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HomeMy WebLinkAbout2023-164 PO 20240145- J&A Concrete Construction LLC Purchase Order r CITY R �,ECO y. Fiscal Year 2024 Page: 1 of: 1 B City of Ashland £ {� �5 Vi ALL i - PNT _ I ATTN: Accounts Payable20 E. Main Purchase L Ashland, OR 97520 Order# 20240145 T Phone: 541/552-2010 0 Email: payable@ashland.or.us V H 0/0 Public Works Department E J&A CONCRETE CONSTRUCTION LLC I 51 Winburn Way N 7600 TRUAX RD. p Ashland, OR 97520 O CENTRAL POINT, OR 97502 Phone: 541/488-5347 R • T Fax: 541/488-6006 lilt _ _ � .�-� Scott Fleury — � �� U�� ��-- �cd�y � X1 Il�� sI �'� 10/05/2023 8061 •FOB ASHLAND OR/NET30 • _ City Accounts Payable Curb and Gutter Replacement 1 Billings curb and gutter replacement 1.0 $4,991.50 $4,991.50 Goods and Services Agreement.(Less than $35,000) Completion date: December 31, 2023 Project Account: E-202213-999 ***************'GL SUMMARY*************** . 081200-704200 / $4,991.Z0, • ( By: Date: ) Authorized Signature . • .F4,s r = = '.4 991.50 1 ` FORM #3 / O / 11 CITY OF A request for a Purchase Order `�� ASHLAND REQUISITION D C�a / " Date of request: 10/03/2023 Required date for delivery: Vendor Name J&A Concrete Construction LLC Address,City,State,Zip 7600 Truax Rd.Central Point,OR 97502 Contact Name&Telephone Number Abel Castaneda Email address SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Invitation to Bid ❑ Emergency ❑ Reason for exemption: Date approved by Council: ❑ Form#13,Written findings and Authorization O AMC 2.50 _(Attach copy of council communication) 0 Written quote or proposal attached O 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 0 Direct Award _(Attach copy of council communication) Contract# ❑ Verbal/Written bid(s)or proposal(s) ❑ Request for Qualifications(Public Works) ❑ State of Washington Date approved by Council: Contract# (Attach copy of council communication) 0 Other government agency contract Intermediate Procurement ❑ Sole Source Agency GOODS&SERVICES ❑ Applicable Form(#5,6,7 or 8) Contract# Greater than$5,000 and less than$100,000 ❑ Written quote or proposal attached Intergovernmental Agreement ❑ (3)Written bids&solicitation attached 0 Form#4,Personal Services$5K to$75K Agency PERSONAL SERVICES 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) ❑ (3)Written proposals&solicitation attached ❑ Form#9,Request for Approval ❑ Annual cost to City exceeds$25,000,Council ❑ Form#4,Personal Services$5K to$75K ❑ Written quote or proposal attached approval required.(Attach copy of council communication) Date approved by Council: ' Valid until:_ ___ (Date) Description of SERVICES Billings Ranch curb and gutter replacement TOTALCOST -$ 4,99.'1.50 Item# Quantity Unit Description of MATERIALS Unit Price Total Cost 0 Per attached quote/proposal TOTAL COST Project Number 2 0 2 2 1 3. Account Number 0 8 1 2 0 0. 7 0 4 2 0 0 Account Number - Account Number - *Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: IT Director Date Support-Yes/No By signing this requisition form,l certify that the City's public contracting requirements have been satisfied. Employee:\)OkinAD UK ' ealleyWDepartment Head: --y10,- ,zuh„ lb.$•2.3 � 131SUR or greater than$5,000) Department Manager/Supervisor: City Manager: (Greater than$00 ) q Funds appropriated for current fiscal year: (YY / NO t ' jli2")' Finance Director-(Equal to or6-rthan$5,000) Date Comments: Form#3-Requisition GOODS AND SERVICES AGREEMENT (LESS THAN $35,000) CONTRACTOR: J&A Concrete Construction LLC • CITY O F CONTACT: Abel Castaneda ASH LAN D 20 East Main Street ADDRESS: 7600 Truax Rd. Ashland, Oregon 97520 Central-Point, OR 97502 Telephone: 541/488-5587 PHONE: 541-951-4009 Fax: 541/488-6006 EMAIL: jna.cast2003@gmail.com This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and J&A Concrete (a domestic business corporation) (hereinafter"Contractor"), for Billings Ranch curb and gutter replacement. 1. CONTRACTOR'S OBLIGATIONS 1.1 Provide Billings Ranch curb and gutter replacement as set forth in the "SUPPORTING DOCUMENTS" attached hereto and, by this reference, incorporated herein. Contractor expressly acknowledges that time is of the essence of any completion date set forth in the SUPPORTING DOCUMENTS, and that no waiver or extension of such deadline may be authorized except in the same manner asheein provided for authority to exceed the maximum compensation. The goods and services defined and described in the"SUPPORTING DOCUMENTS"shall hereinafter be collectively referred to as"Work." 1.2 Contractor shall obtain and maintain during the term of this Agreement andinitil: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; and • Workers' Compensation. 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; • Contractor shall immediately notify the City of any change in insurance coverage. • Contractor shall supply an endorsement naming the City,its officers,employees and agents as additional insureds by the Effective Date of this Agreement; and Page 1 of 7: Goods and Services Agreement between the City of Ashland and J&A Concrete Construction LLC • Be evidenced by a certificate or certificates of such insurance approved by the City. 1.3 Contractor 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. As evidence of the insurance required by this Agreement, the Contractor shall furnish an acceptable insurance certificate prior to commencing any Work. 1.4 Contractor agrees that no person shall, on the grounds of race, color, religion, creed, sex, marital status, familial status or domestic partnership, national origin, age, mental or physical disability, sexual orientation, gender identity or source of income, suffer discrimination in the performance of this Agreement when employed by Contractor. Contractor agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. Further, Contractor agrees not to discriminate against a disadvantaged business enterprise,minority-owned business,woman- owned business, a business that a service-disabled veteran owns or an emerging small business enterprise certified under ORS 200.055, in awarding subcontracts as required by ORS 279A.110. 