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HomeMy WebLinkAbout2022-148 PO 20230063- Polaris Land Surveying LLC Purchase Order Fiscal Year 2023 Page: 1 of: 1 Q CITY 1 ECO ER r ; i� B City of Ashland �a �A•r .¢r L ATTN:Accounts Payable20 E. Main Purchase Ashland, OR 97520 • Order'# 20230063 T Phone: 541/552-2010 O Email: payable@ashland.or.us • ✓ H C/O Public Works Department E POLARIS LAND SURVEYING LLC l 51 Winburn Way N PO BOX 459 p Ashland, OR 97520 • ASHLAND, OR 97520 Phone: 541/488-5347 R T Fax: 541/488-6006 .:: "'t E�JER eld� Wrr�El r* t eLE1q- ).3 _s (541)482-5009 _ Scott Fleu • 1Efa]g(7 07/_11/2022 604 FOB ASHLAND OR City Accounts Payable ._ �E -'� `'+,i�IDS�.� -,. $ -� ,. __ R•pt=_ '"r3? - i .=.. 9�L , r-I P Til t MP- Surveying Walnut Street 1 Surveying services for Walnut Street .1.0 117,000.00 $17,000.00 Personal Services Agreement(Less than $35,000) Completion date: 06/30/2023 . Project Account: . *************** GL SUMMARY*************** 081200-704200 $17,000.00 . • • ` 1 =ru By: 1\ 1_II Date: 1/14)/7/V = Auth nze• ignature t .17 000.00 'FORM #3 CITY OF A request for a Purchase Orde oLe ASH LAN D REQUISITION Date of request: 07/01)2022. Required date for delivery: Vendor Name Polaris Land Surveying Address,City,State,Zip PO Box 459 Ashland, OR 97520 Contact Name&Telephone Number Shawn Kampmann Email address SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Invitation to Bid ❑ Emergency ❑ Reason for exemption: Date approved by Council:_ ❑ Form#13,Written findings and Authorization ❑ AMC 2.50 (Attach copy of council communication) ❑ Written quote or proposal attached ❑ Written quote or proposal attached _(If council approval required,attach copy of CC) ❑ Small Procurement ❑ Request for Proposal Cooperative Procurement Not exceeding$5,000 Date approved by Council: ❑ State of Oregon ❑ Direct Award _(Attach copy of council communication) Contract# ❑ VerbalNVritten bid(s)or proposal(s) ❑ Request for Qualifications(Public Works) ❑ State of Washington Date approved by Council:_ Contract# _(Attach copy of council communication) ❑ Other government agency contract Intermediate Procurement ❑ Sole Source Agency GOODS&SERVICES ❑ Applicable Form(#5,6,7 or 8) Contract# Greater than$5,000 and less than$100,000 ❑ Written quote or proposal attached • Intergovernmental Agreement ❑ (3)Written bids&solicitation attached ❑ Form#4,Personal Services$5K to$75K Agency PERSONAL SERVICES Date approved by Council: ❑ Annual cost to City does not exceed$25,000. Greater than$5,000 and less than$75,000 Valid until: Date Agreement approved by Legal and approved/signed by ❑ Less than$35,000,by direct appointment ❑ Special Procurement City Administrator.AMC 2.50.070(4) ❑ (3)Written proposals&solicitation attached ❑ Form#9,Request for Approval ❑ Annual cost to City exceeds$25,000,Council Al Form#4,Personal Services$5K to$75K ❑ Written quote or proposal attached approval required.(Attach copy of council communication) Date approved by Council: Valid until: Date Description of SERVICES Surveying services for Walnut Street - TOTAL COST 17,000 00 Item# Quantity Unit Description of MATERIALS Unit Price Total Cost ❑■ Per attached quote/proposal TOTAL Project Number _ _ _ Account Number - Account Number - Account Number 0 81 2 0 0 .7 0 4 2 0 0 • *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 nf(form,I certify that the City's public contracting requirements have been satisfied. Jo..w. / 00 Employee: Department He.: _ ►��� r*5 20 zZ Department Manager/Supervisor: City Manager: equal t:or greater than$5,000) (Greater than$35,000J, Funds appropriated for current fiscal year: YES NO `I (7Z F once Director-(Equal to or greater than$5,000) Date Comments: • Form#3-Requisition PERSONAL SERVICES AGREEMENT (LESS THAN$35,000) CONSULTANT: Polaris Land Surveying,LLC CITY OF ADDRESS: PO Box 459 AS H LAN D Ashland,OR 97520 20 East Main Street Ashland,Oregon 97520 TELEPHONE: 541-482-5009 Telephone: 541/488-5587 Fax: 541/552-6006 EMAIL: shawn@polarissurvev.com This Personal Services Agreement(hereinafter"Agreement")is entered into by and between the City of Ashland,an Oregon municipal corporation(hereinafter"City")and Polaris Land Surveying,LLC,a domestic business corporation("hereinafter"Consultant"),to provide surveying services for right-of-way and topographic engineering survey of an approximate 700 feet strip of Walnut Street. NOW THEREFORE, in consideration of the mutual covenants contained herein,the City and Consultant hereby agree as follows: 1. Effective Date and Duration: This Agreement shall become effective on the date of execution on behalf of the City, as set forth below(the"Effective Date"), and unless sooner terminated as specifically provided herein,shall terminate upon the City's affirmative acceptance of Consultant's Work as complete and Consultant's acceptance of the City's final payment therefore,but not later than June 30, 2023. 