HomeMy WebLinkAbout2023-080 PO 20240014- Cascade Columbia Distribution CITY RECORDER Purchase Order Fiscal Year 2024 Page: 1 of: 1 & o _ t E= gid E� 1 ?I�ALL B City of Ashland �� �:=_��i3 !�_ t� � i. NCS I ATTN: Accounts Payable20 E. Main Purchase L Ashland, OR 97520 Order# 20240014 T Phone: 541/552-2010 O Email: payable@ashland.or.us • V H C/O Wastwater Treatment Plant E CASCADE COLUMBIA DISTRIBUTION I 1195 Oak Street N 6900 FOX AVE S p Ashland, OR 97520 0 SEATTLE, WA 98108 Phone: 541/488-5348 R T Fax: 541/552-2364 F - � (206) 282-6334 Ben Russell _ .8t FdBIH� —�c e..,01 07/12/2023 697 FOB ASHLAND OR/NET30 City Accounts Payable :t: - fi=x .-- T',1W;11 _ - - WVVTP Sodium Hypochlorite 1 12.5% Sodium Hypochlorite $3.66/Gallon 4.0 ORDR $2,013.00 $8,052.00 (2)Totes porder 275 Gallons/Tote Delivery ier s included in price Invitation to Bid Firm pricing for FY 2024/ Project Account: ***************GL SUMMARY*************** 086100-601500 $8,052.00 ,® I I I By: i Date: trif Au orize• Signatu d 8 052.00 FORM #3 CITY OF A request for a Purchase Order ASHLAND REQUISITIONt% ,// ft"- ( Date of request: 07/07/2023 Required date for delivery: Vendor Name Cascade Columbia Address,City,State,Zip 14200 SW Tualatin Sherwood Rd Unit B Sherwood,OR 97140 Contact Name&Telephone Number REP/Jeff Zachman(cell)971-253-9215 ORDERS/503-625-5293 Email address cascade-sherwood@cascadecolumbia.com SOURCING METHOD . ' O Exempt from Competitive Bidding ■❑ Invitation to Bid Z, 0 Emergency O Reason for exemption:_ Date approved by Council_6/20/2023 0 Form#13,Written findings and Authorization O AMC 2.50 _(Attach copy of council communication) 0 Written quote or proposal attached ❑ Written quote or proposal attached _(If council approval required,attach copy of CC) O Small Procurement ' 0 Request for Proposal Cooperative Procurement Not exceeding$5,000 Date approved by Council: .❑ State of Oregon ❑ Direct Award _(Attach copy of council communication) Contract# ❑ Verbal/Written 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) 0 Other government agency contract Intermediate Procurement 0 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 O (3)Written bids&solicitation attached ❑ Form#4,Personal Services$5K.to$75K Agency PERSONAL SERVICES Date approved by Council:_ 0 Annual cost to City does not exceed$25,000. Greater than$5,000 and less than$75,000 Valid until: (Date) , Agreement approved by Legal and approved/signed by O Less than$35,000,by direct appointment 0 Special Procurement City Administrator.AMC 2.50.070(4) O (3)Written proposals&solicitation attached 0 Form#9,Request for Approval 0 Annual cost to City exceeds$25,000,Council O Form#4,Personal Services$5K to$75K 0 Written quote or proposal attached approval required.(Attach copy of council communication) Date approved by Council: Valid until:_ _ (Date) Description of SERVICES ST 12.5%sodium hypochlorite is used to clean the membrane filters TOTAL>C.. . Item# Quantity Unit Description of MATERIALS Unit Price Total Cost FY 24 4 orders order is 2,275 gallon totes--total of 8 totes/year 2013.00 8052.00 •0 Per attached quote/proposal TOTAL COST;' Project Number Account Number 0 8 6 1 0 0.6 0 1 5 0 0 $8052 00 Account Number - Account Number - *Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: IT Director Date Support-Yes/No By signing this requisition form,I certify that the City's public contracting requirements have been satisfied. Employee: Department Head: �wrr,.. 7.II• 3 '411M40 �i i al to or/eater than$5,000) Department Manager/Supervisor: a /e.d City Manager: '61 ' ',/. - -1;' f (create than 5,000) Funds appropriated for current fiscal year: YE /NO d Finance Director-(Equal 40 greater than$5,000) MI—I Comments: Form#3-Requisition • r® Council Business Meeting • • June 20, 2023 Agen'da,lltemm . ITB - Chemicals for Water and Wastewater Treatment Plant • s -From, Michael Morrison Operations Deputy Director • Contact, • michael.morrisonvaashland.or.us 541-552-2325 ItemType ` ,' Requested by Council 1=1Update 0 Request for Approval 0Presentation CI SUMMARY • The Water and Wastewater Treatment Plants procure chemicals that are required to maintain consistent treatmentplant operations and meet water quality standards as required by the Oregon Health Authority (water) and the Department of Environmental Quality (wastewater)..Approval is being requested to award public contracts to the lowest bidders that meet the individual chemical specifications resulting from a formal competitive sealed bid (Invitation to Bid) . • POLICIES,PLANS&GOALS SUPPORTED • City Council Goals: . • • Essential Service • o Water • o Wastewater • • Continue to leverage resources to develop and/or enhance Value Seniices • Department Goals: . • • Maintain existing infrastructure to meet regulatory requirements and minimize life-cycle costs. • Deliver timely life cycle