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HomeMy WebLinkAbout2023-090 PO 20240058- Coleman Creek Consulting Inc Purchase Order Fri, ,,sia 0 1 CiTY RECORDER Fiscal Year 2024 Pager 1' of: 1 4 B City of Ashland - R g r�-Ie �a-I =- ,_ _- - _ L ATTN: Accounts Payable Y 20 E. Main Purchase L Ashland, OR 97520 Order# 20240058 T Phone: 541/552-2010 0 Email: payable@ashland.or.us V H C/O Public Works Department E COLEMAN CREEK CONSULTING, INC 1 51 Winburn Way - N 810 LEONARD STREET p Ashland, OR 97520 ' D ASHLAND, OR 97520 Phone: 541/488-5347• - R T Fax: 541/488-6006 -- ir:70 o-�sta a c�010I011aIW1.--- !_v1V3i:7T= 0-1.275_.°t - —=�T i�a i',� e: ___ - -._— .�,�,2�:T`._�ot_t°•-- ==e:- -- - _-=- _ _. _— _ _ _ Scott Fleury:fflra t -- gF € .=6.1.i a a' p®g: =_ aJ=—_ 4:I=€'a:g�m` - 71--1 a 'F_:_ .g - t=w= —�--' �t-.i la''� = - __ a std °i-�_t__]�sa � t I aP � �q �_ — 08/08/2023 3538 FOB ASHLAND OR/NET30' City Accounts Pa able Y- =,--------__ - - -0f�i a'W — a L>d -._7--27711`is.- c. -. =-_-: c- Et.�._ _ 'e�i i'( �]gSa- '.€�g ' l-re Asbestos/Lead Consulting - 1 Asbestos/Lead Consulting 1.0 $15,000.00 $15,000.00 Personal Services Agreement(Less than $25,000) . Completion date: June 30, 2023 Project Account: *************** GL SUMMARY*************** 088400 604100 $15,000.00' / I I I I I . V • - r J ::-.-- -..,--‘-_,--...--_,--- 'CM_ __ 'c._ ^_ -._- 101 By: 'N7-aelDaterV2-' ,_ - W == -Authorized Signat Eg :' $15 000.00 ( " • 1 , FORM #3 / CITY OF A request for a Purchase Order e 'AS H LAN D REQUISITION 7--D P-4,01-1:9 Cate 08/02/2023 Required date for delivery: Vendor Name Coleman Creek Consulting Inc. Address,City,State,Zip 810 Leonard Street Ashland,OR 97520 Contact Name&Telephone Number David Fawcett 541-535-7108 Email address SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ 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 ❑ 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) ❑ Request for Qualifications(Public Works) ❑ State of Washington Date approved by Council_ i Contract# __(Attach copy of council communication) ❑ Other government agency contract Intermediate Procurement ❑ Sole Source Agency GOODS&SERVICES ❑ Applicable Form(#5,6,7 or 8) Contract# Greater than$5,000 and less than$100,000 ❑ Written quote or proposal attached Intergovernmental Agreement ❑ (3)Written bids&solicitation attached 0 Form#4,Personal Services$5K to$75K Agency PERSONAL SERVICES 0 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) U. (3)Written proposals&solicitation attached Date approved by Council:_ ❑ 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 Asbestos/lead consulting ` ;11'0S00:,'-',-_ ___ _.!, _ Item # Quantity Unit Description of MATERIALS Unit Price Total Cost I El Per attached quote/proposal a,TOTAL COST' 3,:t:!:':' Project Number _ _ Account Number 088400 - 604100 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 IJ 0 VANVE:Ciallei Department Head: $ •2.2 3 ual or greater than$5,000) Department Manager/Supervisor: City Administrator: (Equal to or greater than$25,000) Funds appropriated for current fiscal year: YES / NO On tiDe puty Finance Director- a or greater than$5,004) atte Comments: Form#3-Requisition PERSONAL SERVICES AGREEMENT (LESS THAN $25,000) CONSULTANT: Coleman Creek Consulting,Inc. CITY OF ASH LAND ADDRESS: 810 Leonard Street 20 East Main Street Ashland, OR 97520 Ashland,Oregon 97520 Telephone: 541/488-5587 TELEPHONE: 541-535-7108 Fax: 541/488-6006 EMAIL: fawbropccountry.net This Personal Services Agreement(hereinafter"Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation(hereinafter"City") and Coleman Creek Consulting, Inc., a domestic professional corporation ("hereinafter"Consultant"), Asbestos/Lead Consulting. NOW THEREFORE, in consideration of the mutual covenants contained herein, the City and Consultant hereby agree as follows: 1. Effective Date and Duration: This Agreement shall become effective on the date of execution on behalf of the City, as set forth below(the"Effective Date"),and unless sooner terminated as specifically provided herein,shall terminate upon the City's affirmative acceptance of Consultant's Work as complete and Consultant's acceptance of the City's final payment therefore,but not later than June 30, 2024. 2. Scope of Work: Consultant will provide Asbestos/Lead Consulting as more fully set forth in the Consultant's Estimate,which is attached hereto as"Exhibit A"and incorporated herein by this reference. Consultant's services are collectively referred to herein as the"Work." 3. Supporting Documents/Conflicting Provisions: This Agreement and any exhibits or other supporting documents shall be construed to be mutually complementary and supplementary wherever possible. In the event of a conflict which cannot be so resolved,the provisions of this Agreement itself shall control over any conflicting provisions in any of the exhibits or supporting documents. 