HomeMy WebLinkAbout2023-137 PO 20240078- Just Bugs Pest Control Purchase Order
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P6-sit NINEu , vim/ M
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B City of Ashland _ � _ _ - .
I ATTN:'Accounts Payable20 E. Main Purchase Q
,L Ashland, OR 97520 Order# 20240078
T Phone: 541/552-2010
0 Email: payable@ashland.or.us
V H C/O Facilities Maintenance Div
E JUST BUGS PEST CONTROL I 90 North Mountain Ave
N PO BOX 746 p Ashland, OR 97520
EAGLE POINT, OR 97524 Phone: 541/488-5358 '
O
R T Fax: 541/552-2304
QI:L L Iff1lS?J3V�
Aldo=T7
— �- ---- -- David Arnold — —� _�--`--
5�.
04 ,010%_r Wardri r ti3r-- 5-7 =a 13 r-08/10/2023 6348 FOB ASHLAND OR/NET-30- City Accounts Payable
CMS MttitMfigttW7,
On-call Pest Control
1 On-call Pest Control 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
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By: MDC•iliDate: v t v›--
Authorized Signatur =6 -gym== .5 000.00
FORM#3 CITY OF
ASHLAND
At request fora Purchase *1 Tier
REQUISITION 1,0/ Date of request: 8/9/2023
Required date for delivery:
ry:
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Vendor Name Just Bugs Pest Control
Address,City,State,Zip PO Box 746, Eagle Point, OR 97524
Contact Name&Telephone Number address address Jesse Leimas 541-292-6998 justbugsor(a.gmail.com
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SOURCING METHOD
❑ Exempt from Competitive Bidding 0 Invitation to Bid 0 Emergency
❑ Reason for exemption: Date approved by Council: • 0 Form#13,Written findings and Authorization
❑ AMC 2.50 _(Attach copy of council communication) ❑ Written quote or proposal attached
❑ Written quote or proposal attached _(If council approval required,attach copy of CC)
® Small Procurement 0 Request for Proposal ' Cooperative Procurement
Not exceeding$5,000 Date approved by Council: ❑ State of Oregon
O Direct Award _(Attach copy of council communication) Contract#
® Verbal/Written quote(s)or proposal(s) ❑ Request for Qualifications(Public Works) 0 State of Washington
Date approved by Council: Contract#
_(Attach copy of council communication) , 0 Other government agency contract
Intermediate Procurement ❑ Sole Source Agency
GOODS&SERVICES 0 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 and solicitation attached ❑ Form#4,Personal Services$5K to$75K Agency
PERSONAL SERVICES Date approved by Council: ❑ Annual cost to City does not exceed$25,000.
Greater than$5,000 and less than$75,000 Valid until:_ (Date) Agreement approved by Legal and approved/signed by
❑ Less than$35,000,by direct appointment ❑ Special Procurement City Administrator.AMC 2.50.070(4)
O (3)Written proposals&solicitation attached ❑ Form#9,Request for Approval 0 Annual cost to City exceeds$25,000,Council
❑ Form#4,Personal Services$5K to$75K ❑ Written quote or proposal attached approval required.(Attach copy of council communication) •
Date approved by Council: .
Valid until: (Date)
Description of SERVICES Total Cost
Pest control for FY24 $.5,000:00
Item # Quantity• Unit Description of MATERIALS Unit Price Total Cost
$0 $0.00
$0 ' $0.00
$0 $0.00
❑ Per attached quotelproposal 'TOTAL- COST
Project Number: - _ _ Account Number: 088400-602400 $,5,000.00
• *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 requisitio -%I ce 'fy that the Cit.' pu 'c c ,acting requirements have been satisfied.
Employee: j�l - ��, Department Head: —%.,• 11111 5,4. 2-
IIIIIMp�� to or greater than$5,000)
Department ManagerlSupervisor: City Manager:
(Greater han$3 ,000)
Funds appropriated for current fiscal year YES / NO i
Finance Director-(Eq or greater than$5,000) e
Comments:
Form#3-Requisition
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GOODS AND SERVICES AGREEMENT ($35,000 OR LESS)-
PROVIDER: Just Bugs Pest Control
CITY of PROVIDER'S.
