exclusive and arc in addition to any other rights and remedies provided by law or under this Agreement. 12. Independent Contractor Status: Consultant is an independent contractor and not an employee of the • City for any purpose. 13. Assignment: Consultant shall not assign this Agreement or subcontract any portion of the Work without the written consent of City. Any attempted assignment or subcontract without written consent of City.shall be void. 14. Default. The Consultant shall be in default of this Agreement if Consultant: commits.any material breach or default of any covenant,warranty,certification,or obligation under the Agreement; institutes an action for relief in bankruptcy or has instituted against it an action for insolvency;makes a general assignment for the benefit of creditors;or ceases doing business on a regular basis of the type identified in its obligations under the Agreement;or attempts to assign rights in,or delegate duties under,this Agreement. 15. Insurance. Consultant shall,at its own expense,maintain the following insurance: a. Workers' Compensation. Consultant shall obtain and maintain Workers' Compensation insurance in compliance with ORS 656.017,which requires subject employers to provide Oregon Workers' Compensation coverage for its subject workers,unless such employers are exempt under ORS 656.126. If exempt under ORS 656.126,Consultant shall certify such exemption to the City. b. Professional Liability insurance with a combined single limit,or theequivalent,of not less than $2,000,000(two million dollars)per occurrence. This is to cover any damages caused by error, omission or negligent acts related to the Work to be provided under this Agreement. c. 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,Death,and Property Damage. d. Automobile Liability insurance with a combined single limit,or the equivalent,of not less than $1,000,000(one million dollars)for each accident for Bodily Injury and Property Damage,including coverage for owned,hired pr non-owned vehicles,as applicable. e. Notice of cancellation or change. There shall be no cancellation,material change,reduction of limits • or intent not to renew the insurance coverage(s)without thirty(30)days' prior'written notice from the Consultant or its insurer(s)to the City. Page 3 of 6: Personal Services Agreement with Industrial Hearing Service,Inc. •• • • f. Additional Insured/Certificates of Insurance. Consultant shall name the City of Ashland,Oregon, and its elected officials,officers and employees as Additional Insureds on any insurance policies, excluding Professional Liability and Workers'Compensation,required herein,but only with respect to Consultant's services to be provided under this Agreement.The-consultant's insurance is primary and non-contributory. As evidence of the insurance coverages required by this Agreement, the Consultant shall furnish acceptable insurance certificates and endorsements prior to commencing the Work under this Agreement. 16. Nondiscrimination: Consultant 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 any Work under this Agreement when employed by Consultant. Consultant agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes,rules and regulations. Further,Consultant 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. - 17. Consultant's Compliance With Tax Laws: 17.1 Consultant represents and warrants to the City that: 17.1.1 Consultant 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 Consultant;and (iii) Any rules,regulations,charter provisions,or ordinances that implement or enforce any of the foregoing tax laws or provisions. 17.1.2 Consultant,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 Consultant;and . . (iii) Any rules,regulations,charter provisions,or ordinances that implement or enforce any of the foregoing tax laws or provisions. • 18. Governing Law;Jurisdiction: This Agreement shall be governed and construed in accordance • with 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. • 19. 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 • Page 4 of 6: Personal Services Agreement with Industrial Hearing Service,Inc. courier,by mailing using registered or certified United States mail,return receipt requested,postage prepaid,or by electronically confirmed at the address or facsimile number set forth below: If to the City: City of Ashland-Fleet Department Attn: Wes Hoadley 90 North Mountain Avenue Ashland,Oregon 97520: Phone: (541)552-2355 With a copy to: City of Ashland—Legal Department -;• • • 20 E.Main Street Ashland,Oregon 97520 Phone:(541)488-5350 If to Consultant: Industrial Hearing Service,Inc. Atm:Kyra Webb 12021 NE Sumner Street Portland,OR 97220 Phone:(503)761-1506 • I ' 20. Amendments. This Agreement may be amended only by written instrument executed by both parties with the same formalities as this Agreement. 