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HomeMy WebLinkAbout2023-061 PO 20240026- Aquatic Ecosystem Sciences LLC • • Purchase Order CITY RECORDER 11/10 6; Fiscal Year 2024 Page: 1 of: 1 B City of Ashland L ATTN: Accounts Payable Purchase L Ashland, OR 97520 Order# �02�00�� T Phone: 541/552-2010 • O Email: payable@ashland.or.us j V H C/O Water Treatment Plant E AQUATIC ECOSYSTEM SCIENCES LLC I 90 North.Mountain Ave N 295 EAST MAIN ST., SUITE 7 ' - p Ashland, OR 97520 ASHLAND, OR 97520 _ Phone: 541/488-5345 R T Fax: 541/552-2329 O 1 e :_A0 a c'� 5 [s Ee.e _ _.� __ - -_g.�-ilk;__IsT.=�ti tf_•—] -[=t=�._ _ — (541)482-1575 Alistair Andre ftaFxi.4Y —.�''-Y ----- ------ 07/18/2023 828 FOB ASHLAND OR/NET30 Ci Accounts Pa able :,- s a1,�p�a a- -mss.-'�- T- :��� - E �yG,�-� a7, . �. -S!2�.t _.i=���_ —___'`- x�-�.- ze=�—. �Ea14�1 � ��A.&r��a-i<S�Qi ����F�`.yiCsl�'� .�"�_ . Consulting Reeder Reservoir • 1 Assist in cyanobacteria samplingand identification of 1.0 $4,800.00 $4,800.00 cyanobacteria density. Consultaion with city staff on treatment • and management of Reeder Reservoir algae blooms. Personal Services Agreement(Less than $35,000) Completion date: June 30, 2024 Project Account: ' ***************GL SUMMARY*************** 081900-604100 j $4,800.00 I, By: AA Date: Authorized Signature, ,4 800.00 • I FORM#3 I ::-:,:i1)...-. 1 it';. t CITT OF ., - _�0 °2 � ASHLAND REQUISITION Date of request 06/20/2023 " Required date for delivery: I 07/01/2023 I Vendor Name - AQUATIC ECOSYSTEM SCIENCES LLC ' Address,City,State,Zip 295 EAST MAIN ST.SUITE 7 ASHLAND,OR,97520. Contact Name&Telephone Number JACOB KANN(541)482-1575 Email address ' Jacob@aquatic-ecosciences.com SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ invitation to Bid 0 Reason for exemption: Date approved by Council:_ ❑ Form#13, " ❑ AMC 2.50 ❑ Form#13,Written findings and Authorization _(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 exceeding$5,000 Date approved by Council: IN Direct Award (Attach copy of council communication) • ❑ Contract Oregone of a . • J(VerbaWWritten bid(s)or proposal(s) 0 Request for Qualifications(Public Works) 0 State of Washington Date approved by Council: Contract# _(Attach copy of council communication) ❑ Other government agency contract ' • • Intermediate Procurement ❑ Sole Source Agency GOODS&SERVICESac Greater than$5,000 and less than$100,000 0 Applicable Form(#5,6,7 or 8) Contract# . 0 Written quote or proposal attached Jnterrtovemmental Agreement ❑ (3)Written bids&solicitation attached 0 Form#4,Personal Services$5K to$75K. Agency PERSONAL SERVICES Date approved by Council: Greater than$5,000 and less than$75,000 -Valid until: 0 AnnualtcostpvtCity does notexceed$25,000. ❑ Less than$35,000,by direct appointment (Date) Agreement approved by Legal and approved/signed by ❑ Special Procurement Ci,Adminisiratoc Ah9C2.50.070(4) ❑ (3)Written proposals&solicitation attached 0 Form#9,Request for Approval ❑ Annual cost to City exceeds$25,000,Council • ❑ Form#4,Personal Services$5K to$75K ❑ Written quote or proposal attached approval required.(Attach copy of council communication) • Date approved by Council:_ Valid until:. (Date) Description of SERVICES Assist in cyanobacteria sampling and identification,interpretation of cyanobacteria density. TOTAL-COST Consultationwith city staff on treatment and management of Reeder Reservoir algae blooms. $ 4,80b.00 _ Item# Quantity Unit Description of MATERIALS Unit Price Total Cost I • • 0 Per attached quote/proposal - TOTAL COST $ Project Number Account Number 0 a 1 9 a 0.6 a 4 1 a 0 . • Account Number Account Number 'Expenditure m ,a charged to the appropriate account numbers forthe financials to accurately reflect the actual expenditures. 1T Director in.!laboratlon with department to approve all hardware and software purchases: By signing this .1_• 'on form,I car*that the City's public contracting requirements have been satisfied. IT Director Date Support-Yes/No , Emplo -e: ��41 , • Department Head: • Departmen •.ana.