1.5 In all solicitations either by competitive bidding or negotiation made by Contractor for work to be performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the. Contractors of the Contractor's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 1.6 Living Wage Requirements: If the amount of this Agreement is $25,335.05 or more, Contractor is required to comply with Chapter 3.12 of the Ashland Municipal Code by paying a living wage,as defined in that chapter, to all employees performing Work under this Agreement and to any Subcontractor who performs 50% or more of the Work under this Agreement. Contractor is also required to post the notice attached hereto as "Exhibit A"predominantly in areas where it will be seen by all employees. 2. CITY'S OBLIGATIONS 2.1 City shall pay Contractor the sum of$4,991.50 (four thousand nine hundred minty-one and fifty cents) as provided herein as full compensation for the Work as specified in the SUPPORTING DOCUMENTS. 2.2 In no event shall Contractor's total of all compensation and reimbursement under this Agreement exceed the sum of$4,991.50 without express, written approval from the City official whose signature appears below, or such official's successor in office. Contractor expressly acknowledges that no other person has authority to order or authorize additional Work which would cause this maximum sum to be exceeded and that any authorization from the responsible official must be in writing. Contractor further acknowledges that any Work delivered or.expenses incurred without authorization as provided herein is done at Contractor's own risk and as a volunteer without expectation of compensation or reimbursement. 3. GENERAL PROVISIONS 3.1 This is a non-exclusive Agreement. City is not obligated to procure any specific amount of Work from Contractor and is free to procure similar types of goods and services from other Contractors in its sole discretion. 3.2 Contractor is an independent contractor and not an employee or agent of the City for any purpose. 3.3 Contractor is not entitled to,and expressly waives all claims to City benefits such as health and disability insurance,paid leave, and retirement. Page 2 of 7: Goods and Services Agreement between the City of Ashland and J&A Concrete Construction LLC 3.4 Contractor shall not assign this Agreement or subcontract any portion of the Work to be provided hereunder without the prior written consent of the City. Any attempted assignment or subcontract without written consent of the City shall be void. Contractor shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all persons employed by them, and the approval by the City of any assignment or subcontract shall not create any contractual relation between the assignee or subcontractor and the City. 3.5 This Agreement embodies the full and complete understanding of the parties respecting the subject matter hereof. It supersedes all prior agreements,negotiations, and representations between the parties, whether written or oral. 3.6 This Agreement may be amended only by written instrument executed with the same formalities as this Agreement. 3.7 The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220, 279B.230 and 279B.235. 3.8 This Agreement shall be governed by the laws of the State of Oregon without regard to conflict of laws principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is in federal court, in which case exclusive venue shall be in the federal district court for the district of Oregon. Each party expressly waives any and all rights to maintain an action under this Agreement in any other venue, and expressly consents that, upon motion of the other party, any case may be dismissed or its venue transferred, as appropriate, so as to effectuate this choice of venue. 3.9 Contractor shall defend, save, hold harmless and indemnify the City and its officers, employees and agents from and against any and all claims,suits,actions,losses,damages,liabilities,costs,and expenses of any nature resulting from, arising out of, or relating to the activities of Contractor or its officers, employees, contractors, or agents under this Agreement. 3.10 Neither party to this Agreement shall hold the other responsible for damages or delay in performance caused by acts of God, strikes,lockouts,accidents, or other events beyond the control of the other or the other's officers, employees or agents. 3.11 If any provision of this Agreement is found by a court of competent jurisdiction to be unenforceable, such provision shall not affect the other provisions, but such unenforceable provision shall be deemed modified to the extent necessary to render it enforceable,preserving to the fullest extent permitted the intent of Contractor and the City set forth in this Agreement.' 3.12 Deliveries will be F.O.B destination. Contractor shall pay all transportation and handling charges for the Goods. Contractor is responsible and liable for loss or damage until final inspection and acceptance of the Goods by the City. Contractor remains liable for latent defects, fraud, and warranties. 3.13 The City may inspect and test the Goods. The City may reject non-conforming Goods and require Contractor to correct them without charge or deliver them at a reduced price,as negotiated.If Contractor does not cure any defects within a reasonable time, the City may reject the Goods and cancel this Agreement in whole or in part. This paragraph does not affect or limit the City's rights, including its rights under the Uniform Commercial Code, ORS Chapter 72 (UCC). Page 3 of 7: Goods and Services Agreement between the City of Ashland and J&A Concrete Construction LLC 3.14 Contractor represents and warrants that the Goods are new, current, and fully warranted by the manufacturer. Delivered Goods will comply with SUPPORTING DOCUMENTS and be free from defects in labor,material and manufacture. Contractor shall transfer all warranties to the City. 4. SUPPORTING DOCUMENTS 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 Contractor's complete written Bid. 4.2 This Agreement and the SUPPORTING DOCUMENTS shall be construed to be mutually complimentary and supplementary wherever possible. In the event of a conflict which cannot be so resolved, the provisions of this Agreement itself shall control over any conflicting provisions in any of the SUPPORTING DOCUMENTS. In the event of conflict between provisions of two of the SUPPORTING DOCUMENTS,the several supporting documents shall be given precedence in the order listed in Article 4.1. 