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HomeMy WebLinkAbout2023-168 PO 20240156- Cut N Break Construction Inc ply Purchase Order CITY RECORDER /M , Fiscal Year 2024 Page: 1 of: 1 B City of Ashland �Z �►1 ®lvl t ATTN: Accounts Payable. L 20 E. Main Purchase L Ashland, OR 97520 Order# 20240156 T Phone: 541/552-2010 O Email: payable@ashland.or.us V \ H C/O Facilities Maintenance Div E CUT N BREAK CONSTRUCTION INC I 90.North Mountain Ave N PO BOX 1455 p Ashland, OR 97520 MEDFORD, OR 97501 Phone: 541/488-5358 R T Fax: 541/552-2304 i70] 117:— (541) �� (541) 779-1482 Robert Halbritter r _Mritti �_ e-41i€a 10/11/2023 475_ _ FOB ASHLAND OR _ Ci Accounts Payable y� pp Concrete Services 1 Remove and replace concrete 1.0 $5,000.00 $5,000.00 Job site: 1295 Oak Street Goods and services Agreement($35,000 or less) Completion date: 06/30/2024 : Project Account: ***************GL SUMMARY*************** 088400-6024001 $5,000.00 • • By: 1; Date: 4. Aut`orized Signatur .�� _ 5 000.00 4:- ce- (2., , FORM #3 Oq CITY OF . A request for a Purchase Oro a ASHLAND REQUISITION , // Date of request: 10/4/23 - Required date for delivery: . Vendor Name Cut' N Break Construction Address,City,State,Zip PO Box 1455, Medford, OR 97501 Contact Name&Telephone Number Michelle Lawton,541-779-1482,concrete@cutnbreak.com Email address SOURCING METHOD ❑ Exempt from Competitive Bidding/ 0 Invitation to Bid ❑ Emergency ❑ Reason for exemption: Date approved by Council: ❑ Form#13,Written findings and Authorization ❑ AMC 2.50 —(Attach copy of council communication) ❑. Written quote or proposal attached ❑ Written.quote or proposal attached 1 If council a.•royal re.uired,attach co. 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) 0 State of Washington Date approved by Council: • Contract# (Attach copy of council communication) 0 Other government agency contract Intermediate Procurement — ""7cy • GOODS&SERVICES 'ract# Greater than$5,000 and less than$100,000 rnmental Agreement ❑ (3)Written bids and so_licitation attached PERSONAL SERVICES al cost to City does not exceed$25,000. Greater than$5,000 and less than$75,000 t approved by Legal and approved/signed by . ❑ Less than$35,000,by direct appointment iistrator.AMC 2.50.070(4) ❑, (3)Written proposals&solicitation attached ' ,al cost to City exceeds$25,000,Council O Form#4,Personal Services$5K to$75K ; equired.(Attach copy of council communication) i Description of SERVICES P:51"(k):1AA 0 r Total Cost Concrete services as needed FY24. A / I • $5 000100 Item # Quantity Unit / ... Unit Price Total Cost — ..... e0 i 0 Per attached quote/proposal TOTAL COST Project Number: _ _ _ Account Number: 088400-60240Q/" _ 5,000.00 *Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: IT Director Date Support-Yes/No By signing this requisitioi m,I -rtify that t - 's pub -.ontracting requirements have been satisfied. AllreEmployee: / -�W� _ , _ _ Department Head: (Equal to or greater than$5,000) Department Manager/Supervisor: City Manager: 0— ,- 23 (Greater han$35,000) Funds appropriated for current fiscal ye• / NO rVi / q� mance Director.: - ual to or greater than$5,000) ( rte! ( q Comments: • Form#3-Requisition F • GOODS AND SERVICES AGREEMENT ($35,000 OR LESS) PROVIDER: Cut 'N Break Construction CITY '0 F • PROVIDER'S -ASHLAND CONTACT: Travis Lawton 20 East Main Street Ashland, Oregon 97520 ADDRESS: PO Box 1'455 Telephone: 541/488-5587 Medford, OR 97501 Fax: 541/488-6006 PHONE: 541-779-1482 This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and Cut 'N Break Construction, (a domestic/foreign business corporation) ("hereinafter"Provider"), for concrete removal and replacement. 1. PROVIDER'S OBLIGATIONS 1.1 Provide concrete removal and replacement as needed for FY24 as set forth in the "SUPPORTING DOCUMENTS" attached hereto and, by this reference, incorporated herein. Provider expressly acknowledges that time is of the essence of any completion date set forth in the SUPPORTING DOCUMENTS, and that no waiver or extension of such deadline may be authorized except in the same - . manner as herein provided for authority to exceed the maximum compensation. The services defined and described in the "SUPPORTING DOCUMENTS" shall hereinafter be collectively referred to as "Work." • 1.2 Provider shall obtain and maintain during the term of this Agreement and until City's final acceptance of all Work received hereunder, a policy or policies of liability insurance including commercial general liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 (two million dollars)per occurrence for Bodily Injury and Property Damage. 