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HomeMy WebLinkAbout2023-166 PO 20240152- John Michael Stevenson Purchase Order PASCI 9 Y F4EC n E R Fiscal Year 2024 Page: 1 of: 1 B City of Ashland 1P6k. �x ill ATTN: Accounts Payable20 E. Main Purchase L Ashland, OR 97520 Order# 20240152 T Phone: 541/552-2010 O Email: payable@ashland.or.us V H C/O Facilities Maintenance Div E JOHN MCHAEL STEVENSON I 90 North Mountain Ave N 2191 HILL WAY p Ashland, OR 97520 O MEDFORD, OR 97504 . Phone: 541/488-5358 RT Fax: 541/552-2304 David Arnold E 81HBAI�Q��I1 ,a_F.. r tRs6 z_ " - ri_�t t�iFtryw r 10/09/2023 8084 FOB ASHLAND OR/NET30 Cit Accounts Parable *caw == — Install Cabinets Fire St#1 1 Remove and reinstall cabinets, shelving and countertops at Fire 1.0 $5,000.00 $5,000.00 Station#1 Goods and Services Agreement(Less than $35,000) Completion date:, 06/30/2024 Project Account: ***************GL SUMMARY*************** 088400-602400 $5,000.00 I I ' I • • By: ly) Date:41472e_horized Signatur .5 000.00 FORM #3 CITY OF --�t Vi _ _ - ASHLAND --.'. A request for a Purchase Order q REQUISITLO ,// ' �� � v2O�` o request: 9/8/2023 frTi Re. 'r•.d date for,elivery: / Vendor Name Address,City,State,Zip 125 Sherman St,Ashland,OR 97520 Contact Name&Telephone Number Mike Stevenson,541-821-6823,stevenson.rocu gmail.com Email address 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: 0 State of Oregon ® Direct Award _(Attach copy of council communication) Contract# ❑ Verbal/Written quote(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 0 Sole Source Agency GOODS&SERVICES 0 Applicable Form(#5,6,7 or 8) Contract# Greater than$5,000 and less than$100,000 0 Written quote or proposal attached Intergovernmental Agreement ❑ (3)Written bids and solicitation attached ❑ Form#4,Personal Services$5K to$75K Agency PERSONAL SERVICES Date approved by Council: 0 Annual cost to City does not exceed$25,000. Greater than$5,000 and less than$75,000 Valid until: (Date) Agreement approved by Legal and approved/signed by ❑ Less than$35,000,by direct appointment 0 Special Procurement City Administrator.AMC 2.50.070(4) ❑ (3)Written proposals&solicitation attached ❑ Form#9,Request for Approval IN :I.-- - • - .:-@ ',25,000,Council ❑ Form#4,Personal Services$5K to$75K 0 Written quote or proposal attached approval required.(Attach copy of col. it communication) Date approved by Council: • Valid until: D.id L��,c�,, Description of SERVICES-���'- Tota Cost ir. q Pfd ei C�roc i t- Ca.✓ i,/6 56 6GZ l� tri . I r ileraer-moi•• _ : :- - . - . - : ,/01-6P-41, G(-il ,r-E $5;0 00 ' - Item # Quantity Unit Descriptio of MATERIALS Unit Price Total Cost Ce / ❑ 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 proire7 hardware and software purchases: IT Director Date Support-Yes/No By signing this requisition form,I certify that the y's publi ontracting requirements have been satisfied. Employee: iii `�-. Department Hete.i. 10.3.Z1 qu Ito or greater than$5,000). Department Manager/Supervisor: City Manager: (G •ater than$35,000) Funds appropriated for current fiscal yea / NO A L, 41k.1 • . r Fin:nce 1i,-c•r-(Equal. . .r greater than$5,000) ' gate IIP Comments: Form#3-Requisition • Kariann Olson . From: Heather Rodriguez• Sent: Monday,October 09,2023 12:34 PM . To: Kariann Olson • Subject: ' ' FW:New Vendors Attachments: W9 Stevenson.pdf;CP 2023 W9.pdf. See below vendors ready for use. Heather Rodriguez,Accounts Payable . ogeg'Lehi City of Ashland Finance Department 20 E Main St,Ashland,Oregon 97520 (541)552-2010 1 TTY 800.735.2900 Heather.Rodriguez@ashland.or.us . Online ashland.or.us;social media(Facebook @CityOfAshlandOregon I Twitter @CityofAshland) This email transmission is official business of the City of Ashland,and it is subject to Oregon Public Records Law for disclosure and retention.If you have received this message in error,please contact me at(541)552-2010.. From:Jesse Smith<jesse.smith@ashland.or.us> Sent:Thursday,October 05, 2023 3:54 PM To: Bryn Morrison<bryn.morrison@ashland.or.us> • . Cc: Heather Rodriguez<heather.rodriguez@ashland.or.us> Subject: FW: New Vendors • From: Heather Rodriguez<heather:rodriguez@ashland.or.us> , • Sent:Wednesday,October 4,2023 1:03 PM To:Jesse Smith<jesse.smithPashland.or.us> Subject: New Vendors ' The following n .