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2020-039 PO 20200386- Robert Lyon Construction
• Purchase Order rag Fiscal Year 2020 Page: 1 of: 1 iTs - _4 I� I"•rl� B City of Ashland -_ - _, _3 LATTN:Accounts Payable Purchase Ashland,�OR 97520 Order# 20200386 T Phone:541/552-2010 p Email: payable@ashland.or.us • V H C/O Street Division E ROBERT LYON CONSTRUCTION INC l 90 North Mountain Ave N PO BOX 1088 p Ashland, OR 97520 p EAGLE POINT,OR 97524 . Phone:541/488-5313 R T 'Fax: 541/552-2304 ) ii 6 1 .�I. I i - iI " -� 1 r-.le ar•. I _ ""r_- --I _ 1111.1111.1111111111111111111111111111111111...... _ Avram Biondo_ 04/03/2020 4894 FOB ASHLAND OR/NET30 Ci Accounts Pavable .-.tv.r._ __ -_. _ _-_.-- �-f_ je I__;Faa--_..:_, _.- a-_-z _—_� `__.'--.--_-- L = z• I.a-11 -;..1�.`0.'_ Trucking Services 1 Trucking Services for FY 20 1 $30,000.0000 $30,000.00 Goods&Services Agreement(Greater than$25,000) . - Completion date: 12/31/2020 Project Account: Project Account ***************GL SUMMARY*************** 081200-604200 $10,000.00 l 081200-704100 $20,000.00 • N- By: l% ,/'4 is Date: "f [ te ( — Authorized Signature = -_— $30 000,00 • ' FORM #3 'CITY OF `,', ,,-- 6 ASHLAND A request for a Purchase !�/rder REQUISITION Date of request: :;03/09%2020 Required date for delivery: Vendor Name . Robert Lyon Construction,Inc. , Address,City,State,Zip PO Box 1088 Eagle Point,OR 97524 Contact Name&Telephone Number Minda Clasen 541-826-8980 Email address SOURCING METHOD ❑ Exempt from Competitive Bidding 0 Emergency ❑ Reason for exemption: 0 Invitation to Bid ❑ 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; 0 Request for Proposal Cooperative Procurement Not exceeding$5,000 Date approved by Council: 0 State of Oregon ❑ Direct Award _(Attach copy of council communication) Contract# O Verbal)Written bid(s)or proposal(s) 0 Request for Qualifications(Public Works) ❑ State of Washington Date approved by Council: Contract# (Attach copy of council communication) 0 Other government agency contract Intermediate Procurement ❑ Sole Source Agency GOODS&SERVICES 0 Applicable Form(#5,6,7 or 8) Contract# Greater than$5,000 and less than$100,000 0 Written quote or proposal attached Intergovernmental Agreement I] (3)Written bids&solicitation attached ❑ Form#4,Personal Services$5K to$75K ' Agency PERSONAL SERVICES ❑ Special Procurement ❑ Annual cost to City does not exceed$25,000. Greater than$5,000 and less than$75,000 0 Form#9,Request for Approval Agreement approved by Legal and approved/signed by ❑ Less than$35,000,by direct appointment 0 Written quote or proposal attached . City Administrator.AMC 2.50.070(4)• O (3)Written proposals&solicitation attached Date approved by Council: 0 Annual cost to City exceeds$25,000,Council ❑ Form#4,Personal Services$5K to$75K Valid until: (Date) approval required.(Attach copy of council communication) Description of SERVICES Total Cost Trucking Services for FY20 . . '$30,000.00 _ _ ,. . . ..... Item# Quantity Unit Description of MATERIALS Unit Price Total Cost ❑ Per attached quotelproposal TOTA_L_ COST_ 081200 704100 $20,000 " Project Number _ _ _ Account Number _ ,_ . 081200 604200 $10,000 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 thisirequisition„�tiform,I certify that the City's public contracting requirements have been satisfied. Employee:VayW 1�,/iymiai+ Department Head: / f 3A.44 2' zo (E�It,cgreatertha $5,000) Department ManagerlSupervisor: City Administrator: / / /'jj-4,0,ij�� (Equal to.i Q•ter than,$25,000) Funds appropriated for current fiscal year: // NO &OtC� 3/ 17//tea Deputy Finance Director-(Equal to or greater than$5,000) Date Comments: Form#3-Requisition GOODS & ,SERVICES AGREEMENT (GREATER THAN$25,000) PROVIDER.: Robert Lyon Construction, Inc. • • CITY OF PROVIDER'S CONTACT: Minda Clasen ASH LAN D 20 East Main Street ADDRESS: P.O.Box 1088 Ashland, Oregon 97520 Eagle Point; Oregon 97524 Telephone: 541/488-5587 Fax: 541/488-6006 PHONE: 541-826-8980 This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and Robert Lyon Construction Inc., a domestic business corporation("hereinafter"Provider"), for trucking services. 1. PROVIDER'S OBLIGATIONS 1.1 Supply all necessary equipment, personnel, materials, and trucks for dump, water, sweeper, vacuum, and lowboy trucking services as set forth in the "SUPPORTING DOCUMENTS" which are 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 goods and 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 liabilit• y insurance with a combined single limit, or the equivalent,. of not less than $2,000,0.00 (two • million dollars)per occurrence for Bodily Injury and.Propetty 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; o 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; o Provider shall immediately notify the City of any change in insurance coverage o Provider shall supply an endorsement naming the City, its officers, employees and agents as additional insureds by the Effective Date of this Agreement; and a Be evidenced by a certificate or certificates of such insurance approved by the City. Page 1 of 6: Goods and Services Agreement between the City of Ashland and Robert Lyon Construction,Inc. 1.3 All subject employers working under this Agreement are either employers that will comply with ORS 656.017 or employers that are exempt under ORS 656.126. As. evidence of the insurance required by this Agreement,the Provider shall furnish an acceptable insurance certificate prior to commencing any Work under this Agreement. 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.1.1.0. 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. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider the sum of$95.00-$200.00 per hour(dependent on the type of truck)as provided herein as full compensation for the Work as specified in the SUPPORTING DOCUMENTS. 2.2 In no event shall Provider's total of all compensation and reimbursement under this Agreement exceed the sum of$30,0000.00 (thirty thousand dollars) without the 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 This Agreement embodies the full and complete understanding of the parties respecting the subject matter hereof. It supersedes all prior agreements, negotiations, and representations between the parties, • whether written or oral. 3.5 This Agreement may be amended only by written instrument executed with the same formalities as this Agreement. • Page 2 of6: Goods and Services Agreement:between'the City of Ashland and Robert Lyon Construction,Inc. • 3.6 The following laws of the State of Oregon are hereby in.cgrporated by reference into this Agreement: ORS 27913.220,279B.230 and 279B.235. 3.7 This Agreement shall be governed by the laws of the State Of Oregon without regard to conflict of laws principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is in federal court, in which case exclusive venue shall be in the federal district court for the district of Oregon. Each party expressly waives any and all rights to maintain an action under this Agreement.in any other venue, and •• • • expressly consents that, upon motion of the other party, any case may be dismissed or its venue transferred, as appropriate, so as to effectuate this choice of venue. 3.8 Pi•ovid.er shall defend,save,hold harmless and indemnify the City and its officers;employees and agents from and against any and all claims, suits,.actions, losses, damages, liabilities, costs; and expenses of any nature resulting from, arising out of, or relating to •the activities of Provider or its officers, • • employees,-contractors, or agents under this Agreement. •• 3.9 Neither party to this Agreement shall hold the other responsible for damages or delay in performance caused by acts of God, strikes, lockouts,accidents, or other events beyond the control of the other or the other's officers, employees or agents. 3.10 If any provision of this Agreement is found by a court of competent jurisdiction to be unenforceable, such provision shall not affect the other provisions,but such unenforceable provision shall be deemed modified to the extent necessary to render it enforceable, preserving to the:fullest extent'permitted the intent of Provider and the City set forth in.this Agreement. 3.11 Deliveries will be F.O.B destination. Provider shall pay all transportation and handling charges for the Goods. Provider is responsible and liable for loss or damage until final inspection.-and acceptance of the Goods by the City. Provider remains liable for latent defects, fraud, and warranties. 3.12 The City .may inspect and test the Goods. The City may reject non-conforming Goods and require Provider to correct them without charge or deliver them at a reduced price, as negotiated, If Provider •• does not cure any defects within a reasonable time, the City may reject the Goods and cancel this Agreement in whole or in part. This paragraph does not affect or limit the City's rights, including its rights under the Uniform Commercial Code, ORS Chapter 72 (UCC). 