5. REMEDIES 5.1 In the event Contractor is in default of this Agreement, City may, at its option, pursue any or all of the remedies available to it under this Agreement and at law or in equity, including, but not limited to: 5.1.1 Termination of this Agreement; 5.1.2 Withholding all monies due for the Work that Contractor has failed to deliver within any scheduled completion dates or any Work that have been delivered inadequately or defectively; 5.1.3 Initiation of an action or proceeding for damages, specific performance, or declaratory or injunctive relief; 5.1.4 These remedies are cumulative to the extent the remedies are not inconsistent, and City may pursue any remedy or remedies singly, collectively, successively or in any order whatsoever. 5.2 In no event shall City be liable to Contractor for any expenses related to termination of this Agreement or for anticipated profits;If previous amounts paid to Contractor exceed the amount'due, Contractor shall pay immediately any excess to City upon written demand provided. 6. TERM AND TERMINATION 6.1 Term This Agreement shall be effective from the date of execution on behalf of the City as set forth below (the"Effective Date"),and shall continue in full force and effect until December 31,2023,unless.sooner terminated as provided in Subsection 6.2. 6.2 Termination 6.2.1 The City and Contractor may terminate this Agreement by mutual agreement at any time. 6.2.2 The City may,upon not less than thirty (30) days' prior written notice, terminate this Agreement for any reason deemed appropriate in its sole discretion. 6.2.3 Either party may terminate this Agreement,with cause,by not less than fourteen(14) days' prior written notice if the cause is not cured within that fourteen (14) day period after written notice. Such termination is in addition to and not in lieu of any other remedy at law or equity. 7. NOTICE Page 4 of 7: Goods and Services Agreement between the City of Ashland and J&A Concrete Construction LLC Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery, by sending via a reputable commercial overnight courier, or by mailing using registered or certified United States mail, return receipt requested, postage prepaid, to the address set forth_below: If to the City: City of Ashland—Public Works Department Attn: Karl Johnson 20 E. Main Street Ashland, Oregon 97520 Phone: (541)488-5587 With a copy to: City of Ashland—Legal Department 20 E. Main Street Ashland, Oregon 97520 Phone: (541)488-5350 If to Contractor: J&A Concrete Construction LLC Attn: Abel Castaneda 7600 Truax Rd. Central Point, Oregon 8. WAIVER OF BREACH One or more waivers or failures to object by either party to the other's breach of any provision,term,condition, or covenant contained in this Agreement shall not be construed as a waiver of any subsequent breach,whether or not of the same nature. 9. CONTRACTOR'S COMPLIANCE WITH TAX LAWS 9.1 Contractor represents and warrants to the City that:. 9.1.1 Contractor shall,throughout the term of this Agreement,including any extensions hereof, comply with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Contractor; and (iii) Any rules,regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.1.2 Contractor, for a period of no fewer than six (6) calendar years preceding the Effective Date of this Agreement, has faithfully complied with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Contractor; and (iii) Any rules,regulations, charter provisions,or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.2 Contractor's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Page 5 of 7: Goods and Services Agreement between the City of Ashland and J&A Concrete Construction LLC Further, any violation of Contractor's warranty, as set forth in this Article 9, shall constitute a material breach of this Agreement. Any material breach of this Agreement shall entitle the City to terminate this Agreement and to seek damages and any other relief available under this Agreement,at law,or in equity. IN WITNESS WHEREOF the parties have caused this Agreement to be signed in their respective names by their duly authorized representatives as of the dates set forth below. CITY OF ASHLAND: J&A CONCRETE CONSTRUCTION LLC (CONTRACTOR • 41117 By: By: a gnature ncotr FLE u e/Ceekoc41- CA30..cis— Printed Name JPrinted Name Io . 3 .Z3 Ov)fle-,C Date Title Date Purchase Order No. /‘14---(W-9 is to be submitted with this signed Agreement) Page 6 of 7: Goods and Services Agreement between the City of Ashland and J&A Concrete Construction LLC EXHIBIT A CITY OF ASHLAND, OREGON City of Ashland LIVING. ALL employers iesaibeci; WAGE below niirst aatnply with City af,i shiand laws regulating payment of a living wage_ SIB.12'per hour, effective June 30r 2023.' • The Living Wage is adjusted annually every VaiPril l June 30 by the Consumer Price Index. Employees,must be paid a portion of the business of of health care,retirement living wage: their employer,if the 401K,and IRS eligible employer has ten or more cafeteria plans(inducing employees,and has rec ed childcare)benefits to the. :p- For all hours worked under a Inancial assistance for the employee's amount of wages. service contract between their project or business from she. employer and the City of C of Ashland over p Note: Far ternporaryr and Ashland if the contract $25,335.05; part-time employees,the Living Wage does not apply exceeds$25,335_05 Of more_ f. if their employer is the City of to thefirst IO40 hours worked, For all hours worked in a Ashland,including the Parks in any alen�dar year. For month,if the employeeand Recreation Department more details,please see spends 54%or mare of the Ashland Municipal cod employee's time in that month `r In calculating the,living wage, Section 3.12.020_ working ars a project or employers may add the value For additional infornratiioni Call the Ashland City Manager's office at 0-488-6002 or write to the City Manager, City Hall,20 East Main meet,Ashland,OR 97520,or visit the City's website at vuww.ashiand.or_us. Notice to Employers: This notice must be posted in areas where it can to seen by all employ_ CITY OF ASHLAND Page 7 of 7: Goods and Services Agreement between the City of Ashland and J&A Concrete Construction LLC i' i' •. .. .. .... BID FORM Bid Title: Billings Ranch Handicap Ramp Replacement Bidding Company J&.A Concrete Construction Name: OR.CCB No. 237481 Bidder Address: 7600 Truax