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2023-104 PO 20240065- Metal Masters Inc
Purchase Order. � 1 � 5 . -. � , r- g Fiscal Year 2024 Page: 1 of: 1 Vali B City of Ashland • _� lil: 1 i tabloid M 4, -- — I ATTN: Accounts Payable Purchase 0240065 L Ashland, OR 97520 Order# T Phone:541/552-2010 O Email: payable@ashland.or.us . I V H C/O Facilities Maintenance Div - E METAL MASTERS INC 1 90 North Mountain Ave , N 3825 CRATER LAKE HWY p Ashland, OR 97520 O MEDFORD, OR 97504 Phone: 541/488-5358 • R T Fax: 541/552-2304 C itrAgp 9k el 6I=--.=9 s _ a cI&—EEaIe§€---ii 17-gr 9.;j_ - -� -=5 zjj fik.ea'€�ldr1'Wzgl = -=::::: --- (541) - — (541) 779-1049 — �-- __.�_ ____._.—. David Arnold '`_n om e@tf=is_ ----N7,..). kiirr 1i9 = -ateii.il_I� -- 6a13 4 1 ilizI firi _ _. i si 11, 1'i=l-5 — 08/08/2023 1709 FOB ASHLAND OR City Accounts Payable 7_�- 'BI--T---- _ d II On-Call HVAC Repairs - 1 On-call Heating and Air Conditioning Repairs 1.0 $5,000.00 $5,000.00 Goods and Services Agreement($35,000 or less) - Completion date: 06/30/2024 ,, Project Account: *************** GL SUMMARY*************** 088400-602400 $5,000.00 I I I I , . ___ ---•-_____L-_:;&.---- . ___ _ =--- ==moi s; it ji._.1.:1.1 .A./ Date: ~SI O ._ _ Authored Signatar - = moi = 5 000.00 } PORN! #3 CITY OF . • � � ASHLAND A request for a Purchase L ,e,0 74 REQUISITION Date of request: 7/1/23 Required date for delivery: - - Vendor Name Metal Masters Address,City,State,Zip 3825 Crater Lake Hwy, Medford, OR 97504 Contact Name&Telephone Number Lisa Stauffer (541)779-1049 Fax Number (541)779-6839 i .,./_.... SOURCING METHOD I— D Exempt from Competitive Bidding ❑ Emergency rA/ • IDReason for exemption: ❑ Invitation to Bid (Copies on file) ❑ Form#13,Written findings and Autho ❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached { ❑ Written quote or proposal attached ® Small Procurement - Cooperative Procurement Less than$5,000 0 Request for Proposal (Copies on file) 0 State of Oregon ® Direct Award Date approved by Council:_ Contract# ❑ Verbal/Written quote(s)or proposal(s) 0 State of Washington Intermediate Procurement 0 Sole Source Contract# • GOODS&SERVICES 0 Applicable Form(#5,6,7 or 8) 0 Other government agency contract $5,00.0 to$100,000 • 0 Written quote or proposal attached Agency ❑ (3)Written quotes attached 0 Special Procurement Contract# PERSONAL SERVICES 0 Form#9,Request for Approval Intergovernmental Agreeme $5,000 to$75,000 0 Written quote or proposal attached 0 Agency ❑ Less than$35,000,by direct appointment Date approved by Council: Date original tract approved by Council: ❑ (3)Written proposals attached . Valid until: (Date) (Date) Description of SERVICES Total Cost 0, $,[5,000 f0 ' Heating and Air Conditioning Service Work As Needed Item# Quantity Unit Description of MATERIALS Unit Price Total Cost 1 Heating and Air Conditioning Services as needed $5,000.00 .'TOTAL ictisr ❑ Per attached quotelproposal ‘$,I...;000, ,__ Project Number - Account Number 088400-602400 *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: 1T.Director Date Support-Yes/No equisition form,l cert', . ity's public contracting requirements have been satisfied. Employee Signature: •SLI Depailliirrrtment Head Signatu . greater n$5,000) Additional signatures(if app[cable): ,, Funds appropriated for current fiscal year: ( / NO S.�J, Y ( (/1 finance Director,r . to or greater than$5,000) Date Comments: • • • Form#3-Requisition • GOODS AND SERVICES AGREEMENT ($35,000 OR LESS) PROVIDER: Metal Masters Heating&Air CITY OF PROVIDER'S ASH LAN D CONTACT: Lisa Stauffer 20 East Main Street Ashland, Oregon 97520 ADDRESS: 3825 Crater Lake Highway Telephone: 541/488-5587 Medford, OR 97504 Fax: 541/488-6006 PHONE: 541-779-1049 This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and Metal Masters Heating & Air, (a domestic business corporation) ("hereinafter"Provider"),for HVAC Heating&Air service as needed. 1. PROVIDER'S OBLIGATIONS 1.1 Provide glass repair and.replacement for FY24 as set forth in the "SUPPORTING DOCUMENTS" attached hereto and, by this reference, incorporated herein. Provider expressly acknowledges that time is of the essence of any completion date set forth in the SUPPORTING DOCUMENTS, and that no waiver or extension of such deadline may be authorized except in the same manner as herein provided for authority to exceed the maximum compensation. The services defined and described in the "SUPPORTING DOCUMENTS"shall hereinafter be collectively referred to as"Work." 1.2 Provider shall obtain and maintain during the term of this Agreement and until City's final acceptance of all Work received hereunder, a policy or policies of liability insurance including commercial general liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 (two million dollars)per occurrence for Bodily Injury and Property Damage. 1.2.1 The insurance required in this Article shall include the following coverages: • Comprehensive General or Commercial General Liability, including personal injury, contractual liability, and products/completed operations coverage; and o Automobile Liability. 1.2.2 Each policy of such insurance shall be on an "occurrence" and not a "claims made" form, and shall: 1 • Name as additional insured "the City of Ashland, Oregon, its officers, agents and employees" with respectto 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 Iimits shall not be increased thereby; • Apply as primary coverage for each additional named insured except to the extent that two or more such policies are intended to "layer" coverage and, taken together, they provide total coverage from the first dollar of liability; • Provider shall immediately notify the City of any change in insurance coverage • Provider shall supply an endorsement naming the City, its officers, employees and agents as additional insureds by the Effective Date of this Agreement; and ® Be evidenced by a certificate or certificates of such insurance approved by the City. Page 1 of 6: Goods and Services Agreement between the City of Ashland and Metal Masters Heat&Air 1.3 Provider shall,at its own expense,maintain Worker's Compensation Insurance in compliance with ORS 656.017, which requires subject employers to provide workers' compensation coverage for all of its subject workers. 