4. All Costs Borne by Consultant: Consultant shall, at its own risk,perform the Work described above and,unless otherwise specified in this Agreement, furnish all labor, equipment,and materials required for the proper performance of such Work. 5. Qualified Work: Consultant has represented, and by entering into this Agreement now represents,that all personnel assigned to the Work to be performed under this Agreement are fully qualified to perform the service to which they will be assigned in a skilled and wtriker-like manner and, if required to be registered,licensed or bonded by the State of Oregon, are so registered, licensed and bonded. ' Page 1 of 5: Personal Services Agreement with Coleman Creek Consulting 6. Compensation: City shall pay Provider for its Work at the hourly rates as set forth in Exhibit"A" (Estimate of Services),which is attached hereto and incorporated herein by this reference, as full compensation for Provider's performance of all Work under this Agreement. In no event shall Consultant's total of all compensation and reimbursement under this Agreement exceed the sum of $15,000.00(fifteen thousand dollars)without the express,written approval from the City official whose signature appears below, or such official's successor in office. Payments shall be made within thirty(30) days of the date of receipt by the City of Consultant's invoice. Should this Agreement be terminated prior to completion of all Work,payments will be made for any phase of the Work completed and accepted as of the date of termination. 7. Ownership of Work/Documents: All Work,work product, or other documents produced in furtherance of this Agreement belong to the City,and any copyright,patent,trademark proprietary or any other protected intellectual property right shall vest in and is hereby assigned to the City. 8. Statutory Requirements: The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220,279B.230 and 279B.235. 9. Living Wage Requirements: If the amount of this Agreement is$25,335.05 or more, Consultant is required to comply with Chapter 3.12 of the Ashland Municipal Code by paying a living wage,as defined in that chapter,to all employees performing Work under this Agreement and to any Subcontractor who performs 50%or more of the Work under this Agreement. Consultant is also required to post the notice attached hereto as"Exhibit B"predominantly in areas where it will be seen by all employees. 10. Indemnification: Consultant hereby agrees to defend,indemnify, save, and hold City, its officers, employees,and agents harmless from any and all losses,claims, actions, costs,expenses,judgments, or other damages resulting from injury to any person(including injury resulting in death),or damage (including loss or destruction)to property, of whatsoever nature arising out of or incident to the performance of this.Agreement by Consultant(including but not limited to,Consultant's employees, agents, and others designated by Consultant to perform Work or services attendant to this Agreement). However,Consultant shall not be held responsible for any losses, expenses, claims, subrogations, actions,costs,judgments, or other damages, caused solely by the negligence of City. 11. Termination: a. Mutual Consent. This Agreement may be terminated at any time by the mutual consent of both parties. b. City's Convenience. This Agreement may be terminated by City at any time upon not less than thirty(30)days'prior written notice delivered by certified mail or in person. c. For Cause. City may terminate or modify this Agreement,in whole or in part, effective upon delivery of written notice to Consultant, or at such later date as may be established by City under any of the following conditions: i. If City funding from federal,state, county or other sources is not obtained and continued at levels sufficient to allow for the purchase of the indicated quantity of services; ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way that the services are no longer allowable or appropriate for purchase under this Agreement or are no longer eligible for the funding proposed for payments authorized by this Agreement; or Page 2 of 5: Personal Services Agreement with Coleman Creek Consulting iii. If any license or certificate required by law or regulation to be held by Consultant to provide the services required by this Agreement is for any reason denied,revoked, suspended, or not renewed. d. For Default or Breach. i. Either City or Consultant may terminate this Agreement in the event of a breach of the Agreement by the other. Prior to such termination the party seeking termination shall give to the other party written notice of the breach and its intent to terminate. If the party committing the breach has not entirely cured the breach within fifteen(15) days of the date of the notice, or within such other period as the party giving the notice may authorize in writing, then the Agreement may be terminated at any time thereafter by a written notice of termination by the party giving notice. ii. Time is of the essence for Consultant's performance of each and every obligation and duty under this Agreement. City,by written notice to Consultant of default or breach,may at any time terminate the whole or any part of this Agreement if Consultant fails to provide the Work called for by this Agreement within the time specified herein or within any extension thereof. iii. The rights and remedies of City provided in this subsection(d)are not exclusive and are in addition to any other rights and remedies provided by law or under this Agreement. 