3.13 Provider represents and warrants that the Goods are new, current, and fully warranted by the manufacturer. Delivered Goods will comply with SUPPORTING DOCUMENTS and be free from defects in labor,material and manufacture. Provider shall transfer all warranties to the City. 4. SUPPORTING DOCUMENTS The following documents are,by this reference, expressly incorporated in.this Agreement,and•are collectively referred to in this Agreement as the "SUPPORTING DOCUMENTS:" o The City's written Invitation to Bid with a Release Date of February 3, 2020. o The Provider's complete written Proposal entitled "Hourly Truck Rental Rates"effective March 1, 2020. } Page 3 of 6: Goods and Services Agreement between the City of Ashland and Robert Lyon Construction,Inc. • 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 la.w 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.December 31,2020,unless sooner terminated as provided in Subsection 6.2. 6.2 Termination 6.2.1 The City and Provider may terminate this Agreement by mutual agreement at any time. 6.2,2 The City may, upon not less than thirty (30) days' prior written notice, terminate this Agreement for any reason deemed appropriate in its sole discretion. 6.2.3 Either party may terminate this Agreement, with cause, by not less than fourteen(14) days' prior written notice if the cause is not cured within that fourteen (14) day period after written notice. Such termination is in addition to and not in lieu of any other remedy at 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—Street Division, Public Works Department Attn: Avram Biondo 20.E. Main Street • Ashland, Oregon 97520 • • Phone: (541)48'8-5313 With a copy to: City of Ashland—Legal Department 20 E. Main Street Ashland, OR 97520 Phone: (541) 488-5350 • Page 4 of 6: Goods and Services Agreement between the City of Ashland and Robert Lyon Construction,Inc. • If to Provider: RLC Robert Lyon Construction Inc. Attn: Minda Classen PO Box. 1088 Eagle Point, OR 97524 541-826-8980 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 W.ITI-I TAX LAWS 9.1 Provider represents and warrants to the City that: 9.1.1 Provider shall, throughout the term of this Agreement, including any extensions hereof, comply with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the.•State of Oregon applicable to Provider; and (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.1.2 Provider, for a period of no fewer than six (6) calendar years preceding the Effective Date of this Agreement, has faithfully complied with: (1) 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; an.d (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of } the foregoing tax laws or provisions. 9.2 Provider's failure to comply with the tax laws of the State of Oregon and all applicable:tax laws of any political subdivision of the State of Oregon shall constitute a Material breach of this Agreement.. Further, any violation of Provider's warranty, as set forth in this Article 9, shall constitute a material breach of this Agreement. Any material breach of this Agreement shall entitle the City to terminate this Agreement and to seek damages and any other relief available under this Agreement,at law,or in equity. } • Page 5 of 6: Goods and Services Agreement between the City of Ashland and.Robert Lyon Construction,Inc. • 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: Robert Lyon C r n,Inc PROVIDER): By By: City Administrator e.„,<ure 41,19 M, , F• Printed.Name Printed Name 31 Z.0 1 Zto e.sLcivitk Date Title (Ooo Date .e,61 Purchase Order No. (W-9 is to be submitted with this signed Agreement) APPROVED AS TO FORM: .47 Assistant City Attorney Date Page 6 of 6: Goods and Services Agreement between the City of Ashland and Robert Lyon Construction,Inc. • . 1D\,.L Rp6ert Lyon Construction, Inc PO Box 1088 Eagle Point, OR 97524 - {I 541826-8980*fax 541826-8981 Office@RobertLvonConstruction.com CCB# 205391 Hourly Truck Rental Rates Trucks Rental Rate/Hour Super Bobtail 4 axle $95.00 Mega Dump $105.00 Side Dump $110.00 Super Transfer 30+Tons $110.00 Truck& Pup 27+Tons $110.00 Tub $105.00 Belly Dump 26-30 Ton $105.00 Belly Dump 22-25 Ton / $100.00 Water Truck $100.00 Lowbed 5 axle $125.00 Flatbed $110.00 Super Bobtail with Equipment Trailer $110.00 Prevailing Wage Rate for any of the above add'I $10/hour Davis Bacon Rate for any of the above add'I $23/hour Power Equipment Sweeper(Non-Boli/Prevailing wage) $150.00 Sweeper(Boll/Prevailing wage)or grindings $175.00 Vacuum Truck(Non-Boli/Prevailing wage) $175.00 Vacuum Truck(Boli/Prevailing wage) $200.00 2-hour Minimum charge Note: RLC Vacuum and Sweeping Trucks include time for travel to job and to clean/wash-out afterwards at RLC yard. . I Screened Granite $12.00/vd. +delivery [ffeetiveMarckl, .02-03 ' 1J CITY OF - FORM #2 S H LAN D INVITATION TO BID—TRADE SERVICES INTERMEDIATE PROCUREMENT $Rclease;date Plz3,-2020J Requested by: Avram Biondo Street Division,Ashland Public Works 541-552-2345 avram.biondo(iiash land.or.us Bids are due by: 2-13-2020 Project name: 2020 City of Ashland Contract Trucking Jobsite location: City of Ashland Oregon Project completion required by: December 31,2020 Bids may be faxed,emailed or hand delivered.Contractors shall submit bid on their company letterhead. Informal email bids and/or late bids will not be accepted.Terms or discounts which are conditioned upon payment within a certain time will not be considered for purposes of comparison of bids. The successful contractor will be required to enter into a contract with the City for the services and provide insurance certificates in their own name for General Liability,Automobile and Workers' Compensation.Workers' Compensation insurance is mandatory.Subcontracting will not be permitted. - "OR EQUAL":Any brand name listed in the specifications as"or equal"or"or equivalent"shall establish the minimum requirements for quality,utility, durability,function,purpose,etc.Other product brands may be offered that are equal to or better than the product brand name.Bidder may show cost difference,altemates and options in the space provided in the quote.This clause is not meant to be restrictive,but to set the minimum standard.THE CITY SHALL DETERMINE,IN ITS SOLE DISCRETION,WHETHER A PRODUCT OFFERED IS"EQUAL."When the designation is"or equal"or "equivalent"City shall make its decision after Bid Closing. SCOPE OF SERVICES Supply equipment,personnel,material,and trucks necessary to provide following services to the City of Ashland. Please provide hourly rates and any minimums for service for the following trucking: 12 yd. bob tail Regular truck and transfer Super transfer Mega dump - . Mechanical sweeper and/or Regen Air sweeper Vac truck Tack distributor truck(include cost of tack per gallon CSS-1 or City,approved alt.) -Lowboy * Include average net weight hauled by trucks and number of trucks available Please note any special requirements to perform work,number of available trucks, and lead time needed to schedule work in bid. *Contractors my bid on one,any number, or all requested services *Services will be on an as needed basis. *Please provide Firm Pricing fiom 2-13-2020 to 12-31-2020 *Maximum amount of contract not to exceed$75,000. Multiple contracts may be awarded. *Upon award, Company must complete a "Goods and Services" contract with the City of Ashland. Sample attached. • All Pricing Must Be Held Firm For 30 Days ' • Form#2—Intermediate Procurement,Invitation to Bid,Trade Services,Page 1 of 2,2/10/2020 ,/IS 2/14/2020 Business Registry Business Name Search Business Registry Business Name Search 02-14-2020 New Search Business Entity Data 13:01 Registry Nbr Entity Entity Jurisdiction Registry Date Next Renewal Renewal Due? Type _ Status Date 1071574-97 DBC ACT OREGON 12-24-2014 12-24-2020 Entity Name ROBERT LYON CONSTRUCTION INC Foreign Name' New Search Associated Names Type PPB PRINCIPAL PLACE OF BUSINESS Addr 1 4777 BUTTE FALLS HWY Addr2 CSZ 'EAGLE POINT'OR 197524 1 I Country 'UNITED STATES OF AMERICA Please clickhere for general information about registered agents and service of process. Type IAGT REGISTERED AGENT Start Date 12-24- Resign Date 2014 Name 'ROBERT I 'LYON I Addr 1 4777 BUTTE FALLS HWY Addr 2 CSZ lEAGLE POINT IOR 197524 1 I Country 'UNITED STATES OF AMERICA Type IMALIMAILING ADDRESS I I Addr 1 PO BOX 1088 Addr 2 CSZ I AGLE POINT OR 97524 Country ITED STATES OF AMERICA Type (PRE 'PRESIDENT I I Resign Date I Name 'ROBERT I [LYON I I Addr 1 4777 BUTTE FALLS HWY Addr2 CSZ 'EAGLE POINT IOR 197524 I I Country 'UNITED STATES OF AMERICA Type 'SEC 'SECRETARY I Resign Date I Name 'KENNETH 1 'LYON I I Addr 1 113 ABERDEEN LN Addr 2 CSZ EAGLE POINT'OR 197524 1 1 Country 'UNITED STATES OF AMERICA New Search Name History I I 1 I A egov.sos.state.or.us/br/pkg_web_name_srch jnq.show_detl?p_be_rsn=1735428&p_srce=BR_INQ&pprint=TRUE 1/2 2/14/2020 Business Registry Business Name Search Business Entity Name Name Name Start Date End"Date Tye Status OBERT LYON CONSTRUCTION INC EN CUR . 