1.4 Provider agrees that no person shall, on the grounds of race, color, religion, creed, sex, marital status, familial status or domestic partnership, national origin, age, mental or physical disability, sexual orientation, gender identity or source of income, suffer discrimination in the performance of this Agreement when employed by Provider. Provider agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. Further, Provider agrees not to discriminate against a disadvantaged business enterprise,minority-owned business,woman-owned business, a business that a service-disabled veteran owns or an emerging small business enterprise certified under ORS 200.055, in awarding subcontracts as required by ORS 279A.110. 1.5 In all solicitations either by competitive bidding or negotiation made by Provider for work to be performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Providers of the Provider's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 1.6 Living Wage Requirements: If the amount of this Agreement is $25,335.05 or more, Provider is required to comply with Chapter 3.12 of the Ashland Municipal Code by paying a living wage,as defined in that chapter, to all employees performing Work under this Agreement and to any Subcontractor who performs 50% or more of the Work under this Agreement. Provider is also required to post the notice attached hereto as "Exhibit A"predominantly in areas where it will be seen by all employees. 1.7 Assignment: Provider 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. Provider 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. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider the hourly rates effective July 1, 2023 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$5,000 (this is maximum, not to exceed amount of ENTIRE Agreement) without express, written approval from the City official whose signature appears below, or such official's successor in office. Provider expressly acknowledges that no other person has authority to order or authorize additional Work which would cause this maximum sum to be exceeded and that any authorization from the responsible official must be in writing. Provider further acknowledges that any Work delivered or expenses incurred without authorization as provided herein is done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement. 3. GENERAL PROVISIONS 3.1 This is a non-exclusive Agreement. City is not obligated to procure any specific amount of Work from Provider and is free to procure similar types of goods and services from other providers in its sole discretion. Page 2 of 6: Goods and Services Agreement between the City of Ashland and Metal Masters Heat&Air 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. 3.6 The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220,279B.230 and 279B.235. 3.7 This Agreement shall be governed by the laws of the State of Oregon without regard to conflict of laws principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is in federal court, • in which case exclusive venue shall be in the federal district court for the district of Oregon. Each party expressly waives any and all rights to maintain an action under this Agreement in any other venue, and expressly consents that, upon motion of the other party, any case may be dismissed or its venue transferred, as appropriate, so as to effectuate this choice of venue. 3.8 Provider shall defend,save,hold harmless and indemnify the City and its officers,employees and agents from and against any and all claims, suits, actions, losses, damages, liabilities, costs, and expenses of any nature resulting from, arising out of, or relating to the activities of Provider or its officers, employees, contractors, or agents under this Agreement. 3.9 Neither party to this Agreement shall hold the other responsible for damages or delay in performance caused by acts of God, strikes, lockouts, accidents,or other events beyond the control of the other or the other's officers, employees or agents. 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. Page 3 of 6: Goods and Services Agreement between the City of Ashland and Metal Masters Heat&Air • • • 4. SUPPORTING DOCUMENTS 4.1 The following documents are, by this reference, expressly incorporated in this Agreement, and are collectively referred to in this Agreement as the "SUPPORTING DOCUMENTS:" • The Provider's complete written Rate Sheet dated July 1, 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 Provider is in default of this Agreement, City may, at its option, pursue any or all of the remedies available to it under this Agreement and at law or in equity, including, but not limited to: 5.1.1 Termination of this Agreement; 5.1.2 Withholding all monies due for the Work that Provider has failed to deliver within any scheduled completion dates or any Work that have been delivered inadequately or defectively; 5.1.3 Initiation of an action or proceeding for damages, specific performance, or declaratory or injunctive relief; 5.1.4 These remedies are cumulative to the extent the remedies are not inconsistent,and City may pursue any remedy or remedies singly, collectively, successively or in any order whatsoever. 5.2 In no event shall City be liable to Provider for any expenses related to termination of this Agreement or for anticipated profits. If previous amounts paid to Provider exceed the amount due,Provider shall pay immediately any excess to City upon written demand provided. 