Rd. Central Point OR 97502 Bidder Contact: Abel Castaneda Contact Telephone: 541.951.4009 Contact Email: jna.cast2003na gmail.com Pursuant to an in compliance with the Bid Documents,the undersigned Bidder agrees to perform the Work for the above-referenced Project for the following Total Bid amount: Item Description, Qty Unit Unit Cost Bid Amount No. 1 MOBILIZATION 1 LS $ $ 400.00 2 TEMPORARY WORK ZONE TRAFFIC CONTROL 1 LS $ $100.00 3 EROSION&SEDIMENT CONTROL 1 LS $ $ 40.00 4 SAWCUTTING 1 LS $ $ 75.00 5 REMOVAL OF CONCRETE CURB&GUTTER 18 LF $ 6.00 $ 108.00 6 REMOVAL OF CONCRETE WALK 210.5 SF $ 4.50 $ 947.25 7 CONCRETE CURBS,CURB&GUTTER 18 LF $ 30.00 $ 540.00 8 CONCRETE WALKS(6-IN THICK WI REBAR) 100 SF $ 10.00 $1000.00 9 CONCRETE ACCESSIBLE RAMP(6-IN THICK W/ 110.5 SF $ 12.50 $ 1381.25 REBAR) 10 TRUNCATED DOMES ON NEW SURFACES 16 SF $ 25,00 $ 400.00 TOTAL BID: $ 4991.50 i. 20—ft- 8—ft ] h_4—ft--- . I a a � 4 - a d d 4 q 4 d 5—ft ▪ a D d Cd • 4 • 4 °4 i 4 .. 4 4 4 ' 4 G ' • °a_ a _ d ' 4 d Q 4 • 8_fit a. d, .• d d • a lea d • dvd 8.5—ft • a • a d a. • Q ° as d a a o0 0 00000001,011111111,1,1,1,110,111o1a A' ,01400000014/000001000101010100014001010001 4 5—ft---agog 0 00000e000e a0000000000000Q000000a aa-° .5—f t a , 111111111111111111111 111111111111111111111 d , 111111111111111111111 J . ,4 .. ••a° ` a . . . , • a. • 1- 18—ft Curb & Gutter —. 18 LF ADA Accessible Ramp — 110.5 SF Truncated Dome — 16 SF Sidewalk — 100 SF *Sidewalk and ramp areashall be 6—in in thickness and have #4 .rebar, 12—in O..C. each direction *New sidewalk shall be doweled to existing sidewalk, 3 dowels © each connection (.#6 x 12") CITY OF Billings Ranch Ramp Replacement DRAWI1 of i -ASHLAND 1 PURI IC WORKS — FNGINFFRING REVISED: 'n" CERTIFICATION OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REQUIREMENTS Contractor is exempt from the requirement to obtain workers compensation insurance pursuant to ORS Chapter 656 for the following reason. Contractor is to initial the appropriate box as follows: SOLE PROPRIETOR (Initials) • Contractor is a sole proprietor,and • Contractor has no employees,and • Contractor will not hire employees or subcontractors to perform this contract. CORPORATION—FOR PROFIT (Initials) • Contractor's business is incorporated;and • All employees of the corporation are officers and directors and have a substantial ownership interest*in the corporation,and • All work will be performed by the officers and directors;Contractor will not hire other employees or subcontractors to perform this contract. CORPORATION-NONPROFIT (Initials)- • Contractor's business is incorporated as a nonprofit corporation,and • Contractor has no employees;all work is performed by volunteers,and ■ Contractor will not hire employees or subcontractors to perform this contract. PARTNERSHIP (Initials) • Contractor is a partnership,and ■ Contractor has no employees,and • All work will be performed by the partners;Contractor will not hire employees or subcontractors to perform this contract,and • • Contractor is not engaged in work performed in direct connection with the construction,alteration,repair, improvement,moving or demolition of an improvement to real property or appurtenances thereto.** GCR LIMITED LIABILITY COMPANY (Initials) • Contractor is a limited liability company,and ■ Contractor has no employees,and ■ All work will be performed by the members;Contractor will not hire employees or subcontractors to perform this contract,and • If Contractor has more than one member,Contractor is not engaged in work performed in direct connection with the opauction, thereto.** alteration, repair,improvement,moving or demolition of an improvement to real property or en / / • 08/25/2023 (Signature of Authorized Signer) (Date) Owner (Authorized Signer's Title) *NOTE: Under OAR436-50-050 a shareholder has a"substantial ownership"interest if the shareholder owns 10%of the corporation,or if less than 10%is owned,the shareholder has ownership that is at least equal to or greater than the average percentage of ownership of all shareholders. **NOTE: Under certain circumstances partnerships and limited liability companies can claim an exemption even when performing construction work. The requirements for this exemption are complicated. Consult with City Attorney's Office before an exemption request is accepted from a contractor who will perform construction work. 1 I ACCORD DATE(MM/DD/YYYY) ki...------ CERTIFICATE OF LIABILITY INSURANCE 08/25/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER COT NAME:Progressive Commercial Lines Customer and Agent Servicing World of Insurance LLC PHONE FAX 1091 MEDFORD CENTER,MEDFORD,OR 97504 (A/c,No,Ext):1-800-444-4487 INC.No): ADDRESS:progresslvecommercial@email.progressive.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Artisan and Truckers Casualty Company 10194 INSURED INSURER B: ABEL CASTANEDA DBA:J&A CONCRETE CONSTRUCTION LLC 7600 TRUAX RD INSURER C: CENTRAL POINT,OR 97502-0000 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 125161922390919542D082523T234632 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ PRREMISES(Ea occurr nce) $ CLAIMS-MADE OCCUR P MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMIPPLIESPER: POLICY n TAGENERAL AGGREGATE $ PRO- PRODUCTS-COMP/OP JECT LOC $ Ei OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO ANY accident) $ BODILY INJURY(Per person) $50,000 A OWNED SCHEDULED _AUTOS ONLY X AUTOS N N 03584112 04/23/2023 10/2312023 BODILYBINJURY(Per accident) $100 000 _AUTOS ONLY NON-OWNEDO (Perraccidenq AMAGE $25,000 $ _UMBRELLA LIAB _OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WOKERS COMPENSATION AND EMPLOY RS'LIABILITY YIN FTATUTE I NCH ANYPROPRIETORIPARTNER/EXECUTIVE n N/A E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED7 (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 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ABEL CASTANEDA ACCORDANCE WITH THE POLICY PROVISIONS. 