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2022-146 PO 20230018- Pacific Crane Certification Co.
Purchase Order RAI CITE�`�; ` Fiscal Year 2023 Page: 1 of: 1 B City of Ashland _ - _r L ATTN: Accounts Payable20 E. Main Purchase L Ashland, OR 97520 Order*; 20230018 T Phone: 541/552-2010 a • . 0 Email: payable@ashland.or.us • V H C/O Fleet/Shop Division E PACIFIC CRANE CERTIFICATION CO I 90 North Mountain Ave N 1394 DENTON WAY c p Ashland, OR 97520 O REDDING, CA 96002 Phone: 541/488-5358 R O Fax: 541/552-2304 81i )a 11 lll[I� f._e._ _ x.. _[ll*sT 6 .uts 9 'aS nal 1v A .@� {eslt 7 u c t -_ c _ _ WesHoadle Dafa4t i —t� J ate qui =T= ' _ ' `f te- �.�'E - � �$ I y �i ®.t t[. 05/27/2022 6469. FOB ASHLAND OR/NET30 City Accounts Payable _ Crane Inspections FY 23 1 Crane Inspections FY 23 1.0 . $5,000.00 $5,000.00 Goods and Services Agreement($35,000 or Less) Completion date: June 30, 2023 Project Account: ***************GL SUMMARY*************** I 086500-602223- $5,000.00 • • -OM1 - By: JR/ Date: 9' n = - Atorizevr }ate _ natureE' � •5 000.00 v t � • FORM #3 • CITY OF ASHLAND A request for a Purchase 0.cl,i, 4 0 ,- d 504 (e . REQUISITION Date of request: • 17/2022 • Required date for delive : • Vendor Name Pacific Crane Certification l r iG i i Address,City,State,Zip 1394 Denton Way, Redding. CA 96002 i.' ,� Contact Name&Telephone Number �� /' '' Email address Glee Wilder 530-226-1902 wjmorgan(a�aol.com 4 I/YY 0-- • SOURCING METHOD t ( 1 1, 40 Exempt from Competitive Bidding ❑ Invitation to Bid ❑ Emergency • ' ❑ Reason for exemption: Dateapproved by Council: ❑ Form#13,Written findings and A tho 'zation P.,', ❑ AMC 2.50 _(Attach copy of council communication) 0 Written quote or proposal attache.' ❑ Written quote or proposal attached (If council approval required,attach cop,o 'C) ® 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 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 0 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 0 Less than$35,000,by direct appointment 0 Special Procurement City Administrator.AMC 2.50.070(4) ❑ (3)Written proposals&solicitation attached 0 Form#9,Request for Approval 0 Annual cost to City exceeds$25,000,Council ❑ Form#4,Personal Services$5K to$75K 0 Written quote or proposal attached approval required.(Attach copy of council communication) Date approved by Council:. Valid until: Description of SERVICES • Total Cost Crane inspections for FY23 $ 5,000.00 Item# Quantity Unit Description of MATERIALS Unit Price Total Cost . $ 0 $0.00 • . $ 0 $0.00 • . $ 0 $0.00 ❑ Per attached quote/proposal • ' TOTAL COST $$0.00 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 requisition f rm,I certi hat the City's public contracting requirements have been satisfied. Employee: l/`� eS Department Head: og (ts(Lc"- • o or greater than$5,000) • Department Manager/Supervisor: City Manager: (Greater than$35,000) Funds appropriated for current fiscal yea r / NO d1/1,1 —7—?z_. Finance Director-(Eorgreaterthan$5,000) Date • Comments: ' \ Fnrtn$4-Roni iicitinn • c‘c • ovi,asocz, = PACIFIC CRANE CERTIFICATION0. • 47' *04, m • 1394 DENTON WAY,REDDING,CA 96002-3621 f. 4'; • OFFICE(S30)S10-1100 MOBILE(S30)941-2772 Aft•A • Nc.e)95" , . April 1.2,2022 Nicole Graham City of Ashland • 90 North Mountain Avenue Ashland,OR 97520 • • Good Afternoon Nicole, Please find attached the estimate of cost of services for the 2022-23 contract year. You will see that our price per Annual Inspections and Certifications remain unchanged from our 2021 Estimate. Total cost of inspections will of course depend on more or fewer units but the cost per specific type of unit remains unchanged. Please let me know if you have questions or comments. Sincerely, • •144F'ff • William J.Morgan V V • Owner,Pacific Crane Certification Co. • • State/FED OSHA Crane Inspections Crane Inspections,CeitlficatIon certificates,Operator training,Dielectric surveys • • • • ss .. reshBoaks- Estimeta E1349 4112J22,11 22 A14 • • • GPacific Cyano Codification 1394 Denton Way 530 510 1100 Rodding,California ., � '9 96002-3621 u y , - United States 'ti ,., , . JT1 • CERTIFICATION . F'reta arece For Ustinito Dato Estimato Number Wes Hoadley 0412/2022 E1349 City of Ashland 90 N.Mountain Avenue Ashland,Oregon • 97520 United Statos • Description F-ato Qty t irto oat Annual Certific tion $42.83 1 $42.83 Unit 1-Aadhine Shop{at Fleet Shop) Annual