2. Scope of Work: Consultant will provide surveying services for right-of-way and topographic engineering survey of an approximate 700 feet strip of Walnut Street as more fully set forth in the Consultant's Proposal dated June 20, 2022, which is attached hereto as "Exhibit A" and incorporated herein by this reference. Consultant's services are collectively referred to herein as the"Work." 3. Supporting Documents/Exhibits; Conflicting Provisions: This Agreement and any exhibits or other supporting documents shall be construed to be mutually complementary 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 exhibits or supporting documents. 4. All Costs Borne by Consultant: Consultant shall,at its own risk,perform the Work described above and,unless otherwise specified in this Agreement, furnish all labor,equipment,and materials required for the proper performance of such Work. 5. Qualified Work: Consultant has represented,and by entering into this Agreement now,represents,that all personnel assigned to the Work to be performed under this Agreement are fully qualified to perform the service to which they will be assigned in a skilledand worker-like manner and,if required to be registered, licensed or bonded by the State of Oregon,are so registered, licensed and bonded. Page 1 of 6: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND POLARIS LAND SURVEYING,LLC. 6. Compensation: City shall pay Provider for its Work at the hourly rates as set forth in Exhibit"A" (Civil, Structural,and Geotechnical Engineering Services Proposal),which is attached hereto and incorporated herein by this reference,as full compensation for Provider's performance of all Work under this Agreement. In no event shall Consultant's total of all compensation and reimbursement under this Agreement exceed the sum of$17,000(seventeen thousand dollars)without the express,written approval from the City official whose signature appears below,or such official's successor in office. Payments shall be made within 30 days of the date of receipt by the City of Consultant's invoice. Should this Agreement be terminated prior to completion of all Work,payments will be made for any phase of the Work completed and accepted as of the date of termination. 7. Ownership of Work/Documents: All Work,work product, or other documents produced in furtherance of this Agreement belong to the City,and any copyright,patent,trademark proprietary or any other protected intellectual property right shall vest in and is hereby assigned to the City. 8. Statutory Requirements: The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220,279B.230 and 279B.235. 9. Living Wage Requirements: If the amount of this Agreement is$22,310.46 or more,Consultant 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. Consultant is also required to post the notice attached hereto as"Exhibit B"predominantly in areas where it will be seen by all employees. 10. Indemnification: Consultant hereby agrees to defend, indemnify, save, and hold City, its officers, employees,and agents harmless from any and all losses,claims,actions,costs,expenses,judgments,or other damages resulting from injury to any person(including injury resulting in death),or damage (including loss or destruction)to property,of whatsoever nature arising out of or incident to the performance of this Agreement by Consultant(including but not limited to,Consultant's employees, agents, and others designated by Consultant to perform Work or services attendant to this Agreement). However,Consultant shall not be held responsible for any losses,expenses,actions,costs,or other damages,caused solely by the gross negligence of City. 11. Termination: a. Mutual Consent. This Agreement may be terminated at any time by the mutual consent of both parties. b. City's Convenience. This Agreement may be terminated by City at any time upon not less than thirty(30)days' prior written notice delivered by certified mail or in person. c. For Cause. City may terminate or modify this Agreement, in whole or in part,effective upon delivery of written notice to Consultant,or at such later date as may be established by City under any of the following conditions: i. If City funding from federal,state,county or other sources is not obtained and continued at levels sufficient to allow for the purchase of the indicated quantity of services; Page 2 of 6: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND POLARIS LAND SURVEYING,LLC. ii. If federal or state regulations or guidelines are modified,changed,or interpreted in such a way that the services are no longer allowable or appropriate for purchase under this Agreement or are no longer eligible for the funding proposed for payments authorized by this Agreement;or iii. If any license or certificate required by law or regulation to be held by Consultant to provide the services required by this Agreement is for any reason denied,revoked, suspended,or not renewed. d. For Default or Breach. i. Either City or Consultant may terminate this Agreement in the event of a breach of the Agreement by the other. Prior to such termination the party seeking termination shall give to the other party written notice of the breach and its intent to terminate. If the party committing the breach has not entirely cured the breach within