21. THIS AGREEMENT AND THE ATTACHED EXHIBITS CONSTITUTE THE ENTIRE UNDERSTANDING BETWEEN THE PARTIES. THERE ARE NO UNDERSTANDINGS, AGREEMENTS,OR REPRESENTATIONS,EITHER ORAL OR WRITTEN,NOT SPECIFIED HEREIN REGARDING THIS AGREEMENT. CONSULTANT,BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE,HEREBY ACKNOWLEDGES THAT HE/SHE HAS READ THIS AGREEMENT,UNDERSTANDS IT,AND AGREES TO BE BOUND BY ITS TERMS AND CONDITIONS. 22. Certification. Consultant shall execute the certification attached hereto as"Exhibit C"and incorporated herein by this reference. - • Page 5 016: Personal Services Agreement with Industrial Hearing Service,Inc. 1 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: Industrial Hearing Service,Inc.(CONSULTANT): B _ By: H / Nebb ature Signature bn-- iY KYR/IPI/r.e6 Printed Name Printed.Name PutSa-tc_ wo Dtzs_cra_ D1(6 07MA/ /L1,QNm9e€. Title Title .3. Zo2 7. /3, 0000Date Date (W-9 is to be submitted with this signed Agreement) Purchase Order No. • " 1 1 . Page 6 of 6: Personal Services Agreement with Industrial Hearing Service,Inc. ® • A�o CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/12/2022 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: Deborah Lopez LaPorte&Associates, Inc. PHONE FAX 5515 SE MILWAUKIE AVENUE (A/c.No.Ext):971-404-3506 (A/C,No):503-231-9021 Portland OR 97202 ADDRESS: dlopez@laporte-insurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Insurance Company 10677 INSURED INDUHEA-01 INSURER B: Industrial.Hearing Service Inc 12021 NE Sumner St INSURER C: Portland OR 97220 INSURER D: • INSURERE: ' • INSURER F: COVERAGES CERTIFICATE NUMBER:122511462 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 SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) A ' X COMMERCIAL GENERAL LIABILITY EPP0241610 4/10/2022 4/10/2023 EACH OCCURRENCE $1,000,000 DAMAGE RETED CLAIMS-MADE X OCCUR PREM SESO(Ea occurrence) $500,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: WA STOP-GAP $1,000,000 A AUTOMOBILE LIABILITY EBA0241610 4/10/2022 4/10/2023 COMaacciBINdent)SIED NGLE LIMIT $1,000,000 (E . ANY AUTO BODILY INJURY(Per person) $ OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY • AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) _ • $ A X UMBRELLA LIABX OCCUR EPP0241610 4/10/2022 4/10/2023 EACH OCCURRENCE $3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $3,000,000 • _ DED RETENTION$ _ $ WORKERS COMPENSATION PER DTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/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 be,attached if more space is required) Certificate Holder and all required entities are additional insured when required by written contract.Endorsements attached. 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. ATTN: Nicole Graham 90 North Mountain Ave. AUTHORIZED REPRESENTATIVE Ashland OR 97520 ; f ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • CinciPlus° BUSINESS AUTO`XC+® (EXPANDED COVERAGE PLUS) ENDORSEMENT• This endorsement modifies insurance provided by the following: BUSINESS AUTO COVERAGE FORM With respect to the coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by this endorsement. A. Blanket Waiver of Subrogation • This provision does not apply unless the valid written contract;has been: SECTION IV - BUSINESS AUTO CONDI- TIONS, A. Loss Conditions, 5. Transfer of - 1. Executed prior to the accident causing Rights of Recovery Against Others to Us is "bodily injury'or"property damage"; and amended by the addition of the following: 2. Is still in force at the time of the"accident" We waive any right of recovery we may have causing "bodily injury" or "property dam- against any person or organization because of age". payments we make for "bodily injury" or "property damage"arising out of the operation D. Employee Hired Auto of a covered "auto"when you have assumed 1. Changes in Liability Coverage liability for such "bodily injury" or "property damage" under an "insured contract", provid- The following is added to the Section II - ed the"bodily injury"or"property damage"oc- Liability Coverage, A. Coverage, 1. curs subsequent to the execution or the "in- Who is an Insured: sured contract". An "employee" of yours is an "insured" B. Noncontributory Insurance while operating an "auto" hired or rented SECTION IV BUSINESS AUTO CONDI- under a contract.or agreement in that "employee's" name, with your permission, TIONS, B. General Conditions, 5. Other In- while performing duties related to the surance c.is replaced by the following: conduct of your business. c. Regardless of the provisions of Par- 2. Changes in General Conditions agraph a. above, this Coverage Form's Liability Coverage is primary