Certification $85.65 1 $85.65 • Unit 2-tutxtation Room(at Root Shop) Annual Codification $342.61 1 $342.61 . Unit 3-Main Ma ntonarbco Bay(at Moot Shop) • Annual Certification $513.92 1 $513.92 Unit 4-Vieding Shop(at Fleet Shop) • • Annual Certification $342.61 1 $342.61 Unit S--ecrtai Supply Storage(at Fleet Shop) Annual Certification $513.92 1 $513.92 • Unit 7-PowerhOzo(at Roodcr Gulch) Annual Certification • • $1.027.84 1 $1,027.84 Unit 8•RASJWAS Building(W.W.T.P.) . Annual Certification $128.48 1 $128.48 htgx.fjrny.teeshboolts,comjajsxsrmarapJrzr-362499 Pagel of 2 `f96hB00k6-Estirnata E134D 412,x22,11:22 ASI Unit 9-Roadworks s Bulldog(W W.T,P) Annual Cortifioation, $171.31 1 $171.31 Lint 10-Chemical Room(at Reeder Gulch) • Annual Certification $342.61 1 $342.61 Unit 11-Melnarane Filtration Building(W.W.T.P.) Annual Certification • $85.65 1 $65.65 Unit 12-Contniugc Dokf alering Building(W,W,T.P.) Annual Certification $402.57 1 $402.57 Unr 13•Firehtx> a Tower(Fire Department) Docullnentotion Foes $495.00 1 $495:00• Administration oast,taxes,and lICiig fen. • Subtotal 4.495.00 • , . Tax 0.00 • l stimato Total(tl;3t)) $4,495.00 • • • • • • Impf;limp.ImMthnretAttimpyn-sima:NPJr7r 367499 I • Psion*2 012 . • • • • GOODS AND SERViCES AGREEMENT($35,000 OR LESS) • PROVIDER: Pacific Crane Certification CITY OF • PROVIDER'S ASHLAND CONTACT': Glee Wilder • 20 East Main Street ADDRESS: 1394 Denton Way • Ashland,Oregon 97szo Telephone: 5411488-5537 Redding,CA 96002 Fax: 541/488-6006 510 -(too PHONE: 530-226Tt9O2 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 Crane Certification, (a domestic/foreign business corporation)("hereinafter`Provider"),for crane inspections. 1. PROVIDER'S OBLIGATIONS 1.1 Provide crane inspections for FY23 as set forth in the"SUPPORTING DOCUMENTS"attached hereto and,by this reference,incorporated hcrcin. Provider expressly acknowledges that time is of the Genco 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"stall hereinafter be collectively referred to as"Work." 1.2 Provider shall obtain and maintain during the train of this Agreement and until t ty'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&jury and Property Damage. 12.1 The insurance required in this Article shall include the following coverages: • Comprehensive'General or Commercial General Liability, including personal injury, contractual liability,and productslcompletcd operations coverage; and • Automobile Liability. 1.22 Each policy,of such insurance shall be on an"occurrence"and not a"claims made"form,and shall: a, 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. Paps I of 6: Goods and Saviees Agccmeat botweerk the City of Ashland and Pacific Graoc Certification • 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. 1A Provider agrees that no person shall,on the grounds of race,color,religion,creed,sex,marital status, familial status or domestic partnership, national orifi 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. Farther,Provider agrees not to discriminate against a disadvantaged business enterprise,minority-otivreedbusincss,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 $22,310.46 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 vrithout 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 assignee or subcontractor and the City. • 2. CiTY'S OBLIGATIONS 2.1 City shall ,pay Provider the hourly rates effective 4114.12022as 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 S5,000(this is maximum,not to exceed amount()TENURE 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 lauthority to order or authorize additional Work which would cause this maximum sum to be exceeded and that any autborrttion 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 tisk 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. Pas 2 ores Goo&sed Services Agreemeurbetwecn the City ofAshlies4 oudPacific Crune Certification 3.2 Provider is an independent contractor and not an employee or agent of the City for any P 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 3A This Agreement embodies the full and complete understanding of the parties respecting the subject master 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 279B220,279B.230 and 2793.235. 