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HomeMy WebLinkAbout2021-024 PO 20210379- Payne, Gregg 1Purchase Order w �, C3 RECD, DE;;A /MN Fiscal Year 2021 ,, • Page: 1 of: I t Vic] >( City of Ashland ; r,_� �I t r_ , i, • ATTN:Accounts Payable Main Purchase L Ashland, OR 97520 Order# 20210379 T Phone:541/552-2010 O Email:payabie©ashland.ar.us • V S H 0/0 Fire and Rescue Department E PAYNE, GREGG l 465 Sisklyou Blvd ' N 7491 HIGHWAY 238 P Ashland, OR 97520 — 0 JACKSONVILLE,OR 97630 Phone:6411482-2770 • O Pax:541/488-6318 I _ ] ]1 1 =Frl�e • Chris Chambers 06/14/2021 6031 Ci Accounts •. ab a — ei= ;� — Fo_s -.i—'_.'.—•�`�S�"¢-_L - _ - "' - I 11 '= �9 1[--t�C-1—s_;- _ -C i I Design Evaucuatlon Postcard • 1 Design services for city evacuation postcards 1.0 $2,000.00 $2,000.00 • Services Agreement(Less than$25,000) Completion date: May 31,2021 • , Project Account: E-G00005-400 • ***************GL SUMMARY*************** 075100-610355 $2,000.00 • • • • • • • • • • Alide • or,- ate: //3 -7 _. Authorized Signature /r T„iE -= 2 000.00 • . W. /7.;C'' q"/ . . FORM#3 ✓� ,/ CITY OF p`_ A p tt� • JJ ppiv/ �S H LAN D t'�vgtimt ikvi't't iji"il,c i Ell l rlltkw REQUISITION r4 . ,___ „.....7,47 F 7Da of request: 06/1012021 R quired date for delivery: 0611112021 Gregg Payne Art&Design Vendor NameG-� Address,City,State,Zip 7491 Highway 230,Jacksonville OR 97630 `yL �� ,�i Contact Name&Telephone Number Gregg Payne, t/ " Email address 9 y , 0 • t' �G T gregg•ayne®mao.com / ed SOURCING METHOD • 1/ Ar IDRxemai from Competitive Bidding I:1 Invitation to Bid CIRmeruencti ❑ Reason for exemption: Date approved by Council:- . ❑ Form 1113,Written findings and Authorization ❑ AMC 2.50 _(Attach copy of council communication) ❑ Written quote or proposal attached ❑ Written quote or proposal attached _._„(If council approval required,attach copy of CC) ❑ Small Procurement • ❑ Request for Proposal • Cooperative Procurement Not exceedlnq$5.000 Date approved by Council_ 0 Stale of Oregon L�j Direct Award (Attach copy of council communication) Contract 11 ❑ Verbal/Written bids)or proposal(s) El Request for dual Motions(Public Works) ❑ State of Washington Date approved by Council: Contract II . (Attach copy of council communication) ❑ Other government agency contract intermediate Procurement• 0 Sole Source Agency \ GOODS&SERVICES • 0 Applicable Form(115,6,7 or 8) ,Contract fl Greater than$5.000 and fess than$100.000 ❑ Written quote or proposal attached Jnterrtovernmental Agreement ❑ (3)Written bids&solicitation attached 0 Form#4,Personal Services$51<to$751< Agency PERSONAL SERVICES Date approved by Council: CI Annual cost to City does not exceed$25,000. . Greater then$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 0 Special Procurement . City Administrator.AMC 2.60,070(4) ❑ (3)Written proposals&solicitation attached 0 Form#0,Request for Approval [LSI Annual cosi to City exceeds$25,000,Council •• Cl Form#4,Personal Services$51(to$75K ❑ Written quote or proposal attached approval required.(Attach copy of council communication) Date approved by Council: Valid until: (Date) ' Description of SERVICES • Total Cost • Design services for City evacuation postcards • • .:g.:2,000• .0.6 . .t . : • Item# Quantity Unit Description of MATERIALS Unit Price Total Cost • . . `" U Per attached quotelproposal • TOTAL COST Project Number o' 0 0 0 0 s..a 0 0 - Account Number 0 1 6 1 0 0.6 1 0 3 6 6 . 2000'00 - Account Number • Account Number • • . • 'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. iT Director In collaboration with department to approve all hardware and software purchases: • IT Director Date Support-Yes/No By signing this requisition form,I certify that the City's public contracting requirements have been satisfied. Employee. cmba,lneu, r ;___� _ Department Head: Ay N� �' City (Equal to or greater 35,000) Department ManagerlSupervisor: Chris Chambers •,-: Ma y.er� �r ►alto. greater tl► n325,000) Funds appropriated for current fiscal year: w,YFS-f No �' -- ��� ��' Fi iance•tiro or-( quad to or areatei ,n OS 11 Date Comments: • Form 113-Requisition SERVICES AGREEMENT(LESS THAN$25,000) PROVIDER: Gregg Payne Art&Design • CITY O F PROVIDER'S CONTACT: ASHLAND 20 East Main Street EMAIL:greggpaynen,mac.com Ashland,Oregon 97520 Telephone: 541/488-5587 ADDRESS: 7491 Highway 238, Jacksonville, OR 97530 • Fax: 541/488-6006 PHONE: (530)•228-3399 • This Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation(hereinafter"City")and Gregg Payne Art&Design,a domestic sole proprietorship ("hereinafter"Provider"),for graphic design work. 1. PROVIDER'S OBLIGATIONS 1.1 Provide art and layout for a postcard for evacuation information, 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. 