-r/Supervisor: - City Manager: (Equal taergreater than$S,aoo) • Funds appropriated for current fiscal yearYES/NO (Greater than$35,000) • Finance Director-(Equal to or greater than$5.000) •Date • Comments: I • 1 Form#3-Requisition C I PERSONAL SERVICES AGREEMENT (LESS THAN $35,000) CONSULTANT: Aquatic Ecosystem Sciences LLC CITY OF CONTACT: Jacob Kann,Ph.D.,President . I ASH LAN D 20 East Main Street ADDRESS: 295 East Main Street, Suite 7, Ashland,Oregon 97520 Ashland, OR 97520 Telephone: 541/488-5587 TELEPHONE: 541-482-1575 • • EMAIL: jacob@aquatic-ecosciences.com This Personal Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and Aquatic. • Ecosystem Sciences, LLC, a domestic limited liability company ("hereinafter "Consultant"), for Reeder Reservoir HABs. 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 set 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 June 30,2024. 2. Scope of Work: Consultant will provide consultation regarding cyanobacteria blooms, algal toxins and taste and odor issues in Reeder Reservoir as more fully set forth in the Consultant's Proposal dated June 15,2023,which is attached hereto as "Exhibit A" and incorporated herein by this reference. Consultant'sservices are collectively referred to herein as the"Work." 3. Supporting Documents/Exhibits; Conflicting Provisions: This Agreement and any exhibits or other supporting documents shall be construed to be mutually 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, are so registered,licensed and bonded. • 6. Compensation: City shall pay Consultant the hourly rate of$150.00 (one hundred and fifty dollars) as 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$4,800.00 (four thousand eight hundred dollars)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,payment 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. 9. Living Wage Requirements: If the amount of this Agreement is $25,335.05 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 injmy 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, actions, costs, or other damages, caused solely by the gross 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 (3 0) 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 le 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. 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.'1 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 are 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 the equivalent, 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 or 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. 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 hot 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 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 thi i 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 federaldistrict 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 lie 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,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 Water Treatment Plant Attn: Alistair Andre 20 E. Main Street Ashland, Oregon 97520 Telephone: 541-488-5345 • With a copy to: City of Ashland-Legal Department 20 East Main Street Ashland, Oregon 97520 Telephone: 541-488-5350 If to Consultant: Aquatic Ecosystem Sciences,LLC Jacob Kann,Ph.D. • 295 East Main Street, Suite 7 Ashland, Oregon 97520 Telephone: 541-482-1575 20. Amendments. This Agreement may be amended only by written instrument executed by both parties with the same formalitiesas 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. • 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: AQUATIC ECOSYSTEM SCIENCES,LLC: By: ____-.1"irditIMENh. By: Alp• 0 Signature ' Jacob Kann STC' tc sc u 2y Printed Name Printed Name • President Title Title 7 . l o. so v& 7/6/2023 Date Date • Purchas e o,�O O (W-9 is to be submitted with this signed Agreement) I EXHIBIT B CITY OF ASHLAND, OREGON City of Ashland • LIVING - - ALL employers described WAGE .1, belOW must complywith City of Aslaiand laws regulating payment at a living wage. . $18.42 per hour effective June 30 ,2023. 