SECTION IV - BUSINESS AUTO CON- and we will not seek contribution . DITIONS, B. General Conditions, 5. from any other insurance for any Iia- Other Insurance is amended by replac- bility assumed under an "insured ing Paragraph 5.b.with the following: contract" that requires liability to be • assumed on a primary noncontributo- , b. . For ,Hired Auto Physical Damage ry basis. Coverage the following are deemed to be covered"autos"you own: C. Additional Insured by Contract (1) Any covered "auto" you lease, SECTION II - LIABILITY COVERAGE, A. hire, rent or borrow; and Coverage, I. Who is an Insured is amended to include as an insured any person or organi- (2) Any covered "auto" hired or zation with which you have agreed in a valid rented by your"employee"under written contract to provide insurance as is of a contract in that individual "em- forded by this policy. ployee's" name, .with your per- , mission, while performing duties This provision is limited to the scope of the related to the conduct of your valid written contract. business. • Includes copyrighted material of ISO AA 288 01 16 , Properties, Inc.,with its permission. Page 1 of 4 • • However, any "auto" that is leased, a. Is effective on the date of acquisition hired, rented or borrowed with a driver or formation, and is afforded for 180 is not a covered"auto". days after such date; E. Audio, Visual and Data Electronic Equip- b. Does not apply to "bodily injury' or ment "property damage" resulting from an • SECTION III - PHYSICAL DAMAGE COV- • "accident" that occurred before you ERAGE, C. Limit of Insurance is amended acquired or formed the organization; by adding the following: c. Does not apply to any newly acquired 4. The most we will pay for all "loss" to au- • or formed organization that is a joint venture or partnership;and dio, visual or data electronic equipment and any accessories used with this d. Does.not apply to an insured under equipment as a result of any one "acci- any other automobile liability policy, dent"is the lesser of: or would be an insured under such a policy but for the termination of such a. The actual cash value of the dam- policy or the exhaustion of such poli- • aged or stolen property as of the time cys limits of insurance. of the"accident"; b. The cost of repairing or replacing the 3. Any of your "employees" while using a covered "auto" in your business or your damaged or stolen property with oth- personal affairs, provided you do not own, er property of like kind and quality;or • hire or borrow that"auto". c. $2,500. G. Liability Coverage Extensions - Supple- Provided the equipment,at the time of the mentary Payments-Higher Limits "loss"is: •SECTION II - LIABILITY COVERAGE, A. a. Permanently installed in or upon the Coverage, 2. Coverage Extensions, a..Sup- covered "auto" in a housing, opening plementary Payments is amended by: or other location that is not normally 1. Replacing the $2,000 Limit of Insurance used by the "auto" manufacturer for for bail bonds with $4,000 in (2); and the installation of such equipment; 2. Repladng the $250 Limit of Insurance for b. Removable from a permanently in- reasonable expenses with$500 in(4). stalled housing unit as described in Paragraph 2.a.above; or H. Amended Fellow Employee Exclusion c. An integral part of such equipment. SECTION II -LIABILITY COVERAGE, B. Ex- F. Who is an Insured-Amended clusions, 5. Fellow Employee is modified as follows: • SECTION II - LIABILITY COVERAGE, A. Exdusion 5. Fellow Employee is deleted. Coverage, 1.Who is an Insured is amended by adding the following: • I. Hired Auto —Physical Damage The following are"insureds": • / If hired"autos"are covered "autos"for Liability 1. Any subsidiary which is a legally incorpo- Coverage, then Comprehensive and Collision Physical Damage Coverages as provided un- rated entity of which you own a financial . der SECTION III - PHYSICAL DAMAGE interest of more than 50% of the voting COVERAGE of this Coverage Part are ex- stock on the effective date of this cover- tended to "autos" you hire, subject to the fol- . age form. lowing: However, the insurance afforded by this 1. The most we will pay for "loss" to any provision does not apply to any subsidiary hired "auto" is $50,000 or the actual cash that is an "insured" under any other au- •value or cost to repair or replace, which- tomobile liability policy, or would be an ever is the least, minus a deductible. "insured" under such policy but for termi- nation of such policy or the exhaustion of 2. The deductible will be equal to the largest such policys limits of insurance. deductible applicable to any owned "auto" 2. Any organization that is newly acquired or for that coverage, or$1,000,whichever is less. formed by you and over which you