+vendor(s) are now ready for review. • is _ e to d into TCM. Vendor 8084—John Michael Stevenson Construction Vendor — s LLC Please let me know if you have any questions. 1 • • Heather Rodriguez,Accounts Payable egieitaicyjetiwk City of Ashland Finance Department , . 20 E Main St,Ashland,Oregon 97520 (541)552-2010 I TTY•800.735.2900 0 Heather.Rodriguez@ashland.or.us Online ashland.or us;social media(Facebook @CityOfAshlandOregon I Twitter @CityofAshland) This email transmission is official business of the City of Ashland,and it is subject to Oregon Public Records Law for disclosure and retention.If you have received this message in error,please contact me at(541)552-2010.. • 2 GOODS AND SERVICES AGREEMENT ($35,000 OR LESS) PROVIDER: Modern Renovations CITY OF PROVIDER'S AS H LAN D CONTACT: . Mike Stevenson 20 East Main Street Ashland, Oregon 97520 ADDRESS: , 125 Sherman.St Telephone: 541/488-5587 Ashland, OR 97520 Fax: 541/488-6006 PHONE: 541-821-6823 This Goods and Services Agreement• (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation(hereinafter "City") and Design Source, (a domestic/foreign business corporation) ("hereinafter"Provider"), for interior design and furniture. I 1. PROVIDER'S OBLIGATIONS 1.1 Provideinterior design and office furnituresales and installation for FY24 as set forth in the. P SUPPORTING DOCUMENTS" attached hereto and, by,this reference, incorporated herein. Provider expressly acknowledges that time is of the essence of any completion'date set forth in the SUPPORTING DOCUMENTS, and that no waiver or extension of such deadline may be authorized except in the same manner as herein provided.for authority to exceed the maximum compensation. The services defined and described in the "SUPPORTING DOCUMENTS" shall hereinafter be collectively referred to as "Work." 1.2 Provider shall obtain and maintain during the term of this Agreement and until City's final acceptance of all Work received hereunder, a policy or policies of liability insurance including commercial general liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 (two million dollars)per occurrence for Bodily Injury and Property Damage. 1.2.1 The insurance required in this Article shall include the following coverages: • Comprehensive General or Commercial General Liability, including personal injury, contractual liability, and products/completed operations coverage; and • 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 theextent that two or more such policies are intended to "layer" coverage and, taken together, they provide total coverage from the first dollar of liability; • Provider shall immediately notify the City of any change in insurance coverage • Provider "shall supply an endorsement naming the City, its officers, employees and agents as additional insureds by the Effective Date of this Agreement; and • Page 1 of 6: Goods and Services Agreement between the City of Ashland and Modern Renovations • 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, gender identity or source of income, suffer discrimination in the performance of this Agreement when employed by Provider. Provider agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. Further, Provider agrees not to discriminate againsta disadvantaged business enterprise,minority-owned business,woman-owned business, a business that a service-disabled veteran owns or an emerging small business enterprise certified under ORS 200.055, in awarding subcontracts as required by ORS 279A.110. 