12-24-2014 Please read before ordering Copies. New Search Summary History Image Transaction Effective Name/Agent Available Date Date Change Dissolved By Action Status AMENDED ANNUAL 11-15-2019 FI -- REPORT Ai AMENDED ANNUAL 12-10-2018 FI REPORT Ali AMENDED ANNUAL 12-04-2017 FI REPORT �� AMENDED ANNUAL 11-11-2016 FI REPORT , AMENDED ANNUAL 11-30-2015 FI REPORT ue2Th _ ARTICLES OF 12-24-2014 FI Agent INCORPORATION © 2020 Oregon Secretary of State. All Rights Reserved. egov.sos.state.or.us/br/pkg_web_name_srch_inq.show_detl?p_be jsn=1735428&p_srce=BR_INQ&p_print=TRUE 2/2 Legal Department Review DOCUMENT TRANSMITTAL AND CONTROL This form will accompany the document through the drafting, review,and signature processes,and will. be kept with the City's final executed copy of the document. Required fields are indicated in gray scale. Document: Robert Lyon Trucking, (Include names of parties to the document) Type of Document: Contract N Lease ❑ Easement ❑ Deed ❑ IGA El Other(Specify) Dept Contact: Tami De Mille-Campos ACTION REQUESTED: Dept:Public Works Phone: Ext 2420 — D Review Draft Date submitted to Legal: 02/14/2020 El Approve final and forward to: Draft due by: ASAP (Unless indicated,Legal will return document to you) Return Requested by: Tami De Mille-Campos Complete this section ONLYthe first time this form is filled out: Has this document been previously worked on by the Legal Dept Staff? ® No ❑ Yes If yes, by whom? LEGAL DEPT First Date Received by Legal Date: a' ) By: l17 p USE ONLY Returned to Dept. for Revision Date: By: Received for additional review by Legal Date: By: Returned to Dept.for Revision Date: By: Received for additional review by Legal Date: By: Returned to Dept.for Revision Date: By: Received for Additional Review by Legal Date: By: Returned to Dept for Revision Date: By: Final Logged out by Legal Date: By: g Comments from LEGAL to DEPARTMENT: Comments from DEPAR 1VIENT to LEI • fff { ❑ See Attached. Return original, executed, document to City ` s ' hoes this document need to be recorded? Recorder for safekeeping? ❑ No - Yes 0 No 111Yes CITY ADMINISTRATOR/DEPARTMENT HEAD Please do not sign the attached document until thisformihjs beenpoved by the Legal Dept below: FINAL LEGAL DEPARTMENT APPROVAL: V) Date: -Z6--Z-a ./7(-- G:llegal\DEPARTMENTS\Contracting\FORMS\Legal Doc Transmittal-KLB.docx } Client#: 176710 ROBELYON YYYY) ATE(MMIDDIM/DD/ ACORDTM CERTIFICATE OF LIABILITY INSURANCE D8/02 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAMEACT Janniel Gonzales Propel Insurance PHONE 541494-7753 FAX 541494-7753 (NC,No,Ext): (A/C,No): Medford Commercial Insurance E-MAIL iel. ro elinsurance.com P 0 Box 936 ADDRESS: ann9onzales @P P Medford,OR 97501 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Western National Mutual Insurance Co. 15377 INSURED INSURER B Robert Lyon Construction, Inc. INSURER C: Central Valley Excavation, Inc. P.O.Box 1088 INSURER D Eagle Point,OR 97524 INSURERE: 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. INSLTR TYPE TYPE OF INSURANCE NSR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY CPP109669705 06/24/2019 06/24/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $300,000 X $500 PD Ded. MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 _ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X JECPRO- T LOC PRODUCTS-COMP/OP AGG. $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY CPP109622205 06/24/2019 06/24/2020Ea OMBacciINEdent)SIj1,000,000 D NGLE LIMIT ( ANY AUTO BODILY INJURY(Per person) $ OWNED AUTOS ONLY AUTOS X SCHEDULED BODILY INJURY(Per accident) $ X HIRTOS ONLY X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY (Per accident) A UMBRELLA LIAB X OCCUR UMB103607600 06/24/2019 06/24/2020 EACH OCCURRENCE $2,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DED X RETENTION$10,000 Excess GL $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (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) The GL&Auto policies include blanket additional insured and blanket waiver of subrogation endorsements [provisions]that provide additional insured/WOS status to the certificate holder when there is a written contract between the named insured and the certificate holder that requires such status. CERTIFICATE HOLDER CANCELLATION The City of Ashland, Oregon SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN its officers,agents and employees ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE l -� ELL-. ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S3747310/M3695080 EKCOO COMMERCIAL GENERAL LIABILITY WNGL490715 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU PRIMARY AND NONCONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or or- additional insureds, the following additional exclu- ganization for whom you are performing opera- sion applies: tions when you and such person or,organization This insurance does not apply to: have agreed in writing in a contract or agreement 1. "Bodily injury", "property damage" or"personal that such person or organization be added as an and advertising injury" arising out of the ren- additional insured on your policy. Such person or dering of, or the failure to render, any profes- organization is an additional insured only with re- sional architectural, engineering or surveying spect to liability for "bodily injury", "property dam- services, including: age" or "personal and advertising injury" caused, in whole or in part, by: a. The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, 1. Your acts or omissions; or opinions, reports, surveys, field orders, 2. The acts or omissions of those acting on your change orders or drawings and specifica- behalf; tions; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. A person's or organization's status as an additional This exclusion applies even if the claims insured under this endorsement ends when your against an additional insured allege negli- operations for that additional insured are complet- gence or other wrongdoing in the supervision, ed. hiring, employment, training or monitoring of However: others by that insured, if the "occurrence" which caused the "bodily injury" or "property 1. The insurance afforded to such additional in- damage", or the offense which caused the sured only applies to the extent permitted by "personal and advertising injury", involved the law; and rendering of or failure to render any profes- 2. If coverage provided to the additional insured sional services by you with respect to your is required by a contract or agreement, the in- providing engineering, architectural or survey- surance afforded to such additional insured ing services in your capacity as an engineer, will not be broader than that which you are re- architect or surveyor. quired by the contract or agreement to provide for such additional insured. WN GL 49 07 15 Page 1 of 2 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 2. "Bodily injury" or "property damage" occurring D. The following is added to the Other Insurance after: Condition and supersedes any provision to the a. All work, including materials, parts or contrary: • equipment furnished in connection with Primary And Noncontributory Insurance such work, on the project (other than ser- This insurance is primary to and will not seek vice, maintenance or repairs) to be per- any contribution from any other insurance formed by or on behalf of the additional in- available to an additional insured under your sured(s) at the location of the covered vailrovided that: operations has been completed; or policy p b. That portion of "your work" out of which (1) The additional insured is a Named Insured the injury or damage arises has been put under such other insurance; and to its intended use by any person or or- (2) You have agreed in writing in a contract or ganization other than another contractor or agreement that this insurance would be subcontractor engaged in performing op- primary and would not seek contribution erations for a principal as a part of the from any other insurance available to the same project. additional insured. C. With respect to the insurance afforded to these additional insureds, the following is added to Sec- tion III—Limits Of Insurance: 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: 1. The minimum amount required by the contract or agreement; or 2. The Limits of Insurance shown in the Declara- tions; . whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. WN GL490715 Page2of2 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. COMMERICAL GENERAL LIABILITY WN GL 39 08 18 COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT The Commercial General Liability Enhancement Endorsement is an optional endorsement that provides coverage en- hancements. The following is a summary of broadened coverages provided by this endorsement. No coverage is pro- vided by this summary, refer to following endorsement for changes in your policy. SUMMARY OF COVERAGES PAGE Bodily Injury And Property Damage Liability • Non Owned Watercraft Up To 50 Feet 2 Property Damage Liability • Elevators 3 • Fire, Lightning, Explosion Or Sprinkler Leakage Exception 3 • Borrowed Equipment ($25,000 Per Occurrence, $50,000 Aggregate, $2,500 Deductible Per Occurrence 3 Supplementary Payments —Amended • Bail Bonds Up To$5,000 4 • Loss of Earnings Up To $500/Day 4 Who Is An Insured Amendments • Employee Bodily Injury To A Co-Employee 4 • Newly Formed Or Acquired Organizations For Up To 180 Days 4 • Blanket Additional Insured —Vendors —As Required By Contract 4 • Blanket Additional Insured—Lessor Of Leased Equipment 6 • Blanket Additional Insured —Managers Or Lessors Of Premises 6 • Blanket Additional Insured —State Or Govemmental Agency Or Subdivision Or Political Subdivision—Permits Or Authorizations 7 • Blanket Additional Insured —State Or Govemmental Agency Or Subdivision Or Political