ASHLAND CONTACT: Debra Kay Kenny
20 East Main Street •
Ashland,Oregon 97520 ADDRESS: PO Box 746
Telephone: 541/488-5587 - Eagle Point, OR 97524
Fax: 541/488-6006
PHONE: 541-292-6998
This Goods and Services Agreement (hereinafter. "Agreement") is entered into by and between the City of
Ashland, an Oregon municipal corporation(hereinafter"City") and Just Bugs Pest Control (a domestic business
corporation)("hereinafter"Provider"), for Insect Control as needed.
1. PROVIDER'S OBLIGATIONS
1.1 : Provide service and repair of overhead doors 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." 0
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1.2 Provider shall obtain andmaintain 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
• Automobile Liability.
1.2.2 Each policy of such insurance shall be on an "occurrence" and not a"claims made" form, and
shall:
• Name as additional insured "the City of Ashland, Oregon, its officers, agents and
employees" with respect to claims arising out of the provision of Work under this
Agreement;
• `Apply to each named and additional named insured as though a separate policy had been
issued to each, provided that the policy limits shall not be increased thereby;
• Apply as primary coverage for each additional named insured except to the extent that two
or more such policies are intended to "layer" coverage and, taken together, they provide
total coverage from the first dollar of liability;
• Provider shall immediatelynotify 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
Page 1 of 6: Goods and Services Agreement between the City of Ashland and Just Bugs Pest Control
• Be evidenced by a certificate or certificates of such insurance approved by the City.
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, genderidentity 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 consentof 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 8/7/23 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 Just Bugs Pest Control
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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 andcomplete 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, 27913.230 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).
Page 3 of 6: Goods and Services Agreement between the City of Ashland and Just Bugs Pest Control
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3.13 Provider represents and warrants that the Goods are new, current, and fully warranted by the
manufacturer. Delivered Goods will comply with SUPPORTING DOCUMENTS and be free from
defects in labor, material and manufacture.Provider shall transfer all warranties to the City.
4. SUPPORTING DOCUMENTS
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 August 7,2023.
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
Page 4 of 6: Goods and Services Agreement between the City of Ashland and Just Bugs Pest Control
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by mailing using registered or certified United States mail, return receipt requested, postage prepaid, to the
address set forth below:
If to the City: .
City of Ashland—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:
Just Bugs Pest Control
Attn.: Jesse Leimas
PO Box 746
Eagle Point, OR 97524 .
541-858-1637
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
Page 5 of 6: Goods and Services Agreement between the City of Ashland and Just Bugs Pest Control •
this Agreement. Any material breach of this Agreement shall entitle the City to terminate this
Agreement and to seek damages and any other relief available under this Agreement,at law,or in equity.
IN WITNESS WHEREOF the parties have caused this Agreement to be signed in their respective names
by their duly authorized representatives as of the dates set forth below.
CITY OF ASHLAND: Just Bugs Pest Control (PROVIDER):
By: By:
Signature
Scar cuEuzy
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Printed Name Printed Name
Com` otnrr o _ 6l,Ji►c// o c
Title Title
Date Date
(ikL,9 is to be submitted with this signed"Agreement)
Purchase Order No.
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Page 6 of 6: Goods and Services Agreement between the City of Ashland and Just Bugs Pest Control
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ifs
fir) ri 11''' ',2),f l�••
,____/\'''''''''''C _ `tib ` CONTROL!
PO BOX 746
Eagle Point OR 97524 •
Phone:541-292-6998 August 7th,2023
E-mail: iustbugsor@gmail.com
Bid Proposal for City of Ashland ,
Quarterly Pest Control,Outside only
Location Pesticide Product Cost
City Hall Suspend -$100
Community Development Taurus,Suspend $100
Police Contact Station Suspend $50
Fire Station 1 Taurus,Suspend $125
Service Center Taurus,Suspend $430
Police Taurus,Suspend $100,
Justice Center(Municipal Court) Taurus,Suspend $100
Hardesty Property Suspend $185
Cemetery Suspend • $160
Fire Station 2 Taurus,Suspend $125
Airport Taurus,Suspend $225
Total cost for quarterly application $1700
Sincerely, ,
Jesse Leimas
Just Bugs Pest Control
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ACCP CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
09/21/2023
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).