fifteen(15)days of the date of the notice,or within such other period as the party giving the notice may authorize in writing, then the Agreement may be terminated at any time thereafter by a written notice of termination by the party giving notice. ii. Time is of the essence for Consultant's performance of each and every obligation and duty under this Agreement. City,by written notice to Consultant of default or breach,may at any time terminate the whole or any part of this Agreement if Consultant fails to provide the Work called for by this Agreement within the time specified herein or within any extension thereof. iii. The rights and remedies of City provided in this subsection(d)are not exclusive and are in addition to any other rights and remedies provided by law or under this Agreement. 12. Independent Contractor Status: Consultant is an independent contractor and not an employee of the City for any purpose. 13. Assignment: Consultant shall not assign this Agreement or subcontract any portion of the Work without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be void. 14. Default. The Consultant shall be in default of this Agreement if Consultant: commits any material breach or default of any covenant,warranty,certification;or obligation under the Agreement; institutes an action for relief in bankruptcy or has instituted against it an action for insolvency;makes a general assignment for the benefit of creditors;or ceases doing business on a regular basis of the type identified in its obligations under the Agreement;or attempts to assign rights in,or delegate duties under,this Agreement. 15. Insurance. Consultant shall,at its own expense,maintain the following insurance: a. Workers' Compensation. Consultant shall obtain and maintain Workers' Compensation insurance in compliance with ORS 656.017,which requires subject employers to provide Oregon Workers' Compensation coverage for its subject workers,unless such employers are exempt under ORS 656.126. If exempt under ORS 656.126, Consultant shall certify such exemption to the City. Page 3 of 6: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND POLARIS LAND SURVEYING,LLC. b. Professional Liability insurance with a combined single limit,or the equivalent,of not less than $2,000,000(two million dollars)per occurrence. This is to cover any damages caused by error, omission or negligent acts related to the Work to be provided under this Agreement. c. 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,Death,and Property Damage. d. Automobile Liability insurance with a combined single limit,or the equivalent,of not less than $1,000,000(one million dollars)for each accident for Bodily Injury and Property Damage,including coverage for owned,hired or non-owned vehicles,as applicable. e. Notice of cancellation or change. There shall be no cancellation,material change,reduction of limits or intent not to renew the insurance coverage(s)without thirty(30)days' prior written notice from the Consultant or its insurer(s)to the City. f. Additional Insured/Certificates of Insurance. Consultant shall name the City of Ashland,Oregon, and its elected officials,officers and employees as Additional Insureds on any insurance policies, excluding Professional Liability and Workers' Compensation,required herein,but only with respect to Consultant's services to be provided under this Agreement.The consultant's insurance is primary and non-contributory.As evidence of the insurance coverages required by this Agreement, the Consultant shall furnish acceptable insurance certificates and endorsements prior to commencing the Work under this Agreement. 16. Nondiscrimination: Consultant 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 any Work under this Agreement when employed by Consultant. Consultant agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes,rules and regulations. Further, Consultant 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. 17. Consultant's Compliance With Tax Laws: 17.1 Consultant represents and warrants to the City that: 17.1.1 Consultant 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 Consultant; and (iii) Any rules,regulations,charter provisions,or ordinances that implement or enforce any of the foregoing tax laws or provisions. 17.1.2 Consultant,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; Page 4 of 6: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND POLARIS LAND SURVEYING,LLC. (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Consultant; and (iii) Any rules,regulations,charter provisions,or ordinances that implement or enforce any of the foregoing tax laws or provisions. 18. Governing Law;Jurisdiction: This Agreement shall be governed and construed in accordance with 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,.exclusiye 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 Agreerent in any other venue. 