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HomeMy WebLinkAbout2022-130 PO 20220313- Pacific Power Group prfAl Purchase Order '� � f' id Fiscal Year 2022 Page: 1 of: 1� — B City of Ashland v sir l.10 IS ,_-1 -. _ L ATTN: Accounts Payable Purchase L 20 E. Main 20220313 Ashland, OR 97520 Order# T Phone: 541/552-2010 O Email: payable@ashland.or.us V PACIFIC POWER GROUP, LLC H C/O Fleet/Shop Division E ATTN: ACCOUNTS RECEIVABLE 1 90 North Mountain Ave N PO BOX 748720 P Ashland, OR 97520 RLOS ANGELES, CA 90074-8720 Phone: 541/488-5358 Email: REMITTANCE@PAC-POWER.COM O Fax: 541/552-2304 /: .6 a"4.01 5®t cZ. Xi; s � lN,H a j 6 13 ti---Tr. B st lE` ti : O l -� (541) 779-4622 ��h-__ £— _ _ Hoadley _._. - s c[]. 6Ia s -E:1 §I 1E� -5r I €ei=aul 4.71-. ��. �€ t=e.@ e � Wes _ _P- -0,..--4-73;-:-w_-:_-- – . _be - _ 04/11/2022 193 FOB ASHLAND OR City Accounts Payable - R On-call Generator Repairs 1 On-call Generator Repairs 1.0 $20,000.00 $20,000.00 Goods &Services Agreement Completion date: June 30, 2022 Project Account: *******,t**,k****GL SUMMARY*************** 086500-602223 $20,000.00 L.".,..1_.;--4?,,: °<7-17-- 2) . - � z 9 ,yc_-vim sr� By: Date: _ Authorized 'ature ,_ - ,_{ _. .20 000.00 R FORM #3 CITY OF • A request for a Purchase _ f._ _ 7___ 3(3 . ASHLAND REQUISITION Date of request: 7/30/21 • Required date for delivery: Vendor Name Pacific Power Group ' Address,City,State,Zip 6200 South 6th Way, Ridgefield,WA 98642 Contact Name&Telephone Number Mike Bourn 360-635-8850 mbourn aa..pacificpowergroup.com - Email address SOURCING METHOD ❑ Exempt from Competitive Bidding 0 Emergency • ❑ Reason for exemption: .❑ Invitation to Bid • 0 Form#13,Written findings and Authorization . ❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached ❑ Written quote or proposal attached . (Attach copy of council communication) _(If council approval required,attach copy of CC) O 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# O Verbal/Written quote(s)or proposal(s) 0 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 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 quotes and solicitation attached 0 Form#4,Personal Services>$5K&<$75K .Agency . PERSONAL SERVICES ® Special Procurement 0 Annual cost to City does not exceed$25,000. Greater than$5,000 and less than$75,000 ® Form#9,Request for Approval Agreement approved by Legal and approved/signed by O Direct appointment not to exceed$35,000 ® Written quote or proposal attached . City Administrator.AMC 2.50.070(4) ' O (3)Written proposals/written solicitation Date approved by Council: June 7,2016 0 Annual cost to City exceeds$25,000,Council O Form#4,Personal Services>$5K&<$75K Valid until: June 30,2023 approval required.(Attach copy of council communication) Description of SERVICES Total Cost FY22 Generator Repairs as needed $20,000.00 ' Item # Quantity Unit Description of MATERIALS Unit Price Total Cost O Per attached quotelproposalTOTAL COST • . $ Project Number_ _ _ _ _ _-_ _ _ Account Number 086500-602223 *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 requisi'on rm,I certify t the•City's public contracting requirements have been satisfied. ee: Em to Department Head: '{(7(2L Employee: N 0 or greater than$5,000) • Department Manager/Supervisor. City Administrator: (Equal to or greater than$25,000) Funds appropriated for current fiscal year: / NO (1) - �1/—!�7�, DeFinanceDirector (Equal to or greater than$5,000) Dale Comments: ' . • . Form#3-Requisition ' • GOODS& SERVICES AGREEMENT • PROVIDER: Pacific Power Group CITY OF PROVIDER'S ASH LAN D CONTACT: Mike Bourn 20 East Main Street Ashland, Oregon 97520 ADDRESS: 6200 South 6th Way Telephone: 541/488-5587 Ridgefield, WA 98642 Fax: 541/488-6006 PHONE: 360-635-8850 This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and Pacific Power'Group, a domestic business corporation("hereinafter"Provider"), for generator maintenance,testing and repair. 