1.2.1 The insurance required in this Article shall include the following coverages: • Comprehensive General or Commercial General Liability, including personal injury, contractual liability, and products/completed operations coverage; and • Automobile Liability. 1.2.2 Each policy of such insurance shall be on an "occurrence" and not "claims made" form, and shall: • Name as additional insured "the City of Ashland, Oregon, its officers, agents and employees" with respect to claims arising out of the provision of Work under this Agreement; • Apply to each named and additional named insured as though a separate policy had been issued to each,provided that the policy limits shall not be increased thereby; • Apply as primary coverage for each additional named insured except to the extent that two or more such policies are intended to "layer" coverage and, taken together, they provide total coverage from the first dollar of liability; • Provider shall immediately notify the City of any change in insurance coverage Page 1 of 6: Goods and Services Agreement between the City of Ashland and Cut N Break Construction • Provider shall supply an endorsement naming the City, its officers, employees and agents as additional insureds by the Effective Date of this Agreement; and • Be evidenced by a certificate or certificates of such insurance approved by the City. 1.3 Provider shall,at its own expense,maintain Worker's Compensation Insurance in compliance with ORS 656.017, which requires subject employers to provide workers' compensation coverage for all of its subject workers. 1.4 Provider agrees that no person shall, on the grounds of race, color, religion, creed, sex, marital status, familial status or domestic partnership, national origin, age, mental or physical disability, sexual orientation, gender identity or source of income, suffer discrimination in the performance of this Agreement when employed by Provider. Provider agrees to comply with all applicable requirements'of federal and state civil rights and rehabilitation statutes, rules and regulations. Further, Provider agrees not to discriminate against a disadvantaged business enterprise,minority-owned business,woman-owned business, a business that a service-disabled veteran owns or an emerging small business enterprise certified under ORS 200.055,in awarding subcontracts as required by ORS 279A.110. 1.5 In all solicitations either by competitive bidding or negotiation made by Provider for work to be performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Providers of the Provider's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. Living Wage Requirements: If the amount of this Agreement is $25,335.05 or more, Provider is required to comply with Chapter 3.12 of the Ashland Municipal Code by paying a living wage; as defined in that chapter, to all employees performing,Work under this Agreement and to any-Subcontractor who performs 50% or more of the Work under this Agreement. Provider is also required to post the notice attached hereto as "Exhibit A"predominantly in areas where it will be seen by all employees. 1.7 Assignment: Provider shall not assign this Agreement or subcontract any portion of the Work to be provided hereunder without the prior written consent of the City. Any attempted assignment or subcontract without written consent of the City shall be void. Provider shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all persons employed by them, and the approval by the City of any assignment or subcontract shall not create any contractual relation between the e assignee or subcontractor and the City. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider the hourly rates effective 8/30/23 as specified in the SUPPORTING DOCUMENTS. 2.2 In no event shall,Provider's total of all compensation and reimbursement under this Agreement exceed the sum of$5,000 (this is maximum, not to exceed amount of ENTIRE Agreement) without express, written approval from the City official whose signature appears below, or such official's successor in office. Provider expressly acknowledges that no other person has authority to order or authorize additional Work which would cause this maximum sum to be exceeded and that any authorization from the responsible official must be in writing. Provider further acknowledges that any Work delivered or expenses incurred without authorization as provided herein is done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement. Page 2 of 6: Goods and Services Agreement between the City of Ashland and Cut'N Break Construction • 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. 