19. Notice; Whenever notice is required or permitted to be given under this Agreement,such notice shall be given in writing to the other partyby personal delivery,by sending via a reputable commercial overnight courier,by mailing using?e er&I or certified United States mail,return receipt requested,postage prepaid, or by electronically confirmed at the address or facsimile number set forth below: If to the'City: Public Works Department Attn: Contract Administrator 20 East Main Street Ashland,Oregon 97520 With a copy to: City of Ashland-Legal Department 20 East Main Street Ashland,Oregon 97520 If to Consultant: Polaris Land Surveying,LLC. PO Box 459 Ashland,OR 97520 20. Amendments. This Agreement may be amended only by written instrument executed by both parties with the same formalities as this Agreement. 21. THIS AGREEMENT AND THE ATTACHED EXHIBITS CONSTITUTE THE ENTIRE UNDERSTANDING BETWEEN THE PARTIES. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR REPRESENTATIONS,EITHER ORAL OR WRITTEN,I EN,NOT SPECIFIED HEREIN REGARDING THIS AGREEMENT. CONSULTANT,BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE,HEREBY ACKNOWLEDGES THAT HE/SHE HAS READ THIS AGREEMENT,UNDERSTANDS IT,AND AGREES TO BE BOUND BY ITS TERMS AND CONDITIONS. Page 5 of 6: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND POLARIS LAND SURVEYING,LLC. 22. Certification. Consultant shall execute the certification attached hereto as"Exhibit C"and incorporated herein by this reference. 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: POLARIS LAND SURVEYING,LLC(CONSULTANT): By: By: 41W Signature ate. Printed Name s.fter ¢Q12.? *k City Marragm-- Title V1/4.1• 1.1112g LAP—. 17, zoLZ 6 T(* 291245Z Zte Date Purchase Order No. (AL-9 is to be submitted with this signed Agreement) • Page 6 of 6: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND POLARIS LAND SURVEYING,LLC. EXHIBIT B CITY OF ASHLAND, OREGON City of Ashland • LIVING ALL employers described WAG E below must comply with City of Ashland laws regulating ea ment of a living wase. $15.96 per,hour,FeffectweJune 30 202'1: t r The Living Wage js adjusted[annually every , n, �,. ,.1�' June 30 by the iConsumer Pnce Index. �a y sa tl+^+ { 5 Yfi44i Employees must be paid a portion of business of their 401K and IRS eligible living wage: employer, if the employer has cafeteria plans(including ten or more employees,and childcare)benefits to the has received financial amount of wages received,by ➢ For all hours worked under a assistance for the project or the employee. business from the City of service contract between their Ashland in excess of ➢ Note: For temporary and employer and the City of $22,310.46. part-time employees,the Ashland if the contract Living Wage does not apply exceeds$22,310.46 or more. ➢ If their employer is the City of to the first 1040 hours worked Ashland,including the Parks in any calendar year. For ➢ For all hours worked in a and Recreation Department. more details,please see month if the employee spends Ashland Municipal Code 50%or more of the ➢ In calculating the living wage, Section 3.12.020. employee's time in that month employers may add the value workingon aproject or v`4 ^ �1.F of health care,retirement, For additional information: Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator, City Hall,20 East Main Street,Ashland, OR 97520,or visit the City's website at www.ashland.or.us. Notice to Employers: This notice must be posted predominantly in areas where it can be seen by all employees. CITY OF ASHLAND Page 1 of 1: EXHIBIT B EXHIBIT C CERTIFICATIONS/REPRESENTATIONS: Consultant,by and through its authorized representative,under penalty of perjury,certifies that(a)the number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be issued to it and(b) Consultant is not subject to backup withholding because: (i)it is exempt from backup withholding,or(ii) it has not been notified by the Internal Revenue Service(IRS)that it is subject to backup withholding as a result of a failure to report all interest or dividends,or(iii)the IRS has notified it that it is no longer subject to backup withholding. Consultant further represents and warrants to City that: (a)it has the power and authority to enter into this Agreement and perform the Work,(b)the Agreement,when executed and delivered,shall be a valid and binding obligation of Consultant enforceable in accordance with its terms,(c)the work under the Agreement shall be performed in accordance with the highest professional standards,and(d)Consultant is qualified,professionally competent,and duly licensed(if applicable)to perform the Work. Consultant also certifies under penalty of perjury that its business is not in violation of any Oregon tax laws,it is an independent contractor as defined in the Agreement, it is authorized to do business in the State of Oregon, and Consultant has checked four or more of the following criteria that apply to its business. (1)Consultant carries out the work or services at a location separate from a private / `' residence or is in a specific portion of a private residence, set aside as thelocation of the business. (2)Commercial advertising or business cards or a trade association membership are purchased for the business. i_ (3)Telephone listing is used for the business separate from the personal residence j listing. (4)Labor or services are performed only pursuant to written contracts. (5)Labor or services are performed for two or more different persons within a period of one year. i() (6)Consultant assumes fmancial responsibility for defective workmanship or for service not provided as evidenced by the ownership of performance bonds, warranties,errors and omission(professional liability) insurance or liability insurance relating to the Work or services to be provided. Consultant's signature 1 JIb 29 r 7.