capital improvement projects. • Maintain and improve infrastructure that enhances the economic vitality of the community. • Evaluate all city infrastructure.regarding planning management and financial resources. • BACKGROUND AND ADDITIONAL INFORMATION The previouspublic contracts awarded for"these chemicals were approved by the City Council on June 15, 2021,for a term that began July 1,2021,and will end on June 30,2023. The contracts in need.of approval now resulted from a formal competitive sealed bid (Invitation to Bid) and eight (8) bids were received in response to this ITB. This ITB allows for multiple contract awards and individual contracts will be awarded to the lowest responsible and responsive bidders for each of the chemicals.The term for these public contracts will begin on July 1,2023,and end on June 30,2024. • In accordance with AMC 2.50.080(C),the City Council acting as the Local Contract Review Board is required to approve the award of public contract(s) resulting from a formal competitive sealed bid. In accordance with AMC 2.50.070(1),the multiple contracts resulting from a single ITB exceeds the delegated authority of$100,000.00 for Goods and Services (type of procurement) and thus requires Council approval. Page l of 2 rail • acth21`kgahci • r•• Council Business Meeting The City's intent is to award the public contracts for chemicals as follows: Estimated number ` 'Cost/Order ;Cost Estimate Water Treatment Plant ' Bidder of orders for FY 2024 FY 2024 FY 202,4 ' Cascade Columbia • Chemical#1 ALUMINUM SULFATE Distribution 13 $7,034.40 $91.447.20 • Company " Cascade Columbia Chemical#2 SODIUM HYPOCHLORITE Distribution 13 $5,032.50 65,422.50 Company Chemical#3 CYTEC SUPERFLOC C-573 NorthStar Chemical 9 $3,400.00 30,600.00 FLOCCULANT Inc. CYTEC SUPERFLOC N-300 LMW Cascade Columbia Chemical#4 FLOCCULANT Distribution 6 $1,649.20 9,895.20 Company Chemical#5 SODA ASH;DENSE,FREE FLOWING TR International • 13 $4,657.50 60,547.50 Trading Company SODIUM CARBONATE Chemical#6 PEROXYHYDRATE,FREE FLOWING— No bids received "GREENCLEAN" _ .Total Estimated Amount-FY 2024 $257,912.40 Estimated number - Cost/Order: Cost:Estiniate Wastewater Treatment Plant - Bidder of orders for FY FY 2024 FY 2024 Cascade Columbia Chemical#7 SODIUM HYPOCHLORITE Distribution 6 $2,013.00 $12,078.00 - Company Cascade Columbia Chemical#8 CITRIC ACID • Distribution. . 2 $7,205.00 14,410.00 • Company Cascade Columbia Chemical#9 ALUMINUM SULFATE Distribution 18 $5,899.50 106,191.00 Company , Total Estimated,'Amounts—FY 2024 $132,679.00 FISCAL IMPACTS • Funds are budgeted each fiscal year for all of the chemicals required for use at each of the plants. DISCUSSION QUESTIONS ' SUGGESTED NEXT STEPS • Staff recommends the public contracts be awarded per the table above and attached bid tab. REFERENCES&ATTACHMENTS • ITB - Bid Tab for Chemicals ' • Page 2 of 2 111111 • adze,%ao • 2023 BID TAB-Invitation to Bid Chemicals for Water&Wastewater Treatment Plants - • Bids due by 2:00:00 PM(PST)May 23,2023 Firm pricing July 1,2023 to June 30,2024 - HEMI-A,-#Io - Cascade .- �- _ - • _ o .'; ,- :-_ ,J -_, .- - -r CheLmLtCrade Aluminum( [ Columbia - ✓ -.ICI - , rNorthstat}Chem,tcal Stinanon.Chemical,ThntcherCoommPanyof Thornton,Miisso and', TRlnteruattonal } { USA,lnc ,,.. . CtemLnlsUS Ed,:Se-- LLC, Services .;)istnbutien , ' ,-- - � Chemtenls,Inc o Inc..-; .Corpornfion -CnleCornin,aac .3'•Bellemin,Inc. Trading' -, A`-• (No Substitution) Company .. u ; • .- _ Thatcher Company of . Late-Received bid' Manufacturer Chemtrade_ NO BID NO BID NO BID NO BID NO BID NO BID NO BID • •Califomia,lnc. 05/24/2023 Number of pounds(Lbs.)per gallon ,11:08 IbsJgal` - •- 11.09 _ in solution - - - • - Number of dry pounds(Lbs.)per 5 3J'dry, 5.41' • gallon Alum - ,'!product/Jallon-- . Price per dry ton $695:70-DST $285.00 • t$8;325:0,0 per..' $3,462.75 Cost per order-4,500 gallons q 500 gallons'',' • Delivery charge per order Deli4g_ry'is • $2,250.00 • included in price' . Comments: • - - --_ Appendices A and B form• , part of our proposal In case of emergencyfor Tote order. ,'S.,-_- . - . • _ - _ $1,262.80*Our _ Price per Tote(300-330 Gal per •'$1;172:4-0/tote packaging is 3,080 -" tote) net lbs.totes(275 gal- • -:';•':_ -_ • • packaging) • Cost per order-.(6)Totes S7 034A0 - - • - $7,576.80 ' =D_-elryeiy is;_-- Delivery charge per order • ;-included in price t $4,250.00 Cascade c ;t. E _ - - r Columbia, :,.Jmicals Jonas,, Novthstnr,ChemIcnl„ -Stiannon_•Chemicnf Tliatcher'Company.of Thornton;-Mosso and.",TR Internatwnnl ---ry' , Md-A-02=TOW Chemtrnde .. • r,� - Univar USA Inc ' So 24 am Chemicalsc ,:,,'y Eeo,Services LLC Chemicals,Inc , .Cor oration --Cahfornia;ina Bellemm;Inc. -Tradm Com an '"a ti Doom any g -t P'"Y kF_„r " LLC: 'r _ Inc.