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. lch party expressly waives any and all rights to maintain en 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 Agent shall hold the other responsible for damages or delay in perfonnance caused by acts of God,strikes,lockouts,accidents,or other events beyond the control of the other or the other's oillcers,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 Provide'and the City set forth in this Agreement 3_11 Deliveries will be FOB destination.Provider shall pay all transportation and handling charges for thc Goods.Provider is reponsrble and liable for loss or damage until final inspection and acceptance ofthe Goods by the City. Provider remains liable for latent defects,fraud,and'warrantias. 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).. 3.13 Provider represents and warrants that the Goods are new, current, and fully warranted by thc manufacturer. Delivered Goods will comply with SUPPORTING DOCUMENTS and be free from defects in labor,material and manufacture.Provider shall transfer all meas to the City. Page 3 ofe% Gooch and Saviccs Agent between the(Sty ofAshtm,d aviPasitic Casae Ccrtiticstian T • • 4. SUPPORTING DOCUMENTS 4.1 The following documents are, by this reference, expressly incorporated in this Agreement, and ac collectively referred to in this Agreement as the"SUPPORTING DOCUMENTS:" • The Provider's complete written Rate Sheet dated April 14,2022. 42 This Agreement and the SUPPORTING DOCUMENTS shall be construed to be mutually complimentary and supplementary wherever possible. In the event of a conflict which=mot 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. S. REMEDIES ' Si 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 thathave been delivered inadequately or defectively; 5.13 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 arc 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 Juno 30,2023,unlesssooner terminated as provided in Subsection 62. 6.2 Termination 62.1 The City and Provider may tcuntinato 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 itt sole discretion. 6.2.3 Either party may terminate this Agreement,with cause,by not Iess'than fourteen(14)days'prior written notice if the cause is not cared within that fourteen(14)day period after written notice. • Such termination is in addition to and not in lieu of any other remedy at law or equity.• 7. NOTICE Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery,by sending via a reputable commercial overnight courier, or by mailing Using registered or certified United.States mail,return receipt requested,postage prepaid, to the address sot forth below: • • If to the City:" Page 4 of6: Coors a d Services Asrevnimt between tt a City of Asi taxi avd Pacific Graeme Gasification • • • City of Ashland Fleet Maintenance Department Attn: Wes lloadley 20 F..Main Street 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 Crane Certification • Attn:Glee Wilder 530-226-1902 • • 8. WAIVER OF BREACH One or more waivers or failures to objectby either party to the other's breath 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 rcpccscnts and war rants 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. 9:12 Provide..,for a period of no fewer than six(6)calendar years preceding the Effective Date of this Agreement, has faithfully complied with: (9 AU tax laws of the State of Oregon,including but not limited to ORS 305.620 and ORS chapters 316,31.7,and 318; • (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider;and (iii) Any rules,Tcgulalior's.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 lbws of the Slate 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 to seek daoaages and any other reliefavaitablc under this Agreement,at law,or in equity. • • rap 5 of6_ Goods and Semi=Agsccincotbctwcaa the Qty of Aslizod and Pacific Cram CertMcat n TN WITNESS WHEREOF the parties bave caused this Agreement to be sawed in their respective Dames by their duly authorized representatives as of the dates set forth bolow. CITY OF ASHLAND: . Pacific Crane Certification(PROVIDER): By: •� $Y- lsa v gnat Printed Name Printed Name f v i c_ wog _a¢ c�c1�__ Title Title 41112o2L4. A��t�-�0z. Date Date • MA is to be submitted with this signed Agreement) Purchase Order No. r • • • • • 6 Qf 6; Goods and Services Agreement betwa a the City of Asbloi►d mid Pacific Crane Certification • CERTIFICATE OF EXEMPTIOM FROM WORKERS COMPENSATION LAWS - I am aware of the provisions of California Labor