Subdivision— Permits Or Authorizations Relating To Premises 8 Damage To Premises Rented To You — $300,000 9 Medical Payments Increased Limit — $10,000 Or Amount Shown on Declarations 9 Conditions • • Knowledge of Occurrence, Offense, Claim Or Suit Amended 9 • Unintentional Failure To Disclose Hazards 9 • Waiver of Subrogation 10 Insured Contract Amended 10 Personal And Advertising Injury Redefined • Televised, Videotaped Or Electronic Publication 10 WN GL 39 08 18 Includes copyrighted material of the Insurance Service Office, Inc.,with its permission. Page 1 of 10 COMMERCIAL GENERAL LIABILITY. WN GL 39 08 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. The SECTIONS of the Commercial General Liability Coverage Form identified in this endorsement will be amended as shown below. SECTION I— COVERAGES AMENDMENTS (3) Parking an "auto" on, or on the ways next to, COVERAGE A — BODILY INJURY AND PROPERTY premises you own or rent, provided the"auto" DAMAGE LIABILITY is not owned by or rented or loaned to you or the insured; A. Non Owned Aircraft Or Watercraft (4) Liability assumed under any "insured con- Item 2. Exclusions, Paragraph g. is replaced by the tract" for the ownership, maintenance or use following: of aircraft or watercraft; or g. Aircraft, Auto Or Watercraft (5) "Bodily injury" or "property damage" arising "Bodily injury" or"property damage" arising out of out of: the ownership, maintenance, use or entrustment (a) The operation of machinery or equipment to others of any aircraft, "auto" or watercraft that is attached to, or part of, a land owned or operated by or rented or loaned to any vehicle that would qualify under the insured. Use includes operation and "loading or definition of"mobile equipment" if it were unloading". not subject to a compulsory or financial This exclusion applies even if the claims against responsibility law or other motor vehicle any insured allege negligence or other wrong- insurance law where it is licensed or doing in the supervision, hiring, employment, principally garaged; or training or monitoring of others by that insured, if (b) The operation of any of the machinery or the"occurrence" which caused the "bodily injury" equipment listed in Paragraph f. (2) or f. or "property damage" involved in the ownership, (3) of the definition of "mobile equip- maintenance, use or entrustment to others of any ment". aircraft, "auto" or watercraft that is owned or B. Damage To Property Coverage Extensions operated by or rented or loaned to any insured. This exclusion does not apply to: Item 2. Exclusions, Paragraph j. is replaced by the following: (1) A watercraft while ashore on premises you j. Damage To Property own or rent; (2) A watercraft you do not own that is: "Property damage" to: (a) Less than 50 feet long; and (1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or (b) Not being used to carry persons or prop- any other person, organization or entity, for erty for a charge; repair, replacement, enhancement, restora- This Subparagraph (2) applies to any person, tion or maintenance of such property for any who with your expressed or implied consent, reason, including prevention of injury to a either uses or is responsible for the use of the person or damage to another's property; watercraft; (2) Premises you sell, gibe away or abandon, if the "property damage" arises out of any part of those premises; WN GL 39 08 18 Includes copyrighted material of the Insurance Service Office, Inc.,with its permission. Page 2 of 10 (3) Property loaned to you; The,insurance provided for "property damage" from (4) Personal property in the care, custody or con- the use of elevators and for "property damage" to trol of the insured; borrowed equipment is excess over any other valid That particular part of real property on which and collectible property insurance (including any de- (5) you or any contractors or subcontractors ductible portion thereof) available to the insured working directly or indirectly on your behalf whether primary, excess, contingent or on any other are performing operations, if the "property basis. damage" arises out of those operations; or C. Damage To Premises Rented To You (6) That particular part of any property that must Item 2. Exclusions, the last paragraph is replaced by be restored, repaired or replaced because the following: "your work" was incorrectly performed on it. Exclusions c. through n. do not apply to damage by Paragraphs (1), (3) and (4) of this exclusion do not fire, lightning, explosion or sprinkler leakage to apply to "property damage" (other than damage by premises while rented to you or temporarily occupied fire, lightning, explosion or sprinkler leakage) to by you with permission of the owner. A separate limit premises, including the contents of such premises, of insurance applies to this coverage as described in rented to you for a period of seven or fewer Paragraph 6. of SECTION III — LIMITS OF consecutive days. A separate limit of insurance INSURANCE. applies to Damage To Premises Rented To You as described in SECTION III—LIMITS OF INSURANCE. COVERAGE B — PERSONAL AND ADVERTISING However, the provisions of this paragraph do not INJURY LIABILITY apply if coverage for Damage To Premises Rented To You is excluded by endorsement. D. Personal And Advertising Injury Item 2. Exclusions is amended by replacing Sub- Paragraph (2) of this exclusion does not apply if the paragraphs b. and c. with the following: premises are "your work" and were never occupied, rented or held for rental by you. b. Material Published With Knowledge Of Falsity Paragraphs (3) and (4) of this exclusion do not apply "Personal and advertising injury" arising out of to the use of elevators. oral, written, televised, videotaped or electronic publication, in any manner, of material, if done by Paragraphs (3), (4), (5) and (6) of this exclusion do or at the direction of the insured with knowledge not apply to liability assumed under a sidetrack of its falsity. agreement. c. Material Published Prior To Policy Period Paragraph (4) of this exclusion does not apply to "Personal and advertising injury" arising out of "property damage" to borrowed equipment while not oral, written, televised, videotaped or electronic being used to perform operations at the jobsite. publication, in any manner, of material whose first Subject to Paragraph 2. of SECTION III—LIMITS OF publication took place before the beginning of the INSURANCE, the rules below fix the most we will pay policy period. for "property damage" under this provision: (1) $25,000 any one "occurrence", regardless of the SUPPLEMENTARY PAYMENTS —COVERAGES A number of persons or organizations who sustain AND B damages because of that"occurrence"; E. Supplementary Payments —Coverages A and B (2) $50,000 annual aggregate; and Item 1. is amended by replacing Subparagraphs b. (3) We will pay only for damages in excess of$2,500 and d. with the following: as a result of any one"occurrence", regardless of b. Up to $5,000 for cost of bail bonds required be- the number of persons or organizations who cause of accidents or traffic law violations arising sustain damages because of that "occurrence". out of the use of any vehicle to which the Bodily We may, or if required by law, pay all or any part Injury Liability Coverage applies. We do not have of any deductible amount, if applicable, to effect to furnish these bonds. settlement of any claim or "suit". Upon notice of our payment of a deductible amount, you shall d. All reasonable expenses incurred by the insured promptly reimburse us for the part of the at our request to assist us in the investigation or deductible amount we paid. defense of the claim or"suit", including actual loss of earnings up to$500 a day because of time off Paragraph (6) of this exclusion does not apply to from work. "property damage" included in the "products-com- pleted operations hazard". WN GL 39 08 18 Includes copyrighted material of the Insurance Service Office, Inc.,with its permission. Page 3 of 10 SECTION II—WHO IS AN INSURED AMENDMENTS The following are added: A. Employee Bodily Injury To A Co-Employee C. Blanket Additional Insured — Vendors — As Re- Paragraph 2. a. (1) is replaced by the following: quired By Contract However, none of these "employees" or "volunteer 1. Section ll —Who Is An Insured is amended to workers" are insureds for "bodily injury" or "personal include as an additional insured any person(s) or and advertising injury": organization(s) (referred to throughout this (a) To you, to your partners or members (if you are a endorsement as vendor) with whom you have partnership or joint venture), to your members (if agreed in a written contract, executed prior 'to ou are a limited liabilitycompany) to a co- loss, to name as an additional insured, but only p y)' with respect to "bodily injury" or "property "employee" while in the course of his or her damage" arising out of"your products" which are employment or performing duties related to the distributed or sold in the regular course of the conduct of your business, or to your other "volunteer workers" while performing duties vendor's business. related to the conduct of your business; However, (b) To the spouse, child, parent, brother or sister of a. The insurance afforded to such vendor only the co-employee" or "volunteer worker" as a applies to the extent permitted by law; and consequence of Paragraph (1)(a) above; b. If coverage provided to the vendor is required (c) For which there is any obligation to share by a contract or agreement, the insurance damages with or repay someone else who must afforded to such vendor will not be broader pay damages because of the injury described in than that which you are required by the Paragraph (1)(a) or (b) above; or contract or agreement to provide for such (d) Arising out of his or her providing or failing to vendor. provide professional health care services. 