1.5 In all solicitations either by competitive bidding or negotiation made by Provider for work to be performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Providers of the Provider's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 1.6 Living Wage Requirements: If the amount of this Agreement is $25,335.05 or more, Provider is required to comply with Chapter 3.12 of the Ashland Municipal Code by paying a living wage,as defined in that chapter, to all employees performing Work under this Agreement and to any Subcontractor who performs 50%.or more of the Work under this Agreement. Provider is also required to post the notice attached hereto as "Exhibit A"predominantly in areas where it will be seen by all employees. 1.7 Assignment: Provider shall not assign this Agreement or subcontract any portion of the Work.to be provided hereunder without the prior written consent of the City. Any attempted assignment or subcontract without written consent of the City shall be void. Provider shall be fully responsible for the acts or omissions of any assigns or subcontractors arid of all persons employed by them, and the approval by the City of any assignment or subcontractshall 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 9/1/23 as specified in the SUP PORTING 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 Modem Renovations 3.2 Provider is an independent contractor and not an employee or agent of the City for any purpose. 3.3 Provider is not entitled to, and expressly waives all claims to City benefits such as health and disability insurance,paid leave, and retirement. 3.4 This Agreement embodies the full and complete understanding of the parties respecting the subject matter hereof. It supersedes all prior agreements,negotiations, and representations between the parties, whether written or oral. 3.5 This Agreement may be amended only by written instrument executed with the same formalities as this Agreement. . 3.6 The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220, 279B.230 and 279B.235. • 3:7 This Agreement shall be governed by the laws of the State of Oregon without regard to conflict of laws principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is in federal court, in which case exclusive venue shall be in the federal district court for the district of Oregon. Each party expressly waives any and all rights to maintain an action under this Agreement in any other venue, and expressly consents that, upon motion of the other party, any case may be dismissed or its venue. transferred, as appropriate, so as to effectuate this choice of venue. 3.8 Provider shall defend, save,hold harmless and indemnify the City and its officers,employees and agents from and against any and all claims, suits, actions, losses,,damages, liabilities;costs, and expenses of .any nature resulting from, arising out of, or relating to the activities of Provider or its officers, employees, contractors, or agents under this Agreement. 3.9 Neither party to this Agreement shall hold the other responsible for damages or delay in performance • caused by acts of God, strikes,lockouts, accidents, or other events beyond the control of the other or the other's officers, employees or agents: 3.10 'If any provision of this Agreement is found by a court of competent jurisdiction to be unenforceable, such provision shall not affect the other provisions, but such unenforceable provision shall be deemed modified to the extent necessary to render it enforceable, preserving to the fullest extent permitted the intent of Provider and the City set forth in this Agreement. .3.11 Deliveries will be F.O.B destination. Provider shall pay all transportation and handling charges for the Goods. Provider is responsible and liable for loss or damage until final inspection and acceptance of the Goods by the City. Provider remains liable for latent defects,fraud, and warranties. 3.12 The City may inspect and test the Goods. The City'may reject non-conforming Goods and require Provider to correct them without charge or deliver them at a reduced price, as negotiated. If Provider does not cure any defects within a reasonable time, the City may reject the Goods and cancel this Agreement in whole or in part. This paragraph does not affect or limit the City's rights, including its rights under the Uniform Commercial Code, ORS Chapter 72 (UCC). • Page 3 of 6:. Goods and Services Agreement between the City of Ashland and Modern Renovations 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 September 1, 2023. 