+ _' _ z. '7 Liip • Late-Received bid Manufacturer NO BID NO BID NO BID NO BID NO BID IinsaInc. NO BID NO BID NO BID 05/24/2023 Number of gallons per tote ,-, 75-gallons'•_--, - Price per gallon '-$3:66/gellon• • Cost per tote . 51,006.50,: - - ' • • Cost per load(5)totes $5,032.50_, - • Delivery charge per order Delivery is . `included in price • ' Commcnis 9•; _ -J - Bid Tab-Page 1 of 4 , • 2023 BID TAB-Invitation to Bid Chemicals for Water&Wastewater Treatment Plants Bids due by 2:00:00 PM(PST)May 23,2023 Firm pricing July 1,2023 to June 30,2024 - ' .-1-1 ami-A #30 Cascade - [ .., toc y � Columbia Chemtrnde - JCI Jones NorthstarChemical, o Shannon Chemical Thatcher;Company of Thoroton,Musso;and TRlnternational c Flocculant-or-Polydyne'lRp -'-, Chemicals'US' Req Sergices LLC, -' - ,UurvarUSA,Inc: - 06Q,,.T�e locculant(�j Distribution •LL_C_ - Chemicals,.Inc.° Inc. . 'Corporation' :California,Inc. Bellemin,Ince ,Trading Company - Substihition) Company, - • • Manufacturer Cytec NO BID NO BID NO BID vPolydynelNlOE"° NO BID NO BID NO BID NO BID Late-Received bid p 106PWG. 05/24!2023 Price per pound(Lb) $2,31/lbs. $1.70/Ib-- `-- Cost per Costper 500 Lb drum $1,155.00 ' - 7s85o.00 Cost per order-4 each 500 lb • drums $4,620.00 ,.•.;$3;400:00 . Delivery charge per order Delivery is FV included in price Comments • Cascade =, ; CHE3b1�ICAL#dry�Tf'pI,'" Clremtrade -- °• - s - • @ tee Columbia - . - JCI Jones Northstar Chemical Shannon Chemical Thatcher Company of Thornton,Musso arid ' TR International - - i r ._ . Chmicals-US Eco Services LLC Univar U Inc Dutnbuhon Chemic-ills,Inc:, Inc.. :' Corporation. . Cnhfornia,'Inc ,Bellemin;Inc, Trading Company '' F occulant� .LLC'. - - - . - - _ ,ComRany, ' Manufacturer - Cytec NO BID NO BID NO BID NO BID NO BID NO BID NO BID NO BID Late-Received bid 05/24/2023 • Price per pound(Lb) - $3.74/lbs. ' . ' Cost per 25kg or 55.12 Lb bag '$106,15 • 55.12 Lb bag `" • _ Cost per order-(8)bags $1,649:20- Delivery charge per order .Delivery is: _ • included in price Comments - • MICA #5c Cascade = Soda r Columbia Cii iIc*15 e. , JCI,Janes -Nortlistar Chemical,- Shannon Chemical-.Thatcher Company of Thornton, -Musso mind I TR'Internationnl- :- - Univar USA,Inc. (Or l garklitiA • Com aeon Chi L_LCs•US. Eco,Ser¢ices LLC Che'micn►s;Inc '.°. "'Inc -Corporation , . ' California,.Inc i. Bellomin,__Inc. Trading Compooyc Manufacturer Tata NO BID NO BID NO BID NO BID 'NO BID NO BID Genesis`Alkali Late-Received bid NO BID 05/24/2023 Number of pounds(Lbs.)per bag 50 lbs. 50 [ . Number of bags per pallet 55 bags --- _ - - Price per pound(Lb) $0.3697/lbs. $0:35' -- - Cost per order 270 bags(5) $5,083:375 pallets (our pallets are 275 - -•., -- • -'$¢,657.50 bags/5 pallets) , Delivery charge per order -'.Included" : Delivery is E Comments r;' - -'-' included in price • - ° Bid Tab-Page 2 of 4 2023 BID TAB-Invitation to Bid Chemicals for Water&Wastewater Treatment Plants - Bids due by 2:00:00 PM(PST)May 23,2023 • Firm pricing July 1,2023 to June 30,2024 • H MT-A il6o B93 ., Cascade . Chemtrade- - - - w Sodium '� Columbia, - JCI Jones Northstar Chemical -Shannon Chemical Thatcher Company of Thornton Musso and ,TR International :Umvar„USA,Int: , °Chemicals US. Eco Services LLC Perez lr .rate ,tel, +T -° Distribution: c LLC Chemicals,Inc. ` J• Inc - ".' Corporation `,California,Inc. Bellemin,Inc. - Trading.Company� a - ("Greenclean'107 Company - ' - _ - e J Late-Received bid Manufacturer ' NO BID NO BID NO BID NO BID NO BID NO BID NO'BID NO BID NO BID• 05/24/2023 • Number of pounds(Lbs.)per bag ' Number of bags per pallet ' • Price per pound(Lb) • • Cost per order 160 bags(4) - pallets • • Delivery charge per order • Comments Cascade.. Chemtrnde - .-• .. - ••a G -'M GAL,137oQ1ES1"''lW Columbia - - ` JCI Jones Nortlrsta'Chemical .Shannon Chemical Thatcher Company of Thornton;Musso and TR International' ,-. ;Univar'USA,:Inc. .,Chemicals US- Eco-Ser¢ices LLC odium a[ ,t M Distribution _ LLC: ` Chemicals,Inc.- . Inc. - Corporation :California,Inc. Bellemin,Inc ' ._Trading Company; - Late-Received bid Manufacturer Hasa Ian. NO BID NO BID NO BID NO BID NO BID NO BID NO BID NO BID 05/24/2023 e Number of gallons per tote 7275ielIon9' . - Price per gallon(gal) ::$3:66 L'gallon.-, - - Cost per tote .$1 006 50 • Cost per load/order(2)totes - $2,013.00'' - ' • -_ - .--Delivery is;- - - - --- ------ - - - • - - - _. ---- - -- - - - - Delivery charge per order `includediaprice • Comments• - . "Chemtrade" - `c - OHEM GAL-8 of'Pai[{� Columbia - - JCI Jones- NorthstarChemical Shannon Chemical Thatcher Company of Thornton Musso earl TR International .Univac USA,Ina Chemicals US' Eca Services LL_G' Gitr c Duti•itiutio -? LLC -- _ Chemicals;Inc- .Ina - . Corporation _,- '.California Inc. Bellemiu,Inc. • 'Trading Company - . - .. ' Company --,' - - -. - _ -- -• _- -.. - - _ _ _ - _. __ _- - '-c Northstar Chemical, Shannon Chemical Thornton,Musso,and Late-Received bid - . Manufacturer !CaS6Sde Colimibi1. NO BID NO BID NO BID NO BID NO BID Inc. Corporation Bellemin,Inc. 05/24/2023 Number of gallons per tote . - -275.gallons',.