12. Independent Contractor Status: Consultant is an independent contractor and not an employee of the City for any purpose. 13. Assignment: Consultant shall not assign this Agreement or subcontract any portion of the Work without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be void. 14. Default. The Consultant shall be in default of this Agreement if Consultant: commits any material breach or default of any covenant,warranty, certification,or obligation under the Agreement; institutes an action for relief in bankruptcy or has instituted against it an action for insolvency;makes a general assignment for the benefit of creditors; or ceases doing business on a regular basis of the type identified in its obligations under the Agreement; or attempts to assign rights in,or delegate duties under, this Agreement. 15. Insurance. Consultant shall, at its own expense,maintain the following insurance: a. Workers' Compensation. Consultant shall obtain and maintain Workers' Compensation insurance in compliance with ORS 656.017,which requires subject employers to provide Oregon Workers' Compensation coverage for its subject workers,unless such employers are exempt under ORS 656.126. If exempt under ORS 656.126, Consultant shall certify such exemption to the City. b. Professional Liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000(two million dollars)per occurrence. This is to cover any damages caused by error, omission or negligent acts related to the Work to be provided under this Agreement. c. General Liability insurance with a combined single limit, or the equivalent,of not less than $2,000,000(two million dollars)per occurrence for Bodily Injury,Death, and Property Damage. d. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than $1,000,000(one million dollars) for each accident for Bodily Injury and Property Damage, including coverage for owned,hired or non-owned vehicles, as applicable. Page 3 of 5: Personal Services Agreement with Coleman Creek Consulting e. Notice of cancellation or change. There shall be no cancellation,material change,reduction of limits or intent not to renew the insurance coverage(s)without thirty(30) days' prior written notice from the Consultant or its insurer(s)to the City. f. Additional Insured/Certificates of Insurance. Consultant shall name the City of Ashland, Oregon, and its elected officials, officers and employees as Additional Insureds on any insurance policies, excluding Professional Liability and Workers' Compensation,required herein,but only with respect to Consultant's services to be provided under this Agreement. The consultant's insurance is primary and non-contributory. As evidence of the insurance coverages required by this Agreement, the Consultant shall furnish acceptable insurance certificates and endorsements prior to commencing the Work under this Agreement. 16. Nondiscrimination: Consultant agrees that no person shall, on the grounds of race, color,religion, creed, sex,marital status, familial status or domestic partnership,national origin, age,mental or physical disability, sexual orientation,gender identity or source of income,suffer discrimination in the performance of any Work under this Agreement when employed by Consultant. Consultant agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes,rules and regulations. Further, Consultant agrees not to discriminate against a disadvantaged business enterprise,minority-owned business,woman-owned business,a business that a service-disabled veteran owns or an emerging small business enterprise certified under ORS 200.055, in awarding subcontracts as required by ORS 279A.110. 17. Consultant's Compliance With Tax Laws: 17.1 Consultant represents and warrants to the City that: 17.1.1 Consultant shall,throughout the term of this Agreement, including any extensions hereof, comply with: (i)All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS Chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Consultant; and (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 17.1.2 Consultant, for a period of no fewer than six(6)calendar years preceding the Effective Date of this Agreement,has faithfully complied with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS Chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Consultant; and (iii) Any rules,regulations, charter provisions,or ordinances that implement or enforce any of the foregoing tax laws or provisions. 18. Governing Law;Jurisdiction: This Agreement shall be governed and construed in accordance with the laws of the State of Oregon without regard to conflict of laws principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is in federal court, in which case exclusive venue shall be in the federal district court for the district of Oregon. Each party expressly waives any and all rights to maintain an action under this Agreement in any other venue. Page 4 of 5: Personal Services Agreement with Coleman Creek Consulting 19. Amendments. This Agreement may be amended only by written instrument executed by both parties with the same formalities as this Agreement. 