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 employees. 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 Requirement: If the amount of this Agreement is$21,507.75 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. 2. CITY'S OBLIGATIONS 2.1 . City shall pay Provider the sum of up to $2,000 as provided herein as full compensation for the Work - as specified in the SUPPORTING DOCUMENTS. 2.2 In no evenshall Provider's total of all compensation and reimbursement under this Agreement exceed the sum o W-thousand dollars 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. 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 All Work product or 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. 3.5 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. • 3.6 This Agreement may be amended only by written instrument executed with the same formalities as this Agreement. 3.7 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. V 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. V 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. 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 Proposal dated 05/14/2021. 4.2 This Agreement and the SUPPORTING DOCUMENTS shall be construed to be mutually complimentary and supplementary wherever possible. In the event of a conflict which cannot be so resolved,the provisions of this Agreement itself shall control over any conflicting provisions in any of the SUPPORTING DOCUMENTS. In the event of conflict between provisions of two of the SUPPORTING DOCUMENTS,the several supporting documents shall be given precedence in the order listed in Subsection 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 TERMINATION 6.1 Term This Agreement shall be effective from the date of execution on behalf of the City as set forth below (the "Effective Date"), and shall continue in full force_and effect until May 31, 2021, 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 inlieu of any other remedy at law or equity. 7. NOTICE Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery, by sending via a reputable commercial overnight courier, or by mailing using registered or certified United States mail, return receipt requested, postage prepaid, to the address set forth below: If to the City: City of Ashland—Ashland Fire&Rescue Attn: Chris Chambers 455 Siskiyou Blvd Ashland, Oregon 97520 Phone: (541) 552-2218 With a copy to: City of Ashland—Legal Department 20 E. Main Street Ashland, OR 97520 Phone: (541)488-5350 5 • If to Provider: • Attn: Gregg Payne Gregg Payne Art&Design 7491 Highway 238 Jacksonville, OR 97530 Email:greggpayne@mac.com Phone: (530)228-3399 8. WAIVER OF BREACH One or more waivers or failures to object by either party to the other's breach of any provision,term,condition, or covenant contained in this Agreement shall not be construed as a waiver of any subsequent breach,whether or not of the same nature. 9. PROVIDER'S COMPLIANCE WITH TAX LAWS 9.1 Provider represents and warrants to the City that: 9.1.1 Provider shall, throughout the term of this Agreement, including any extensions hereof, comply • with: c (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) Anyrules,regulations, charterprovisions, or ordinances that implement or enforce anyof � � p 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. . I • • 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: Gregg Payne Art&Design(PROVIDER): By: (e„., CR--{ By:Y 1 -7� Signature Printed Name Gregg Payne Printed Name T /r-C_ C" / € Owner Title Title 5//7/9—/ 5/14/2021 Date Date • Purchase Order No. ,(W-9 is to be submitted with this signed Agreement) 66EE-888 0ES woo•auAed66a.a6 woo•oewjauAed66a.a6 '000x$ apaoxa op.qou poefo.ad lepo1 •ay .aad •OS$ 7 s.anoy Sz o4 5'Z a4.ew14sg •s6adf.ao Sid❑d agopty algequlJd ul padanllap aq op..p..ae dew pang •puelysv j.o Ag10 ayq.Aq papinodd pew•aoj.!V ul oj.ul pue sdew gj.e.a❑ •sapls ypoq uo papul.ad aq op sp.aeo „c9•gx«r9•c9 .ao.J sae suolsuawl❑ •suoisJan auoz ape.aedas uaa.jo e dew pue uolgewJo;ul uolpenoeng puelL.lsv 1:802/171../g • OE9L6 1_10 all!nuos>loer • SEE /SMH 1. 