main- tain majority ownership. The insurance 3. Hired Auto - Physical Damage coverage provided by this provision: , • is excess over any other collectible insur- ance. Includes copyrighted material of ISO AA 288 01 16 Properties, Inc.,with its permission. Page 2 of 4 • • 4. Subject to the above limit,deductible,and K. Transportation Expense-Higher Limits excess provisions we will provide cover- SECTION III - PHYSICAL DAMAGE COV- age equal to the broadest coverage appli- cable to any covered "auto" you own in- ERAGE, A. Coverage, 4. Coverage Exten- • sured under this policy. sions is amended by replacing $20 per day • with $50 per day, and $600 maximum with Coverage indudes loss of use of that hired au- $1,500 maximum in Extension a. Transpor- to, provided it results from an "accident" for tation Expenses. which you are legally liable and as a'result of which a monetary loss is sustained by the L. Airbag Coverage leasing or rental concern. The most we will SECTION III - PHYSICAL DAMAGE COV- pay for any.one"accident"is$3,000. ERAGE, B. Exclusions, 3.a. is amended by If a limit for Hired Auto - Physical Damage is adding the following: shown in the Schedule, then that limit replac- However, the mechanical. and electrical es, and is not added to, the $50,000 limit indi- breakdown portion of this exdusion does not cated above. apply to the accidental discharge of an airbag. J. Rental Reimbursement This coverage for airbags is excess over any other collectible insurance or warranty. SECTION III - PHYSICAL DAMAGE is amended by adding the following: M.• Loan or Lease Gap Coverage 1. We will pay for rental reimbursement ex- • 1. SECTION III - PHYSICAL DAMAGE penses incurred by you for the rental of . COVERAGE, C. Limit of Insurance is an"auto"because of a loss"to a covered deleted in its entirety and replaced by the "auto". Payment applies in addition to the following, but only for private passenger otherwise applicable amount of each coy- type"autos"with an original loan or lease, erage you have on a covered "auto";No and only in the event of a "total loss" to deductible applies to this coverage. such a private passenger type"auto": • 2. We will pay only for those expenses in- a. The most we will pay for"loss"in any curred during the policy period beginning one"accident"is the greater of: 24 hours after the "loss" and ending, re- (1) The amount due under the terms • gardless of the policys expiration, with of the lease or loan to which the lesser of the following number of your covered private passenger days: type "auto"is subject, but will not a. The number of days reasonably re- `include: quired to repair the covered "auto". If (a), Overdue'lease or loan pay- , •"loss"is caused by theft,this number ments; of days is added to the number of • days it takes to locate the covered (b) Financial penalties imposed "auto"and return it to you; or under the lease due to high b. 30 days: mileage, excessive use or • abnormal wear and tear; 3. Our payment is limited to the lesser of the following amounts: (c) Security deposits not re- • funded by the lessor; a. Necessary and'actual expenses in- • (d) Costs for extended warran- curred; or ' ties, Credit Life Insurance, b. $50 per day. Health, Accident or Disabil- ity Insurance purchased 4. This coverage does not apply while there • with the loan or lease; and • are spare or reserve "autos" available to • you for your operations. (e) Carry-over balances from previous loans or leases, or 5. We will pay under this coverage only that amount of your rental reimbursement ex- • (2) Actual cash value of the stolen penses which is not alreadyprovided for or damaged property. under SECTION III - PHYSICAL DAM- b. An adjustment for depreciation and AGE COVERAGE, A. Coverage, 4. physical condition will be made in de- Coverage Extensions. termining actual cash value at the time of"loss". • • Includes,copyrighted material of ISO AA 288 01 16 Properties, Inc.,with its permission. Page 3 of 4 • 2. SECTION V - DEFINITIONS is amended P. Unintentional Failure to Disclose Hazards • by adding the following, but only for the SECTION IV - BUSINESS AUTO CONDI- purposes of this Loan or Lease Gap TIONS, B. General Conditions, 2. Conceal- Coverage: menta Misrepresentation oFraud is , 'Total loss" means a "loss" in which the amended by adding the following: cost of repairs plus the salvage value ex- ceeds the actual cash value. However; if you unintentionally fail to disdose any hazards existing on the effective.date of N. Glass Repair-Waiver of Deductible this Coverage Form, we will.not deny cover- SECTION III PHYSICAL DAMAGE COV- age under this Coverage Form because of ERAGE, D.Deductible is amended by adding such failure. the following: • Q. Mental Anguish Resulting from Bodily