6. TERM AND TERMINATION 6.1 Term This Agreement shall be effective from the date of execution on behalf of the City as set forth below • (the "Effective Date"), and shall continue in full force and effect until June 30, 2024, 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: Page 4 of 6: Goods and Services Agreement between the City of Ashland and Metal Masters Heat&Air • • • If to the City: • City of Ashland—Facilities Maintenance Department Attn: David Arnold " • 20 E. Main Street Ashland, Oregon 97520 Phone: (541) 552-2292 • • With a copy to: • City of Ashland—Legal Department • 20 E. Main Street • Ashland, OR 97520 • Phone: (541)488-5350 • If to Provider: • Metal Masters Heat&Air Attn: Lisa Stauffer • • • • 3825 Crater Lake Hwy • • • Medford, OR 97504 • " 541-779-1049 • 8. WAIVER OF BREACH • One or more waivers or failures to object by either party to the other's breach of any provision,term,condition, or covenant contained in this Agreement shall not be construed as a waiver of any subsequent breach,whether or not of the same nature. • 9. PROVIDER'S COMPLIANCE WITH TAX LAWS 9.1 Provider represents and warrants to the City that: • • 9.1.1 Provider shall, throughout the term of this Agreement, including any extensions hereof, comply . . with: • " • (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: (i) .All tax laws of the State of Oregon, including'but not limited to ORS 305.620 and ORS • chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to • Provider; and • (iii) Any rules,regulations, charter provisions, or ordinances that implement or enforce any of • the foregoing tax laws or provisions. • 9.2 Provider's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Provider's warranty, as set forth in this Article 9, shall constitute a material breach of this Agreement. Any material breach of this Agreement shall entitle the City to terminate this • • Agreement and to seek damages and any other relief available under this Agreement,at law,or in equity. Page 5 of 6: Goods and Services Agreement between the City of Ashland and Metal Masters Heat&Air jt • i . 1 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: Metal Masters Heat&Air(PROVIDER): By. B3c4,°: a i gnatur Signature Saar c12-y .I - k-ka. . ' (Printed Nati`ie • Printed Name Pu3c—%( wt.') k� C�f21�C 2L COVIA1012i6ed 6C--L1-6CY6( C6at Title Title / (zf 1 Date Date (is to be submitted with this signed Agreement) Purchase Order No. Page 6 of 6: Goods and Services Agreement between the City of Ashland and Metal Masters Heat&Air • • METAL t. 11[,� Medford Klamath Falls , � ' 3825 Crater Lake Highway 4168 Washburn Way 44 Medford,Oregon 97504 Klamath Falls,Oregon 97603 tel 800.866.9437 HEAT & AIR :r te1541,779.1049 tel 541.883.3237 metalmasters-inc.com , 11111A441, fax 541.779.6839 fax 541.885.2480 CCB#529 June 28, 2023 •City of Ashland 90 N Mountain Avenue Ashland, OR 97520 •Pricing for Metal Masters service work: Labor$125.00 per hour(regular business hours 8 a.m.to 4:30 p.m.) Labor$250.00 per hour(after hours 4:30 p.m.to 8 a.m.) Parts pricing varies with each repair/service call. Business Hours 8 a.m.to 4:30 p.m. • Thank you. • Lisa Stauffer,Commercial Services Coordinator Metal Masters, Inc . 541-779-1049 • • • • • a.> '. METAL ASA) Medford Klamath Falls 3825 Crater Lake Highway 4168 Washburn Way HEAT & AIR Medford,Oregon 97504 Klamath Falls,Oregon 97603 tel 800.866.9437 tel 541.779.1049 te1541.883.3237 • metalmasters-inc,com ' t fax 541.779.6839 fax 541.885.2480 CCB#529 July 1,2023 City of Ashland • 90 North Mountain Avenue Ashland,OR 97520 V V I Pricing for Metal Masters service work: Labor$125.00 per hour(regular business hours) Labor$250.00 per hour(after hours 4:30 p.m.to 8 a.m.) Parts pricing varies with each repair/service call. . Business Hours 8 a.m.to 4:30 p.m. Thank you. V Cil L` isa Stauffer,Commercial '-rvices Coordinator Metal Masters Inc 541-779-1049 V ® DATE(MM/DD/YYYY) A 5 o CERTIFICATE OF LIABILITY INSURANCE • 7/27/2023 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(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 Protectors Insurance, LLC PHONE Kendall Pori FAX P.O. Box 4669 (A/c.No.Ext): (541)842-2963 (A/C.No): Medford OR 97504 E-MAIL kendallp@protectorsins.com INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:SAIF Corporation 524113 INSURED METAL-1 INSURER B:The Cincinnati Insurance Co 10677 Metal Masters Inc 3825 Crater Lake Hwy INSURER C: Medford OR 97504 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:300306681 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. TR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYY) B )( COMMERCIAL GENERAL LIABILITY Y Y EPP 0280784 10/1/2022 10/1/2023 EACH OCCURRENCE $1,000,000 CLAIMS-MADE f X l OCCUR DAMAGE TO RENTEDPREMISES(Ea occurrence) $500,000 _ 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 FM? LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y ' Y EBA 0280784 10/1/2022 10/1/2023 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X 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) $ B X UMBRELLA LIAB X OCCUR Y Y EPP 0280784 10/1/2022 10/1/2023 EACH OCCURRENCE $2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DED RETENTION$ $ A WORKERS COMPENSATION Y 812256 10/1/2022 10/1/2023 X AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $1,000,000 OFFI CE R/MEMB ER 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,may bo attached if more space Is required) *Umbrella Liability is following form to schedule of underlying policies: Employers Liability,General Liability,Automobile Liability Certificate holder is additional insured if by written contract,per attached policy endorsements CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Department 20 E Main St AUTHOR) RESENTATIVE,IV�� /� Ashland OR 97520 123. j 4,41rl /� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BROAD FORM CONTRACTORS ADDITIONAL INSURED - AUTOMATIC STATUS AND AUTOMATIC WAIVER OF SUBROGATION WHEN REQUIRED IN WRITTEN CONTRACT, AGREEMENT, PERMIT OR AUTHORIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Additional Insured - Owners, Lessees Or (1) The Coverage Part to which this Contractors - Automatic Status For Other endorsement is attached pro- Parties When Required In Written Contract vides coverage for"bodily injury" Or Agreement With You or "property damage" included 1. Section II - Who Is An Insured is within the "products-completed amended to Include as an additional in- sured operations hazard";and any person or organization you (2) The written contract or written have agreed in writing in a contract or agreement requires you to pro- agreement to add as an additional In- vide additional insured coverage sured on this Coverage Part. Such per- Included within the "products- son(s) or organization(s) is an additional completed operations hazard" Insured only with respect to liability for: for that person or organization. a. "Bodily injury", "property damage" or If the written contract or written "personal and advertising injury" agreement requires you to provide caused, in whole or in part, by the additional insured coverage included performance of your ongoing opera- within the "products-completed oper- tions by you or on your behalf, under ations hazard" for a specified