2. With respect to the insurance afforded to these However, if a suit seeking damages for "bodily injury" vendors, the following additional exclusions or "personal and advertising injury" to any co- apply: "employee" or other "volunteer worker" arising out of a. The insurance afforded the vendor does not and in the course of the co-"employee's" or"volunteer apply to: worker's" employment or while performing duties (1) "Bodily injury" or "property damage" for related to the conduct of your business, or a suit which the vendor is obligated to pay dam- seeking damages brought by the spouse, child, ages by reason of the assumption of parent, brother or sister of the co-"employee" or other liability in a contract or agreement. This "volunteer worker", is brought against you or a co- exclusion does not apply to liability for "employee" or a"volunteer worker", we will reimburse damages that the vendor would have in the reasonable costs that you incur in providing a the absence of the contract or defense to the co-"employee" or "volunteer worker" agreement; against such matters. Any reimbursement made (2) Any express warranty unauthorized by pursuant to this sub-section will be in addition to the you; limits of liability set forth in the Declarations. (3) Any physical or chemical change in the B. Newly Acquired Organizations product made intentionally by the vendor; Paragraph 3. a. is replaced by the following: • (4) Repackaging, except when unpacked a. Coverage under this provision is afforded only solely for the purpose of inspection, until the 180th day after you acquire or form the demonstration, testing, or the organization or the end of the policy period, substitution of parts under instructions whichever is earlier; from the manufacturer, and then repackaged in the original container; WN GL 39 08 18 Includes copyrighted material of the Insurance Service Office, Inc.,with its permission. Page 4 of 10 • (5) Any failure to make such inspections, 4. With respect to the insurance afforded to these adjustments, tests or servicing as the 'vendors, the following is added to Section III — vendor has agreed to make or normally Limits Of Insurance: undertakes to make in the usual course If coverage provided to the vendor is required by of business, in connection with the a contract or agreement, the most we will pay on distribution or sale of the products; behalf of the vendor is: (6) Demonstration, installation, servicing or repair operations, except such a. The minimum amount required by the operations performed at the vendor's contract or agreement; or premises in connection with the sale of b. The Limits of Insurance shown in the the product; Declarations; (7) Products which, after distribution or sale whichever is less. by you, have been labeled or relabeled or used as a container, part or ingredient of This endorsement shall not increase the any other thing or substance by or for the applicable Limits of Insurance shown in the vendor; or Declarations. (8) "Bodily injury or "property damage" 5. With respect to the insurance afforded to these arising out of the sole negligence of the additional insureds, the following additional vendor for its own acts or omissions or exclusion applies: those of its employees or anyone else This insurance does not apply to: acting on its behalf. However, this a. "Bodily injury", "property damage" or exclusion does not apply to: "personal and advertising injury" arising out (i) The exceptions contained in of the rendering of, or the failure to render, Subparagraphs (4) or (6); or any professional architectural, engineering or (ii) Such inspections, adjustments, tests surveying services, including: or servicing as the vendor has (1) The preparing, approving, or failing to agreed to makeor normally prepare or approve, maps, shop undertakes to make in the usual drawings, opinions, reports, surveys, course of business, in connection field orders, change orders or drawings with the distribution or sale of the and specifications; or products. (2) Supervisory, inspection, architectural or 3. This Provision C. does not apply: engineering activities. a. To any insured person or organization from This exclusion applies even if the claims whom you have acquired such products, or against an additional insured allege any ingredient, part or container, entering negligence or other wrongdoing in the into, accompanying or containing such supervision, hiring, employment, training products; or monitoring of others by that insured, if b. To any vendor for which coverage as an addi- the "occurrence" which caused the tional insured specifically is scheduled by "bodily injury" or "property damage", or endorsement; or the offense which caused the "personal c. When liability included within the "products- . and advertising injury", involved the completed operations hazard" has been ex- rendering of or failure to render any cluded for such product either by the provi- professional services by you with respect sions of the coverage part or by endorse- to your providing engineering, meet. architectural or surveying services in your capacity as an engineer, architect or surveyor. WN GL 39 08 18 Includes copyrighted material of the Insurance Service Office, Inc.,with its permission. Page 5 of 10 4. With respect to the insurance afforded to these D. Blanket Additional Insured — Lessor Of Leased additional insureds, the following additional Equipment exclusion applies: 1. Section II —Who Is An Insured is amended to This insurance does not apply to: include as an additional insured any person(s) or organization(s) from whom you lease equipment a. "Bodily injury", "property damage" or when you and such person(s) or organization(s) "personal and advertising injury" arising out have agreed in writing in a contract or agreement, of the rendering of, or the failure to render, executed prior to loss, that such person(s) or any professional architectural, engineering or organization(s) be added as an additional insured surveying services, including: on your policy. Such person(s) or organization(s) (1) The preparing, approving, or failing to is an insured only with respect to liability for prepare or approve, maps, shop "bodily injury", "property damage" or "personal drawings, opinions, reports, surveys, and advertising injury"caused, in whole or in part, field orders, change orders or drawings by your maintenance, operation or use of and specifications; or equipment leased to you by such person(s) or organization(s). (2) Supervisory, inspection, architectural or engineering activities. However, the insurance afforded to such This exclusion applies even if the claims additional insured: against an additional insured allege a. Only applies to the extent permitted by law; negligence or other wrongdoing in the and supervision, hiring, employment, training or b. Will not be broader than that which you are monitoring of others by that insured, if the required by the contract or agreement to "occurrence" which caused the"bodily injury" provide for such additional insured. or "property damage", or the offense which A person's or organization's status as an addi- caused the "personal and advertising injury", tional insured under this endorsement ends when involved the rendering of or failure to render their contract or agreement with you for such any professional services by you with respect leased equipment ends. to your providing engineering, architectural or 2. With respect to the insurance afforded to these surveying services in your capacity as an additional insureds, this insurance does not apply engineer, architect or surveyor. to any "occurrence" which takes place after the E. Blanket Additional Insured — Managers Or Les- equipment lease expires. sors Of Premises 3. With respect to the insurance afforded to these 1. Section II —Who Is An Insured is amended to additional insureds, the following is added to include as an additional insured any person(s) or Section III—Limits Of Insurance: organization(s) with whom you have agreed in a If coverage provided to the additional insured is written contract, executed prior to loss, to name required by a contract or agreement, the most we as an additional insured, but only with respect to will pay on behalf of the additional insured is: liability arising out of the ownership, maintenance a. The minimum amount required by the or use of that part of the premises leased to you, contract or agreement; or subject to the following additional exclusions: b. The Limits of Insurance shown in the This insurance does not apply to: Declarations; a. Any"occurrence" which takes place after you whichever is less. cease to be a tenant in that premises. This endorsement shall not increase the b. Structural alterations, new construction or applicable Limits of Insurance shown in the demolition operations performed by or on Declarations. behalf of such additional insured. WN GL 39 08 18 Includes copyrighted material of the Insurance Service Office, Inc.,with its permission. Page 6 of 10 • However: F. Blanket Additional Insured — State Or a. The insurance afforded to such additional Governmental Agency Or Subdivision Or Political insured only applies to the extent permitted Subdivision — Permits Or Authorizations by law; and Section II — Who Is An Insured is amended to in- b. If coverage provided to the additional insured clude as an additional insured any state or is required by a contract or agreement, the governmental agency or subdivision or political insurance afforded to such additional insured subdivision with whom you have agreed in a written will not be broader than that which you are contract, executed prior to loss, to name as an required by the contract or agreement to additional insured, subject to the following provisions: provide for such additional insured. 