20. THIS AGREEMENT AND THE ATTACHED EXHIBITS CONSTITUTE THE ENTIRE UNDERSTANDING BETWEEN THE PARTIES. THERE ARE NO UNDERSTANDINGS, AGREEMENTS,OR REPRESENTATIONS,EITHER ORAL OR WRITTEN,NOT SPECIFIED HEREIN REGARDING THIS AGREEMENT. CONSULTANT,BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE,HEREBY ACKNOWLEDGES THAT HE/SHE HAS READ THIS AGREEMENT,UNDERSTANDS IT,AND AGREES TO BE BOUND BY ITS TERMS AND CONDITIONS. 21. Certification. Consultant shall execute the certification attached hereto as"Exhibit C"and incorporated herein by this reference. IN WITNESS WHEREOF the parties have caused this Agreement to be signed in their respective names by their duly authorized representatives as of the dates set forth below. CITY OF ASHLAND: COLEMAN CREEK CONSULTING (CONSULTANT): By: W� By: gnatur. -4 gnature of'r -Da 1) (dr l LJClL Printed Name Printed Name (� itAt Title Title . 2 . 23 p8--p Date Date MI is to be submitted with this signed Agreement) D �D �j Purchase Order No. 01--- ; f� ; �v Page 5 of 5: Personal Services Agreement with Coleman Creek Consulting EXHIBIT B CITY OF ASHLAND, OREGON City of Ashland LIVING ALL employers described WAG E below must comply with City of Ashland laws regulating la ment of a living wae. $18.12_per hour, ef#e'dive:June:30;:2023..;. Ina, The`Living,Wage is adjusted annually;every June 30 by the Consumer:Price:Index ; : ;::::.: Employees must be paid a portion of business of their 401K and IRS eligible living wage: employer,if the employer has cafeteria plans(including ten or more employees,and childcare)benefits to the has received financial amount of wages received by > For all hours worked under a assistance for the project or the employee. business from the City of service contract between their Ashland in excess of > Note: For temporary and employer and the City of $25,335.05. part-time employees,the Ashland if the contract Living Wage does not apply exceeds$25,335.05 or more. > If their employer is the City of to the first 1040 hours worked Ashland, including the Parks in any calendar year. For ➢ For all hours worked in a and Recreation Department. more details,please see month if the employee spends Ashland Municipal Code 50%or more of the ➢ In calculating the living wage, Section 3.12.020. employee's time in that month employers may add the value working on a project or of health care, retirement, For additional information: Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator, City Hall, 20 East Main Street,Ashland, OR 97520,or visit the City's website at www.ashland.or.us. Notice to Employers: This notice must be posted predominantly in areas where it can be seen by all employees. CITY O F ASHLAND Page 1 of 1 EXHIBIT B EXHIBIT C CERTIFICATIONS/REPRESENTATIONS: Consultant,by and through its authorized representative,under penalty of perjury, certifies that(a) the number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be issued to it and(b)Consultant is not subject to backup withholding because: (i)it is exempt from backup withholding, or(ii) it has not been notified by the Internal Revenue Service(IRS)that it is subject to backup withholding as a result of a failure to report all interest or dividends, or(iii)the IRS has notified it that it is no longer subject to backup withholding. Consultant further represents and warrants to City that: (a)it has the power and authority to enter into this Agreement and perform the Work,(b)the Agreement,when executed and delivered, shall be a valid and binding obligation of Consultant enforceable in accordance with its terms, (c)the work under the Agreement shall be performed in accordance with the highest professional standards,and(d)Consultant is qualified,professionally competent,and duly licensed(if applicable)to perform the Work. Consultant also certifies under penalty of perjury that its business is not in violation of any, Oregon tax laws, it is an independent contractor as defined in the Agreement, it is authorized to do business in the State of Oregon,and Consultant has checked four or more of the following criteria that apply to its business. (1)Consultant carries out the work or services at a location separate from a private residence or is in a specific portion of a private residence, set aside as the location of the business. X (2) Commercial advertising or business cards or a trade association membership are purchased for the business. (3)Telephone listing is used for the business separate from the personal residence listing. (4)Labor or services are performed only pursuant to written contracts. (5)Labor or services are performed for two or more different persons within a period of one year. (6) Consultant assumes financial responsibility for defective workmanship or for service not provided as evidenced by the ownership of performance bonds, warranties, errors