4.2 This Agreement and the SUPPORTING DOCUMENTS shall be construed to be mutually complimentary and supplementary wherever possible. In the event of a conflict which cannot be so resolved, the provisions of this Agreement itself shall control over any conflicting provisions in any of the SUPPORTING DOCUMENTS. In the event of conflict between provisions of two of the SUPPORTING DOCUMENTS,the several supporting documents shall be given precedence in the order listed in.Article 4.1. 5. REMEDIES 5.1 In the event Provider is in default of this Agreement, City may, at its option, pursue any or all of the remedies available to it under this Agreement and at law or in equity, including, but not limited to: 5.1.1 Termination of this Agreement; 5.1.2 Withholding all monies due for the Work that Provider has failed to deliver within any scheduled completion dates or any Work that have been delivered inadequately or defectively; 5.1.3 Initiation of an action orproceeding 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. 6.2Termination. 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 writingto 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 Modern Renovations 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 4"\. . If to Provider: Modern Renovations l Attn: Mike Stevenso�ig I kill V1/4/141 � (17f ' Off- 91 504' 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 Modern Renovations 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: Modern Renovati ns (PROVIDER): By: By: Signature � Seer c u g-y ...1014/s/ PI"CPA-et, 'C✓(1J<,i1 Printed Name Printed Name I�aJlAL L. 'L S otgg,LRL OJAKIE— Title , Title to. 3. 23 1 11914 Date Date (W-9 is to be submitted with this signed Agreement) Purchase Order No. l / c- --- Page 6 of 6: Goods and Services Agreement between the City of Ashland and Modern Renovations September 1, 2023 Mike Stevenson, Modern Renovations (541) 941-6177 2191 Hill Way Medford, OR. 97504 OR. CCB#181429 Estimates Ashland Fire Station#yCity of Ashland I Labor ' h Materials. Scope of project: Remove upper-lower cabinets from store room and re-install a portion of them in another area.Add shelving or file cabinet to complete the new 10 ft. section of cabinets. Install salvaged upper cabinets above new section, per clients design. Best Practice will be used to salvage existing countertops, but new countertop may need to be purchased at additional cost. Demo existing cabinets, shelving, and countertops $700.00 $25.00 Remove and store unused cabinets Instali upper-lower cabinets, shelving, and countertop. $3,200.00 $500.00 Add file cabinet or custom shelving to lower cabinets Repair drywall where needed and paint. 4i Labor and Materials Sub Totals' . 0 0 $390 00 $525 0 Total-Thank,you for your businessla' $4,425.00 14/4 � OVM15 . PROGRESS/VE' • Your ID Cards . . . . • Keep these cards handy—in your wallet or glove compartment—and contact us anytime •• you have a question or need to report a claim. • • • \ If you have a claim,we'll get you back on the roadas soon as possible.And while you'll • always have a choice where to repair your vehicle, when you use a shop in our preapproved. • network,we'll guarantee the repairs for as long as you own or lease your ve icle. . Thank you for choosing Progressive.' . /FOLD PAGE ALONG PE'FORATION AND TEAR • . INSURANCE IDENTIFICATION CARD-Oregon INSURANCE IDENTIFICATION CARD-Oregon • Policy Number 963380393 NAIC Number.10194 ,_ Policy Number.963380393 NAIC Number:10194 Effective Date:11/15/2022 Expiration Date:11/15/2023 Effective Date:11/15/2022 Expiration Date:11/15/2023 . Insurer-Artisan and Truckers Casualty Co 1-800-876-5581 Insurer-Artisan and Truckers Casualty Co 1-800-876-5581 P.O.Box 6807 Cleveland,OH 44101 I ' P.O.Box 6807 Cleveland,OH 44101 Named Insured(s): M Stevenson Named Insured(s): . John M Stevenson • . • • i Your Agent -- - - i