` 270 Gallons per tote 330 Gallons - 330 Price per gallon(gal) $13:10"/gallon - , $13.35 per gallon' - $32.77/gallon $16.75 Cost per tote ?$3,602,50-- $3,605,50 $10,814.10/330 gallon $5,527,50 tote Cost per load/order(2)totes ''•$7;205.00-r ,. - • $7,209:00 $21,628.20 • $11,055.00 • `De1iJery'is; - Delivery charge per order i i6luded in price'' $0.00 included $0.00 Commons Tcrms:0%,Net 30 days • . Bid Tab-Page3of4 . / - • • • 2023 BID TAB-Invitation to Bid Chemicals for Water&Wastewater Treatment Plants • Bids due by 2:00:00 PM(PST)May 23,2023 Firm pricing July 1,2023 to June 30,2024 „Cascade•; Chemtrnde' e-ERMIG-`AL N9 iVSV 1 i, Columbia' Chemicals U$ Eco Serv. LLC JCI Jones 'IYorthstnr Chemical, Shannon Chemical_Thatcher Company of Thornton,Musso,and `TR International Aluminum Sulfate - - - Chemicals.Inc. :.Inc. - Corporation • `California,Inc. •Bellemin,Inc. Trading,Company_ .UnrvnnUSA,Ine. • "T)istrihu_tion T:T.(' = - Thatcher Company of Late-Received bid • Manufacturer Chemtrade Chemtrade Eco Services LLC NO BID NO BID NO BID p y NO BID NO BID California,Inc. 05/24/2023 Number of pounds(Lbs.)per gallon 11.08-11; , 11.134 11.1 • 11.09 in solution Number of dry pounds(Lbs.)per '5 31'lbs;;di 5.34 534 5,41 gallon produdf • /gallon - $675.00* FOR CONVERSION Price per dry ton $493.00rD$T:, . PURPOSE ONLY, $640.00 $285.00 - _ PRICE EQUATES TO $1.8225/GALLON $5;$99.50 peri • $3,462.75 Cost per order-4;500 gallons o $8,201.25 $7,680.00 4,Sg0 galln Delivery:is. : Delivery charge per order included in once Included N/A $2,250.00 Comments - - Delivery included in • Appendices A and13 form price pan of our proposal • • • • • • • • • • • • • • .Bid Tab-Page 4 of 4 • • WASTEWATER TREATMENT PLANT CHEMICALS—FY 2024 CONTRACTOR: Cascade Columbia Distribution Company CITY OF ' �5 H LAN D CONTACT: Lance Jones,Municipal Contracts Manager 20 East Main Street ADDRESS: 6900 Fox Avenue South, Seattle,WA 98108 Ashland,Oregon 97520 • Telephone: 541/488-5587 PHONE: 206-282-6334 Fax: 541/488-6006 EMAIL: lancej@cascadecolumbia.com This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and ,Cascade Columbia Distribution Co., an assumed business name of Newco, Inc.; a Corporation of Washington ("hereinafter "Contractor"), for Wastewater Treatment Plant Chemical4. 1. CONTRACTOR'S OBLIGATIONS 1.1 Provide WWTP chemicals as specified in the Invitation to Bid released April 21,2023 and as set forth in the"SUPPORTING DOCUMENTS"attached hereto and,by this reference,incorporated herein. Contractor 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 Contractor shall obtain and maintain during the term of this Agreement and until City's fmal acceptance of all Work received hereunder, a policy or policies of liability insurance including commercial general liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 (two million dollars)per occurrence for Bodily Injury and Property Damage. 1.2.1 The insurance required in this Article shall include the following coverages: • • Comprehensive General or Commercial General Liability, including personal injury, contractual liability, and products/completed operations coverage; and • Automobile Liability. • Workers' Compensation 1.2.2 Each policy of such insurance shall be on.an "occurrence" and not a "claims\ade" form, and shall: • Name as additional insured "the City of Ashland, Oregon, its officers, agents and employees" with respect to claims arising out of the provision of Work under this Agreement; •• Apply to each named and additional named insured as though a separate policy had been issued to each,provided that the policy limits shall not be increased thereby; • Apply as primary coverage for each additional named insured except to the extent that two or more such policies are intended to "layer" coverage and, taken together, they provide total coverage from the first dollar of liability; • Contractor shall immediately notify the City of any change in insurance coverage • Contractor shall supply an endorsement naming the City,its officers,employees and agents as additional insureds by the Effective Date of this Agreement; and • Be evidenced by a certificate or certificates of such insurance approved by the City. _Page 1 of 6: Goods and Services Agreement between the City of Ashland and Cascade Columbia Distribution Company 1 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 Contractor shall. furnish an acceptable insurance certificate prior to commencing any Work under this Agreement. . 