6t7L N J I S g ❑ @ 1 1=1 V 8 N A. V d J J g H J • • ' . • CERTIFICATION OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REQUIREMENTS. Contractor is exempt from the requirement to obtain 'workers cOMpeasation imatatatince pursuant to ORS Chapter 654 for the following reason. Contractor is to initial the appropriate box as&Book*: ia. SOLE' . 3 . _ PROPRIETOR onitifits • Contractor is a sole proprietor,and 1 COritTSCIOr has no employees,and * Contractor will not hire emarleyees or subcontractors to Perform this cortaract. CORPORATION-....FOR PROFIT . . itnitisi•;•) a Corot'I taniMest is itteinportited,.and .. • All emplOyees of the corporation ate 6 frictssa and direttota and have a aubstatitial oatatership interest*in the corporation,and • All'work.will be performed hat the officerS and diNetorst Contractor Will not hire OW 011400Ye0 or stibcontrstarors to perfornathia contract. CORPORATION - NONPROFIT (Initials't a ntractor's business is incorporated as a nonprofit corporatioa,and s'' Contractor has no employees all work is'poribrined by volunteers and • Contractor-will not hire employees or subcontractors,to perforro this contract. - ' PARTNERSHIP • tlti.44 a °entree:tor ia a partnerattip,arid • Contmetor has no employeea,mad • MI work will he performed by the whims:,Contractor will not hire employees or subtontratiors to perform this coattail.and at contractor is not wigged in work perfumed in direct connection with the constrtiction,alteration.,roan: irriproveirreat,moving or demolition oleo improvement to real property Or appurtenances thereto." LIMITED LIABILITY COMPANY . I Inifoilai S Contractor is a limited liability company,and - • Contractor has no employees,and • ALL work will.be performed by the members;Contractor will not hire employees or auhcrauractors to perform this . • contract;and ii If Contractor has more than one meiOber,Contractor is not engaged in work performed in direct connection with the construadon,aleitatiora,repair,improvement,moving Or dernolition of an improvement to real property or appurtenances;berate.** . . ae---------). . i ( ' . .. _ / i/s (Sianato ,6 uilioria 'Signet) ( AO' ,. . a---a , . . ....;.......—, (Auilt 1ihad Si ' Title) . . *NOTE: Under 43AR43f3-50-050 a shareholder has a asubatintial awnership"interval if the shareholder owns In%of the corponnien.or if less than la%is owned,the shareholder has ownership that is at least Null to or greater than the average percentage of ownerthip of all shareholders, **NOTE: Under certain circumstances partnerships and limited liability companies can claim an exemption even wheriaaarfonning . conarruCtien work. The requirements for thia exemption are complicated. Consult with City Attorney's Office before in exemption request is accepted from a colitractot who wi i I perform constraction work. . . , • C �® ADATE(MM/DD/YYYY) •�CAREP� CERTIFICATE OF LIABILITY INSURANCE 03/19/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE,CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(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 Judi Johnson . NAME: StateFarm Judi Johnson State Farm Insurance INC.N.Ext): 541-899-1875 FAx Not: 0 645 N 5th Street E-MAIL ) m udi.johnson.cmld statefarm.co 0-0,, ADDRESS: •) Jacksonville,OR 97530-9659 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: State Farm Fire and Casualty Company 25143 INSURED' INSURER B: Gregg Payne Art&Design INSURER C: • 7491 Highway 238 INSURER D: Jacksonville,OR 97530-9139 INSURER E: INSURER F: ' COVERAGES CERTIFICATE NUMBER: 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. I S TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP/DD/YYLIMITS INSD WVD POLICY NUMBER (MM/DD/YYYY) (MMYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED — CLAIMS-MADE IXI OCCUR PREMISES Ea occurrence) $ 300,000 MED EXP(Any one person) $ 5,000 97-CP-S421-2 04/03/2020 04/03/2022 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 XPOLICY Ei LOC PRODUCTS-COMP/OP AGG $'2,000,000 OTHER: $ AUTOMOBILE LIABILITY '\ COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED • '/ PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY • (Per accident) , • $ UMBRELLA LIAR _ OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ — DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/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 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 East Main Street AUTHORIZED REPRESENTATIVE - Ashland,OR 97520 Judi Johnson by electronic signature I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.12 03-16-2016