Your Agent• - INSURANCE LOUNGE LLC 1-541-479-4975 INSURANCE LOUNGE LLC-1-541-479-4975 -- - - 1221 NE 7TH ST 1221 NE 7TH ST - - • , GRANTS PASS,OR 97526 GRANTS PASS,OR 97526 • Year Make Model VIN j Year Make Model VIN • 2011'FORD F250 1FT7X26608EB49988 2011 FORD F250 1FT7X2860BE849988 . FOLD FOLD FOLD FOLD FOLD.FOLD FOLD FOLD FOLD FOLD FOLD FOLD FOLD FOLD'FOLD FOLD FOLD'FOLD;OLD FOLD. . -FOLO FOLD FOLD FOLD FOLD FOLD FOLD COLD FOLD FOLD FOLD FOLD FOLD FOLD FOLD FOLD FOLD FOLD FOLD FOLD. 1 Manage,your policy anytime - .Manage your policy anytime- . • with just a,few clicks at. with justa few clicks at . agent.progressive.com agent.progressive.com • E , FOLD PAGE ALONG PERFORATION AND TEAR Processed on Nov 13.2022 at 01:42 p.m. ill II I II III Ull IIIH Ill IIll HhlMhl 11111111 lll 1III "< > 100 100 S 110 6117E00 0£ldDVdd J � • • --------------- -------------------------------------- • .1A/Ih7dJOdd lozrou vzoe�� .1A/1171/001/c/ (ozrol)bzor(mod • uosuanets W uyoF c uosuana;s Uy 111101 IF YOU'RE IN AN ACCIDENT IF YOU'RE IN AN ACCIDENT 1. Remain at the scene.Don't admit fault - • 1. Remain at the scene.Don't admit fault 2. Find a safe location,call the police,and exchange driver information. { 2. Find a safe location,call the police,and exchange driver information. 3. Call Progressive right away. 3.Call Progressive right away. • TO REPORT A CLAIM TO REPORT A CLAIM Ca111-800-274-4499 or go to daims.progressive.com. i Call 1-800.274-4499 or go to daims.progressive.com. • PROGRESSIVE ; .� { PROGRESSIVE KEEP THIS CARD IN YOUR VEHICLE WHILE IN OPERATION. KEEP THIS CARD IN YOUR VEHICLE WHILE IN OPERATION. MIX • Paperibles ;4A1:067 Lr.:i.'Pp3:li responsible sources FSC FSC"'C102931 - • • //'ss INSURANCE LOUNGE LLC PROG/i'E11/Y/E° 1221 NE 7TH ST GRANTS PASS,OR 97526 AUTO Policy Number: 963380393 Underwritten by: Artisan and Truckers Casualty Co • • July 3,2023 JOHN M STEVENSON • 2191 HILL WAY Policy Period: Nov 15,2022 Nov 15,2023 MEDFORD,OR 97504 • Page 1 of 2 • 1-541-479-4975 INSURANCE LOUNGE LLC Contact your agent for personalized service. •Auto Insurance a9eOnlineServicee.com Coverage Summary Makepayments, or check ling actusiofa,cldate aim.policy information or check status of a claim. • This is your Declarations Page 1-800-274-4499 To report a claim. • Your policy information has changed Your coverage began on November 15,2022 at the later of 12:01 a.m.or the effective time shown on your application. This policy period ends on November 15,2023 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 a vehicle may not be combined with the limits for the same coverage on another vehicle. The policy contract is form 9611A OR(02/22). The contract is modified by forms 4884(10/08)and A331 (11/21). Policy changes effective July 1, 2023 • Changes requested on: Jul 1,2023 12:57 p.m. Requested by: John M Stevenson • • Premium change: $276.39 S Changes: . The 1971 Camaro RS has been added. A Multi-Car discount has been added to your policy. The changes take effect as of the date and time requested shown above. Drivers and household residents John M Stevenson Additional information: Named insured • • • • • • 111 Form 6489M OR(04(22) Continued • • •• • Policy Number963380393 John M Stevenson Page2 of 2 • . • Outline of coverage • 3O11FORD FZSU4DOOR EXT CAB • NN:1FT7X3B6VBEB499QO Garaging ZIP Code97504 Primary use of the vehicle: Commute Annual miles:6,000 7'999 Length of vehicle ownership wheri policy started or vehicle added:At least 1 year but less than 3 years Limits Deductible Premium Liability•ToOtheo • $347 Bodily Injury Liability $10V,o8Oeach 00,000 each acciden Property Damage Liability $100,000 each accident • Personal Injury Protection $25,000 $0 54 Motorist $100,000 each 0l000each accident 39 Uninsured Motorist Property Damage _$50,OOOeach accident $200 10 $300 hit&run Comprehensive Actual Cash Value • $500 80 Comprehensive Window Glass $0 glass Collision • Actual Cash Value $500 163 Total premium for 2011 FORD • $693 1971 Camaro RS VIN:124871N554346 • • Garaging ZIP Code:97504 ` ' Primary use