and omission(professional liability)insurance or liability insurance relating to the Work or services to be provided. A Consu ant's si: a re oga�-z3 Date Page 1 of 1 EXHIBIT C ^c3 Coleman Creek Consulting, Inc. FEE SCHEDULE 2023 Asbestos/Lead Consulting ASBESTOS ANALYSIS 301A Bulk Sample Analysis 25. per sample 301A Bulk Sample Analysis RUSH 50. per sample 303A PCM Air Sample Analysis 10. per sample 305A TEM Air Sample Analysis (24 HR TOT) 75. per sample LEAD PAINT ANALYSIS 701L Paint Chip Lead Analysis 25. per sample 703L Lead Air Sample Analysis 25. per sample ASBESTOS/LEAD CONSULTING 307A Asbestos/Lead Survey 60. per hour 309A Reporting 60. per hour 311A Project Specifications 60. per hour 313A Project Management 60. per hour 315A Asbestos Air Monitoring/Clearance 60. per hour 507A MA IERIALS & SUPPLIES 508A SHIPPING 509A MILEAGE 0.60 per mile 510A PER DIEM 125. per day 511A CONTRACT SERVICES 513A PROJECT SUPPORT SUBMITTED BY: Coleman Creek Consulting, Inc. 810 Leonard Street Ashland, OR 97520 David W. Fawcett Director of Asbestos Operations 810 Leonard Street,Ashland,Oregon 97520 541-535-7108 Phone A`o o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 04/25/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES . BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Hart Insurance Agency - Medford PHONE Kristi R Dolmage FAX PO Box 1240 ANC,No,Ext) (541) 779-4232 (A/C.No): E-MAIL kdolma Grants Pass OR 97528 ADDRESS: geQhartinallranCe.COm INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Admiral Insurance Company 24856 INSURED INSURER B: Coleman Creek Consulting Inc INSURER C: 810 Leonard Street INSURERD: Ashland OR 97520 INSURERE: (541) 535-7108 INSURERF: COVERAGES KD CERTIFICATE NUMBER:Cert ID 25834 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY► (MM/DDIYYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 AMAGE TO CLAIMS-MADE X OCCUR Y FEIECC13827 03/18/2023 03/18/2024 pREMSES(Ea occu ence) $ 50,000 X Pollution Liability MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRC POLICY X JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Professional Liab $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) • ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEM BER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes.describe under - - --- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ $ $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Certificate holder is included as additional insured per attached forms ECC3190712, ECC3200712 which do not apply to Professional Liability part, and ECC5480317 CERTIFICATE HOLDER CANCELLATION tami.campos@ashland.or.us 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. Public Works Dept. 20 East Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 O ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 Coleman Creek Consulting, Inc. Endorsement Number: 5 Automatic Additional Insured — Owners, Lessees or Contractors This endorsement, effective 03/18/2023, attaches to and forms a part of Policy Number FEI-ECC-13827-10. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. In consideration of an additional premium of$Applied,this endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY CONTRACTORS POLLUTION LIABILITY SCHEDULE Name of Person or Organization: Any person(s) or organization(s)whom the Named Insured agrees, in a written contract,to name as an additional insured. However, this status exists only for the project specified in that contract. The person or organization shown in this Schedule is included as an insured, but only with respect to that person's or organization's vicarious liability arising out of your ongoing operations performed for that insured. ECC-319-0712 ©2018, Freberg Environmental, Inc. Page 1 of 1 Coleman Creek Consulting, Inc. Endorsement Number: 6 Automatic Waiver of Subrogation Endorsement This endorsement, effective 03/18/2023, attaches to and forms a part of Policy Number FEI-ECC-13827-10. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies coverage provided under the following coverage part(s): COMMERCIAL GENERAL LIABILITY CONTRACTORS POLLUTION LIABILITY SCHEDULE Name of Person or Organization: Any person(s) or organization(s)to whom the Named Insured agrees, in a written contract,to provide a waiver of subrogation. However,this status exists only for the project specified in that contract. The Company waives any right of recovery it may have against the person or organization shown in the above Schedule because of payments the Company makes for injury or damage arising out of the insured's work done under a contract with that person or organization. The waiver applies only to the person or organization in the above Schedule. Under no circumstances shall this endorsement act to extend the policy period,change the scope of coverage or increase the Aggregate Limits of Insurance shown in the Declarations. ECC-320-0712 ©2018, Freberg Environmental, Inc. Page 1 of 1 • Coleman Creek Consulting, Inc. Endorsement Number: 21 Automatic Primary and Non-Contributory Insurance Endorsement Designated Work Or Project(s) This endorsement, effective 03/18/2023, attaches to and forms a part of Policy Number FEI-ECC-13827-10. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the Coverage Part(s) indicated below: COMMERCIAL GENERAL LIABILITY CONTRACTORS POLLUTION LIABILITY PROFESSIONAL LIABILITY SCHEDULE Name of Person or Organization: Any person(s) or organization(s)whom the Named Insured agrees, in a written contract,to provide Primary and/or Non-contributory status of this insurance. However, this status exists only for the project specified in that contract. In consideration of an additional premium of$Applied, and notwithstanding anything contained in this policy to the contrary, it is hereby agreed that this policy shall be considered primary to any similar insurance held by third parties in respect to work performed by you under any written contractual agreement with such third party. It is further agreed that any other insurance which the person(s) or organization(s) named in the schedule may have is excess and non-contributory to this insurance. ECC-548-0317 ©2018, Freberg Environmental, Inc. Page 1 of 1 AD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 01/09/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: 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 certifidate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Hart Insurance Agency PHONE Kristi Dolmage FAX PO Box 1240 (AIC.No.Extl: (541) 779-4232 (A/C.No):(541) 772-3963 E-MAIL Grants Pass OR 97528 ADDRESS: kdolmageQhartinsurane.com • INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Ohio Security Insurance Compan 24082 INSURED INSURER B: Coleman Creek Consulting Inc INSURER C: 810 Leonard Street INSURERD: Ashland OR 97520 INSURER E: (541) 944-5318 INSURERF: COVERAGES KD CERTIFICATE NUMBER:Cert ID 24743 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP WLILIMITS LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO LOC PRODUCTS-COMP/OPAGG $ PRO- JECT OTHER: $ AUTOMOBILE LIABILITY ED SINGLE LIMIT (Ea accident) $ 1,000,000 A ANY AUTO BAS56324209 01/01/2023 01/01/2024 BODILY INJURY(Per person) $ X OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED7 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION tami.canmpos@ashland.or.us 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. Public Works Dept. . 20 East Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 0 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 5 CERTIFICATION OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REQUIREMENTS Contractor is exempt from the requirement to obtain workers compensation insurance under ORS Chapter 656 for the following reason, Contractor is to initial the appropriate box as follows: SOLE PROPRIETOR (Initials) n Contractor is a sole proprietor,and u Contractor has no employees,and . d Contractor will not hire employees or subcontractors to perform this contract. V i CORPORATION—FOR PROFIT (Initials) u Contractor's business is incorporated;and n All employees of the corporation are officers and directors and have a substantial ownership interest*in the corporation,and n All work will be performed by the officers and directors;Contractor will not hire other employees or subcontractors to perform this contract. CORPORATION-NONPROFIT (Initials) n Contractor's business is incorporated as a nonprofitcorporation,and u Contractor has no employees;all work is performed by volunteers,and • Contractor will not hire employees or subcontractors to perform this contract. PARTNERSHIP (Initials) n Contractor is a partnership,and • n Contractor has no employees,and . n All work will be performed by the partners;Contractor will not hire employees or subcontractors to perform this contract,and n Contractor is not engaged in work performed in direct connection with the construction,alteration,repair, • improvement,moving or demolition of an improvement to real property or appurtenances thereto.** LIMITED LIABILITY COMPANY (Initials) n Contractor is a limited liability company,and U Contractor has no employees,and . ,n All work will be performed by the members;Contractor will not hire employees or subcontractors to perform this contract,and • n If Contractor has more than one member,Contractor is not engaged in work performed in direct connection with the construction,alteration,repair,improvement,moving or demolition of an improvement to real property or appurtenances thereto.** (Signature of^ Authorized Signer) (Date) A4 (Signer'sTitle *NOTE: Under OAR436-50-050 a shareholder has a"substantial ownership"interest if the shareholder owns 10%of the corporation,or if less than 10%is owned,the shareholder has ownership that is at least equal to or greater than the average percentage of ownership of all shareholders. • **NOTE: Under certain circumstances partnerships and limited liability companies can claim an exemption even when performing construction work. The requirements for this exemption are complicated. Consult with City Attorney's Office before an exemption request is accepted from a contractor who will perform construction work. E i • •