1. This insurance applies only with respect to op- 2. With respect to the insurance afforded to these erations performed by you or on your behalf for additional insureds, the following is added to which the state or governmental agency or sub- Section III—Limits Of Insurance: division or political subdivision has issued a If coverage provided to the additional insured is permit or authorization. required by a contract or agreement, the most we However: will pay on behalf of the additional insured is: a. The insurance afforded to such additional a. The minimum amount required by the insured only applies to the extent permitted contract or agreement; or by law; and b. The Limits of Insurance shown in the b. If coverage provided to the additional insured Declarations; is required by a contract or agreement, the insurance afforded to such additional insured whichever is less. will not be broader than that which you are This endorsement shall not increase the required by the contract or agreement to applicable Limits of Insurance shown in the provide for such additional insured. Declarations. 2. This insurance does not apply to: 3. With respect to the insurance afforded to these a. "Bodily injury", "property damage" or "per- additional insureds, the following additional sonal and advertising injury" arising out of op- exclusion applies: erations performed for the federal govern- This insurance does not apply to: ment, state or municipality; or a. "Bodily injury", "property damage" or b. "Bodily injury" or "property damage" included "personal and advertising injury" arising out within the "products-completed operations of the rendering of, or the failure to render, hazard". any professional architectural, engineering or 3. With respect to the insurance afforded to these surveying services, including: additional insureds, the following is added to (1) The preparing, approving, or failing to Section III—Limits Of Insurance: prepare or approve, maps, shop If coverage provided to the additional insured is drawings, opinions, reports, surveys, field orders, change orders or drawings required by a contract or agreement, the most we and specifications; or will pay on behalf of the additional insured is: (2) Supervisory, inspection, architectural or a. The minimum amount required by the engineering activities. contract or agreement; or This exclusion applies even if the claims b. The Limits of Insurance shown in the against an additional insured allege Declarations; negligence or other wrongdoing in the whichever is less. supervision, hiring, employment, training or This endorsement shall not increase the monitoring of others by that insured, if the applicable Limits of Insurance shown in the "occurrence" which caused the"bodily injury" Declarations. or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or failure to render any professional services by you with respect to your providing engineering, architectural or surveying services in your capacity as an engineer, architect or surveyor. WN GL 39 08 18 Includes copyrighted material of the Insurance Service Office, Inc.,with its permission. Page 7 of 10 4. With respect to the insurance afforded to these b. The construction, erection or removal of additional insureds, the following additional elevators; or exclusion applies: c. The ownership, maintenance or use of any This insurance does not apply to: elevators covered by this insurance. a. "Bodily injury", "property damage" or However, "personal and advertising injury" arising out a. The insurance afforded to such additional of the rendering of, or the failure to render, insured only applies to the extent permitted any professional architectural, engineering or by law; and surveying services, including: b. If coverage provided to the additional insured (1) The preparing, approving, or failing to is required by a contract or agreement, the prepare or approve, maps, shop insurance afforded to such additional insured drawings, opinions, reports, surveys, will not be broader than that which you are field orders, change orders or drawings required by the contract or agreement to and specifications; or provide for such additional insured. (2) Supervisory, inspection, architectural or 2. With respect to the insurance afforded to these engineering activities. additional insureds, the following is added to This exclusion applies even if the claims Section III—Limits Of Insurance: against an additional insured allege If coverage provided to the additional insured is negligence or other wrongdoing in the required by a contract or agreement, the most we supervision, hiring, employment, training or will pay on behalf of the additional insured is: monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" a. The minimum amount required by the or "property damage", or the offense which contract or agreement; or caused the "personal and advertising injury", b. The Limits of Insurance shown in the involved the rendering of or failure to render Declarations; any professional services by you with respect whichever is less. to your providing engineering, architectural or • surveying services in your capacity as an This endorsement shall not increase the engineer, architect or surveyor. applicable Limits of Insurance shown in the G. Blanket Additional Insured — State Or Declarations. Governmental Agency Or Subdivision Or Political 3. With respect to the insurance afforded to these Subdivision —Permits Or Authorizations Relating additional insureds, the following additional To Premises exclusion applies: Section II — Who Is An Insured is amended to in- This insurance does not apply to: elude as an additional insured any state or a. "Bodily injury", "property damage" or govemmental agency or subdivision or political "personal and advertising injury" arising out subdivision with whom you have agreed in a written of the rendering of, or the failure to render, contract, executed prior to loss, to name as an any professional architectural, engineering or additional insured, subject to the following provision: surveying services, including: 1. This insurance applies only with respect to the fol- (1) The preparing, approving, or failing to lowing hazards for which the state or prepare or approve, maps, shop govemmental agency or subdivision or political drawings, opinions, reports, surveys, subdivision has issued a permit or authorization field orders, change orders or drawings in connection with premises you own, rent or and specifications; or control and to which this insurance applies: (2) Supervisory, inspection, architectural or a. The existence, maintenance, repair, engineering activities. construction, erection or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures; or WN GL 39 08 18 Includes copyrighted material of the Insurance Service Office, Inc.,with its permission. Page 8 of 10 This exclusion applies even if the claims SECTION IV — COMMERCIAL GENERAL LIABILITY against an additional insured allege CONDITIONS AMENDMENTS negligence or other wrongdoing in the supervision, hiring, employment, training or A. Knowledge Of Occurrence monitoring of others by that insured, if the Item 2. Duties In The Event Of Occurrence, Of- "occurrence" which caused the "bodily injury" fense, Claim or Suit is amended by adding the fol- or "property damage", or the offense which lowing: caused the "personal and advertising injury", e. You must give us or our authorized representa- involved the rendering of or failure to render tive prompt notice of an "occurrence", claim or any professional services by you with respect loss only when the "occurrence", claim or loss is to your providing engineering, architectural or known to: surveying services in your capacity as an engineer, architect or surveyor. (1) You, if you are an individual; (2) A partner, if you are a partnership; SECTION III—LIMITS OF INSURANCE AMENDMENTS (3) An executive officer or insurance manager, if you are a corporation; or A. Damage To Premises Rented To You (4) A member or manager, if you are a limited Paragraph 6. is replaced by the following: liability company. 