PRODUCERCONTACT Rebecca McGregor '
Reinholdt&0'
Harra Insurance
1756 Ashland Street _(A/CD,NNo.Ext):_ _(541)482-1921 FAX
1756 (541)833-2333
Ashland, OR 97520 ADDRE
E-MAIL s: rmcgregor@reinholdtins.com
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License#: 800442 INSURER(S)AFFORDING COVERAGE NAIC#
• INSURER A: Accelerant Specialty Insurance Company
INSURED
FCD Family LLC INSURER B: Progressive Insurance 10194
ABN: Just Bugs.Pest Control INSURER C: Saif Corporation
2217 Roberts Rd INSURER D:
Medford, OR 97504 INSURERE:
INSURER F: •
-
COVERAGES CERTIFICATE NUMBER: 00020531-401418 REVISION NUMBER: 21
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 INSD SUBR WVD POLICY NUMBER /YPOLICY EFF POLICY EXP •
LIMITS
{MM/DDYYY) (MM/DD/YYYY)
A X COMMERCIAL GENERAL LIABILITY Y LI P00070GL002651-00 06/14/2023 06/14/2024 EACH OCCURRENCE $ 2,000,000
DAMAGE TO RENTED
• CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000
MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 2,000,000
-GEN'L AGGREGATE LIMIT APPLIES PER: • GENERAL AGGREGATE $ 2,000,000
X POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000
OTHER: $ •
'B AUTOMOBILE LIABILITY Y 962687484 10/20/2022 10/20/2023 (Ee acBcideDno INGLE LIMIT $ 1,000,000
ANY AUTO BODILY INJURY(Per person) $
•
OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY X AUTOS
HIRED NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY AUTOS ONLY (Per accident)
•
UMBRELLA LIAB _ OCCUR EACH OCCURRENCE
EXCESS LIAB CLAIMS-MADE •
AGGREGATE $
DED RETENTION$ • $
C WORKERS COMPENSATION • 100047899 • 06/01/2023 06/01/2024 X STAT_ UTE I OTH-
ER 500,000
AND EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N - EL.EACH ACCIDENT $• 500,000
N/A
OFFICER/MEMBER EXCLUDED? y
(Mandatory in NH) _ E.L.DISEASE-EA EMPLOYEE $ 500,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
•
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) .
Certificate holder is listed as Additional Insured with Primary and Non-contributory and Waiver of Subrogation wording when
required by written contract with respect to General Liability and Commercial Auto.Blanket Waiver of Subrogration provided on
the workers compensation policy as per Pol_PC1_E430B.
• Workers Comp: No coverage for LLC members.
•
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.
90 N Mountain Ave
• Ashland, OR 97520 AUTH IZED REPRESENTATIVE
-414,e0101--
(REB)
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by REB on 09/21/2023 at 05:43PM •
•
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED (INCLUDING COMPLETED OPERATIONS)
AUTOMATIC STATUS WHEN REQUIRED IN WRITTEN AGREEMENT WITH YOU
•
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The insurance provided by this endorsement shall not serve to increase our limits of insurance as described in SECTION III-LIMITS OF
. INSURANCE.
•
A. SECTION II—WHO IS AN INSURED is amended to include as an additional insured any person or organization for whom you are.
performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person
or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with
respect to liability for:
1. "Bodily injury","property damage"or"personal and advertising injury"caused,in whole or in part,by:
a. Your acts or omissions;or
b. The acts or omissions of those acting on your behalf in the performance of your ongoing operations for that additional
• insured;and
• 2. "bodily injury", "property damage" included in the "products-completed operations hazard" with respect to "your work"
performed for that additional insured.
.B. Only with.respect to the insurance afforded to any additional insureds by this endorsement, paragraph 4. Other Insurance,
subparagraph a.Primary Insurance of SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to read as
follows: •
This insurance shall be considered primary if any other valid and collectible insurance'is available to any person or
organization included as an additional insured under this endorsement and such other insurance shall be excess of and will
not contribute to.the insurance afforded by this endorsement.