1. PROVIDER'S OBLIGATIONS 1.1 Provide generator maintenance, testing and repair for FY22 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 goods and 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 the extent that two or more such policies are intended to "layer" coverage and, taken together, they provide total coverage from the first dollar of liability; • Provider shall immediately notify the City of any change in insurance coverage • Provider shall supply an endorsement naming the City, its officers, employees and agents as additional insureds by the Effective Date of this Agreement; and • Be evidenced by a certificate or certificates of such insurance approved by the City. 1.3 All subject employers working under this Agreement are either employers that will comply with ORS 656.017 or employers that are exempt under ORS 656.126. 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 applicablerequirements 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 VIOf the Civil Rights Act of 1964 and other federal nondiscrimination laws. 2. CITY'S OBLIGATIONS V 2.1 City shall pay Provider for its Work at the hourly rates and charges as set forth in Exhibit"X", entitled "Rate Sheet,"which is attached hereto and incorporated herein by this reference,'as full compensation for Provider's performance of all'Work under this Agreement. ' ' 2.2' In no event shall Provider's total of all compensation and reimbursement-under this Agreement exceed the sum of$20,000 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. . 3. GENERAL PROVISIONS 3.1 This is a non-exclusive Agreement. City isnot 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 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, whetherwritten or oral. V V 3.5 This Agreement may be amended only.by.written instrument executed with the same formalities as this Agreement 3.6 V The following laws of the State'of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220, 279B.230 and 2798235. 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, suchprovision 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. 4. SUPPORTING DOCUMENTS 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 June 14, 2021 5. REMEDIES 0 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; 0 5.1.2 Withholdingall 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 exceedthe 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, 2022, unless sooner terminated as provided in.Subsection 6.2. • • 6.2 Termination 6.2.1 The City and Provider may terminate this Agreementby mutual agreement at any time. 6.22 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 periodafter written.notice. Such termination is in addition to and not in lieu=of any other remedy at law or equity. 7.. NOTICE Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery,by sending via a reputable commercialovernight 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—Fleet Department Attn: Wes Hoadley 90 North Mountain Avenue Ashland, Oregon 97520 Phone: (541)552-2355 With a copy to: City of Ashland—Legal Department 20 E.Main Street Ashland,OR 97520 Phone: (541)488-5350 If to Provider: Pacific Power Group Attn: Mike Bourn 6200 South 6th Way Ridgefield,WA 98642 ` 360-635-8850 • . 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 apolitical subdivision of the State of Oregon applicable to Provider; and . (iii) . Any rules, regulations, charter provisions, or ordinances that implenient or enforce any of the foregoing tax laws or provisions. • 9.1.2 Provider, for a period of no fewer than six(6) calendar years preceding the Effective Date of this Agreement, has faithfully complied with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of,Oregon applicable to Provider; and (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of. the foregoing tax laws or provisions. 