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 allclaims 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 arisingunder 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. r • 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 Page 3'of 6: Goods and Services Agreement between the City of Ashland and Cut'N Break Construction • Agreement in whole or in part. This paragraph does not affect or limit the City's rights, including its rights under the Uniform Commercial Code, ORS Chapter 72 (UCC). 3.13 Provider represents and warrants that the Goods are new, current, and fully warranted by the manufacturer. Delivered Goods will comply with SUPPORTING DOCUMENTS and be freefrom defects in labor, material and manufacture. Provider shall transfer all warranties to the City. 4. SUPPORTING DOCUMENTS 4.1 The.following documents are, by this reference, expressly incorporated in this Agreement, and are collectively referred to in this Agreement as the "SUPPORTING DOCUMENTS:" • The Provider's complete written Rate Sheet dated August 30, 2023. 4.2 This Agreement and the SUPPORTING DOCUMENTS shall be construed to be mutually complimentary and supplementary wherever possible. In the event of a conflict which cannot be so resolved, the provisions of this Agreement itself shall control over any conflicting provisions in any of the SUPPORTING DOCUMENTS. In the event of conflict between provisions of two of.the SUPPORTING DOCUMENTS,'the several supporting documents shall be given precedence in the order listed in Article 4.1.. 5. REMEDIES 5.1 In the event Provider is in default of this Agreement, City may, at its option, pursue any or all of the remedies available to it under this Agreement and at law or in equity, including, but not'limited to: 5.1.1 Termination of this Agreement; . 5:1.2 Withholding all monies due for the Work that Provider has failed to deliver within any scheduled completion dates or any Work that have been delivered inadequately or defectively; 5.1.3 Initiation of an action or proceeding for damages, specific performance, or declaratory or injunctive relief; 5.1.4 These remedies are cumulative to the extent the remedies are not inconsistent,and City may pursue any remedy or remedies singly, collectively, successively or in any order whatsoever. • 5.2 In no event shall City be liable to Provider for any expenses related to termination of this Agreement or for anticipated profits. If previous amounts paid to Provider exceed the amount due, Provider shall pay immediately any excess.to City upon written demand provided. 6. TERM AND TERMINATION 6.1 Term This Agreement shall be effective from the date of execution on behalf of the City as set forth below (the "Effective Date"), and shall continue in full force and effect until June 30, 2024, unless sooner terminated as provided in Subsection 6.2. 6.2 Termination ' 6.2.1 The City and Provider may terminate this Agreement by mutual agreement at any time. 6.2.2 The City may, upon not less than thirty (30) days' prior written notice, terminate this Agreement for any reason deemed appropriate in its sole discretion. 6.2.3 Either party may terminate this Agreement, with cause, by not less than fourteen (14) days' prior written notice if the cause is not cured within that fourteen (14) day period after written notice. Such termination is in addition to and not in lieu of any other remedy at law or equity. 7. NOTICE Page 4 of 6: Goods and Services Agreement between the City of Ashland and Cut'N Break Construction • . by mailing using registered or certified United States mail, return receipt requested, postage prepaid, to the • address set forth below: - • • If to the City: • City of Ashland—Facilities Maintenance Department • Attn: David Arnold . 20 E. Main Street • • Ashland, Oregon 97520 Phone: (541) 552-2292 • • With a copy to: • :_ • City of Ashland—Legal Department • 20 E. Main Street . • Ashland, OR 97520 Phone: (541)488-5350 • If to Provider: • Cut 'N Break Construction • PO Box 1455 • • 'Medford, OR 97501 . 541-779-1482 • concrete@cutnbreak.com 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 National Fire Fighter Corp • • 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: Cut'N Break Construction (PROVIDER): By. + I I By. • Signature Scott ���� 4 4 Printed Name • Printed Name • I Title I Title t0. -- 2— Date Date • (W-9,is to be submitted with this signed Agreement) . Purchase Order No. ®• • • • • • • • • Page 6 of 6: Goods and Services Agreement between the City of Ashland and National Fire Fighter Corp CUT 'N BREAK CONSTRUCTION INC. P.O. Box 1455 Medford, OR 97501-0108 CCB License #72046 541-779-1482/FAX 541-772-1913 John Lawton, President August 30, 2023 City of Ashland . Att: Dave 541-951-0292 David.arnold@ashland.or.us Job Site: 1295 Oak St Ashland This proposal is to