6. Subject to Paragraph 5. above, the most we will B. Other Insurance pay under Coverage A for damages because of Item 4. Other Insurance, b. Excess Insurance (1) "property damage" to any one premises, while (a) (ii) is replaced bythe following: rented to you, or in the case of damage by fire, p lightning, explosion or sprinkler leakage, while (ii) That is fire, lightning, explosion or sprinkler leak- rented to you or temporarily occupied by you with age insurance for premises rented to you or permission of the owner is the greater of: temporarily occupied by you with permission of the owner; a. $300,000; or C. Unintentional Failure To Disclose Hazards b. The amount shown next to the Damage To Item 6. Representations is replaced by the following: Premises Rented To You Limit in the Decla- rations. 6. Representations And Unintentional Failure To However, the provisions of this paragraph do not Disclose Hazards apply if Damage To Premises Rented To You a. By accepting this policy,you agree: Coverage is excluded by endorsement. (1) The statements in the Declarations are B. Medical Expense Limit accurate and complete; Paragraph 7. is replaced with the following: (2) Those statements are based upon repre- 7. Subject to Paragraph 5. above, the most we will septations you made to us; and pay under Coverage C for all medical expenses (3) We have issued this policy in reliance because of "bodily injury" sustained by any one upon your representations. person is the greater of: b. If you unintentionally fail to disclose any haz- ards existing at the inception date of your a. $10,000; or policy, we will not deny coverage under this b. The amount shown next to the Medical Ex- Coverage Part because of such failure. pense Limit in the Declarations. However, this provision does not affect our This insurance does not apply if coverage for right to collect additional premium or exercise Medical Expenses is excluded either by the pro- our right of cancellation or non-renewal. visions of the coverage part or by endorsement. WN GL 39 08 18 Includes copyrighted material of the Insurance Service Office, Inc.,with its permission. Page 9 of 10 D. Waiver of Subrogation SECTION V—DEFINITIONS AMENDMENTS Item 8. Transfer of Rights of Recovery Against A. Insured Contract Amended Others to Us is hereby amended by the addition of Paragraph 9. a. is replaced by the following: the following: We waive any right of recovery we may have because a. A contract for a lease of premises. However, that of payments we make for injury or damage arising out portion of the contract for a lease of premises that of your ongoing operations or"your work" done under indemnifies any person or organization for a written contract, executed prior to loss, requiring damage by fire, lightning, explosion or sprinkler such waiver with that person or organization and leakage to premises while rented to you or included in the "products-completed operations temporarily occupied by you with permission of hazard". However, our rights may only be waived the owner is not an "insured contract"; prior to the "occurrence" giving rise to the injury or B. Personal And Advertising Injury Redefined damage for which we make payment under this Paragraph 14. d. and e.are replaced by the following: Coverage Part. The insured must do nothing after a loss to impair our rights. At our request, the insured d. Oral, written, televised, videotaped or electronic will bring "suit"or transfer those rights to us and help publication of material that slanders or libels a us enforce those rights. person or organization or disparages a person's or organization's goods, products or service; e. Oral, written, televised, videotaped or electronic publication of material that violates a person's right of privacy; WN GL 39 08 18 Includes copyrighted material of the Insurance Service Office, Inc.,with its permission. Page 10 of 10 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): PER WRITTEN CONTRACT OR AGREE- MENT WHERE YOU AGREED TO PRO- VIDE A SEPARATE GENERAL AGGRE- GATE LIMIT FOR EACH PROJECT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes le- gate Limit for that designated construction gaily obligated to pay as damages caused by project. Such payments shall not reduce "occurrences" under Section I — Coverage A, the General Aggregate Limit shown in the and for all medical expenses caused by acci- Declarations nor shall they reduce any dents under Section I — Coverage C, which other Designated Construction Project can be attributed only to ongoing operations General Aggregate Limit for any other at a single designated construction project designated construction project shown in shown in the Schedule above: the Schedule above. 1. A separate Designated Construction Proj- 4. The limits shown in the Declarations for ect General Aggregate Limit applies to Each Occurrence, Damage To Premises each designated construction project, and Rented To You and Medical Expense that limit is equal to the amount of the continue to apply. However, instead of General' Aggregate Limit shown in the being subject to the General Aggregate Declarations. Limit shown in the Declarations, such 2. The Designated Construction Project Gen- limits will be subject to the applicable eral Aggregate Limit is the most we will Designated Construction Project General pay for the sum of all damages under Aggregate Limit. Coverage A, except damages because of B. For all sums which the insured becomes "bodily injury" or "property damage" legally obligated to pay as damages caused by included in the "products-completed oper- "occurrences" under Section I — Coverage A, ations hazard", and for medical expenses and for all medical expenses caused by under Coverage C regardless of the accidents under Section I — Coverage C, number of: which cannot be attributed only to ongoing a. Insureds; operations at a single designated construction project shown in the Schedule above: b. Claims made or "suits" brought; or 1. Any payments made under Coverage A c. Persons or organizations making for damages or under Coverage C for claims or bringing "suits". medical expenses shall reduce the amount 3. Any payments made under Coverage A available under the General Aggregate for damages or under Coverage C for Limit or the Products-completed Opera- medical expenses shall reduce the Desig- tions Aggregate Limit, whichever is ap- nated Construction Project General Aggre- plicable; and CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 2. Such payments shall not reduce any Des- D. If the applicable designated construction proj- ignated Construction Project General ect has been abandoned, delayed, or aban- - Aggregate Limit. doned and then restarted, or if the authorized C. When coverage for liability arising out of the contracting parties deviate from plans, blue "products completed operations hazard" is prints, designs, specifications or timetables, provided, any payments for damages because the project will still be deemed to be the same of "bodily injury" or "property damage" in construction project. cluded in the "products-completed operations E. The provisions of Section III — Limits Of In- hazard" will reduce the Products-completed surance not otherwise modified by this Operations Aggregate Limit, and not reduce endorsement shall continue to apply as the General Aggregate Limit nor the Desig- stipulated. nated Construction Project General Aggregate Limit. Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25 03 05 09 WN CA 48 06 16 MOTOR CARRIER ENHANCEMENT ENDORSEMENT The Motor Carrier Enhancement Endorsement is an optional endorsement that provides coverage enhancements. The following is a summary of broadened coverages provided by this endorsement. No coverage is provided by this summary, refer to following endorsement for changes in your policy. SUMMARY OF COVERAGES PAGE Accidental Airbag Deployment Coverage 3 Blanket Additional Insured 2 Blanket Waiver of Subrogation 4 Broadened Definition of Insured includes: Newly Acquired Organizations for up to 180 Days 2 Employees as Insureds 2 Subsidiaries in Which You Own 50% or More 2 Deductible Waiver for Glass Repair 3 Employee Hired Auto 2, 4 Fellow Employee Coverage 3 Knowledge of Accident, Claim, Suit or Loss 3 Loss Of Use Expenses-Amended 3 Personal Effects 3 Supplementary Payments-Amended: Bail Bonds up to$5000 2 Loss of Earnings up to$500/Day 2 Tractor Trailer Combined Deductible 3 Transportation Expense Limits—Amended 3 Unintentional Failure to Disclose Hazards 4 WN CA 48 06 16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 4 WN CA 48 06 16 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MOTOR CARRIER ENHANCEMENT ENDORSEMENT This endorsement modifies the insurance provided under the following: MOTOR CARRIER COVERAGE FORM With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. The SECTIONS of the Motor Carrier Coverage Form identified in this endorsement will be amended as shown below. SECTION II — COVERED AUTOS LIABILITY h. Any "employee" of yours is an "insured" while COVERAGE AMENDMENTS using a covered "auto" weighing less than A. Who Is An Insured 10,000 pounds that you don't own, hire or borrow in your business or your personal affairs. SECTION II — COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured i. An "employee" of yours is an "insured" while is amended to add: operating an "auto" weighing less than 10,000 pounds that is hired or rented under a contract f. Any legally incorporated subsidiary of yours in or agreement in that "employee's" name, with which you own more than 50% of the voting your permission, while performing duties related stock on the effective date of this coverage form. to the conduct of your business. However, "insured" does not include any B. Blanket Additional Insured subsidiary of yours that is an "insured" under any SECTION II — COVERED AUTOS LIABILITY other automobile liability policy, or would be an COVERAGE, A. Coverage, 1. Who Is An Insured, "insured" under such policy but for termination of paragraph e. is amended to add the following: such policy or the exhaustion on such policy's limits of insurance. Any person or organization who is required under a g. Any organization which is newly acquired or written contract or agreement between you and that formed by you and over which you maintain person or organization, that is signed and executed majority ownership. However, coverage under by you before the "bodily injury" or "property this provision: damage" occurs and that is in effect during the policy period, to be named as an additional insured (1) is afforded only for the first 180 days after is an "insured" for Liability Coverage, but only for you acquire or form the organization or until damages to which this insurance applies and only to the end of the policy period, whichever the extent that persons or organization qualifies as comes first; an "insured" under the Who Is An Insured provision (2) does not apply to "bodily injury" or"property contained in SECTION II. damage" that results from an "accident"that C. Liability Coverage Extensions — Supplementary occurred before you formed or acquired the Payments organization; SECTION II — COVERED AUTOS LIABILITY (3) does not apply to any newly acquired or COVERAGE, A. Coverage, 2. Coverage formed organization that is a joint venture or Extensions, a. Supplementary Payments is partnership; and amended by replacing subparagraphs (2) and (4) (4) does not apply to an "insured" under any with the following: other automobile liability policy, or would be (2) Up to $5,000 for cost of bail bonds (including an "insured" under such a policy but for bonds for related traffic law violations) required termination of such policy or the exhaustion.. because of an "accident" we cover. We do not of such policy's limits of insurance. have to furnish these bonds. (4) All reasonable expenses incurred by the • "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. WN CA 48 06 16 Includes copyrighted material of Insurance Services Office, Inc.,with its permission:. Page 2 of 4 D. Fellow Employee Coverage D. Glass Repair—Deductible Waiver SECTION II — COVERED AUTOS LIABILITY SECTION IV — PHYSICAL DAMAGE COVERAGE, COVERAGE, B. Exclusions, 5. Fellow Employee, A. Coverage, 3. Glass Breakage— Hitting A Bird the following is added: Or Animal — Falling Objects Or Missiles, is amended by adding the following: Co-Employee Lawsuit Defense Cost Reimbursement No deductible will apply to glass breakage if such glass is repaired, in a manner acceptable to us, If a suit seeking damages for "bodily injury" to any rather than replaced. fellow"employee" of the"insured" arising out of and in the course of the fellow"employee's" employment E. Accidental Airbag Deployment Coverage or while performing duties related to the conduct of SECTION IV — PHYSICAL DAMAGE COVERAGE, your business, or a suit seeking damages brought A. Coverage is amended by adding the following: by the spouse, child, parent, brother or sister of that fellow "employee", is brought against you, we will 5. We will pay to reset or replace factory installed reimburse reasonable costs that you incur in the airbag(s) in any covered "auto" for accidental defense of such matters. Any reimbursement made discharge, other than discharge due to a pursuant to this sub-section will be in addition to the collision loss. limits of liability set forth in the Declarations. This coverage is applicable only if SECTION IV - PHYSICAL DAMAGE COVERAGE comprehensive coverage applies to the covered AMENDMENTS "auto". A. Transportation Expense—Limits Amended This coverage is excess over anyy other collectible insurance or reimbursement by SECTION IV— PHYSICAL DAMAGE COVERAGE, manufacturer's warranty. A. Coverage, 4. Coverage Extension, a. F. Tractor Trailer Combined Deductible Transportation Expenses is amended by replacing $20 per day/$600 maximum limit with $50 per SECTION IV — PHYSICAL DAMAGE COVERAGE, day/$1,000 maximum limit. D. Deductible is amended by adding the following: B. Hired Auto Physical. Damage — Loss Of Use If you have a "loss" to a tractor (power unit) and Expenses—Limits Amended one or more "trailers", which are attached to one SECTION IV PHYSICAL DAMAGE COVERAGE, another at the time of the"loss", then only the single highest deductible for any of such covered "autos" A. Coverage, 4. Coverage Extension, b. Loss of will apply. Use Expenses is amended by replacing the $20 per day/$600 maximum limit with $50 per day/$750 SECTION V — MOTOR CARRIER CONDITIONS maximum limit. AMENDMENTS C. Personal Effects Coverage A. Duties In.The Event Of Accident, Claim, Suit Or SECTION IV— PHYSICAL DAMAGE COVERAGE, Loss A. Coverage, 4. Coverage Extension is amended SECTION V—MOTOR CARRIER CONDITIONS,A. by adding the following: Loss Conditions, 2. Duties In The Event Of c: Personal Effects Accident, Claim, Suit Or Loss, a. is amended by adding the following: We will pay up to $500 for "loss" to personal effects,which are: This condition applies only when the "accident" or "loss"is known to: (1) Owned by an"insured"; and (1) You, if you are an individual; (2) In or on your covered"auto." (2) A partner, if you are a partnership; This coverage applies only in the event of the total (3) An executive officer or insurance manager, if theft of your covered"auto." No deductible applies to_ you are a corporation; or this coverage. (4) A member or manager, if you are a limited liability company. But, this section does not amend the provisions relating to notification of police, protection or examination of the property which was subject to the "loss" • WN CA 48 06 16 Includes copyrighted material of Insurance Services Office, Inc.,with its permission.. Page 3 of 4 K B. Blanket Waiver of Subrogation D. Employee Hired Auto Section V — MOTOR CARRIER CONDITIONS, A. SECTION V—MOTOR CARRIER CONDITIONS, B. Loss Conditions, 5. Transfer of Rights of General Conditions,5. Other Insurance—Primary Recovery Against Others to Us, is amended by And Excess Insurance Provisions, f. is deleted adding the following exception: and replace by the following: However, we waive any right of recovery we may f. For Hired Auto Physical Damage Coverage, the have against any person or organization to the following are deemed to be a covered"auto"you extent required of you by a written contract signed own: and executed prior to any "accident" or "loss", (1) Any covered"auto"that you lease, hire, rent provided that the "accident" or "loss" arises out of or borrow; and operations contemplated by such contract. The waiver applies only to the person or organization (2) Any covered "auto" weighing less than designated in such contract. 10,000 pounds hired or rented by your C. Unintentional Failure to Disclose Hazards "employee" under a contract in that individual employee's" name, with your SECTION V—MOTOR CARRIER CONDITIONS, B. permission, while performing duties related General Conditions, 2. Concealment, to the conduct of your business. Misrepresentation Or Fraud, is amended to add However, any "auto" that is leased, hired, rented or the following paragraph: borrowed with a.driver is not a covered"auto". If you unintentionally fail to disclose any hazards existing at the inception date of the policy, or during the policy period in connection with any additional hazards, we will not deny coverage under this Coverage Part because of such failure. WN CA 48 06 16 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 4 of 4 Client#: 177249 ROBELYON2 YYYY) ATE(MM/DD/ ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Therese Pritchett Propel Insurance PHONE FAX 866 577-1326 800 499-0933 (A/C,No,Ext): (A/C,No): Medford Workers Compensation ADDRIESS: Therese.Pritchett@Propelinsurance.com P O Box 936 INSURER(S)AFFORDING COVERAGE NAIC f! Medford, OR 97501 INSURERA:SAIF Corporation 36196 INSURED INSURER B: Robert Lyon Construction, Inc. INSURER C: P.O. Box 1088 Eagle Point,OR 97524-1088 INSURER D 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. LTR TYPE OF INSURANCE ADDLNSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMISES(Ea RENTED $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 480270 07/01/2019 07/01/2020 X PER 0TH- AND EMPLOYERS'LIABILITY STATUTE X ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? Y N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,-may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland,OR 97520 AUTHORIZEDRREPRRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S3747317/M3699700 TMPOO