1.4 Contractor 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 Contractor. Contractor agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. Further, Contractor agrees not to discriminate against a disadvantaged business enterprise,minority-owned business,woman- owned business,a business that a service-disabled veteran owns or an emerging small business enterprise certified under ORS 200.055, in awarding subcontracts as required by ORS 279A.110. 1.5 In all solicitations either by competitive bidding or negotiation made by Contractor 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 Contractors of the Contractor's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. . . • 1.6 Living Wage Requirements: If the amount of this Agreement is $25,335.05 or more, Contractor 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. Contractor is also required to post the notice attached hereto as "Exhibit A"predominantly in areas where it will be seen by all employees. 2. CITY'S OBLIGATIONS 2.1 City shall pay Contractor the amounts as follows and as provided herein as full compensation for the Chemicals specified below and in the SUPPORTING DOCUMENTS. 'Estimated-1,, 4 Cost/Order,;. Cost,`Estimate wastewater Treatment Plant :, Bidder' : number ofor"ders .'F'Y 2024' 72°24', far RY 2024'. Cascade Columbia SODIUM HYPOCHLORITE Distribution Company 6 $2,013.00 $12,078.00 CITRIC ACID Cascade Columbia 2 $7,205.00 14,410.00 Distribution Company Cascade Columbia ALUMINUM SULFATE Distribution Company 18 $5,899.50 106,191.00 • Total Estimated Amounts—FY 2024.I $132,679.00 2.2 In no event shall Contractor's total of all compensation and reimbursement under this Agreement exceed the sum of$160,000.00 (one hundred sixty thousand dollars), without express, written approval from the City official whose signature appears below, or such official's successor in office. Contractor 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 responsibleofficial must be in writing. Contractor further acknowledges that any Work delivered or expenses incurred without authorization as provided herein is done at Contractor's own risk and as a volunteer without expectation of compensation or reimbursement. Page 2 of 6: Goods and Services Agreement between the,City of Ashland and Cascade Columbia Distribution Company • 3. GENERAL PROVISIONS •• 3.1 This is a non-exclusive Agreement. City is not obligated to procure any specific amount of Work from Contractor and is free to procure similar types of goods and services from other Contractors in its sole discretion. 3.2 Contractor is an independent contractor and not an employee or agent of the City for any purpose. 3.3 . Contractor is not entitled to,and expressly waives all claims to City benefits such as health and disability insurance,paid leave, and retirement. 3.4 . Contractor shall not assign this Agreement or subcontract any portion of the Work to be provided hereunder without the prior written consent of the City. Any attempted assignment or subcontract without written consent of the City shall be void. Contractor shall be fully responsible for the acts or omissions of any.assigns or subcontractors and of all persons employed by them, and the approval by the City of any assignment or subcontract shall not create any contractual relation between the assignee or subcontractor and the City. 3.5 This Agreement embodies the full and complete understanding of the parties respecting the subject matter hereof. It supersedes all prior agreements,negotiations, and representations between the parties, -. whether written or oral. 3.6 This Agreement may be amended only by written instrument executed with the same formalities as this Agreement. 3.7 The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220, 279B.230 and 279B.235. 3.8 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. 3.9 Contractor 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 Contractor or its officers, employees, contractors, or agents under this Agreement. 3.10 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. 3.11 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 Contractor and the City set forth in this Agreement. • 3.12 Deliveries will be F.O.B destination. Contractor shall pay all transportation and handling charges for the Goods. Contractor is responsible and liable for loss or damage until final inspection and acceptance of the Goods by the City. Contractor remains liable for latent defects, fraud, and warranties. Page 3 of 6: Goods and Services Agreement between the City of Ashland and Cascade Columbia Distribution Company • 3.13 The City may inspect and test the Goods. The City may reject non-conforming Goods and require Contractor to correct them without charge or deliver them at a reduced price,as negotiated.If Contractor 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): • 3.14 Contractor 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. Contractor 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:" • • Exhibit A: The Contractor's complete written bid dated May 17,2023. • 4.2 This Agreement and the SUPPORTING DOCUMENTS shall be construed to be mutually complimentary and supplementary wherever possible. In the event of a conflict which cannot be so resolved, the provisions of this Agreement itself shall control over any conflicting provisions in any of the SUPPORTING DOCUMENTS. In the event of conflict between provisions of two of the SUPPORTING DOCUMENTS,the several supporting documents shall be given precedence in the order listed in Article 4.1. . 