remove and replace concrete as discussed. • 2- 8"deep x 4'3"wide steps ❖ Chainsaw concrete ❖ Remove damaged concrete • ❖ Install#3 rebar dowels drilled into existing concrete ••• Install forms ❖ Place and broom finish 4000 psi concrete EQUIPMENT,MATERIAL,AND LABOR: $2,750.00 When saw cutting, Cut 'N Break Construction, Inc. is not responsible for anydamage to anything in or below the concrete. This includes water lines, electrical line, sprinkler systems, etc. Your signature indicates that you have read this notice and fully understand the limits of Cut'N Break Construction,Inc. responsibility. Billing and Payment Procedures: Invoices are presented on completion of work. Invoices are due and payable upon receipt. Delinquent invoices are subject to 1 1/2% monthly on unpaid balance. We accept Visa and MasterCard for your convenience. Should you have any questions or need any additional information regarding the above proposal please do not hesitate to contact this office. . THIS ESTIMATE IS GOOD FOR 30 DAYS! Signing one copy of this letter and returning it in the enclosed envelope indicates acceptance of this proposal. Thank you, Travis Lawton Superintendent • ACCEPTED By: Date: • THIS ESTIMATE IS GOOD FOR 30 DAYS! • www.saif.com . ■ • • SaIrwork. • Life. Oregon. Oregon Workers' Compensation Certificate of Insurance Certificate holder: • CITY OF ASHLAND ATTN: PUBLIC WORKS DEPT. 20 EAST MAIN STREET • ASHLAND, OR 97520 • • The policy of insurance listed below has been issued to the insured named below for the policy period indicated.The insurance afforded by this policy is subject to all the terms,exclusions and conditions of such policy; this policy is subject to change or cancellation at any time. Insured Producer/contact Cut'N Break Construction Inc Brown&Brown of Oregon LLC PO Box 1455 Shantal Young Medford, Or 97501-0108 541.494.2673 shantal.young@bbrown.com Issued 10/02/2023 Limits of liability Policy 489003 Bodily Injury by Accident $1,000,000 each accident Period 10/01/2023 to 10/01/2024 Bodily Injury by Disease $1,000,000 each employee Body Injury by Disease $1,000,000 policy limit Description of operations/locations/special items Important This certificate is issued as a matter of information only and confers no rights to the certificate holder.This certificate does not amend,extend or alter the coverage afforded by the policies above.This certificate does not constitute a contract between the issuing insurer,authorized representative or producer and the certificate holder. Authorized representative CAt- Chip Terhune President and CEO • • • r • 400 High Street SE • Salem,OR 97312 P:800.285.8525 Policy_OLCA_CertiricateOflnsurance F:503.584.9812 • • ACO DATE(MM/DD/YYYY) • �;,,,_..'' CERTIFICATE OF LIABILITY INSURANCE 10/03/2023 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, subjectto 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 iii lieu of such endorsement(s). PRODUCER • NAME OT CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY PHONE FAX HOME OFFICE:P.O.BOX 328 (A/C,No,Ext):888-333-4949 (A/C,No):507-446-4664 OWATONNA,MN 55060 ADDREss:CLIENTCONTACTCENTER(O]FEDINS.COM • INSURERS AFFORDING COVERAGE. NAIC(I INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 171-997-0 INSURER B: CUT'N BREAK CONSTRUCTION,INC. INSURER C: POBOX 1455 MEDFORD,OR 97501-0108 INSURER o: INSURER El , • INSURER F: COVERAGES CERTIFICATE NUMBER:177 REVISION NUMBER:0 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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��gBY PAID CLAIMS. pp���� yy yQ�� IS�t TYPE OF INSURANCE INSDL WWR POLICY NUMBER IMM/pDIYYYYI 1MMIODIYYYYI - LIMITS X COMMERCIAL GENERAL UABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE nOCCUR1AMD DLAGE TO RENTED PREMISES $100,000 _ MEDEXP(My�one person) EXCLUDED A Y N 9829854 04/13/2023 04/13/2024 PERSONAL&ADV INJURY $1,000,000 �GENL AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $2,000,000 . —X1 POLICY PRO.JECT LOC PRODUCTS 8 COMP/OP AGO $2,000,000 OTHER: • AUTOMOBILE UABIUTY fOMNDBINDLE LIMIT $1,000,000 X ANY AUTO _ BODILY INJURY(Per Person) • A _OWNED AUTOS ONLY_SCHAUTEDULED Y N 9829854 04/13/2023 04/13/2024 BODILY INJURY(Per A¢1denf _ HIRED AUTOS ONLY AON�ONED rPor ROPEAccidmi)RTY DAMAGE • X UMBRELLA LAB X OCCUR EACH OCCURRENCE $4,000,000 A EXCESS LIAB CLAIMS-MADE Y N 9829855 04/13/2023 04/13/2024 AGGREGATE $4,000,000 • DED I (RETENTION WORKERS COMPENSATION PER STATUTE OTHER AND EMPLOYERS'LIABILITY YIN - ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT OFFICERIMEMBER EXCLUDED? N/A , (Mandatory In NH) EL DISEASE CA EMPLOYEE IT yes,describe Hider DESCRIPTION OF OPERATIONS below E.L DISEASE•POUCY UMIT • • • • DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Addition!Remarks Schedule,may be attached if more space is required) SEE ATTACHED PAGE • • CERTIFICATE HOLDER CANCELLATION 171-997-0 177 0 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED CITY OF ASHLAND 20 E MAIN ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ASHLAND,OR 97520-1814 ACCORDANCE WITH THE POLICY PROVISIONS, • AUTHORIZED REPRESENTATIVE e „ u. ` • • • • O 1988-2015 ACORD CORPORATION.AH rights reserved. • ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID:171-997-0 AcGPREP LOC#: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED FEDERATED MUTUAL INSURANCE COMPANY CUT'N BREAK CONSTRUCTION,INC. PO BOX 1455 POLICY NUMBER - - MEDFORD,OR 97501-0108 SEE CERTIFICATE#177.0 CARRIER NAIC CODE EFFECTIVE DATE:SEE CERTIFICATE#177.0 SEE CERTIFICATE#177.0 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: . 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE ADDITIONAL INSURED ALSO INCLUDES: THE CITY OF ASHLAND, ITS OFFICERS, EMPLOYEES AND AGENTS THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT ENDORSEMENT FOR BUSINESS AUTO LIABILITY. INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. INSURANCE PROVIDED BY THE BUSINESS AUTO LIABILITY IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. COMMERCIAL UMBRELLA FOLLOWS FORM ACCORDING TO THE TERMS, CONDITIONS, AND ENDORSEMENTS FOUND IN THE COMMERCIAL UMBRELLA POLICY. FOR REASONS OTHER THAN NON-PAYMENT OF PREMIUM, 30 DAYS NOTICE WILL BE PROVIDED TO THE CERTIFICATE HOLDER IN THE . EVENT THAT THE ISSUING COMPANY CANCELS THE POLICY BEFORE THE EXPIRATION DATE OF THE POLICY. 1 • • • • 1 • ACORD 101(2008/01) O 2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO CA 04 49 11 16• . THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • • PRIMARY AND NONCONTRIBUTORY • OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: • AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. The following is added to the Other Insurance B. The following is added to the Other Insurance Condition in the Business Auto Coverage Form Condition in the Auto Dealers Coverage Form and and the Other Insurance - Primary And Excess supersedes any provision to the contrary: Insurance Provisions in the Motor Carrier This Coverage Form's Covered Autos Liability • Coverage Form and supersedes any provision to Coverage, and General Liability Coverages are the contrary: primary toandwill not seek contribution from any This Coverage Form's Covered Autos Liability other insurance available to an "insured". under Coverage is primary ' to and will not seek your policy provided that: contribution from any other insurance available to 1. Such "insured" is a Named Insured under an "insured" under your policy provided that: such other insurance; and 1. Such "insured" is a Named Insured under 2.• You have agreed in writing in a contract or such other insurance; and agreement that this insurance would be 2. You have agreed in writing in a contract or primary and would not seek contribution from any other insurance available to such agreement that this insurance would be "insured". primary and would not.seek contribution from any 'other insurance 'available to such "insured". ' CA 04 49 11 16 - © Insurance Seivices Office, Inc., 2016 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. WHO IS AN INSURED for"bodily injury" and "property damage" liability is amended to include: Any person or organization other than a joint venture, for which you have agreed by written contract to procure bodily injury or property damage "auto" liability insurance arising out of operation of a covered "auto"with your permission. However, this additional insurance does not apply to: (1) The owner or anyone else from whom you hire or borrow a covered "auto". This exception does not apply if the covered "auto" is a "trailer"connected to a covered "auto"you own. (2) Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household. (3) Someone using a covered "auto" while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours. (4) Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees", while moving property to or from a covered "auto". (5) A partner (if you are a partnership), or a member. (if you are a limited liability company) for a covered "auto"owned by him or her or a member of his or her,household. B. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached. In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any insured, or to procure insurance. C. The limits of insurance applicable to such insurance shall be the lesser 'of the limits required by the agreement between the parties, or the limits provided by this policy. D. Additional exclusions. The insurance afforded to any person or organization as an insured under this endorsement does not apply: 1. To "loss"which occurs prior to the date of your contract with such person or organization; 2. To "loss" arising out of the sole negligence of any person or organization that would not 'be an insured except for this endorsement. 3. To "loss" for any leased or rented "auto" when the lessor or his or her agent takes possession of the leased or rented "auto"or the policy period ends, whichever occurs first. Includes copyrighted material of Insurance Services Office, Inc. with its permission. CA-F-127 (03-03) Policy Number: 9829854 Transaction Effective Date:04/13/2023 • , COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract Condition and supersedes any provision to the or agreement that this insurance would be contrary: primary and would pot seek contribution. Primary And Noncontributory Insurance from any other insurance available to the This insurance is primary to and will not seek additional insured. contribution from any.other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and- V • • © Insurance Services Office, Inc., 2018 Page 1 of 1 CG 20 01 12 19 Policy Number: 9829854 Transaction Effective Date: 04/13/2023 COMMERCIAL GENERAL LIABILITY CG 20 33 12 19 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED_- OWNERS, LESSEES OR CONTRACTORS. - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION • AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: • • COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or additional insureds, the following additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to: organization have agreed in.writing in a contract 1. "Bodilyg • or agreement that such person or organization be injury",ry , property damage" or "personal and advertising injury" arising out added as an additional insured on your policy. Such person or organization is an additional . of the rendering of, or the failure to render, insured only with respect to liability for "bodily • any professional architectural, engineering or surveying services, including: injury", "property damage" or "personal and advertising injury" caused, in whole or in part,.by: a. The preparing, approving, or failing to 1. Your acts or omissions; or prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, 2. The acts or omissions of those acting on your change orders or drawings and behalf; • specifications; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. However, the insurance afforded to i such This exclusion applieseven if the claims additional insured: against any insured allege negligence or other 1. Only applies to the extent permitted by law; wrongdoing in the supervision, hiring, and employment, training or monitoring of others 2. Will not be broader than that which you are by that insured, if the "occurrence" which required by the contract or agreement to caused the "bodily injury" or "property provide for such additional insured. damage", or the offense which caused the A person's or organization's status as an "personal and advertising injury", involved the additional insured under this endorsement ends rendering of or the failure to render any when your operations for that additional insured professional architectural, engineering or are completed. surveying services. • © Insurance Services Office, Inc., 2018 _ Page 1 of 2 CG 20 33 12 19 Policy Number: 9829854 Transaction Effective Date:04/13/2023 , ► 2. "Bodily injury"• or "property damage" C. With respect to the insurance afforded to these occurring after: additional insureds, the following is added to a. Allwork, including materials, parts or Section III - Limits Of Insurance: equipment furnished in connection with ' The most we will pay on behalf of the additional such work, on the project (other than insured is the amount of insurance: service, maintenance or repairs) to be 1. Required by the contract or agreement you performed by or on behalf of the additional have entered into with the additional insured; insured(s) at the location of the covered or operations has been completed; or 2: Available under the applicable limits of b. That portion of "your work" out of which insurance; the injury or damage arises has been put to its intended use by any person or whichever is less. organization other than another contractor This endorsement shall not increase ' the or subcontractor engaged in performing applicable limits of insurance. operations for a principal as a part of the same project. • J • • • • • Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 33 12 19 Policy Number: 9829854 Transaction Effective Date:04/13/2023