-61;2- Date .-612Date • Page 1 of 1: EXHIBIT C • A�® CERTIFICATE OF LIABILITY INSURANCE DA 5(MMyDD/YY) 022 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(les)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 AME CT Ryan Schorovsky SfafeFarm Jon Snowden Insurance Agency,Inc. (A/C,No,Ext): (541)482-2461 (A/C.No): (541)482-4957 CYO420 Bridge St AIL ADDRESS: ryan.schorovsky.szmr@statefarm.com cu INSURER(S)AFFORDING COVERAGE NAIC#. Ashland OR 97520 INSURER A: State Farm Fire and Casualty Company 25143 INSURED INSURERS: State Farm Mutual Automobile Insurance Company 25178 Polaris Land Surveying,LLC INSURER C: PO Box 459 INSURER D: INSURERS: _ _ _ Ashland OR 97520 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 ADD—SUB POLICY EFF ROLICYEXP LTR TYPE OF INSURANCE INSD WVD, POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 X DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ 300,000 MED EXP(Any one person) $ 5,000 L Y 97-CQ-H089-5 05/07/2022 05/07/2023 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE_ $ 2,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE UABIUTY L23 4521-030-371 04/30/2022 10/30/2022 COMBINED SINGLE LIMIT (Es M / $ 1,000,000 ANY AUTO 090 4953-B09-37F 02/09/2022 08/09/2022 BODILY INJURY(Per person) $ B OWNED �/'SCHEDULED AUTOS ONLY /� AUTOS Y BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ _ S UMBRELLA LIAB _OCCUR EACH OCCURRENCE _ $ EXCESS LIAB CLAIMS-MADE AGGREGATE _ $ DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND.EMPLOYERS'UABILITY STATUTE ER $ - ANY PROPRIETOR/PARTNER/EXECUTIVE Y!N E.L.EACH ACCIDENT. $ 500,000 OFFICER/MEMBER EXCLUDED? n N IA 97-CM-P557-9 05/05/2022 05/05/2023 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes;describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached Ir morespace Is required) Land Surveying On-call services The City of Ashland,its elected officials&employees are Included as additional insureds. Coverage is primary and non-contributory. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF ASHLAND OREGON AND ITS ELECTED ACCORDANCE WITH THE POLICY PROVISIONS. OFFICIALS,OFFICERS&EMPLOYEES AUTHORIZED REPRESENTATIVE ASHLAND 0 E MAIND OR 97520 ST � Scie-terA - A 1 ' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.14 04-13-2022 CMP-4684.1 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. ADDITIONAL INSURED—OWNERS, LESSEES,OR CONTRACTORS(Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number:97-CQ-H089-5 Named Insured: POLARIS LAND SURVEYING LLC Name And Address Of Additional Insured Person Or Organization: CITY OF ASHLAND OREGON AND ITS ELECTED OFFICIALS,OFFICERS&EMPLOYEES 20 E Main St Ashland OR 97520-1814 • 1. SECTION II—WHO IS AN INSURED of SECTION II—LIABILITY is amended to include,as an additional insured,any person or organization shown in the Schedule,but only: a. Ongoing Operations With respect to liability for"bodily injury","property damage",or"personal and advertising injury"caused by your ongoing operations for that additional insured and only to the extent that such"bodily injury","property damage"or"personal and advertising injury"is caused by your negligence or the negligence of those performing operations on your behalf;or b. Products-Completed Operations To the extent that the liability for"bodily injury"or"property damage"is caused by"your work°performed for that additional insured and included in the"products-completed operations hazard". 2. Any insurance provided to the additional insured shall only apply with respect to a claim made or a"suit"brought for damages for which you are provided coverage. 3. Primary Insurance.The insurance afforded the additional insured shall be primary insurance.Any insurance carried by the additional insured shall be noncontributory with respect to coverage provided by you. All other policy provisions apply. CMP-4684.1 1009821 2000 154101 200 05-14-2019 ©,Copyright,State Farm Mutual Automobile Insurance Company,2018 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. A�® CERTIFICATE OF LIABILITY INSURANCE DATE A s;2sDDIY ) 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(les)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 LeZette Brewton NAME: Assurance Risk Managers,Inc. PHONE (303)454-9562 FAX (303)454-9564 (AIC,No,Ext): (A/C,No): 10651 East Bethany Drive E-MAIL lezette.brewton@arm-i.com ADDRESS: Suite 300 INSURER(S)AFFORDING COVERAGE NAIC# Aurora CO 80014-2688 INSURER A: Hanover Insurance Company 22292 INSURED INSURER B: Polaris Land Surveying,LLC. INSURER C: P O Box 459 INSURER D: , INSURER E: Ashland OR 97520.0016 INSURER F: COVERAGES CERTIFICATE NUMBER: 22-23 EO REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL-SUBR POLICYEFF POLICY EXP LIR TYPE OF INSURANCE INSD WVD POLICY.NUMBER (MM/DDTYYYY) (MMIDDIYYYY) LIMITS COMMERCIAL GENERALUABIUTY EACH OCCURRENCE $ DAMAGE TO RENTED - CLAIMS-MADE 0OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ - PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ POLICY n j�T LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE UMIT $ (Ea accident) - ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _AUTOS ONLY (Per accident) _ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION STATUTE ETH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE ^ N!A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ A Professional Liability Claims Made.Policy LH4 A349055 08 06/28/2022 06/28/2023 Each Claim 1,000,000 Aggregate 2,000,000 • DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) PSA($25,000 or less) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Ashland Oregon&its Elected Officials&Employees ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main St AUTHORIZED REPRESENTATIVE .,! Ashland OR 97520 J ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD StateFarm AK State Farm Mutual Automobile Insurance Company R 48672-1-P MATCH 00380 MUTL VOL ®' PO Box 2358 Bloomington IL 61702-2358 DECLARATIONS PAGE NAMED INSURED 00380 37-0909-1 P A POLICY NUMBER 090 4953-B09-37G — moon 0056 POLICY PERIOD MAY 19 2022 to AUG 09 2022 POLARIS LAND SURVEYING LLC 12:01 A.M.Standard Time PO BOX 459 — ASHLAND OR 97520-0016 AGENT — JON SNOWDEN INSURANCE AGCY INC — 420 BRIDGE ST ASHLAND,OR 97520-2206 — PHONE:(541)482-2461 DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. IF AN AMOUNT IS DUE,THEN A SEPARATE STATEMENT IS ENCLOSED. YOUR CAR XAR MD, La. '' BOCs' Et IICLCENUIlt GAS: .. 1999 TOYOTA TACOMA PICKUP 4TAWN72NXXZ489828 600H500000 ittek& 2,1446 ..Y _ .n. ..... ..:_a.,..ffi%1.�¢a• eBSk =soYna1.4.62Mx'��>s-��rrar.�»¢'. .:�a:�.e:e�aar.reA� a�c.:r�.vim.... •., ,� .� ..::r`.� aA^'1'iRr k•..�rP:RGJ. . i. 4 A Liability Coverage N Each Person, Each Accident Pro.ert Damage Limit . .,..- p.7"4- n.t 4 2 at,. , .x•,•a `l'aa: '- a .................................... r $1,000,000 (See_Policy Schedule for Limits MOIM:` t:„ s G Collision Coverage-$250 Deductible $30.33 O' . p:" a ...17 -, .AY k040. . Z;;;;;*; s. Pt Aggiaagaliffigait U Uninsured.Motor Vehicle Covera•a $48.34 ���'`e+'t . M..:�r��... .r�r:fa .^ :. .. ... ...,.. . ..<... a.M. ,._ ' Each Person, Each Accident"ir _ '„= . .ort :`,4; 46''.ti�ffiC 9 VOW!.�y&:it fri*,”' i.'avy 04 +t'd,4 r a a r.; aira•:•sntiv c, •mists- o;:�t . 'za' '. 0 `?atilt'pr miuritiar*ifi1AY x.2112 'O AttGXOV2n22M __.. .z;=_.r... . 1(13,42 M1s+fs nuttbil Replaced policy number 0904953-37F. Your total renewal premium for FEB 09 2022 to AUG 09 2022 is$413.11. Location used to determine rate charged-151 CLEAR CREEK DR,ASHLAND OR 97520. ., '`•.vm.• e l.,. .-a xR •,-�M®6 5.,..�.:,'F `2.wti�..� . .$-. ,i' .�e.� .`.y�t "••�.,• ++`�--6.�. Z.t_.. J0Y�n.. YOUR POLICY CONSISTS OF THIS DECLARATIONS PAGE THE POLICY BOOKLET - FORM 9837B AND ANY ENDORSEMENTS THAT APPLY, I1CLUDING THOSE ISSUED TO YOU WITH ANY SUBSEQUENT RENEWAL TICE. 01 6028BJ ADDITIONAL INSURED PRIOR NOTICE OF TERMINATION)-S&B JAMES CONSTRUCTION CO 8425 AGATE R WHITE CITY OR 97503-1076. 02 6028BJ ADDITIONAL INSURED (PRIOR NOTICE OF TERMINATION)-THE CITY OF ASHLAND0-ITS9ELECTED OFFICIALS, OFFICERS & EMPLOYEES, 20 E MAIN ST, ASHLAND 60911TJ BUSINESS FF GUARANTEED RENEWAL. 6128BL AMENDATORY ENDORSEMENT. 6771AP AMENDMENT OF NONRENEWAL. 6937B.2 AMENDATORY ENDORSEMENT. 6196AA WAIVER OF SUBROGATION UNDER THE LIABILITY COVERAGE: IN FAVOR OF S&B JAMES CONSTRUCTION CO. Agent: JON SNOWDEN INSURANCE AGCY INC Telephone: (541)482-2461 01248/03343 See Reverse Side Prepared JUN 142022 090B-AE6 155.3866.2 04-2005 01025hd) (01 a02544) I4SXON (ola025te) This policy is issued by State Farm Mutual Automobile Insurance Company. MUTUAL CONDITIONS 1. Membership.While this policy is in force,the first insured shown on the Declarations Page is entitled to vote at all meetings of members and to receive dividends the Board of Directors in its discretion may declare in accordance with reasonable classifications and groupings of policyholders established by such Board. 2. No Contingent Liability. This policy is non-assessable. 