length that written contract or written of time for that person or organize- agreement. Ongoing operations does tion, the "bodily Injury" or "property not apply to "bodily injury"or"proper- damage" must occur prior to the ex- . ty damage"occurring after: piration of that period of time In order (1) All work, including materials, for this Insurance in apply. parts or equipment furnished in If the written contract or written connection with such work, on agreement requires you to provide the project (other than service, additional Insured coverage for a maintenance or repairs) to be person or organization per only ISO performed by or on behalf of the additional Insured endorsement form additional insured(s) at the loca- number CG 2010, without specifying tion of the covered operations an edition date, and without specif I- has been completed; or cally requiring additional insured coverage Included within the "prod- (2) That portion of "your work"out of ucts-completed operations hazard", which the injury or damage aris- this Paragraph b. does not apply to es has been put to its intended that person or organization. use by any person or organiza- tion other than another contrac- 2. If the written contract or written agree- tor or subcontractor engaged In ment described In Paragraph 1. above performing operations for a prin- specifically requires you to provide addi- cipal as a part of the same pro- tional Insured coverage to that person or ject;and organization: b. "Bodily injury" or "property damage" a. Arising out of your ongoing opera- caused, in whole or in part, by"your tions or arising out of'your work"; or work" performed under that written contract or written agreement and in- b. By way of an edition of an ISO addl- cluded in the "products-completed tional insured endorsement that in- operations hazard", but only If: cludes arising out of your ongoing Includes copyrighted material of Insurance GA 4523 05 20 Services Office, Inc., with its permission. Page 1 of 3 • operations or arising out of "your graph B.1., the following additional exclu- work"; sions apply: then the phrase caused, in whole or in This insurance does not apply to: part, by in Paragraph Al.a.and/or Para- graph A.1.b.above,whichever applies,is a. "Bodily injury", "property damage" or replaced by the phrase arising outof. "personal and advertising injury" aris- ing out of operations performed for 3. With respect to the insurance afforded to the federal government,state or mu-. the additional insureds described in Para- nicipality;or ' graph A.1., the following additional exclu- sion applies: b. "Bodily injury" or "property damage" included within the "products- This insurance does not apply to "bodily completed operations hazard." injury", "property damage" or "personal ' and advertising injury" arising out of the C. The insurance afforded to additional insureds rendering of, or the failure to render, any described in Paragraphs A.and B.: professional architectural, engineering or 1. Only applies•to the extent permitted by surveying services,including: law;and a. The preparing,approving or failing to 2. Will not be broader than that which you prepare or approve, maps, shop are required by the written contract, writ- drawings, opinions, reports, surveys, ten agreement, written permit or written field orders, change orders or draw- authorization to provide for such addition- ings and specifications;or al insured;.and b. Supervisory, Inspection, architectural 3. Does not apply to any person, organiza- or engineering activities. • tion, state, governmental agency or sub- This exclusion applies even if the claims division or political subdivision specifically against any insured allege negligence or named as an additional insured for the other wrongdoing in the supervision, hir- same project in the schedule of an en- ing, employment,training or monitoring of dorsement added to this Coverage Part. others by that insured, if the "occurrence" However, Paragraphs C.1.and C.2.above do which caused the "bodily injury"or"prop- gra p not apply If the applicable written contract, erty damage", or the offense which written agreement, written permit or written caused the"personal and advertising inju- authorization requires an edition of an ISO ry", involved the rendering of, or the fail- additional insured endorsement that does not ure to render, any professional architec- include these provisions. tura!, engineering or surveying services. 4. This Paragraph A_does not I to addi- D. With respect to.the insurance afforded to the apply additional insureds described in Paragraphs tional insureds described in Paragraph B. A.and B.,the following is added to Section III B. Additional Insured-State Or Governmental =Limits Of Insurance: Agency Or Subdivision Or Political Subdi- 1. The most we will pay on behalf of the ad- vision - Automatic Status When Required ditional insured is the amount of insur- In Written Permits Or Authorizations ance: 1. Section II - Who Is An Insured is • a. Required by the written contract,writ- amended to include as an additiohal in- ten agreement,written permit or writ- sured any state or governmental agency ten authorization described in Para- or subdivision or political subdivision you graphs A. and B. For the purpose of have agreed in writing in a permit or au- determining the required amount of thorization to add as an additional Insured insurance only, we will include the on this Coverage Part. Such state or gov- minimum amount of any Umbrella Li- ernmental agency or subdivision or politi- ability or Excess Liability coverage cal subdivision is an additional insured required for that additional insured in only with respect to operations performed that written contract, written agree- by you or on your behalf for which the ment,written permit or written author- state or governmental agency or subdivi- ization; or sion or political subdivision has issued, in writing,a permit or authorization. b. Available under the,applicable limits 2. With respect to the Insurance afforded to of insurance; the additional insureds described in Para- whichever is less. Includes copyrighted material of Insurance GA 4523 05 20 Services Office, Inc.,with its permission. Page 2 of 3 However, Paragraph D.1. does not apply 1. The additional insured is a Named In- if the applicable