5. REMEDIES . 5.1 In the event Contractor is in default of this Agreement, City may, at its option,pursue any or all of the remedies available to it under this Agreement and at law or in equity, including,but not limited to: 5.1.1 Termination of this Agreement; . 5.1.2 Withholding all monies due for the Work that Contractor 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 Contractor for any expenses related to termination of this Agreement or for anticipated profits. If previous amounts paid to Contractor exceed the amount due, Contractor shall pay immediately any excess to City upon written demand provided. • • • Page 4 of 6: Goods and Services Agreement between the City of Ashland and Cascade Columbia Distribution Company 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 June 30, 2024, unless, sooner terminated as provided in Subsection 6.2. 6.2 Termination • 6.2.1 The City and Contractor 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 Attention: Ben Russell,Wastewater Treatment Plant Supervisor 90 N. Mountain Avenue Ashland, Oregon 97520 Telephone: (541) 488-5348 . • With a copy to: City of Ashland • Attention: Legal Department 20 E.Main Street Ashland, Oregon 97520 Telephone: (541)488-5350 • • If to Contractor: Cascade Columbia Distribution Company Attention: Lance Jones,Municipal Contracts Manager 6900 Fox Avenue South Seattle, WA 98108 Telephone: (206)282-6334 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.. CONTRACTOR'S COMPLIANCE WITH TAX LAWS 9.1 Contractor represents and warrants to the City that: 9.1.1 Contractor shall,throughout the term of this Agreement,including any extensions hereof, comply with: Page 5 of 6: Goods and Services Agreement between the City of Ashland and Cascade Columbia Distribution Company (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 Contractor; and (iii) Any rules,regulations, charter provisions, or,ordinances that implement or enforce any of • the foregoing tax laws or provisions. 9.1.2 Contractor, 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 Contractor; and (iii) Any rules,regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. • 9.2 Contractor'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 Contractor'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. 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: CASCADE COLUMBIA DISTRIBUTION CO. By: By: C' anager /Signature close k L 1_e Src • Lance Jones Printed Name Printed Name 7/227a3 Municipal Contracts Manager e Title 7/20/2023 g es-zo ' . Date Purchase Order No. 20 4f 6`49 4 (W-9 is to be submitted with this signed Agreement) AP D AS TO FORM: sistant City Attorney • CCl2�. Z3 Date • • Page 6 of 6: Goods and Services Agreement between the City of Ashland and Cascade Columbia Distribution Company • I • l • ic, R CERTIFICATE OF LIABILITY.IN`SURANCE DATE(MM/DDIYWY) �' 8/1/2023 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. r IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)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: Stephen Erni • Arthur J.Gallagher Risk Management Services, LLC ' PHONEFAX 777 108th Avenue NE, Suite 200 INC.No.Exi):425-586-1002 • tAic,Not:425-451-3716 Bellevue WA 98004 • ADDRESS Stephen_Erni@aig.com • . INSURER(S)AFFORDING COVERAGE NAIC# • INSURER A:National Union Fire Insurance Company of Pittsburg - 19445. ' INSURED NEWCINC-02 INSURER B:AIG Specialty Insurance Company• 26883 • Newco,Inc.dba Cascade Columbia ' Distribution Company INSURER c 6900 Fox Ave. S - INSURER D: •• • - Seattle WA 98108 INSURER E: . ' , - • INSURER F: '.. - ' • ' COVERAGES - ' • 'CERTIFICATE NUMBER:962543844 . . REVISION NUMBER: - • THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR•CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS • CERTIFICATE MAY BE ISSUED'OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, ' EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. . • INSR TYPE OF INSURANCE ADDL SUER ' POLICY EFF POLICY EXP .LIMITS • LTR = INSD WVD POLICY NUMBER' (MM/DD/YYYYI (MM/DD/YYYY) B X COMMERCIAL GENERAL LIABILITY • Y 14260608-01 ' 10/31/2022 10/31/2023 EACH OCCURRENCE $1,000,000 •• CLAIMS-MADE X OCCUR • PREMISES(Es occurrence) $1,000,000 • • X Pollution Liab. MED ERCP(Any one person) $25,000 • • X Vendors Liab. • • PERSONAL 8'ADV INJURY $1,000,000 • GE 'L AGGREGATE LIMITAPPLIES PER: i • • ' GENERAL AGGREGATE ' $2,000,000 • POLICY X JECT .X LOG • PRODUCTS-COMP/OPAGG $2,000,000. ' . • OTHER: $ • A AUTOMOBILE LIABILITY • Y 018-41-2558- '10/31/2022 10/31/2023 COMacciBINdent)EDINGLELIMIT $1,000,000 • (Ea X ANY AUTO . •' BODILY INJURY(Per,person) $ ' ' • OWNED SCHEDULEDBODILY INJURY(Per accident) $ AUTOS ONLY _AUTOS '- . HIRED NON-OWNED . . 