C. Only with respect to the insurance afforded to any additional insureds by this endorsement, paragraph 8.Transfer Of Rights of
Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the
following:
•
We will waive any right of recovery we may have against any person or organization added as an additional insured under the
terms of this endorsement against whom you have agreed to waive such right of recovery in a written contract or agreement
because of payments we make for "bodily injury" or "property damage" arising out of your ongoing operations or "your work"
included within the products completed operations hazard done under a contract or agreement with that person or organization."
•
•
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
•
SGL 0070 0005012 22 • • •Page 1 of 1
www.saif.com •
Life.
Oregon.
•
Carrier no: 20001 • Endorsement no: WC000313
(Ed. 430B)
SAIF policy: 100047899 FDC Family LLC
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 with whom the insured-employer is required by
written contract to waive subrogation rights.
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: June 01, 2023
This endorsement changes the policy to which it is attached and is effective on the date issued unless
otherwise stated.
Countersigned April 27, 2023 at Salem, Oregon
7 t •
WC000313 Chip Terhune
(Ed. 430B) President and Chief Executive Officer
•
•
•
•
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400 High Street SE
Salem,OR 97312
P:800.285.8525
F:503.373.8020
Pol PCt E430B
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Form 2366 (02/11)M_CL
Blanket Additional Insured Endorsement
This endorsement modifies insurance provided by the Commercial Auto Policy,Motor Truck Cargo Legal
Liability Coverage Endorsement,and/or Commercial General Liability Coverage Endorsement,as appears
on the declarations page.All terms and conditionsof the policy apply unless modified by this
endorsement.
If you pay the fee for this Blanket Additional Insured.Endorsement,we agree with you that any person
or organization with whom you have executed a written agreement prior to any loss is added as an
additional insured with respect to such liability coverage as is afforded by the policy, but this insurance
applies to such additional insured only as a person or organization liable for your operations and then
only to the extent of that liability.This endorsement does not apply to acts,omissions, products,work,
or operations of the additional insured. -
• Regardless of the provisions of paragraph a. and b. of the"Other Insurance" clause of this policy, if the
person or organization with whom you have executed a written agreement has other insurance under
which it is the first named insured and that insurance also applies,then this insurance is primary to and
non-contributory with that other insurance when the written contract or agreement between you and
that person or organization,signed and executed by you before the bodily injury or property damage
occurs and in effect during the policy period, requires this insurance to be primary and non-
contributory.
In no way does this endorsement waive the"Other Insurance'.'clause of the policy, nor make this policy
primary to third parties hired by the insured to perform work for the insured or on the insured's behalf.
ALL OTHER TERMS,LIMITS,AND PROVISIONS OF THE POLICY REMAIN UNCHANGED.
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Form 2367 (06/10)M_CL
Blanket Waiver of Subrogation Endorsement
This endorsement modifies insurance provided by the Commercial Auto Policy,Motor Truck Cargo Legal
Liability Coverage Endorsement, and/or Commercial General Liability Coverage Endorsement,
as appears on the declarations page. All terms and conditions of the policy apply unless modified by
this endorsement.
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If you pay the fee for this Blanket Waiver of Subrogation Endorsement, we agree to waive any
and all subrogation claims against any person or organization with whom a written waiver
agreement has been executed by the named insured, as required by written contract, prior to
the occurrence of any loss.
ALL OTHER TERMS, LIMITS AND PROVISIONS OF THE POLICY REMAIN UNCHANGED.
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REINHOLDT AND 0 HARR PRO(7REJJIVE® •
1756 ASHLAND ST COMMERCIAL
ASHLAND,OR 97520
Named insured , Policy number: 962687484
• Underwritten by:
Artisan and Truckers Casualty Co
FDC Family LLC ) November 1,2022
Father and Daughter Clean Up Service;Ju Policy Period:Oct 20,2022-Oct 20,2023
2217 ROBERTS RD. • Page 1 of 5
MEDFORD,OR 97504
• agent.progressive.com
Online Service
Make payments,check billing activity,print
polity documents,update your policy or
check the status of a claim.
• Commercial Auto 1-541-482-1921
•
Insurance Coverage Summary REINHOLDTAND 0 HARR
• + Contact your agent for personalized service.