111 411 Living Wage is adjusted annually every June 30 by the Consumer Price Index, Employees must Ibe- paid a portion of the business of rfhealthcare,retirement • living usage: their employer if the OK,and IRS eligible employer hasten or more cafeteuia;plans(iincluding employees,and has re ted chiidcar4 benefits to the FFc'ta9tha�rsv lk�erRurrdera financial aesistancefor the employees amnnuntofwage. seriuive=tract between their project or business ham tfGe emr�la r anif'the City of City of Ashland over r Note:For ternparary�and • $25,335.05 Ashland if the contrail , part-time employees,the r eels$23,335LOb or name. w Ding Wage ices not apply Iftlreiremployeristhe CRY of ilethefirstI Ohours worked • .Ashland,including the Perks in any denier year. For • i Far all hours em+rked in and Recreation Department amore deals,please Ste 115�nnli,iftiheemplsy'ee spends 5i0%or mare of the Ashland I's�unici l two employees time in that month ° In calcurath'Igtltie hicag wag ; Section 3:12.020_ vrofigoroaprajcctmr employers may add the value -For-additional-1 dor-illation: • Call]the Ashland City i4Gana ?s office at 541-480-6002 or turife tate City Manager, City NI,23 East Main Street Ashland,OR 97520,or visit the City's website at w ww:ashlaird.or us. Notice to Employers: This notioe must be Misted in areas where it can be seen by all employ s. CITY OF ASHLAND I 1 • EXHIBIT A Aquatic Ecosystem Satences.6LC` - www,dqua tic.ocosctouces com • JACOB KANN,PH.D. AQUATIC ECOLOGIST ....• '^ o '" "` '"pY 295 Eastmain St.Sulfa 7 Ashland,OR 97520 Voice:541-482-1575 ,..!' Fax:641.552- 2 y' ,,�' '�f j . 1fA13. Email:Jacob(gaquauc-ecoselences.com June 15,2023 • Alistair Andre-Water Treatment Plant Supervisor City of Ashland Water Division 90 N.Mountain Ave. Ashland,Oregon,97520 RE:2023 Consulting Quote for Reeder Reservoir HABs Dear Alistair, As per your email here is a quote to provide consulting services for Reeder Reservoir water quality and algal blooms.The below estimate of Services to be performed for the City of Ashland includes consultation regarding cyanobacteria blooms,algal toxins,and taste and odor issues in Reeder Reservoir.Specific items may include but are not limited to: • • Assist in identifying and recording cyanobacteria sourced in Reeder Reservoir. • Interpretation and determination of cyanobacteria density and potential for toxicity. • Assist in sample preparation for toxin analysis. • Site visits to determine abatement viability and timing. • Consultation with City water treatment staff on sonde data collection,interpretation and reporting strategies. Billing Rate is$150/hr. Quote: =$4,800.00 Please let me know if you have any questions.Thank you. - Sincerely, ! Jacob Kann,Ph.D.,President Aquatic Ecosystem Sciences LLC • • • ' I • • • EXHIBIT C • CERTIFICATIONS/REPRESENTATIONS: Consultant,by and through its authorized representative,under penalty of perjury, certifies that(a)the number shown on the 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 subjectto 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. (2) Commercial advertising or business cards or a trade association membership are purchased for the business. (3) Telephone listing is used for the business separate from the personal residence • listing. . (4) Labor or services are performed only pursuant to written contracts. • (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 omission(professional liability).insurance or liability insurance relating to the Work or services to be provided. • Consultant's signature • • Date ACO)�i, CO - CERTIFICATE-OF LIABILITY INSURANCE DATE(MM/2023) 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:lithe 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: i Susan Jain(73092CH) ' PHONE FAX 450 Siskiyou Blvd Ste 5, (A/C,No,EXT):541-482-8463 (A/C,No):541-488-4215 . E-MAIL • Ashland OR 97520 5107 ' ADDRESS: sjain1@farmersagentcom • • i INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Truck Insurance Exchange 21709 INSURER B: Farmers Insurance Exchange 21652 AQUATIC ECOSYSTEM SCIENCES INSURER c: Mid Century Insurance Company 21687 295 E MAIN ST#7 • INSURER D: ' ASHLAND OR 97520 INSURER E: INSURER F: COVERAGES • CERTIFICATE NUMBER: REVISION NUMBER: i • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR 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 ALLTHETERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDTL SUER POLICY NUMBER POLICY EFF POLICY EXP • LIMITS LTR • INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY ' EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea Occurrence) $ 75,000 MED EXP(Any one person) $ 5,000 B Y N 035120419 11/17/2022 11/17/2023 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY I 1 PROJECT LOC .- PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) , ANY AUTO BODILYINJURY(Perperson) $ OWNED AUTOS SCHEDULED BODILY INJURY(Per accident)$ ONLY AUTOS N HIRED AUTOS . NON-OWNED PROPERTY DAMAGE $ ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB 1 CLAIMS-MADE , AGGREGATE $ DED RETENTION$ $ WORKERSCOMPENSATIO& PER I f I OTHER $ AND EMPLOYERS'LIABILITY STATUTE ANY PROPRIETOR/PARTNER/ Y/N E.L.EACH ACCIDENT $ EXECUTIVE OFFICER/MEMBER - N/A EXCLUDED?(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 9 If yes,describe under DESCRIPTION OF L OPERATIONS below i E.L.DISEASE-POLICY LIMIT $ Professional Liability per claim $1,000,00C D Y N EEH27619950 11/15/2023 11/15/2024 per year $1,000,00C • DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 295 E MAIN ST#7,ASHLAND,OR 97520 CERTIFICATE HOLDERCANCELLATION CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 51 WINBURN WAY DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE c : et�J} a/t g�Z�'/J`Y�e ASHLAND OR' 97520 Y ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION.All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICYNUMBER: J7239 1st Edition FARMERS INSURANCE ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS- SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERS COVERAGE FORM APARTMENTOWNERS LIABILITY COVERAGE FORM ' CONDOMINIUM LIABILITY COVERAGE FORM SCHEDULE Name Of Additional Insured Location(s)Of Covered Operations Person(s)Or Organization(s) -. • CITY OF ASHLAND 51 WINBURN WAY _ _ ASHLAND, OR 97520 Information required to complete this Schedule,-if not shown above,will be shown in the Declarations. A. The following is added to Paragraph C.Who Is An Insured of the applicable Coverage Form: Any person(s) or organization(s)shown in the Schedule is also an additional insured, but only with respect to liability for"bodily injury","property damage"or"personal and advertising injury"caused,in whole or in part,by your acts or omissions or the acts or omissions of those acting on your behalf in the performance of your ongoing operations for the additional insured(s)at the location(s)designated above. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law;and b: If coverage provided to the additional insured is required by a contract or agreement;the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds,the following additional exclusions apply: This insurance does not apply to"bodily injury"or"property damage"occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project(other than service,maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the location of the covered operations has been completed;or 2. That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to'the insurance afforded to these additional insureds,the following is added to Paragraph D. Liability And Medical Expenses Limits Of Insurance of the applicable Coverage Form: If coverage provided to the additional insured is required by a contract or agreement,the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement;or 2. Available under the applicable Limits Of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits Of Insurance shown in the Declarations. This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all-the terms of the policy. J7239-ED 1 02-19 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 1 937239 J7239101 ' c GEICO. GEICO Casualty Company 14111 Danielson Street Poway,CA 92064-6886 JACOB KANN AND NINA M GALLWEY { June 15,2023 374 IDAHO ST ASHLAND OR 97520-3034 Policy Number:4286119542 Company: GEICO Casualty Company To Whom It May Concern: This letter is to verify that the following individual(s)are listed as drivers and/or named insureds for the above referenced policy as of June 15,2023: Jacob Kann Please contact us if we may be of further assistance. Sincerely, GEICO Customer Service POCDRV(12-15) • I � • • • • • GEICO GEICO CASUALTY COMPANY Washington DC • VERIFICATION OF COVERAGE • • (SEE BELOW UNDER CAUTIONARY NOTE) MAILING ADDRESS Policy Number:4286119542 