written contract, written sured under such other insurance; and agreement, written permit or written au- thorization requires an edition of an ISO 2. You have agreed in writing in a contract, additional Insured endorsement that does agreement, permit or authorization de- not include these provisions. scribed in Paragraph A.or B.that this in- surance would be primary to any other in- 2. This endorsement shall not increase the surance available to the additional in- applicable limits of insurance. sured. E. Section IV - Commercial General Liability As used in this endorsement, wrap-up insur- Conditions is amended to add the following: ance means a centralized insurance program Automatic Additional Insured Provision under which one party has secured either in- surance or self-insurance covering some or all This insurance applies only if the "bodily inju- of the contractors or subcontractors perform- ry" or "property damage" occurs, or the "per- ing work on one or more specific project(s). sonal and advertising injury" offense is corn- Primary Arid Noncontributory Insurance mitted: When Required By Written Contract, 1. During the policy period; and Agreement, Permit Or Authorization 2. Subsequent to your execution of the writ- Except when wrap-up insurance applies to the ten contract or written agreement, or the claim or "suit" on behalf of the additional in- issuance of a written permit or written au- sured,this insurance is primary to and will not thorization, described in Paragraphs A. seek contribution from any other insurance and B. available to the additional insured described in Paragraphs A.and B.provided that: F. Except when G.below applies,the following is added to Section IV - Commercial General 1. The additional Insured is a Named In- Liability Conditions, Other Insurance, and sured under such other insurance;and supersedes any provision to the contrary: 2. You have agreed in writing in a contract, When Other Additional Insured Coverage agreement, permit or authorization de- Applies On An Excess Basis scribed in Paragraph A.or B.that this in- surance would be primary and would not This insurance is primary to other insurance seek contribution from any other insur- available to the additional insured described in ance available to the additional insured. Paragraphs A.and B.except: As used in this endorsement, wrap-up insur- 1. As otherwise provided in Section IV - ance means a centralized insurance program Commercial General Liability Condi- under which one party has secured either in- tions, Other Insurance, b. Excess In- surance or self-insurance covering some or all surance; or of the contractors or subcontractors perform- 2. For any other valid and collectible insur- ing work on one or more specific project(s). ance available to the additional insured as H. Section IV - Commercial General Liability an additional insured on another insur- Conditions, Transfer Of Rights Of Recov- ance policy that is written on an excess ery Against Others To Us is amended by the basis. In such case,this Insurance is also addition of the following: excess. Waiver of Subrogation G. The following is added to Section IV -Com- mercial General Liability Conditions, Other We waive any right of recovery against any Insurance, and supersedes any provision to additional insured under this endorsement, the contrary: because of any payment we make under this endorsement, to whom the insured has Primary Insurance When Required By Writ- waived its right of recovery in a written con- ten Contract, Agreement, Permit Or Au- tract, written agreement, written permit or writ- thorization ten authorization. Such waiver by us applies only to the extent that the insured has waived Except when wrap-up insurance applies to the its recovery right ofagainst such additional In- • claim or "suit" on behalf of the additional in- g g sured prior to loss. sured, this insurance is primary to any other insurance available to the additional insured described In Paragraphs A. and B. provided that: Includes copyrighted material of Insurance GA 4523 05 20 Services Office, Inc.,with its permission. Page 3 of 3 www.saif.com to,F. Jdork.. Life. Oregon. Carrier no: 20001 Endorsement no: WC000313 (Ed. 430B) SAIF policy: 812256 Metal Masters Inc Waiver of Our Right to Recover from Others Endorsement We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Description: All Operations Contractor name: Persons and/or organizations who,with the insured-employer are parties to a construction agreement as defined in ORS 30.140. This endorsement does not alter the rights of an injured worker to pursue recovery from another party or SAIF to receive a statutory share of recoveries by an injured worker, even from the party listed in the schedule. The premium charge for this endorsement is based on one (1) percent of your manual premium. Effective date: October 01, 2022 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Countersigned September 22, 2022 at Salem, Oregon WC000313 Chip Terhune (Ed. 430B) President and Chief Executive Officer 400 High Street SE Salem,OR 97312 P:800.285.8525 F:503.373.8020 PoLPCf_E4300 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CinciPlus® BUSINESS AUTO XC+® (EXPANDED COVERAGE PLUS) ENDORSEMENT This endorsement modifies insurance provided by the following: BUSINESS AUTO COVERAGE FORM With respect to the coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by this endorsement. A. Blanket Waiver of Subrogation This provision does not apply unless the valid SECTION IV - BUSINESS AUTO CONDI- written contract has been: TiONS, A. Loss Conditions, 5. Transfer of 1. Executed prior to the accident causing Rights of Recovery Against Others to Us Is "bodily injury"or"property damage"; and amended by the addition of the following: 2. Is still in force at the time of the"accident'' We waive any right of recovery we may have causing 'bodily Injury" or "property dam- against any person or organization because of age". payments we make for "bodily injury" or "property damage"arising out of the operation D. Employee Hired Auto of a covered "auto" when you have assumed 1. Changes in Liability Coverage liability for such "bodily Injury" or "property damage" under an "insured contract", provid- The following is added to the Section II - ed the"bodily injury"or"property