9.2 Provider's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any• political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Provider's warranty, as-set forth in this Article 9, shall constitute a material breach of this Agreement. Any material breach of this Agreement shall entitle the City to terminate this Agreement and toseek 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: Pacific Power Group (PROVIDER): By: ��� '' By:7/,,,e? • TO Signature INa'cr" q'ccu c Michael D. Bourn Printed Name Printed Name . u&c._... Senior Business Development Manager Title Title 4 112.2_ 6/15/2021 . Date Date • . (W-9 is to be submitted with this signed Agreement), Purchase Order No. " (c0 /171 . PACIFIC '' POWER GROUP June 14, 2021 City of Ashland • Attention: Nicole Graham 0 •`,; Fleet Services/ Facilities Maintenance \ 90 North Mountain Avenue ,\ 1 Ashland, OR 97520 \ Re: Generator Service Rates,July 1, 2021—June 30, 2022 Hello Nicole, Pacific Power Group's current rates for generator services are detailed below: • Posted labor rate for call outs and repair services: $145.00 per hour dayshift, \\\ Monday through Friday 8:00am to 5:00pm. o Overtime is billed at 1.5x dayshift • Discounted labor rate for scheduled maintenance services: $135.00 per hour , dayshift, Monday through Friday 8:00am to 5:00pm. o Overtime is billed,at 1.5x dayshift • Travel: Applicable labor rate, and$2.75 per mile. ° , o Travel is invoiced round trip, portal-to-portal from our shop location for • call outs and repair services, and one-way for scheduled maintenance services Scheduled services (Annual PM Services, Load Bank Testing, etc.) are typically quoted specific to the equipment and invoiced at a flat rate per the quoted price. A price } quote for scheduled services on your power generation equipment can be provided upon request. 0 • • 6100 South 6th Way I Ridgefield,WA 98642 ' 0 On-Highway Q Power Generation 0 Marine ©'Industrial Engines /�f/� PACIFIC POWER GROUP Pacific employs journeyman level technicians in the major population centers in which we operate. Oregon operations are managed and overseen from our primary service hub in Ridgefield, WA. i;, • • We appreciate City of Ashland's continued business with Pacific. Please don't hesitate �t • to contact me for any additional information or assistance. We look forward to serving you again soon. Best regards, • Michael D. Bourn Sr. Business Development Manager Ph: 360-635-8850 i;, Email: mbourn@pacificpowergroup.com a Encl: Contact List, W-9, Insurance Request Form {y • • • • 6100 South 6th Way I Ridgefield,WA 98642 On-Highway 0 Power Generation 0 Marine 0 Industrial Engines ACo . , CERTIFICATE OF LIABILITY INSURANCE °ATE`MMIDDIYYYY) L..------ 6/15/2021 • THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder-is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Melody Kirkendall • Durham and Bates Insurance PHONE FAX 720 SW Washington St. (A/C.No.Ext):503-241-0154 (A/c,No):503-542-0625 Ste 250 ° ADDRess: melodyk@dbates.com Portland OR 97205-3554 • INSURER(S)AFFORDING COVERAGE r NAIC# INSURER A:Federal Insurance Co. 20281 INSURED • - INSURER B:Great Northern Ins Co . 20303 Yaculta Companies Inc.; Pacific Power Group, LLC; . Southwest Products Corporation ' • INSURER C: . • 805 Broadway St. Suite 700 INSURER D: Vancouver WA 98660 INSURER E: • INSURER F: , COVERAGES CERTIFICATE NUMBER:1148540015 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 TR TYPE OF INSURANCE ANSA SUBR POLICY NUMBER /YPOLICY EFF POLICY EXP LIMITS . (MMIDDYYY) (MMIDDIYYYY) B X COMMERCIAL GENERAL LIABILITY Y 36048941 5/1/2021 5/1/2022 EACH OCCURRENCE $1,000,000 • DAMAGE RETED CLAIMS-MADE X OCCUR PREM SESO(Ea occur ence)• $1,000,000' _ _ MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X Tai LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: Stop Gap Liability $1,000,000 A AUTOMOBILE LIABILITY 73597757 5/1/2021 5/1/2022 COMBINED SINGLE LIMIT $1,000,000 • A 73597759-HI 5/1/2021 5/1/2022 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ L OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY ,� AUTOS ONLY - (Per accident) $ - A X UMBRELLA LIAB X OCCUR 78185143 5/1/2021 5/1/2022 EACH OCCURRENCE $1.0,000,000 EXCESS LIAB CLAIMS-MADE - AGGREGATE $10,000,000 DED RETENTION$ $ A WORKERS COMPENSATION 71756056 5/1/2021 5/1/2022 . X PER OTH • - AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVEN N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED7 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) The