JACOB KANN AND NINA M GALLWEY Effective Date:05-01-23 374 IDAHO ST Expiration Date:11-01-23 ASHLAND OR 97520-3034' Registered State:OREGON To whom It may concern: This letter is to verify that we have issued coverage under the above policy number for the dates indicated in the effective and expiration date fields for the vehicle listed.This should serve as proof that the below mentioned vehicle meets or exceeds the financial responsibility requirement for your state. This verification of coverage does not amend,extend or alter the coverage afforded by this policy. Vehicle Year: 2005 Make: TOYOTA • Model: HIGHLANDER VIN: JTEHD21A150033263 • • • COVERAGES • LIMITS DEDUCTIBLES Bodily Injury Liability Each Person/Each Occurrence $100,000/$300,000 Property Damage Liability $1.00,000 Medical Payments $5,000 Personal Injury Protection Uninsured Motorists Bodily Injury Non-Ded Each Person/Each Occurrence $100,000/$300,000 Uninsured Motorists-Property Damage $20,000 ' Comprehensive(Excluding Collision) Emergency Road Service • $250 Ded ERS COMP Lienholder Additional Insured Interested Party Additional Information: • Issue Date:06-15-23 -' • If you have any additional questions,please call 1-800-841-3000. CAUTIONARY NOTE:THE CURRENT COVERAGES,LIMITS,AND DEDUCTIBLES MAY DIFFER FROM THE COVERAGES,LIMITS AND DEDUCTIBLES IN EFFECT AT • OTHER TIMES DURING THE POLICY PERIOD.THIS VERIFICATION OF COVERAGE REFLECTS THE COVERAGES,LIMITS,AND DEDUCTIBLES AS OF THE ISSUED DATE OF THIS DOCUMENT WHICH IS SHOWN UNDER"ADDITIONAL INFORMATION"OR IF AN ISSUED DATE IS NOT SHOWN,THE DATE OF THIS FACSIMILE OR EMAIL U3312-17 • • • 1 • • • • • CERTIFICATION.OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REQUIREMENTS Contractor is exempt from the requirement to obtain workers compensation insurance pursuant to ORS Chapter 656 for the following reason. Contractor is to initial the,•appropriate box as follows: SOLE PROPRIETOR (Initials) • Contractor is a sole proprietor,and ■ Contractor has no employees,and • Contractor will not hire employees or subcontractors to perform this contract. CORPORATION—FOR PROFIT (Initials) • Contractor's business is incorporated;and • All employees of the corporation are officers and directors and have a substantial ownership interest*in the corporation,and ■ All work will be performed by the officers and directors;Contractor will not hire other employees or subcontractors to perform this contract. CORPORATION-NONPROFIT (Initials) ■ Contractor's business is incorporated as a nonprofit corporation,and • ■ Contractor has no employees;all work is performed by volunteers,and • Contractor will not hire employees or subcontractors to perform this contract. PARTNERSHIP • (Initials) ■ Contractor is a partnership,and • Contractor has no employees,and. ■ All work will be performed by the partners;Contractor will not hire employees or subcontractors to perform this contract,and • Contractor is not engaged in work performed in direct connection with the construction,alteration,repair, improvement,moving or demolition of an improvement to real property or appurtenances thereto.** JK LIMITED LIABILITY COMPANY . (Initials) ■ 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 subcontractors to perform this contract,and • • 'If Contractor has more than one member,Contractor is not engaged in work performed in direct connection with the construction,alteration,repair,improvement,moving or demolition of an improvement to real property or appurtenances thereto.** 7/6/2023 (Signature of Authorized Signer) (Date) President 1 (Authorized Signer's Title) *NOTE: Under OAR436-50-050 a shareholder has a"substantial ownership"interest if the shareholder owns 10%of the corporation,or if less than 10%is owned,the shareholder has ownership that is at least equal to or greater than the average percentage of ownership of all shareholders. **NOTE: Under certain circumstances partnerships and limited liability companies can claim an exemption even when performing construction work. The requirements for this exemption are complicated. Consult with City Attorney's Office before an exemption request is accepted from a contractor who will perform construction work. ;, j