damage"cc- Liability Coverage, A. Coverage, 1. curs subsequent to the execution or the "in- Who is an Insured: cured contract". An "employee" of yours is an "insured" B. Noncontributory insurance while operating an "auto" hired or rented SECTION IV - BUSINESS AUTO CONDI- under a contract or agreement in that TIONS, B. General Conditions, 5.Other In- "employee's" name, with your permission, while performing duties related to the surance c.is replaced by the following: conduct of your business. • c. Regardless of the provisions of Par- 2. Changes in General Conditions agraph a. above, this Coverage Form's Liability Coverage is primary SECTION IV - BUSINESS AUTO CON- and we will not seek contribution DITIONS, B. General Conditions, 5. from any other insurance for any Iia- Other Insurance is amended by replac- bility assumed under an "insured ing Paragraph 5.b.with the following: contract" that requires liability to be b. For Hired Auto Physical Damage assumed on a primary noncontributo- ry basis. Coverage the following are deemed to be covered"autos"you own: C. Additional Insured by Contract (1) Any covered "auto" you lease, SECTION II - LIABILITY COVERAGE, A. hire, rent or borrow;and Coverage, I. Who is an Insured Is amended to include as an Insured any person or organi- (2) Any covered "auto" hired or zatlon with which you have agreed In a valid rented by your "employee"under written contract to provide insurance as is af- a contract in that individual "em- forded by this policy. ployee's" name, with your per- mission, while performing duties This provision is limited to the scope of the related to the conduct of your valid written contract. business. Includes copyrighted material of ISO AA 288 01 16 Properties, Inc., with its permission. Page 1 of 4 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BROAD FORM CONTRACTORS ADDITIONAL INSURED AUTOMATIC STATUS AND AUTOMATIC WAIVER OF SUBROGATION WHEN REQUIRED IN WRITTEN CONTRACT, AGREEMENT, PERMIT OR AUTHORIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Additional Insured - Owners, Lessees Or (1) The Coverage Part to which this Contractors - Automatic Status For Other endorsement is attached pro- Parties When Required In Written Contract , vides coverage for"bodily injury" Or Agreement With You or "property damage" included 1. Section II - Who Is An Insured is within the "products-completed amended to include as an additional in- sured operations hazard"; and any person or organization you (2), The written contract or written have agreed in writing in a contract or agreement requires you to pro- agreement to add as an additional in- vide additional insured coverage sured on this Coverage Part. Such per- included within the "products- son(s) or organization(s) is an additional completed operations hazard" insured only with respect to liability for: for that person or organization. a, "Bodily injury" "property damage" or If the written contract or written "personal and advertising injury" agreement requires you to provide caused, in whole or in part, by the additional insured coverage included performance of your ongoing opera- within the "products-completed oper- tions by you or on your behalf, under ations hazard" for a specified length that written contract or written of time for that person or organiza- agreement. Ongoing operations does tion, the "bodily injury" or "property not apply to "bodily injury" or"proper- damage" must occur prior to the ex- ty damage"occurring after: piration of that period of time in order (1) All work, including materials, for this insurance to apply. parts or equipment furnished in If the written contract or written connection with such work, on agreement requires you to provide the project (other than service, additional insured coverage for a . maintenance or repairs) to be person or organization per only ISO performed by or on behalf of the additional insured endorsement form additional insured(s) at the loca- number CG 20 10, without specifying tion of the covered operations an edition date, and without specifi- has been completed;or cally requiring additional insured "prod- (2) That portion of"your work"out of coverage included within the which the injury fodamagewrk" ut s-of ucts-completed operations hazard", has been put to its intended this Paragraph b. does not apply to ethat person or organization. use by any person or organiza- tion other than another contrac- 2. If the written contract or written agree- tor or subcontractor engaged in ment described in Paragraph 1. above performing operations for a prin- specifically requires you to provide addi- cipal as a part of the same pro- tional insured coverage to that person or ject; and organization: b, "Bodily injury" or "property damage" a. Arising out of your ongoing opera- caused, in whole or in part, by "your tions or arising out of"your work"; or work" performed under that written contract or written agreement and in- b, By way of an edition of an ISO addi- cluded in the "products-completed tional insured endorsement that in- operations hazard", but only if: cludes arising out of your ongoing Includes copyrighted material of Insurance GA 4523 05 20 Services Office, Inc., with its permission. Page 1 of 3 • operations or arising out of "your graph B.1., the following additional exclu- work"; sions apply: then the phrase caused, in whole or in This insurance does not apply to: part, by in Paragraph A,1:a, and/or Para- graph A,1.b. above,whichever applies, is a, 'Bodily injury", "property damage" or replaced by the phrase arising out of "personal and advertising injury" aris- ing out of operations performed for 3. With respect to the insurance afforded to the federal government, state or mu- the additional insureds described in Para- nicipality: or graph A.1., the following additional exclu- sion applies: b. "Bodily injury" or "property damage" included within the "products- This insurance does not apply to "bodily completed operations hazard." injury", "property damage" or "personal and advertising injury" arising out of the C, The insurance afforded to additional insureds rendering of, or the failure to render, any described in Paragraphs A. and B.: professional architectural, engineering or 1. Only applies to the extent permitted by surveying services, including: law; and a, The preparing, approving