City of Ashland,Oregon,its officers,agents and employees are Additional Insured on a primary basis as respects General Liability per form 80-02-2367 attached. CERTIFICATE HOLDER CANCELLATION ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. , . City of Ashland ' 20 East Main Street • Ashland OR 97520 AUTH•RIZED REPRESENTATIVE 11 I //r ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • AGENCY CUSTOMER ID: LOC#:• ACOREP• ADDITIONAL REMARKS SCHEDULE .Page 1 of AGENCY • NAMED INSURED Main Office Pacific Power Products Holdings Inc.; Pacific Power Group LLC; Southwest Products Corporation • POLICY NUMBER 805 Broadway St,Suite 700 Vancouver WA 98660 CARRIER NAIC CODE EFFECTIVE DATE: • ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM.TITLE: CERTIFICATE OF LIABILITY INSURANCE • Pacific Power Products Holdings Inc. • Pacific Power Group LLC Pacific Power Products Managements LLC Southwest Products Corporation Pacific Detroit Realty LLC Southwest Products Realty, LLC • Pacific Power Products Profit Sharing&401(K)Plan • Hanco Industrial Engines Pacific Detroit Diesel-Allison • Pacific Power Generation Pacific Power Products Company Pacific Power Rentals Perkins Pacific Pacific Marine Power Pacific Engine Works Pacific Reman Center • Pacific Power Group Pacific Power Management Solutions Pacific Power Products Group Pkenergy Solutions • Pacific Power Products Company LLC • Pkenergy Solutions, LLC • NMT Diesel, Inc. Northtrends TDS Inc Cascade Turf Farwest Golf • Pacific Truck Performance Power Products Machine Pacific Detroit Diesel Allison Inc Profit Sharing Southwest Products Corporation dba Southwest Products OWP Engines • • • • • • • • • • • ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks.of ACORD • • CHUBBLiability Insurance • • Endorsement Policy Period MAY 1,2021 TO MAY 1,2022 • Effective Date MAY 1,2021 Policy Number 3604-89-41 PTL Insured YACULTA COMPANIES INC. Name of Company GREAT NORTHERN INSURANCE COMPANY Date Issued • This Endorsement applies to the following forms: GENERAL LIABILITY • Under Who Is An Insured,the following provision is added. Who Is An Insured . Additional Insured- Persons or organizations shown in the Schedule are insureds;but they are insureds only if you are Scheduled Person obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by Or Organization this policy. However,the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded • status as an insured; • for activities that did not occur,in whole or in part,before the execution of the contract or • agreement;and • with respect to cianinges,loss,cost or expense for injury or darTinge to which this insurance applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section(regardless of any limitation applicable thereto). • with respect to any assumption of liability(of another person or organization)by them in a contract or agreement.This limitation does not apply to the liability for ciamages,loss,cost or - expense for injury or damage,to which this insurance applies,that the person or organization would have in the absence of such contract or agreement. • • ^ • Liability Insurance Additional Insured-Scheduled Person Or Organization continued Form 80-02-2367(Rev.5-07) Endorsement ' Page 1 • CHUBBm L r • Liability Endorsement (continued) • Under Conditions,the following provision is added to the condition titled Other Insurance. Conditions • Other Insurance— ff you are obligated,pursuant to a contract or agreement,to provide the person or organization Primary,Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy,then in such case Insurance—Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. . . Schedule Persons or organizations that you are obligated,pursuant to a contract or agreement,to provide with such,insurance as is afforded by this policy. • • • • All other terms and conditions remain unchanged • Authorized Representative (—) �� • • • • • • • • • liability Insurance Additional insured Scheduled Person Or Organization \, : last page Form 80,02-2357(Rev.5-07) Endorsement / Page 2