Code Section 3700, which requires every employer to be insured against liability for workers'compensation or to undertake self- insurance in accordance with the provisions of that code. I affirm that at all times in performing the work for which this Certificate is provided I will not employ any person in any manner so that I become subject to the workers' compensation laws of California. I also understand thatif while performing the work for which this Certificate is provided I employ someone so that become subject to the workers' compensation laws of California,.the.claim of exemption executed under this form will no longer be valid. I affirm that iif I become subject to the workers' compensation laws of California while performing the work for which this Certificate is provided I will obtain a Certificate of Workers' Compensation Insurance, submit that Certificate to Silverado Contractors, Inc. immediately following its effective date, and continuously maintain the coverage provided by the Certificate in accordance with the law. I certify under penalty of perjury under the laws of the State of California that the information provided on this exemption statement is true and accurate.. • Digital William J.MorgariMergahsigned by VI/Miami Signature: Date:2022.04.26083139-07'00' Date:4/26/22 Name:_William J. Morgan Title: Owner • • • - r • • Auto Insurance Confirmation • 4/26/22,8:59 AM From: USAA.Customer.Service@mailcenter.usaa.com, • To: wjmorgan@aol.com, • Subject: Auto Insurance Confirmation Date: Tue,Apr 26,,2022 8:50 am To ensure delivery to your inbox,please add USAA.Customer.Servicenc mailcenter.usaa.com to your address book. • 11%.%1SP USAA° • • Auto Insurance Confirmation • • Please use this as confirmation of auto insurance; however,this doesn't take the place of an insurance • identification card. • Registered owner: WILLIAM MORGAN • Address: 1394 DENTON WAY • REDDING CA 9600? Policy number: GIC 047350068 7101 Policy effective date: • December 10, 2021 • Policy expiration date: June 10, 2022 • Vehicle: • 2018 GMC SIERRA 2500 • • VIN: 1 GTI2UEY4JF269072 • Bodily injury liability limit: .$1,000,000 each person/ • • $1,000,000 each accident Property damage liability limit: $500,000 each accident • Comprehensive deductible: $500 • Collision deductible: $500 Lienholder: ' ALLY FINANCIAL PO BOX 8102 COCKEYSVILLE • • MD 21030 https://mail.aol.com/webmail-std/en-us/PrintMessage Page 1 of 2 Auto Insurance Confirmation 4/26/22,8:59 AM Meets California minimum statutory liability requirements This confirmation of coverage neither affirmatively nor negatively amends, extends or alters the coverage given by the policy issued by USAA General Indemnity Company. How to Contact Us Thank you for choosing us for your auto insurance needs. If you have any questions, please contact us using one of the following options: `b Phone: 210-531-USAA(8722), our mobile shortcut#8722 or 800-531-8722 Fax: 800-531-8877 .I Thank you, • USAA General Indemnity Company • AeiGo Paperless Review and edit your online document preferences at usaa.com. • jj USAA You • Gel Support Discuss.Explore. mGO MOBILE' COMMUNITY visit the USAA community. .apps& more © © More Please do not reply to this e-mail. To contact USAA,visit our secure contact page. Ni1/4 Privacy Promise N • • • USAA General Indemnity Company,9800 Fredericksburg Road,San Antonio,Texas 78288 • �SAA® • 93127-0111 • • • • • • • • • https://mail.aol.com/webmail-std/en-us/PrintMessage / Page 2 of 2 ASHLAND OR 97520-1849 ADDRESS INFORMATION. �I�I��I��II�IIIII�IIIIII�I�I�II'IIT'I�III��IIIII�I���II�II����� . •a 0 F • 0 s • • ::Y:i•:�..._. .. :. .; is";�.iiiiiiY??;:;i<:•```}i}ii:��<'v��i''vi��iiii:�Y}is���i»iijjiji:�ii>ii>Y>jij:?�ji}i}iii:ti.>iii:�?>$»:�Y»YY>YYYYYYYY>`}>::i::Y$'YYi:�:{iii:::{:�:?:;.i:+?;:}<:i:;:i:;i:}:::}::$j:: :::AtaDITIOI+.1�?4i:.:;tN:.:fiJRE[):$:IVOTI..GE:QF....CSV:�.RA�GE:::::. :::::::::.::.::::::::::::::::::::::.:::::::::::::::::::.::�.