7600 TRUAX RD CENTRAL POINT,OR 97502-0000 . AUTHORIZED REPRESENTATIVE 170444Z ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: A PRO ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED World of Insurance LLC ABEL CASTANEDA DBA:J&A CONCRETE CONSTRUCTION LLC POLICY NUMBER 7600 TRUAX RD 03584112 CENTRAL POINT,OR 97502-0000 • CARRIER NAIC CODE Artisan and Truckers Casually Company 10194 EFFECTIVE DATE:04/23/2023 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Additional Coverages Insurance coverage(s) Limits Uninsured/Underinsured Motorist $50,000/$100,000 Liability coverage may not apply to all scheduled vehicles. ACORD 101(2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Client#:189672 JACONC2 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 9/13/2023 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Jaime Zumwalt Propel Insurance PHONE 800 499-0933 FAX 866 577-1326 (A/C,No,Ext): (AIC,No): 1201 Pacific Avenue;Suite 1000 E-MAIL •aime.zumwalt ro elinsurance.com ADM Human Resources •ADDRESS:1 p Tacoma,WA 98402-4321 INSURER(S)AFFORDING COVERAGE NAIL# INSURERA:Western National Mutual Insurance Co. 15377 INSURED INSURER B: J&A Concrete Construction,LLC 7600 Truax Road INSURER C: INSURER D: • Central Point,OR 97502 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP IYLIMITS ?NSR WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDYYY) A X COMMERCIAL GENERAL LIABILITY CPP127018802 08/01/2023 08/01/2024 EACH OCCURRENCE $1,000,000 ���IAGEIOEj Eog CLAIMS-MADE X OCCUR MISE l a occurrence) $1()0,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY _$1,000,000 GEM_AGGREGATE LIMIT APPLIES PER: % GENERAL AGGREGATE $2,000,000PRO . X POLICY )ECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) _ $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY _AUTOS T _ PROPERTY DAMAGE ONLY AUTOSONLY Perrcint $ $ A x UMBRELLA LIAB X OCCUR UMB105407000 09/12/2023 09/12/2024 EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000. DED X RETENTION$10,000 _ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ • DESCRIPTION OF OPERATIONS)LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) • CERTIFICATE HOLDER CANCELLATION City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland,OR 97520 AUTHORIZED REPRE SENTATIVEi�r ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 252016/03 ( ) 1 of 1 The ACORD name and logo are registered marks of ACORD #S6150006/M6150005 JLHO2 COMMERCIAL GENERAL LIABILITY CG MU 0009 06 22 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY COMMERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT This endorsement modifies the insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM With respect to the coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. The SECTIONS of the Commercial General Liability Coverage Form identified in this endorsement will be amended as shown below. SECTION I—COVERAGES AMENDMENTS COVERAGE A—BODILY INJURY AND PROPERTY DAMAGE LIABILITY A. Non Owned Aircraft Or Watercraft Item 2. Exclusions,Paragraph g.is replaced by the following: g. Aircraft,Auto Or Watercraft "Bodily injury" or"property damage" arising out of the ownership, maintenance, use or entrustment to others of • any aircraft, "auto"or watercraft owned or operated by or rented or loaned to any insured. Use includes operation and"loading or unloading". This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the super- vision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury' or"property damage"involved in the ownership, maintenance, use or entrustment to others of any aircraft,"auto"or watercraft that is owned or operated by or rented or loaned to any insured. This exclusion does not apply to: (1) A watercraft while ashore on premises you own or rent; (2) A watercraft you do not own that is: (a) Less than 50 feet long;and (b) Not being used to carry persons or property for a charge; This Subparagraph (2) applies to any person, who with your expressed or implied consent, either uses or is responsible for the use of the watercraft; (3) Parking an"auto"on, or on the ways next to, premises you own or rent, provided the "auto"is not owned by or rented or loaned to you or the insured; (4) Liability assumed under any"insured contract"for the ownership, maintenance or use of aircraft or watercraft; or (5) "Bodily injury'or"property damage"arising out of: (a) The operation of machinery or equipment that is attached to, or part of, a land vehicle that would qualify under the definition of"mobile equipment"if it were not subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged; or (b) The operation of any of the machinery or equipment listed in Paragraph f. (2) or f. (3) of the definition of "mobile equipment". CG MU 0009 06 22 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 2 of 10 13. Damage To Property Coverage Extensions Item 2.Exclusions, Paragraph j. is replaced by the following: j. Damage To Property "Property damage"to: (1) Property you own, rent, or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's property; (2) Premises you sell,give away or abandon, if the"property damage"arises out of any part of those premises; (3) Property loaned to you; (4) Personal property in the care, custody or control of the insured; (5) That particular part of real property on which you or any contractors or subcontractors working directly or indirectly on your behalf are performing operations, if the"property damage"arises out of those operations; or (6) That particular part of any property that must be restored, repaired or replaced because "your work" was incorrectly performed on it. Paragraphs(1), (3) and (4) of this exclusion do not apply to "property damage"(other than damage by fire, lightning, explosion or sprinkler leakage) to premises, including the contents of such premises, rented to you for a period of seven or fewer consecutive days. A separate limit of insurance applies to Damage To Premises Rented To You as described in SECTION III — LIMITS OF INSURANCE. However, the provisions of this paragraph do not apply if coverage for Damage To Premises Rented To You is excluded by endorsement. Paragraph (2) of this exclusion does not apply if the premises are "your work" and were never occupied, rented or held for rental by you. Paragraphs(3) and(4) of this exclusion do not apply to the use of elevators. Paragraphs(3), (4),(5) and(6)of this exclusion do not apply to liability assumed under a sidetrack agreement. Paragraph (4) of this exclusion does not apply to "property damage"to borrowed equipment while not being used to perform operations at the jobsite. Subject to Paragraph 2.of SECTION III—LIMITS OF INSURANCE,the rules below fix the most we will pay for"property damage"under this provision: (1) $25,000 any one "occurrence", regardless of the number of persons or organizations who sustain damages because of that"occurrence"; (2) $50,000 annual aggregate;and (3) We will pay only for damages in excess of$2,500 as a result of any one"occurrence", regardless of the number of persons or organizations who sustain damages because of that"occurrence". We may, or if required by law, pay all or any part of any deductible amount, if applicable, to effect settlement of any claim or"suit". Upon notice of our payment of a deductible amount,you shall promptly reimburse us for the part of the deductible amount we paid. Paragraph (6) of this exclusion does not apply to "property damage" included in the "products-completed operations hazard". The insurance provided for "property damage" from the use of elevators and for "property damage" to borrowed equipment is excess over any other valid and collectible property insurance (including any deductible portion thereof) available to the insured whether primary, excess,contingent or on any other basis. C. Damage To Premises Rented To You Item 2.Exclusions,the last paragraph is replaced by the following: Exclusions c. through n. do not apply to damage by fire, lightning, explosion or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in Paragraph 6.of SECTION III—LIMITS OF INSURANCE. CG MU 0009 06 22 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 3 of 10 COVERAGE B—PERSONAL AND ADVERTISING INJURY LIABILITY D. Personal And Advertising Injury Item 2.Exclusions is amended by replacing Sub-paragraphs b.and c.with the following: b. Material Published With Knowledge Of Falsity "Personal and advertising injury" arising out of oral, written, televised, videotaped or electronic publication, in any manner, of material, if done by or at the direction of the insured with knowledge of its falsity. c. Material Published Prior To Policy Period "Personal and advertising injury" arising out of oral, written, televised, videotaped or electronic publication, in any manner, of material whose first publication took place before the beginning of the policy period. SUPPLEMENTARY PAYMENTS—COVERAGES A AND B E. Supplementary Payments—Coverages A and B Item 1.is amended by replacing Subparagraphs b.and d.with the following: b. Up to $5,000 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or"suit", including actual loss of earnings up to$500 a day because of time off from work. SECTION II—WHO IS AN INSURED AMENDMENTS A. Employee Bodily Injury To A Co-Employee Paragraph 2.a.(1) is replaced by the following: However, none of these "employees" or "volunteer workers" are insureds for "bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a co-"employee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other"volunteer workers"while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of the co-"employee" or"volunteer worker" as a consequence of Paragraph(1)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraph (1)(a) or(b)above;or (d) Arising out of his or her providing or failing to provide professional health care services. However, if a suit seeking damages for "bodily injury" or"personal and advertising injury" to any co-"employee" or other"volunteer worker" arising out of and in the course of the co-"employee's" or"volunteer worker's" employment or while performing duties related to the conduct of your business, or a suit seeking damages brought by the spouse, child, parent, brother or sister of the co-"employee" or other "volunteer worker", is brought against you or a co-"employee"or a"volunteer worker", we will reimburse the reasonable costs that you incur in providing a defense to the co-"employee" or"volunteer worker"against such matters. Any reimbursement made pursuant to this sub-section will be in addition to the limits of liability set forth in the Declarations. B. Newly Acquired Organizations Paragraph 3.a. is replaced by the following: a. Coverage under this provision is afforded only until the 180t day after you acquire or form the organization or the end of the policy period,whichever is earlier; CG MU 0009 06 22 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 4 of 10 The following are added: C. Blanket Additional Insured—Vendors—As Required By Contract 1. Section Il —Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) (referred to throughout this endorsement as vendor) with whom you have agreed in a written contract, executed prior to loss, to name as an additional insured, but only with respect to"bodily injury" or"property damage"arising out of"your products"which are distributed or sold in the regular course of the vendor's business. However, a. The insurance afforded to such vendor only applies to the extent permitted by law;and b. If coverage provided to the vendor is required by a contract or agreement, the insurance afforded to such vendor will not be broader than that which you are required by the contract or agreement to provide for such vendor. 2. With respect to the insurance afforded to these vendors,the following additional exclusions apply: a. The insurance afforded the vendor does not apply to: (1) "Bodily injury" or"property damage"for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (2) Any express warranty unauthorized by you; (3) Any physical or chemical change in the product made intentionally by the vendor; (4) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (5) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (6) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; (7) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor;or (8) "Bodily injury" or"property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (i) The exceptions contained in Subparagraphs (4) or(6);or (ii) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. 3. This Provision C. does not apply: a. To any insured person or organization from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products; b. To any vendor for which coverage as an additional insured specifically is scheduled by endorsement; or c. When liability included within the"products-completed operations hazard" has been excluded for such product either by the provisions of the coverage part or by endorsement. 