3. Annual Meeting. The annual meeting of the members of the company shall be held at its home office at Bloomington, Illinois,on the second Monday of June at the hour of 10:00 A.M., unless the Board of Directors shall elect to change the time and place of such meeting, in which case, but not otherwise, due notice shall be mailed each member at the address disclosed in this policy at least 10 days prior thereto. In Witness Whereof, the State Farm Mutual Automobile Insurance Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. Secretary President • BIO a. you;or 3. PERSONAL INJURY PROTECTION 6030GJ BUSINESS NAMED INSURED COVERAGE b. any of your agents,em- M This endorsement is a part of the policy. Because of the type of named insured shown on the ployees, or business a. Additional Definitions Declarations Page of this policy and the changes made below,all references to resident relatives partners Insured is changed to read: o and non-owned cars in the policy are deleted.Except for the changes this endorsement makes,all while maintaining or using Insured means: pil other provisions of the policy remain the same and apply to this endorsement. your car,a newly acquired Anyperson who suffers bodily u: rncar,a temporary substitute - a, 1. DEFINITIONS 3. any other person or organization car, or a trailer owned by jury while occupying or through be- <2- liable for the use of a you; ing struck as a pedestrian by: o You or Your is changed to read: vehicle byan insured as defined (3) The following exclusion is added: 1. your car,or N You or Your means the named insured or in 1.or 2.above,but only for such a named insureds shown on the Declara- vicarious liability. This provision THERE IS NO COVERAGE 2• a newly acquired car which is g o tions Page. applies only if the vehicle is: FOR AN INSURED FOR either the same type of vehicle Z—. as2. LIABILITY COVERAGE a. neither owned b nor hired DAMAGES RESULTING your car or is required to be Y� insured by the Personal Injury cist a. Additional Definition by,that other person or or- FROM: Protection Act. °.,a) pganization;and 1. THE HANDLING OF Insured is changed to read: Such vehicle must be operated by b. neither available for,nor be- PROPERTY BEFORE IT IS or with our permission and its Insured means: ing used for, carrying per- MOVED FROM THE youY Fi 1. you for: sons for a charge. PLAPTEDWHE E IT IS - permission.must be within the scope of such use BY THE EV- P-4 Insured does not include the United a. the ownership, maintenance, SURED FOR b. Exclusions or use of States of America or any of its MOVEMENT INTO OR agencies. ONTO A VEHICLE FOR (1) Exclusion 3.is changed to read: C (1)your car; b. Exclusions WHICH THE INSURED IS 3. LOSS OF INCOME OR LOSS 01 a acquired car; PROVIDED LIABILITY (2) newly q (1) Exclusion 4.is changed to read: OF SERVICES EXPENSES FOR or COVERAGE BY THIS A PEDESTRIAN STRUCK �V 4. FOR BODILY INJURY POLICY; OUTSIDE OF OREGON; 14 (3) a trailerand TO THAT INSURED'S , 0 FELLOW EMPLOYEE 2. THE HANDLING OF (2) The language that reads: b. the maintenance or use of a WHILE THE FELLOW PROPERTY AFTER IT ISIX THERE IS NO COVERAGE temporary substitute car, EMPLOYEE IS IN THE MOVED FROM THE VE- FOR AN INSURED WHO IS O 2. any person for his or her use of: COURSE AND SCOPE OF HICLE DESCRIBED IN 1. OCCUPYING A VEHICLE HIS OR HER EMPLOY- ABOVE TO THE PLACE p a. your car, MENT; WHERE IT IS FINALLY WHILE IT IS: Fi b. a newlyacquired car; DELIVERED BY THE IN- a. MADE AVAILABLE;OR M q (2) Exclusion 7.is changed to read: SURED;OR b. BEING USED U c. a temporary substitute car; 7. WHILE MAINTAINING 1�-, or OR USING A VEHICLE 3. THE MOVEMENT OF TO CARRY PERSONS FORA IN CONNECTION WITH PROPERTY BY MEANS CHARGE. This exclusion does d. a trailer while attached to a THAT INSURED'S EM- OF A MECHANICAL DE- not apply to: car described in a.,b.,or c. PLOYMENT IN OR EN- VICE, OTHER THAN A above. a. the use of a private passen- GAGEMENT OF ANY HAND TRUCK,THAT IS ger car on a share-the-ex- a Such vehicle must be used KIND IN A CAR BUSI- NOT ATTACHED TO THE pense basis;or within the scope of your con- NESS. This exclusion does VEHICLE DESCRIBED sent;and not apply to: IN 1.ABOVE. Page 1 of 4 6030GJ Page 2 of 4 6030GJ ©,Copyright,State Farm Mutual Automobile Insurance Company,2015 CO,Copyright,State Farm Mutual Automobile Insurance Company,2015 m m m Q rn N O 0 W b. you and resident relatives (3) Exclusion 5.is changed to read: 2. you or any person entitled to re- 3. a temporary substitute car,and while occupying a non- cover compensatory damages as owned car as a passenger. 5. WHILE MAINTAINING a result of bodily injury to an in- 4. a camper that is designed to be c7 OR USINGA VEHICLE IN sured defined in item 1.above. mounted on a pickup truck and is changed to read: n, CONNECTION WITH is shown on the Declarations g THERE IS NO COVERAGE THAT INSURED'S EM- b. Exclusions Page; PP FOR AN INSURED WHO IS PLOYMENT IN OR EN- Exclusion 2.is deleted. including itsparts and its equipment cn oOCCUPYING A VEHICLE GAGEMENT OF ANY o WHILE IT IS: KIND IN A CAR BUSI- 6. PHYSICAL DAMAGE COVERAGES that are common to the use of the its 0 aa. MADE AVAILABLE;OR NESS. This exclusion does Additional Definitions hicle as a vehicle. However,parts 0 and equipment of campers must be b. BEING USED not apply to any of your: a. Covered Vehicle is changed to read: securely fixed as a permanent part of a TO CARRY PERSONS FORA a. agents; Covered Vehicle means: the camper. zCHARGE. b. employees;or 1. your car, b. Insured is changed to read: 4. MEDICAL PAYMENTS COVERAGE c. business partners 2. a newly acquired car, Insured means you. a° a. Additional Definitions while maintaining or using Insured is changed to read: your car,a newly acquired car,a temporary substitute Insured means any person while occupying: • car, or a trailer owned by you; 1. your car, (4) Exclusions 7.and 