'PROPERTY DAMAGE $ • AUTOS ONLY _ AUTOS ONLY - ' , (Per.accident) $ ' • B • UMBRELLA LIAB X OCCUR • 14260809'-01 ' 10/31/2022, 10/31/2023' EACH OCCURRENCE • $20,000,000 . X EXCESS LIAB" CLAIMS-MADE .•1 - AGGREGATE • $20,000,000 • -DED RETENTION$ ' $ , g WORKERS COMPENSATION • 14260008-01 • 10/31/2022 10/3t/2023 PER X OTH- AND•EMPLOYERS'LIABILITY • • y/N STATUTE ER WA Stop Gap ANYPROPRIETOR/PARTNER/EXECUTIVE N!A E.L.EACH ACCIDENT , $1,000,000 OFFICER/MEMBER EXCLUDED? (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,maybe attached if more space Is required) Regarding current project'and contract,The City of Ashland is listed as an additional insured for General Liability and Automobile Liability • ''CERTIFICATE HOLDERCANCELLATION '. ' • • • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE . THE EXPIRATION 'DATE THEREOF, NOTICE WILL. BE DELIVERED IN City of Ashland • ACCORDANCE WITH'THE POLICY PROVISIONS. . 20EMain - ' . I - Ashland OR 97520 • AUTHORIZEDREPRESENTATIVE ' USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) • The ACORD name and logo are registered marks of ACORD • . • • • ENDORSEMENT • This endorsement, effective 12:01 A.M. 10/31/2022 forms a part of Policy No. 184-12-558 _ issued to NEWCO, INC. DBA CASCADE COLUMBIA DISTRIBUTION COMPANY • by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. • ADDITIONAL INSURED.-'WHERE REQUIRED UNDER CONTRACT OR AGREEMENT • This endorsement modifies insurance provided under the.foliowing: • • BUSINESS AUTO COVERAGE FORM • • .SCHEDULE • ADDITIONAL INSURED: 'BLANKET WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT. I. SECTION II - COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. - Who Is Insured, is amended to add: ' d. 'Any person or organization, shown inthe schedule above, to whom you become obligated ' to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization'of the . type provided by.this policy, but only with respect to liability arising out of use'of a covered "auto". However, the insurance provided will not exceed the lesser of: (1.) The coverage and/or limits of this policy, or . (2) The coverage and/or limits required by said contract Or agreement. • • • • • • • • • • • . AUTHORIZED REPRESENTATIVE • • • • • • • • 87950 (9/14) Includes copyrighted material of Insurance Services Office, Inc.with its permission. Page 1 of 1 • , . • . . . . . • • . . . . , .• . . . • . . , . . ' . • • . . . • • • ' • _ . . . POLICY NUMBER:. 184-12-558 . . • COMMERCIAL AUTO • • • CA 04 44 16 13 THIS ENDORSEMENT CHANGES THE,POLICY. PLEASE READ IT CAREFULLY. • WAIVER OF TRANSFER OF RIGHTS' OF RECOVERY • AGAINST OTHERS TO US1WAIVER OF' SUBROGATION) •. • • This endorsement modifies insurance provided under the following': , • , . • . AUTO DEALERS COVERAGE FORM • ' • • • BUSINESS AUTO COVERAGE FORM • • • I • ' MOTOR CARRIER COVERAGE FORM ' ' • ' . • ' •\ • , . • • . With respect'to coverage provided by this endorsement, the'provisions of the Coverage Form apply unless modified by the endorsement. • • This endorsement changes the policy effective on the inception' date of the policy unless another date is -- indicated below. • • • • - _ ' Named Insured: NEWCO, INC. DBA CASCADE.COLUMBIA DISTRIBUTION COMPANY . . Endorsement Effective Date: 10/31/2022 ', _ . • , . • • • • • • • • . 'SCHEDULE . . - • • • • • . . • , Name(s) of Person(s) Or Organization(s): . . • • ' • • • • - BLANKET WHERE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT • ' • information required to complete this Schedule, if not shown above, will be shown in the Declarations. . - • • . .• The Transfer Of Rights Of Recovery Against ' ' . - , • • • Others To Us condition does not apply to the'• • • • • • . person(s) or organization(s) shown in the Schedule, . . . . • • . . - but only to the extent that subrogation is waived • ' ' . ' prior to the "accident" or the "loss" under a . • ' . . contract with that person or organization. • . - • ' . • • - • . . ' . • , . . . . . - . • • ' • . . • . • ' • • • 1 • . . . 