Inju- No deductible applies to glass damage if the ry glass is repaired in a manner acceptable to us SECTION V-DEFINITIONS, C. "Bodily inju- ,rather than replaced. ry" is deleted in its entirety and replaced by • the following: O. Duties in the Event of an Accident, Claim, Suit or Loss-Amended "Bodily injury"means bodily injury,sickness or SECTION IV - BUSINESS AUTO CONDI- disease sustained by a person, induding men- TIONS,A. Loss Conditions,2. Duties in the tal anguish and death sustained by the same • person that results from such bodily injury, Event of Accident, Claim,Suit or Loss, a.is sickness or disease. "Bodily injury" does not amended by adding the following: include mental anguish or death that does not This condition applies only when the "acci- result from bodily injury, sickness or disease. dent"or loss"is known to: R. Coverage for Certain Operations in Con- 1. You,if you are an individual; vection with Railroads 2. A partner, if you are a partnership; With respect to the use of a covered "ayto" in • operations for or affecting a railroad: . 3. An executive officer or insurance manag- er, if you are a corporation; or 1. Section V-Definitions, H. "Insured con- tract", 1.c.is amended to reed: 4. A member or manager, if you are a lim ited liability company. c. An easement or license agreement; 2. Section V-Definitions, H. "Insured con- • tract",2.a.is deleted. • • Includes copyrighted material of ISO AA 288 01 16 Properties, Inc.,with its permission. Page 4 of 4 • www.saif.com - • say work. Life. Oregon. Oregon Workers' Compensation • Certificate of Insurance Certificate holder: • CITY OF ASHLAND 90 N MOUNTAIN AVE 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 Industrial Hearing Service Inc SAIF Corporation PO Box 55997 Portland Service Center Portland, Or 97238-5997 503.673.5283 servic@saif.com Issued 07/14/2022 Limits of liability Policy 448552 . Bodily Injury by Accident $1,000,000'each accident Period 07/01/2022 to 07/01/2023 Bodily Injury by Disease $1,000,000 each employee Body Injury by Disease $1,000,000 policy limit • Description of operations/locations/special items 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. , Authorized representative. eAt— • Chip Terhune President and CEO • • • • • . • 400 High Street SE Salem,0R 97312 P:800.285.8525 • Policy_OLCA_CertificateOflnsurance F:503.584.9812 • ' EXHIBIT C . • CERTIFICATIONS/REPRESENTATIONS: Consultant,by and through its authorized representative,under penalty of perjury,certifies that(a)the number shown onthe attached W-9 form is its correct taxpayer ID(or is waiting for the number to be issued to it and(b)Consultant is not subject to backup withholding because: (i) it is exempt'from backup withholding,or(ii)it has not been notified by the Internal Revenue Service(IRS)that it is subject to backup withholding as a result of a failure to report all interest or dividends,or(iii)the IRS has notified it that it is no longer subject to backup withholding. Consultant further represents and warrants to City that: (a)it has the power and authority to enter into this Agreement and perform the Work,(b)the Agreement,when executed and delivered,shall be a valid and binding obligation , of Consultant enforceable in accordance with its terms,(c)the work under the Agreement shall be performed in accordance with the highest professional standards,and(d)Consultant is qualified,professionally competent,and duly licensed(if applicable)to perform the Work. ` Consultant also certifies under penalty of perjury that its business is not in violation of any Oregon tax laws, it is an independent contractor as defined in the Agreement,it is authorized to do business in the State of Oregon,and Consultant has checked four or more of the following criteria that apply to its business. (1)Consultant carries out the work or services at a location separate from a private residence or is in a specific portion of a private residence,set aside as the location of the business. Y - (2)Commercial advertising or business cards or a trade association membership are, - v purchased for the business. ' (3)Telephone listing is used for the business separate from the personal residence ' listing. V (4)Labor or services are performed only pursuant to written contracts. V (5)Labor or services are performed for two or more different persons within a period of one year. (6)Consultant assumes financial responsibility for defective workmanship or for • service not provided as evidenced by the ownership of performance bonds, • warranties,errors and omissipn(professional liability) insurance or liability insurance relating to the Work or services to be provided.- . 14 4 1,ileb.b. ' Cons ant's signature 1. 13 • 2-0 a-- . Date • Page I of EXHIBIT C • .