4. With respect to the insurance afforded to these vendors, the following is added to Section III — Limits Of Insurance: If coverage provided to the vendor is required by a contract or agreement, the most we will pay on behalf of the vendor is: a. The minimum amount required by the contract or agreement;or b. The Limits of Insurance shown in the Declarations; CG MU 0009 06 22 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 5 of 10 • whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. 5. With respect to the insurance afforded to these additional insureds,the following additional exclusion applies: This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys,field orders,change orders or drawings and specifications;or (2) Supervisory,inspection,architectural or engineering activities. This exclusion applies even if the claims against an additional insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or failure to render any professionalservices by you with respect to your providing engineering, architectural or surveying services in your capacity as an engineer, architect or surveyor. D. Blanket Additional Insured—Lessor Of Leased Equipment 1. Section II —Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) from whom you lease equipment when you and such person(s) or organization(s) have agreed in writing in a contract or agreement, executed prior to loss, that such person(s) or organization(s) be added as an additional insured on your policy. Such person(s) or organization(s) is an insured only with respect to liability for "bodily injury", "property damage" or"personal and advertising injury" caused by your negligent acts or omissions in the maintenance, operation or use of equipment leased to you by such person(s)or organization(s). However,the insurance afforded to such additional insured: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. c. Does not apply to any"occurrence"which takes place after the equipment lease expires; A person's or organization's status as an additional insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. 2. With respect to the insurance afforded to the Lessor,the following additional exclusions apply: "Bodily injury"or"property damage"arising out of: (1) The assumption of liability in a contract or agreement.This exclusion does not apply to liability for damages that the Lessor would have in the absence of the contract or agreement; (2) Any express warranty made by the Lessor; (3) The demonstration, installation, servicing, inspections,adjustments,tests, repair, or maintenance operations by or for the Lessor; (4) The negligence or strict liability of the Lessor for its own acts or omissions or those of its employees or anyone else acting on its behalf;or (5) Any failure on the part of the Lessor to provide information, instructions and/or warnings with respect to the • maintenance, use or operation of the equipment. 3. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is: a. The minimum amount required by the contract or agreement; or b. The Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG MU 0009 06 22 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 6 of 10 4. With respect to the insurance afforded to these additional insureds,the following additional exclusion applies: This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render,any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys,field orders,change orders or drawings and specifications;or (2) Supervisory, inspection,architectural or engineering activities. This exclusion applies even if the claims against an additional insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or failure to render any professional services by you with respect to your providing engineering, architectural or surveying services in your capacity as an engineer, architect or surveyor. E. Blanket Additional Insured—Managers Or Lessors Of Premises 1. Section II —Who Is An Insured is amended to include as an additional insured any person(s) or organization(s) with whom you have agreed in a written contract, executed prior to loss, to name as an additional insured, but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you, subject to the following additional exclusions: This insurance does not apply to: a. Any"occurrence"which takes place after you cease to be a tenant in that premises. b. Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2. With respect to the insurance afforded to these additional insureds, the following is added to Section III —Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is: a. The minimum amount required by the contract or agreement;or b. The Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. 3. With respect to the insurance afforded to these additional insureds,the following additional exclusion applies: This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural,engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys,field orders,change orders or drawings and specifications;or (2) Supervisory, inspection,architectural or engineering activities. This exclusion applies even if the claims against an additional insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or failure to render any professional services by you with respect to your providing engineering, architectural or surveying services)in your capacity as an engineer, architect or surveyor. CG MU 0009 06 22 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 7 of 10 F. Blanket Additional Insured—State Or Governmental Agency Or Subdivision Or Political Subdivision—Permits Or Authorizations • Section II —Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision with whom you have agreed in a written contract, executed prior to loss, to name as an additional insured, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2. This insurance does not apply to: a. "Bodily injury", "property damage" or"personal and advertising injury" arising out of operations performed for the federal government,state or municipality;or b. "Bodily injury"or"property damage"included within the"products-completed operations hazard". 3. With respect to the insurance afforded to these additional insureds, the following is added to Section III —Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is: a. The minimum amount required by the contract or agreement;or b. The Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. 