4 . . . .. . , • • . . . . . ' • . • . • ' • . , . ' • . • • __, • ' . • • • • • , • . . . . ' . - • ' • • • • • . ' CA 04 44,10 13 . @Insurance Services Office, Inc., 2011 , Page 1 of 1 0 • . . • . . ' • • . . . . . . • • • ENDORSEMENT NO.12 • • This endorsement,effective 12:01 AM, 10/31/2022 • Forms a part of Policy No: 14260808-01 . Issued to:Newco, Inc. DBA Cascade Columbia Distribution Company By:AIG Specialty Insurance Company • • THIS ENDORSEMENT CHANGES THE POLICY.'PLEASE READ IT CAREFULLY. ADDITIONAL INSURED VENDORS ENDORSEMENT—PRIMARY AND NON-CONTRIBUTORY • This endorsement modifies insurance provided under the following: • COMMERCIAL GENERAL LIABILITY AND POLLUTION LEGAL LIABILITY COVERAGE FORM • • SCHEDULE Name of Person(s)or Organization(s)(Vendor): • • • Where required by written contract when such contract was signed and executed prior to the sale,distribution,handling or- transfer of your product . • Your Products: • • • All products sold,handled or distributed by the insured • Solely as respects Coverages A, E-1, E-2 and E-3,if applicable,SECTION II -WHO IS AN INSURED is amended to include as an insured any person(s) or organization(s) (referred to herein as the "vendor") shown.in the Schedule above, but only with respect to bodily injury, property damage, environmental damage, or emergency response costs arising out of your products shown in the Schedule above which are distributed or sold in the regular courseof the vendor's business,subject to all of the terms and conditions of this Policy and the additional following exclusions,terms and conditions: • 1.. The insurance afforded the vendor does not apply to: a. Bodily injury, property damage, environmental damage, or emergency response costs for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement.This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; • c. Any physical or chemical change in your product made intentionally by the vendor; • d. Repackaging,except when unpacked solely for the purpose of inspection,demonstration,testing,or the substitution • of parts under instructions from the manufacturer,and then repackaged in the original container; • e. Any failure to make such inspections, adjustments, tests or servicing as_the vendor),has agreed to make or normally undertakes to make in the usual course of business,in connection with the distribution or sale of your product; • f. •Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of your product; • 103388(10/09) PAGE 1 OF 2 CI4401 • • ENDORSEMENT NO.12 CONTINUED • g. Your product which,after distribution or sale by you,has been labeled or relabeled,or used as a container, part or ingredient of any other thing or substance,by or for the vendor;or h. Bodily injury, property damage, environmental damage or emergency response costs arising out of the • sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting onits behalf.However,this exclusion does not apply to: • (1) The exceptions contained in Sub-paragraphs d.or f.above;or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business,in connection with the distribution or sale of your product. 2; This insurance does not apply to any products you have acquired from,a vendor,or any ingredient,part or container,entering into,accompanying or containing such products. 3. Solely with respect to the coverageafforded to the vendor pursuant to this Endorsement, SECTION IV- CONDITIONS,paragraph 4.Other Insurance is deleted in its entirety and replaced with the following: • 4. Other Insurance This insurance is primary and non-contributory,and our obligations are not affected by any other insurance carried by such vendor whether primary,excess,contingent,or on any other basis. . • • • • • All other terms,conditions,and exclusions shall remain the same • • • UTH IZRESEN'ATIVE•:• ' Or countersignature(where required bylaw) 103388(10/09) •Page 2 of 2 • CI4401 • • ENDORSEMENT NO.5 This endorsement,effective 12:01 AM,10/31/2022 • Forms a part of Policy No:14260808-01 • • Issued to:Newco,'Inc.DBA Cascade Columbia Distribution Company By:AIG Specialty Insurance Company • . THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • WAIVER OF TRANSFER OF RIGHTS OF RECOVERY • AGAINST OTHERS TO US ENDORSEMENT ' This endorsement modifies insurance provided under the following: • COMMERCIAL GENERAL LIABILITY AND • POLLUTION LEGAL LIABILITY COVERAGE FORM • It is hereby agreed as follows: • SECTION IV_CONDITIONS,Paragraph 7.Transfer of Rights of Recovery Against Others to Us—Applicable to Coverages A,B, C and E is amended by the addition of the followingat the end of such subparagraph: We waive any right of recovery we may have against the person or organization shown in the Schedule below because of payments we make under, Coverage A, B, C and E for injury' or damage arising out of your ongoing operations or your work done under a contract with that person or organization and included in the products-completed.operations hazard. This waiver applies only to the person or organization shown in the Schedule below. SCHEDULE Name of Person or Organization: Blanket where required by writtencontract or agreement • • • • • • All other terms,conditions,and exclusions shall remain the same. • din• " ;UTH IP'IZE r' EPRE$EN ATIVE Or countersignature(where required by law) • 94283(3/07) - PAGE 1 OF 1 CI3021 • •