�:::::::::::::::::::::::.::::::::::::.:::.:.:.::..:.:....:. •::..:. .................................................................................................................................................................................................................................::....:.. .......................................................................................................................................................................................................................................... State Farm Mutual Automobile Insurance Company• - 1355-FA96-A NAMED INSURED: • POLICY NO: 266 7181-F24-55J COVERAGE: MORGAN,WILLIAM& YR/MAKE/MODEL: NONOWNED AUTO BI AND PD LIABILITY PACIFIC CRANE CERTIFICATION CO VIN/CAMPER: $1 MIL 1394 DENTON WAY AGENT NAME: JEFF AVERY INSURANCE AGCY INC $500 DED.COMP/COLE. • REDDING CA 96002-3621 AGENT PHONE: • (530)243-4600 ENDORSEMENT NO: 6028BU POLICY EFFECTIVE 6164DP 6165CS DEC 24 2021 UNTIL TERMINATED gi POLICY MESSAGES: This policy shown above supersedes policy#2667181-551. co 2 The policy includes a loss payable clause.protecting the additional insured's interest in the described car to the extent of the insurance o provided and subject to all policy provisions.The additional insured will be given 20 days notice if the policy is terminatedUntil such notice e, is provided,it shall be presumed that the required renewal premiums have been paid.The additional insured must notify us within 10 days of o any change of interest or ownership coming to their attention.Failure to do so will render this policy null and void. • 0 •• • • • • • • • • • • • • • • • • • • • • FRT • • PACIF-1 OP ID:AA ACORO" DATE(MM/DDnvvy) CERTIFICATE OF LIABILITY INSURANCE 04/28/2022 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 925-475-8623 CONTACT Anja Arroyo,CISR-Acct Mgr Nixon Insurance Agency PHONE FAX g Y A/C No,Ext):925-475-8623 I(NC,Na):925-521-1608 aff.of Atlantic-Pacific Ins. 396 Civic Drive,#A - ADd"alEss:aarroyo@nixoninsuranceagency.com Pleasant Hill,CA 94523 Chris Nixon,CIC,CPCU INSURER(S)AFFORDING COVERAGE NAIC# • INSURER A:Kinsale Insurane Company INSURED INSURER B:HISCOX Insurance Company,Inc. 10200 Pacific Crane Certifications William Morgan INSURER C: • 1394 Denton Wa Redding,CA 9602 INSURER D: • 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVO (MM/DD/YYYYI (MM/DD/YYYYI A X COMMERCIAL GENERAL LIABILITY • EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR0100131940-1 11/04/2021 11/04/2022 DAMAGE TO RENTED 100,000 X X PREMISES(Ea occurrence) $ MED EXP(Any one.person) $ Excluded PERSONAL&ADV INJURY $ Excluded GENL AGGREGATE LIMIT APPLIES PER: • GENERAL AGGREGATE $ 2,000,000 X POLICY LOC PRODUCTS-COMP/OPAGG $ Excluded • OTHER: • $ AUTOMOBILE LIABILITY (Ea acBlc deD)SINGLE LIMIT $ ANY AUTO • BODILY INJURY(Per person) $ OWNED • SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ • • HIRED NON-OWNED - PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) $ — . UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY PER ERO Y/N • ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Prof Liability ANE4630705-21 11/04/2021 11/04/2022 Occ-Agg $1M/$3M B Claims-Made E&O SIR 7,500 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) City of Ashland,Oregon,its officers,agents and employees are named as Additional Insured as respects to liability arising out of work or operations performed by the named insd per attached#CAS5015 0420. Primary wording provided by CG0001 12/041WOS Applies per attchd CAS4002 0110 Cancellation provision per attached CAS2007 0220. • • CERTIFICATE HOLDER CANCELLATION • ASHLA-4 • 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 AUTHORIZED REPRESENTATIVE au x.+ (2444110._ ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. • ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT- EXCLUDING PRODUCTS/COMPLETED OPERATIONS • Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100131940-0 11/04/2020 12:01AM at the Named Pacific Crane Certifications • Insured address shown on the Declarations Additional Premium: Return Premium: $0 $0 This endorsement modifies insurance provided under the following: • COMMERCIAL GENERAL LIABILITY COVERAGE A. SECTION II-WHO IS AN INSURED is amended to include any person or organization you are required to include as an Additional Insured on this Policy by written contract in effect during the policy period and executed prior to the "occurrence"of the"bodily injury"or"property damage",but only for the vicarious liability imposed on the Additional Insured provided that such liability is caused by the sole negligent conduct of the Named Insured. However: - 1. The insurance afforded to such Additional Insured only applies to the extent permitted by law;and 2. Will not be broader than that which you are required