4. With respect to the insurance afforded to these additional insureds,the following additional exclusion applies: This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural,engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys,field orders,change orders or drawings and specifications; or (2) Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against an additional insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or failure to render any professional services by you with respect to your providing engineering, architectural or surveying services in your capacity as an engineer, architect or surveyor. G. Blanket Additional Insured—State Or Governmental Agency Or Subdivision Or Political Subdivision—Permits Or Authorizations Relating To Premises Section II—Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision with whom you have agreed in a written contract, executed prior to loss, to name as an additional insured,subject to the following provision: 1. This insurance applies only with respect to the following hazards for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization in connection with premises you own, rent or control and to which this insurance applies: a. The existence, maintenance, repair, construction, erection or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners or decorations and similar exposures;or b. The construction, erection or removal'of elevators;or CG MU 0009 06 22 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 8 of 10 c. The ownership, maintenance or use of any elevators covered by this insurance. However, a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. 2. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is: a. The minimum amount required by the contract or agreement; or b. The Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. 3. With respect to the insurance afforded to these additional insureds,the following additional exclusion applies: This insurance does not apply to: a. "Bodily injury", "property damage" or"personal and advertising injury" arising out of the rendering of, or the failure to render,any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys,field orders,change orders or drawings and specifications;or (2) Supervisory, inspection,architectural or engineering activities. This exclusion applies even if the claims against an additional insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or failure to render any professional services by you with respect to your providing engineering,architectural or surveying services in your capacity as an engineer, architect or surveyor. - SECTION III—LIMITS OF INSURANCE AMENDMENTS A. Damage To Premises Rented To You Paragraph 6. is replaced by the following: 6. Subject to Paragraph 5. above, the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, lightning, explosion or sprinkler leakage, while rented to you or temporarily occupied by you with permission of the owner is the greater of: a. $300,000;or b. The amount shown next to the Damage To Premises Rented To You Limit in the Declarations. However, the provisions of this paragraph do not apply if Damage To Premises Rented To You Coverage is excluded by endorsement. B. Medical Expense Limit Paragraph 7.is replaced with the following: 7. Subject to Paragraph 5.,above, the most we will pay under Coverage C for all medical expenses because of "bodily injury"sustained by any one person is the greater of: a. $10,000;or b. The amount shown next to the Medical Expense Limit in the Declarations. This insurance does not apply if coverage for Medical Expenses is excluded either by the provisions of the . coverage part or by endorsement. CG MU 0009 06 22 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 9 of 10 SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS AMENDMENTS A. Knowledge Of Occurrence Item 2.Duties In The Event Of Occurrence,Offense,Claim or Suit is amended by adding the following: e. You must give us or our authorized representative prompt notice of an"occurrence", claim or loss only when the "occurrence",claim or loss is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) An executive officer or insurance manager, if you are a corporation;or (4) A member or manager, if you are a limited liability company. B. Other Insurance Item 4.Other Insurance,b.Excess Insurance(1)(a)(ii) is replaced by the following: (ii) That is fire, lightning, explosion or sprinkler leakage insurance for premises rented to you or temporarily occupied by you with permission of the owner; C. Unintentional Failure To Disclose Hazards Item 6.Representations is replaced by the following: 6. Representations And Unintentional Failure To Disclose Hazards a. By accepting this policy,you agree: (1) The statements in the Declarations are accurate and complete; (2) Those statements are based upon representations you made to us;and (3) We have issued this policy in reliance upon your representations. b. If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Part because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. D. Waiver of Subrogation Item 8.Transfer of Rights of Recovery Against Others to Us is hereby amended by the addition of the following: We waive any right of recovery we may have because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a written contract, executed prior to loss, requiring such waiver with that person or organization and included in the "products-completed operations hazard". However, our rights may only be waived prior to the "occurrence" giving rise to the injury or damage for which we make payment under this Coverage Part. The insured must do nothing after a loss to impair our rights. At our request, the insured will bring "suit"or transfer those rights to us and help us enforce those rights. SECTION V—DEFINITIONS AMENDMENTS A. Insured Contract Amended Paragraph 9.a. is replaced by the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner is not an"insured contract"; B. Personal And Advertising Injury Redefined Paragraph 14.d. and e.are replaced by the following: d. Oral, written, televised, videotaped or electronic publication of material that slanders or libels a person or organization or disparages a person's or organization's goods,products or service; e. Oral,written,televised,videotaped or electronic publication of material that violates a person's right of privacy; CG MU 0009 06 22 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 10 of 10