or failing to 2. Will not be broader than that which you prepare or approve, maps, shop are required by the written contract, writ- drawings, opinions, reports, surveys, ten agreement, written permit or written field orders, change orders or draw- authorization to provide for such addition- ings and specifications; or al insured; and b. Supervisory, inspection, architectural 3. Does not apply to any person, organiza- or engineering activities. tion, state, governmental agency or sub- This exclusion applies even if the claims division or political subdivision specifically against any insured allege negligence or named as an additional insured for the other wrongdoing in the supervision, hir- same project in the schedule of an en- ing, employment, training or monitoring of dorsement added to this Coverage Part. others by that insured, if the 'occurrence" However, Paragraphs C,1. and C,2, above do which caused the "bodily injury" or "prop- not apply if the applicable written contract, erty damage", or the offense which written agreement, written g permit or written caused the "personal and advertising inju authorization requires an edition of an ISO ry", involved the rendering of, or the fail- q ure to render, anyprofessional architec- additional insured endorsement that does not include these provisions. tural, engineering or surveying services. 4. This Paragraph A. does not apply to addi- D, With respect to the insurance afforded to the additional insureds described in Paragraphs tional insureds described in Paragraph B. A, and B.,the following is added to Section III B. Additional Insured-State Or Governmental -Limits Of Insurance: Agency Or Subdivision Or Political Subdi- 1. The most we will pay on behalf of the ad- vision - Automatic Status When Required ditional insured is the amount of insur- In Written Permits Or Authorizations ance: 1. Section II - Who Is An Insured is a. Required by the written contract,writ- amended to include as an additional in- ten agreement, written permit or writ- sured any state or governmental agency ten authorization described in Para- or subdivision or political subdivision you graphs A. and B. For the purpose of have agreed in writing in a permit or au- determining the required amount of thorization to add as an additional insured insurance only, we will include the on this Coverage Part. Such state or gov- minimum amount of any Umbrella Li- ernmental agency or subdivision or politi- ability or Excess Liability coverage cal subdivision is an additional insured required for that additional insured in only with respect to operations performed that written contract, written agree- by you or on your behalf for which the ment, written permit or written author- state or governmental agency or subdivi- ization; or sion or political subdivision has issued, in writing, a permit or authorization. b, Available under the applicable limits 2, With respect to the insurance afforded to of insurance; the additional insureds described in Para- whichever is less. Includes copyrighted material of Insurance GA 4523 05 20 Services Office, Inc.,with its permission. Page 2 of 3 However, Paragraph D.1. does not apply 1. The additional insured is a Named In- if the applicable written contract, written sured under such other insurance;and agreement, written permit or written au- ' thorization requires an edition of an ISO 2. You have agreed in writing in a contract, additional insured endorsement that does agreement, permit or authorization de- not include these provisions. scribed in Paragraph A. or B.that this in- surance would be primary to any other in- 2. This endorsement shall not increase the surance available to the additional in- ' applicable limits of insurance. sured. E. Section IV - Commercial General Liability As used in this endorsement, wrap-up insur- Conditions is amended to add the following: ance means a centralized insurance program Additional Insured Provision under which one party has secured either in- Automaticsurance or self-insurance covering some or all This insurance applies only if the "bodily inju- of the contractors or subcontractors perform- ry" or "property damage" occurs, or the "per- ing work on one or more specific project(s). sonal and advertising injury" offense is corn- Primary And Noncontributory Insurance mitted: When Required By Written Contract, 1, During the policy period; and Agreement, Permit Or Authorization 2. Subsequent to your execution of the writ- Except when wrap-up insurance applies to the ten contract or written agreement, or the claim or "suit" on behalf of the additional in- issuance of a written permit or written au- sured,this insurance is primary to and will not thorization, described in Paragraphs A. seek contribution from any other insurance and B. available to the additional insured described in Paragraphs A. and B. provided that: F. Except when G.below applies,the following is added to Section IV - Commercial General 1. The additional insured is a Named In- Liability Conditions, Other Insurance, and sured under such other insurance;and supersedes any provision to the contrary: 2. You have agreed in writing in a contract, When Other Additional Insured Coverage agreement, permit or authorization de- Applies On An Excess Basis scribed in Paragraph A. or B.that this in- surance would be primary and would not This insurance is primary to other insurance seek contribution from any other insur- available to the additional insured described in ance available to the additional insured. Paragraphs A. and B.except: As used in this endorsement, wrap-up insur- 1, As otherwise provided in Section IV - ance means a centralized insurance program Commercial General Liability Condi- under which one party has secured either in- . tions, Other Insurance, b. Excess In- surance or self-insurance covering some or all surance;or of the contractors or subcontractors perform- 2. For any other valid and collectible insur- ing work on one or more specific project(s). ance available to the additional insured as H. Section IV - Commercial General Liability an additional insured on another insur- Conditions, Transfer Of Rights Of Recov- ance policy that is written on an excess ery Against Others To Us is amended by the basis. In such case, this insurance is also addition of the following: excess. Waiver of Subrogation G. The following is added to Section IV - Com- m •ercial General Liability Conditions, Other additional insured under this endorsement, Insurance, and supersedes any provision to the contrary: because of any payment we make under this endorsement, to whom the insured has Primary Insurance When Required By Writ- waived its right of recovery in a written con- ten Contract, Agreement, Permit Or Au- tract, written agreement, written permit or writ- thorization ten authorization. Such waiver by us applies only to the extent that the insured has waived Except when wrap-up insurance applies to the its right of recovery against such additional in- claim or "suit" on behalf of the additional in- sured prior to loss. sured, this insurance is primary to any other insurance available to the additional insured described in Paragraphs A. and B. provided that: Includes copyrighted material of Insurance GA 4523 05 20 Services Office,Inc., with its permission. Page 3 of 3 • • 'COY erne CGL C' Ontractors'Broadened Endorsement Contractors'..Commercial General Liability l3roadened.Endorsement•GA233 <:> t�b l.it .. .�.....� �...................................................................................................................................................L,irt'ttt�. ; >> i>>i:�::>::<: Employee benefit liability.($'1,600 deductible) $.1.,000,000 each employee/. $3,006;000 aggreg.atP Expands.darnage to premises rented to•insured to include lightning, At the lesser.of$500,000 or the srncike., soot or Wafer CGL tsach.occurrence lirnit • Waiver of subrogation if required in a writteri'contract .Included Unintentional failure to disalbse.existirig hazards provision Included Broadened notice of occurrence included Property damage to borrowed equipment when riot in use. $10;000•ou'h occurrence • ($250.ded ii cti ble) • • Newly formed or.newiy"a`cquir•ed organizations for up to 180 days • Included Automatic additiO.nal insured:coverage where required in a written, contract or oral agreernent•(where a certificate of insuranceshowing that person•or organization as an.additional insured"has:been issued) included fey: lessors of premises, lessors of equipment;_vendors, state or political subdivision's permits relating to.prernise , state or political subdivision's permits relating to contractor operations Autor-natic additional insured co.verage.where required in a written contractor oral agreerncrit (vihere a certificate of insurance showing that persdn or organization es an additional.insured has been issued)from 'Included the named insured's work performed for that person or erganizatiOn. Varying degrees.of coverage apply based uponftheadditional insured requirements included in written and oral.contracts (except.4Z) Supplementary payments Bail bonds $1.,000 . Loss of earnings $350 per.day Empioyees as.insureds for specified healthcare services (nurses, EMTs Included and paramedics) Medical payments s1.o;000 any.one•person • • Voluntaty.property-damage ($250 deductible) $1,000 each occurrence Care, custody er control ($250 deductible), $5,000 each occurrence broadened contractual liability for:Wdr'k within 50 feet of railroad property Included Tris is not apollcy,Fore complete statement.of the coverages and exclusions,pleasesee the policy contract,Foi inforrnation:coverage availability In your slate,puolos 5r,policy service,Please cOntactyour iochl.independenl agent rdcomrnotuling coVerage.'The Cincinnati insurance Companies'and°Cincirinati"refer to member.companles.cif the Insurer group providing properly and.casualty coverages through n The'Cincinnati Insurance Company or olio Of Its wholly owned Subsidiaries—c'The Clncinnaii.lndemnity'Corhpany,rt The Cincinnati ,• Casualty Company orn'The tinclnnatl Specialty Undeiwritors Insurance Company—and life and dlsabiiltyincome insurance and annuities through n The Cinciimfall Life Insurance:Coriipariy.Each insurer hds sole finandial re,ponslb.ility for ite oinf products,Not all subsidiaries operate in all states.6200 S.Gllmore Road,Fairfield,OH 45014-5141.vnrov.cinfin:com CopyrightL2012TheCinciririaliarisuronceConipariy.Allirlghtsreseryed.Donelpdstontine,Inwholeorinpart, C1hit 1l�NATI without Written permission. INSi;RAF'J f CQi i'ANIES Adv. 694(7/12),Ed:2 r,.sv.rtpild. 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: Metal Masters Heat&Air(PROVIDER): By: • Signature Signature zip5-(-0t. Printed.NamePrinted Name COVVatlajta Title Title /1 (zg Date Date (W-9 is to be submitted with this signed Agreement) Purchase Order No. • • • Page 6 of 6: Goods and Services Agreement between the City of Ashland and Metal Masters Heat&Air `c o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/29/2023 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 NAME: Hart Insurance Agency - Medford PHONE Rristi Dolmage FAX PO Box 1240 (A/C.No.Ex): (541) 779-4232 (A/C,No): ADDRESS: kdolmage@hartinsurance.com Grants Pass OR 97528 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Navigators Specialty Insurance INSURED INSURER B:United National Insurance Co Pressure Point Roofing Inc INSURER C: 5235 Rainbow Drive INSURERD: Central Point OR 97502 INSURERE: (541) 772-1945 INSURERF: COVERAGES KD CERTIFICATE NUMBER:Cert ID 25569 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 ANSA SU yp POLICY NUMBER POLICY EFF POLICY EXP LIMITS {MM/DDIYYYY) (MM/DD/YYYY) B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE CLAIMS-MADE X OCCUR Y Y CSC0000411 03/29/2023 03/29/2024 PREMSESO(Ea occu RENTED $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PRn LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) I 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) $ A X UMBRELLALIAB X OCCUR SE23EXCZODKTPIC 03/29/2023 03/29/2024 EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N PER H ER ANYPROPRIETOR/PARTNERIEXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ $ DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Certificate holder is additional insured per forms attached: Primary and Noncontributory CG2001 12/19; Additional Insured CG2010 04/13; Additional Insured Completed Operations CG2037 04/13; Waiver EPA-1719 01/14 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 E Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 ©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