by the written contract to provide for such Additional Insured. • B. The insurance provided to the Additional Insured under this endorsement is limited as follows: 1. This insurance does not apply to"bodily injury"or"property damage"arising out of"your work"or"your product" included in the"products-completed operations hazard." • 2. Any insurance provided by this endorsement to an Additional Insured shall be excess over any other valid and collectible insurance available to the Additional Insured whether primary,excess,contingent or on any other basis unless a written contract specifically requires that this insurance apply on a primary or primary and noncontributory basis. 3. Where there is no duty to defend the Named Insured,there is no duty to defend the Additional Insured.Where there is no duty to indemnify the Named Insured,there is no duty to indemnify the Additional Insured. 4. This insurance does not apply to"bodily injury"or"property damage"arising out of the sole negligence of the Additional Insured or any employees of the Additional Insured. C. With respect to the insurance afforded to the Additional Insured,the following is added to SECTION III—LIMITS OF INSURANCE: The most we will pay on behalf of the Additional Insured is the amount of insurance: 1. Required by the written contract;or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CAS5015 0420 Page 1 of 2 D. Duties of the Additional Insured in the event of"occurrence",claim or"suit": 1. The Additional Insured must promptly give notice of an"occurrence",a claim which is made or a"suit",to any other insurer which has insurance for a loss to which this insurance may apply. 2. The Additional Insured must promptly tender the defense of any claim made or"suit"to any other insurer which also issued insurance to the Additional Insured as aNamed Insured or to which the Additional Insured may qualify as an Additional Insured for a loss to which this insurance may apply. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. • • • • • • • • CAS5015 0420 Page 2 of 2 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. • WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US-BLANKET Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100131940-0 11/06/2020 12:01AM at the Named Pacific Crane Certifications Insured address shown on the Declarations Additional Premium: Return Premium: $0 $0 • Policy Change Number:1 This endorsement modifies insurance provided under the following: • COMMERCIAL GENERAL LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE SECTION IV—CONDITIONS,8.Transfer of Rights of Recovery against Others to Us is amended by the addition of the following: We waive any right of recovery we may have against persons or organizations because of payments we make for injury or damage arising out of"your work"done under a written contract with that person or organization wherein you have agreed to provide this waiver. • • ALL OTHER TERMS AND CONDITIONS OF THE POLICY.REMAIN UNCHANGED. • • • • • • • • • • • • CAS4002 0110 Page 1 of 1 • • THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. • • COMMON CONDITIONS - CASUALTY • • • Attached To and Forming Part of Policy Effective Date of Endorsement Named Insured 0100131940-0 11/04/2020 12:01AM at the Named Pacific Crane Certifications Insured address shown on the Declarations Additional Premium: - Return Premium: • $0 $0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE • LIQUOR LIABILITY COVERAGE I OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE • CANCELLATION • a. The first Named Insured shown in the Declarations may cancel this Policy by mailing or delivering to us advance written notice of cancellation. b. We may cancel this Policy by mailing or delivering to the first Named Insured written notice of cancellation at least: • 1) Ten(10)days before the effective date of cancellation if we cancel for non-payment of premium;or 2) Thirty(30)days before the effective date of cancellation if we cancel for any other reason. c. We will mail or deliver our notice to the first Named Insured's last mailing address known to us. If notice is mailed, • proof of mailing will be sufficient proof of notice. d. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. e. If this Policy is cancelled,we will send the first Named Insured any refund due subject to the minimum earned premium provisions of the Policy. If we cancel for reasons other-than non-payment of premium,the refund will be pro rata. If we cancel due to non-payment of premium or if the first Named Insured cancels,the refund may be less than pro rata. The cancellation will be effective even if we have not made or offered a refund. NON-RENEWAL--the When We Do Not Renew Condition of the Policy is deleted and replaced with the following: • a. If we elect not•to renew this Policy,we shall mail written notice to the first Named Insured at the address shown in the Declarations. Such written notice of non-renewal shall be mailed at least thirty(30)days prior to the end of the policy period. • , b. If notice is mailed,proof of mailing will be sufficient proof of notice. , • CHANGES This Policy contains all the agreements between you and us concerning the insurance afforded. The first Named Insured shown in the Declarations is authorized to make changes in the terms of this Policy with our consent.This • Policy's terms can be amended or waived only by endorsement issued by us and made a part of this Policy. TERMS,CONDITIONS AND PREMIUMS • The first Named Insured shown, in the Declarations is responsible for the payment of all premiums and will be the payee for any return premiums we pay. On each renewal, continuation or anniversary of the effective date of the Policy or on an annual basis, the Company will determine the rate and premium and may amend the terms and conditions of the Policy in accordance with the rates and rules then in effect. EXAMINATION OF YOUR BOOKS AND RECORDS We may examine and audit your books and records as they relate to this Policy at any time during the policy period and up to three years afterward. • CAS2007 0220 Page 1 of 3 • • TRANSFER OF YOUR RIGHTS AND DUTIES UNDER THIS POLICY Your rights and duties under this Policy may not be transferred without our written consent except in the case of death of an individual Named Insured. If you die,your rights and duties will be transferred to your legal representative, but only while acting within the scope of duties as your legal representative. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties,but only with respect to that property. SERVICE OF SUIT • - In the event of the failure of the Company to pay any amount claimed to be due under this Policy,the Company will submit to the jurisdiction of any court of competent jurisdiction within the United States of America or Canada. All matters arising under this Policy shall be determined in accordance with the choice of lay)rules of such court. Nothing in this clause constitutes or should be understood to constitute.a waiver of the Company's rights to commence an action in any Court of competent jurisdiction in the United States,to remove an action to a United States District Court, or to seek a transfer of a case to another Court as permitted by the laws of the United States or of any State in the United States. Service of process in any such suit may be made upon the President and Chief Executive Officer of the Company or his . designee at the address shown on the Declarations of this Policy. In any suit instituted upon this contract and against the President and Chief Executive Officer of the Company or his designee,the Company will abide by the final decision of such Court or of any Appellate Court in the event of an appeal. The President and Chief Executive Officer of the Company or his designee are authorized and directed to accept service of process. • Pursuant to any statute of any state,territory or district of the United States of America,the Company designates the Superintendent,Commissioner or Director of Insurance or other officer specified for the purpose in the statute,or his successors in office,as its true and lawful attorney upon whom may be served any lawful process in any action,suit or proceeding instituted by or on behalf of the insured or any beneficiary under this Policy arising out of this contract of insurance. The Company designates the above-named as the person to whom said officer is authorized to mail such process or a true copy of such process. • • . TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US—the Transfer Of Rights Of Recovery Against Others To Us Condition of the Policy is deleted and replaced with the following: If any person or organization to or for whom we make