• This is your Declarations Page 1-800-444-4487
For customer service if your agent is •
Your coverage has changed unavailable or to report a claim.
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Your coverage began the later of October 20,2022 at 12:01 a.m.or the effective time shown on your application.This policy period
ends on October 20,2023 at 12:01 a.m.
This coverage summary replaces your prior one.Your insurance policy and any policy endorsements contain a full explanation of your •
coverage.The policy limits shown for an auto may not be combined with the limits for the same coverage on another auto,unless the
policy contract allows the stacking of limits.The policy contract is form 6912(02/19).The contract is modified by forms 2852OR
(02/19), 16520R(02/19), 1890(02/19),1891 (02/19),2366(02/11),2367(06/10),2311 (02/19),Z313(04/21),4852OR(02/19), .
48810R(02/19)and Z228(01/11).
The named insured organization type is a corporation.
Policy changes effective October 31, 2022 .
Changes processed on: October 31,2022 2:46 p.m. •
Premium change: $75.00
Changes: Blanket Waiver of Subrogation was added. I ,
• The changes shown above will not be effective prior to the time the changes were requested.
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'Continued
Form 6489 OR(04/20)
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Policy number: 962687484
FDC Family LLC
Page2 of 5
Outline of coverage -
Description Limits Deductible Premium
Liability To Others $4,739
Bodily Injury and Property Damage Liability $1,000,000 combined single limit
Hired Auto Liability To Others 86
Bodily Injury and Property Damage Liability $1,000,000 combined single limit
. Employer Non-Owned Auto Liability To Others , 92
Bodily Injury and Property Damage Liability $1,000,000 combined single limit
Uninsured/Underinsured Motorist $1,000,000 combined single limit 252
Uninsured Motorist Property Damage $200 84
See Auto Coverage Schedule Limit of liability each accident less deductible $300 hit&run
Personal Injury Protection • ' . 244
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• See Auto Coverage Schedule Limit of liability each person less deductible • •
Medical Payments Rejected --
Comprehensive • 374•
See Auto Coverage Schedule Limit of liability less deductible
Collision 1,363
• See Auto Coverage Schedule Limit of liability less deductible
• Rental Reimbursement 315
See Auto Coverage Schedule
Roadside Assistance 113
See Auto Coverage Schedule Limit of liability less deductible
Subtotal policy premium $7,662
Blanket Waiver of Subrogation Fee 75
Blanket Additional Insured Fee 75'
. Total 12 month policy premium and fees $7,812
Number of Employees: (0-10)
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Cost of Renting, Hiring, or Borrowing: $5,000 or less(if any)
Rated drivers
1. Benjamin Ralston •
2. Hannah Parsley
3. Michael R Parsley
4. Jesse L Leimas
5. Thomas B Downing
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Continued
Form 6489 OR(04120)
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Policy number:,962687484
FDC Family LLC
' Page3 of 5
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Auto coverage schedule . . •
1, • 2013 FORD F150 Actual Cash Value(plus$2,000.00 Permanently Attached Equip) _
VIN:1FTFW1EF8DFB68239 Garaging Zip Code:97504 Radius:50 miles ••
Personal use:Y Body type: Pickup Truck
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Liability UM/UIM UM PD UM PD PIP PIP • PIP
Liability Premium Premium • Limit Premium Limit Deductible Premium
Premium $1064 $63 $20,000 $22 $25,000 $0 $61
Comp Comp Collision Collision
• Physical Damage Deductible Premium Deductible Premium
Premium $500 $103 $500 $292
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Rental Rental Roadside Roadside
Other Coverages Limit Premium Deductible Premium • Auto Total
Premium $50 per day $45 $0 $31 $1,681
Max$1,500 •
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2. 2019 RAM 1500 Actual Cash Value(plus$2,000.00 Permanently Attached Equip)
VIN:1C65RFFT3KN553225 Garaging Zip Code:97504 Radius: 50 miles •
Personal use:Y Body type: Pickup Truck
Liability UM/UIM UM PD UM PD PIP PIP PIP
Liability Premium Premium Limit • Premium Limit Deductible Premium •
Premium $1148 $63 $20,000 $22 $25,000 $0 $65. '
Comp Comp Collision Collision
• Physical Damage Deductible Premium Deductible Premium
Premium $500 $88 $500 $422.