of the vehiclePleasure/Personal • Annual miles:0-3,999 Length nfvehicle ownoshipwhe p� policy started or vehicleyears or added�Sm�e Limits Deductible Premium Liability To Others • $65 BOdily Injury Liability $100,000 each 00,000 each accident • Property Damage Liability $100,000 each accident • Personal Injury Protection $25,000 $0 15 Motorist $100,000 00,000 each acciden14 Uninsured Motorist Property Damage $50,OOOeach accidant $200 19 $300 hit&run Comprehensive Cash Value or Stated Amount $500 381 Comprehensive Window Glass $0 glass Collision • *Actual Cash Value or Stated Amount $500 446 Total premium for 1971 Camaro • ^ $940 *In the event of a total loss of this vehicle,the maximum amount payable is the lesser of the actual cash value or the stated amount of$100,000. Total 12 month policy premium $1,633.00 Premium discounts Policy • 963380393 Rve-YerAodentFmeAummadc[ardPayments(ACP),Home Owner, .‘ Multi-Car,Continuous Insurance: Platinum and Three-Yearr SafDriving Lienholder information • Vehicle Lienholder 2011 FORD F250 OREGON COMMUNITY CU 1FT7X2B6Q8EB49988 FORT WORTH,TX 76124 Form 6489M OR(04/22) / _____7„,,,,s. • MIKESTE-01 RMICKLE '°�R oW CERTIFICATE OF LIABILITY. INSURANCE DATE A E(MM! 023 DDIYYYY) 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). CONTACT PRODUCER NAME: Insurance Lounge LLC • (A/C,No,Ext):(541)479-4975 (AAic, No):(866)573=8657 ADDRESS:support@insurancelounge.com ' • INSURER(S)AFFORDING COVERAGE NAIC# ‘ INSURER A:CNA General Liability INSURED • INSURER B: Mike Stevenson dba:Modern Renovations INSURER C: • PO BOX 1396 • INSURER D: MEDFORD,OR 97501-0104 • 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYYI (MM/DD/YYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR C6984220140 4/7/2023 4/7/2024 DAMAGE TO RENTED 100,000 X XPREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 . OTHER: Deductible $ 1,000 COMBINED SINGLE LIMIT AUT BILE LIABILITY � (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $• AWNED SCHEDULEDO �� AUTOSWNEONLY AUTOS BODILY INJURY(Per accident) $ AH RED NON-OWNED PROPERTY DAMAGE TOS ONLY — AUTOS ONLY (Per accident) $ • $ UMBRELLA LIAB _ OCCUR • EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ • WORKERS COMPENSATION • I STATUTE I I'AH - AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? Iyes,(Mandatory Ib andNH) •c= 1 t 1N� �MQ�KJN20 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) Balnaket additional insured when required by written contract or agreement,primary and non-contributory,waiver of subrogation per attached form CNA9758 (04/20). CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE. City of Ashland ACCORDANCE WITH THE POLICY PROVIS IO WILL BE DELIVERED IN T 90 N,Mountain Ave Ashland,OR.97520-2014 Ashland,OR 97520 AUTHORIZED REPRESENTATIVE 44(A/it_ . ACORD 25(2016/03) , ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • BEST CHOICE CONTRACTOR PROGRAM cNABlanket Additional Insured - Owners, Lessees or. Contractors• This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Policy Number: 06984220140 . . Endorsement Effective: 4/7/2023 at 12:01 a. m. Named Insured: • Authorized Representative: JOHN MICHAEL STEVENSON, DBA: Modern Renovations • SCHEDULE Name of Additional Insured Person(s) or Organization(s): (Blanket) (Specific) • Any person or organization that the Named Insured is obligated by virtue of a written contract or written • agreement to make an additional insured on this Coverage Part, provided such contract or agreement: ❑ Is currently in effect or becomes effective during the policy period; and D Was executed prior to: a. the "bodily injury," or"property damage"; or b. the offense that caused the "personal and advertising injury"; for which the additional insured seeks.coverage. Location(s) of Covered Operations: Any location in the "coverage territory" that is subject to the contract or agreement specified above. A. Section II—Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization shown in the Schedule is held liable for your acts or omissions arising out of your ongoing