payment under this Policy has rights to recover damages from another,those rights are transferred to us.That person or organization must do nothing after loss to impair them. At our request,the insured will bring suit or transfer those rights to us and help us enforce them. LEGAL ACTION AGAINST US—the Legal Action Against Us Condition of the Policy is deleted and replaced with the following: No one may bring a legal action against us under this Policy unless there has been full compliance with all of the terms • of this Policy. No suit, action or proceeding for the recovery of any claim under this Policy shall be sustainable in any court of law or equity unless it is commenced within twelve (12) months next after discovery by the insured of the occurrence which gives rise to the claim, provided however,that if by the laws of the state within which this Policy is issued,such limitation is invalid then any such claims shall be void unless such action,suit or proceeding is commenced within the shortest limit of time permitted by the laws of such state. We will not be liable for damages that are not payable under the terms of this Policy or that are in excess of the applicable Limit of Insurance. BINDING ARBITRATION All disputes under this Policy shall be subject to binding arbitration as follows: - a. All disputes over coverage or any rights afforded under this Policy,including whether an entity or person is a Named Insured,an insured,an additional insured,or entitled to.coverage under the Supplementary Payments CAS2007 0220 Page 2 of 3 • • . provisions of this Policy or the effect of any applicable statutes or common law upon the contractual obligations owed,shall be submitted to binding arbitration,which shall be the sole and exclusive means to resolve the dispute. Either party may initiate the binding arbitration. The arbitration forum and process shall be agreed to by the parties. In the event the parties cannot agree on an arbitration forum and process, the matter shall be submitted to the American Arbitration Association. The arbitration shall be before a panel of three arbitrators, unless the parties agree to one arbitrator,all of whom shall • have experience in insurance coverage of the type afforded by this Policy. If the parties select a panel of three arbitrators, each party shall select an arbitrator and the chosen arbitrators shall select a third arbitrator. The American'Arbitration Association shall decide any disputes concerning the selection of the Arbitrators. The potential arbitrators from which the arbitrators shall be selected shall not be confined to those provided by the American Arbitration Association. Each party shall bear the costs of its arbitrator and shall share equally the costs of the third arbitrator and arbitration process.In the event of a single arbitrator,the cost shall be shared equally by the parties.The decision of the arbitration is final and binding on the parties. b. All disputes regarding payment(s) owed under this Policy for any deductible or premium, including but not limited to any audit premium,shall be settled by binding arbitration administered by the American Arbitration Association in accordance with the AAA Expedited Procedures.This arbitration shall be the sole and exclusive means to resolve the dispute. Either party may initiate the binding arbitration. Each party will provide relevant documents in support of its position. In order to eliminate undue burden and expense,there shall be no other discovery allowed.The arbitration will be based solely on the documents submitted by the parties and there shall be no in-person or oral hearing.The disputes shall be decided by a single arbitrator.The arbitrator's decision shall be accompanied by a reasoned opinion and shall be binding upon all parties. Any judgment or award rendered by the arbitrator may be entered in any court having jurisdiction to enforce such judgment or award. Each party shall bear its own costs and expenses and an equal share of the _ arbitrator's fee and any administrative fees associated with the arbitration. Except as may be required by law,neither a party nor the arbitrator may disclose the existence,content,or results of any arbitration hereunder without the prior written consent of both parties. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. • • • • • CAS2007 0220 Page 3 of 3 • •