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Rental Rental Roadside Roadside
Other Coverages Limit Premium Deductible Premium Auto Total
Premium $50 per day $45 • $0 $15 $1,868
Max$1,500•
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3: 2019 TNT Trailer Stated Amount:* $5,000(including Permanently Attached Equip)
VIN:5M3BE1211L1009181 Garaging Zip Code:97504 Radius:50 miles
Personal use:•N 'Body type:Utility Trailer
Liability
Liability Premium •
Premium $31 •
Comp Comp Collision Collision
Physical Damage Deductible Premium Deductible Premium
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Premium $500 $21 $500 $21
Rental Rental •
Other Coverages Limit Premium Auto Total
Premium $50 per day $45 . . $118
Max$1,500 . •
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• Continued
Form 6489 OR(04/20) •
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Policy number: 962687484
FDC Family LLC
Page4 of 5
4. 2021 Patriot Trailer Stated Amount:*$10,000(including Permanently Attached Equip)
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VIN:4YMBD122XMR007571 Garaging Zip Code:97504 Radius:50 miles
Personal use: N Body type: Utility Trailer
Liability -
Liability Premium
Premium $31
Comp Comp Collision Collision
Physical Damage Deductible Premium Deductible Premium
Premium $500 $39 $500 $37
Rental Rental •
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Other Coverages Limit Premium Auto Total
Premium $50 per.day $45 $152
Max$1,500 • •
5. 2010 TOYOTA TACOMA Actual Cash Value(plus$2,000.00 Permanently Attached Equip)
VIN:3TMKU4HN7AM026856 Garaging Zip Code:97504 Radius:50 miles
Personal use:Y Body type: Pickup Truck
Liability UM/UIM UM PD UM PD PIP PIP PIP
Liability Premium Premium Limit Premium Limit Deductible Premium
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Premium • $1169 $63 $20,000 $20 $25,000 $0 $56
Comp Comp Collision Collision ••
Physical Damage Deductible Premium Deductible 'Premium.
Premium $500 $40 $500 $244
Rental Rental • Roadside Roadside •
Other Coverages Limit Premium Deductible Premium Auto Total
Premium $50 per day $45 $0 $37 $1,674
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Max$1,500
6. 2014 TOYOTA TACOMA Actual Cash Value(plus$2,000.00 Permanently Attached Equip) •
• VIN:3TMJU4GN2EM170883 Garaging Zip Code:97504 Radius:50 miles. •
Personal use:Y Body type:Pickup Truck
Liability UM/UIM UM PD UM PD - . PIP PIP PIP
Liability Premium Premium Limit Premium Limit Deductible Premium
Premium $1265 $63 $20,000 $20 $25,000 $0 $62
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• Comp . Comp Collision Collision
Physical Damage Deductible Premium Deductible Premium
Premium $500 $38 $500 $304
Rental Rental Roadside • Roadside
Other Coverages Limit Premium Deductible Premium Auto Total
Premium • $50 per day $45 $0 $30 •
$1,827
Max$1,500 •
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• Continued
Form 6489 OR(04/20) • -
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Policy number: 962687484 •
• FDC Family LLC
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Page5 of 5
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7, 2021 Patriot Trailer Stated Amount:*$12,000(including Permanently Attached Equip)
VIN:4YMBC1421MR008625 Garaging Zip Code:97504 Radius:50 miles . •
Personal use: N Body type: Utility Trailer
Liability
Liability • Premium •
Premium $31
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Comp Comp Collision Collision •
Physical Damage Deductible Premium Deductible Premium •
Premium • $500 $45 $500 . $43
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Rental Rental
Other Coverages Limit Premium Auto Total
Premium $50 per day $45 $164
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Max$1,500 •
*A vehicle's stated amount should indicate its current retail value,including any special or permanently attached equipment. In the
event of a total loss,the maximum amount payable is the lesser of the Stated Amount or Actual Cash Value,less deductible. Be sure
to check stated amount at every renewal in order to receive the best value from your Progressive Commercial Auto policy.
Premium discounts • •
Policy
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962687484 Paid In Full and Multi-Product
Additional Insured information •
Blanket Additional Insured applies.