operations performed,for that insured. B. With respect to the insurance afforded to these additional insureds,the following additional exclusions apply: This insurance does not apply to"bodily injury" or"property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the location of the covered operations has been completed; or • 2. That portion of"your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing , operations for a principal as part of the same project. C. With respect to the insurance afforded to these additional insureds,this insurance also does not apply to "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. D. Primary and Noncontributory Insurance If so required by a written contract or written agreement, this insurance will be primary to, and will not seek contribution from, other insurance under which the additional insured is a named insured: But in all other CNA97587XX(4-2020) Policy No: C6984220140 Page 1 of 2 Effective Date: 4/7/2023 Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.used with permission. • 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: )\1.AhSOLE 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 V (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 V (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.** 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 willnot 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 construction,alteration,repair,improvement,moving or demolition of an improvement to real property or appurtenances thereto.** - W 2.5 (Sig tore of Authorized Signer) (Date) (Authorized Signer's Title) r *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. V BEST CHOICE CONTRACTOR PROGRAM CNA • Blanket Additional Insured - Owners, Lessees or Contractors instances, and notwithstanding anything to the contrary in the condition entitled Other Insurance, this insurance will be excess of any otherinsurance available to the additional insured. E. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended to add the following to the condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit: Any additional insured pursuant to this Coverage Part will, as soon as possible: 1. Give us written notice of any claim, or of any"occurrence" or offense that may result in a claim; 2. Send us copies of all legal papers received and otherwise cooperate with us in the investigation, defense or settlement of the claim; and 3. Make available any other insurance and tender the defense and indemnity of any claim to any other insurer or self-insurer whose policy or program applies to a,loss that we cover under this Coverage Part However, if the written contract requires this insurance to be primary and non-contributory,this paragraph 3. does not apply to insurance on which the additional insured is a named insured. • F. Solely with respect to the insurance granted by this endorsement: • 1. The words "you" and "your" refer to the Named Insured shown in the Declarations. 2. "Your work" means work or operations performed by you or on your behalf, and materials parts or equipment furnished in connection with such work or operations. G. Blanket Waiver of Subrogation We waive any right of recovery we may have against an entity that is an additional insured under the terms•of,- this endorsement with respect to payments we make for injury or damage arising out of"your work" done under a written contract or written agreement with that person or organization, provided such contract or agreement: 1. Requires such a waiver of our rights; 2. Is currently in effect or becomes effective during the policy period; and 3. Wasrexecuted prior the "bodily injury", "property damage" or"personal and advertising injury" that gave rise to the claim. • All other terms and conditions of the Policy remain unchanged. This endorsement,which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. • • CNA97587XX(4-2020) . Policy No: C6984220140 Page 2 of 2 • Effective Date: 4/7/2023 • Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.used with permission.