Waiver of Subrogation information
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Blanket Waiver of Subrogation applies.
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•Form 6489 OR(04/20) •
_
1 ®
ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYI)
06/08/2023 '
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. '7 •
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 .
Reinholdt&0' Hava Insurance, ' NAME: Rebecca McGregor
PHONE
No.Ext): (541)482-1921 Fes'
• • ' 1756 Ashland Street\ E-MAIL (A1C.No):(541) 3-2333
- Ashland, OR 97520 \ ADDRESS: , rmcgregor@reinholdtins.com •
License#: 800442 . \' •
INSURER(S)AFFORDING COVERAGE NAIC#
\ INSURER A AccelerantSpecialtylnsurance ompany
INSURED' INSURER B: Progressive Insurance 10194
FCD Family LLC \ 9
ABN:Just Bugs Pest Contryopl INSURER Saif Corporation
2217 Roberts Rd r \' INSURER D: .. )
Medford, OR 97504 % -,, m
SURER E:
INSURERF:
• COVERAGES 'CERTIFICATE,NUMBER: 00020531.320242 / • REVISION NUMBER: 17 •
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANE LISTED BELOW HAVE BEEN ISSUED TO THONSURED NAMED ABOVE FOR THE POLICY PERIOD`'.
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, ERM OR CONDITION OF ANY CONTRACT 9R 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.LIMNS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -
INSR ADDL SUBR a
LTR TYPE OF INSURANCE INSR WVD \ POLICY NUMBER (MMILDDYIYYI Y) (MM/DD//YYYYI • LIMITS
A X COMMERCIAL GENERAL LIABILITY LIPOO OGL002651-00 ,06/14/2023 06/14/2024 EACH0CCURRENCE $ 2,000,000
/ DAMAGE TO RENTED
CLAIMS-MADE X OCCURi PREMISES(Ea occurrence) $ 100,000
e MED EXP(Any one person) $ 5,000
�
- PERSONAL&ADV INJURY• $ 2,000,000
, GEN'L AGGREGATE LIMIT APPLIES PER: i- GENERAL AGGREGATE $ • 2,000,000
X POLICY n ECS tOC • a' PRODUCTS-COMP/OP AGO $ 2,000,000
(OTHER: _/- _ $
B AUTOMOBILE LIABILITY , 9626874$4 10/20/2022 10/20/2023a aacideD SINGLE LIMIT $ 1,000,000
ANY AUTO BODILY INJURY(Per person) $
OWNED SCHEDULED BODILY INJURY(Peraccident)
AUTOS ONLY X AUTOS �' $
HIRED NON-OWNED PROPERTY DAMAGE
AUTOS ONLY _ AUTOS ONLY , \ (Per accident) •
•
UMBRELLA LIAB , OCCUR f \\ EACH OCCURRENCE _ $
EXCESS LIAB CLAIMS-MADE fr AGGREGATE $
DED RETENTIONS f/ $ •
C WORKERS COMPENSATION f' 100047899 ' 06/01/2023' 06/01/2024 X STATUTE ERH 500, 000
AND EMPLOYERS'LIABILITY Y 1 e
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT -' $ 500,000
OFFICER/MEMBEREXCLUDED? N/A
(Mandatory In NH) / E.L.DISEASE-EA EMPLOYEE $ ' 500,000
If DESS,describeIPIunderE.L DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS belo/ •
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DESCRIPTION OF OPERA ONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is requir )
Certificate holder is listed as Additional Insured with Primary and Non-contributory and Waiver •f Subrogation wording when
. required by written contractwith respect to General Liability and Commercial Auto. Blanket,Waiv of Subrogration provided on
the workers.compensation _
policy as per PoI_PC1E430B.
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Workers Comp: No coverage for LLC members. - ,
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CERTIFICATE HOLDER : CANCELLATION \`
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BEICANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DEL ERED IN • '
Proof Of Insuran• ce ACCORDANCE WITH THE POLICY PROVISIONS. .
' AUTH IZED REPRESENTATIVE
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I REB
' @-1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(201.6/03) The ACORD name and logo are registered marks of ACORD. -Printed by REB on 06/08/2023 at 11:07AM