9.are deleted. O 2. a newly acquired car, 5. UNINSURED MOTOR VEHICLE BOD- OCci 3. a temporary substitute car,or ILY INJURY COVERAGE and UNIN- SURED MOTOR VEHICLE BODILY t 4. a trailer while attached to a car INJURY AND PROPERTY DAMAGE a described in 1.,2.,or 3.above. COVERAGE O Such vehicle must be used within a. Additional Definitions the scope of your consent. b. Exclusions Insured is changed to read: O (1) Exclusion 1.is deleted. Insured means: O (2) Exclusion 4.is changed to read: 1. any person while occupying: x 4. THERE IS NO COVER- a. your car, U AGE FOR AN INSURED b. a newly acquired car;or H WHO IS OCCUPYING A E--4VEHICLEWHILE IT IS: c. a temporary substitute car. a. MADE AVAILABLE; Such vehicle must be used OR within the scope of your con- b. BEING USED sent. Such person occupying a f=7 vehicle used to carry persons TO CARRY PERSONS for a charge is not an insured; FORA CHARGE; and Page 3 of 4 6030GJ Page 4 of 4 6030GJ ©,Copyright,State Farm Mutual Automobile Insurance Company,2015 ©,Copyright,State Farm Mutual Automobile Insurance Company,2015 m v m m e N 5 6' 6771AP AMENDMENT OF NONRENEWAL INIYgNCb 60911 CERTIFICATE OF GUARANTEED RENEWAL This endorsement is a part of the policy. Except for the changes it makes,all other terms of the This endorsement is a part of the policy.Except for the changes it makes,all other provisions of policy remain the same and apply to this endorsement. the policy remain the same and apply to this endorsement. This endorsement is issued by the STATE FARM MUTUAL AUTOMOBILE INSURANCE GENERAL TERMS COMPANY of Bloomington,Illinois. Nonrenewal is changed to read: 1. We will not cancel or nonrenew this policy Guaranteed Renewal available for use; 7. Nonrenewal as long as: and If we decide not to renew this policy,then,at least 45 days before the end of the current a. this policy insures a private passenger e. no person other than you becomes a policy period,we will mail or deliver a nonrenewal notice to the most recent policy ad- ° car, named insured on thispolicy. dress that we have on record for the named insured. Proof of mailing shall be sufficient Z N proof of notice. b. premiums are paid when due; 2. You will be able to select from those cov- o n c. all drivers of your car maintain valid erages which continue to be available from drivers licenses; State Farm Mutual Automobile Insurance d. you continue to reside in an area in Company. which State Farm Mutual Automobile 3. Coverage will be provided by our Car Pol- F., Insurance Company sells automobile icy, including any revisions that may be PA insurance and has the Certificate of made to it. 0 0 0 0 0 F U H PA Page 1 of 1 6091T Page 1 of I 6771AP N w O W StateFarm State Farm Mutual Automobile Insurance Company 39564-1-B MATCH 00447 MUTL VOL C)0. PO Box 2368 Bloomington IL 61702-2368 DECLARATIONS PAGE NAMED INSURED 00447 37-090B-1 B A POLICY NUMBER L23 4521-D30-37J — 000198 ooss POLICY PERIOD JUN 19 2022 to OCT 30 2022 POLARIS LAND SURVEYING LLC 12:01 A.M.Standard Time PO BOX 459 — ASHLAND OR 97520-0016 AGENT — JON SNOWDEN INSURANCE AGCY INC — 420 BRIDGE ST ASHLAND,OR 97520-2206 — PHONE:(541)482-2461 DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. IF AN AMOUNT IS DUE,THEN A SEPARATE STATEMENT IS ENCLOSED. YOUR CAR JODEL- • BONY aT LEYVEHICL=E ITY NUMBEi �GLA .; 2001 TOYOTA TACOMA PICKUP 5TEWN72N21Z728384 603H500000 'fa.. `tea I : . .. _ ir).?°.44?i a i'rfl::z<::.�. :._,,.ws,,i�'ic:.a:..> .. .r . �.,`".'...7a4d,:.> .4 . ..":kv.c: A Liability Coverage Each Person, Each Accident Property Dama.e Limit !qq, 3FIg 1-80- ..-.5'.H: 3^ t•1.8COn•1:,.•1, . .1'. .�. tI WwDH k 'i .=kg.'' � `�.k:Y:. 4 ��S'A.Lti. ••� A -..�.. ��' $1,000,000 N uaRe1M4.xcn.r.. rr0. (See Polio Schedule��'�+ foruLimits.its. A., '3 'u �Y-a '�e;te -R 4a f"w- -k'i,-.:&"7!:Rg- �h 3 (^e.'_ _ .. .. ... .... �:s: . `B;;;WWW.***:,.; G Collision Covera.e-$200 Deductible $52.96 f.: <« :"�'• "tet9' •gam, '-'=- - f4 " .•:.. .-. . " R kftei U Uninsured Motor Vehicle Covera.e $72.68 Each Person, Each Accident PT* " „r , 03030 Q§(Q(1 et"al »�>ei �4 ....-' ; wh,;4.0.:` .F F Total rioniiurtiMail UN 1'I 20 Afd-daTi3Q ._-_ Cm $34) 42,5 Thr0us'laitili Replaced policy number L234521-371. Your total renewal premium for APR 30 2022 to OCT 30 2022 is$471.54. Location used to determine rate charged-151 CLEAR CREEK DR,ASHLAND OR 97520. YOUR POLICY CONSISTS OF THIS DECLARATIONS PAGE THE POLICY BOOKLET - FORM 9837B AND ANY ENDORSEMENTS THAT APPLY, INCLUDING THOSE ISSUED TO YOU WITH ANY SOBSEOUENT RENEWAL TICE. 01 6028BJ ADDITIONAL INSURED PRIOR NOTICE OF TERMINATION)-S&B JAMES CONSTRUCTION CO 8425 AGATE R WHITE CITY OR 97503-1076. 02 6028BJ ADDITIONAL INSURED ( RIOR NOTICE OF TERMINATIONI-THE CITY OF ASHLANDtj-ITS9ELECTED OFFICIALS, OFFICERS & EMPLOYEES, 20 MAIN ST, ASHLAND 6030GJ BUSINESS NAMED INSURED. 6128BL AMENDATORY ENDORSEMENT. 6771AP AMENDMENT OF NONRENEWAL. 6937B.2 AMENDATORY ENDORSEMENT. 6196AA WAIVER OF SUBROGATION UNDER THE LIABILITY COVERAGE: IN FAVOR OF S&B JAMES CONSTRUCTION CO. Agent: JON SNOWDEN INSURANCE AGCY INC Telephone: (541)482-2461 02164/03595 See Reverse Side Prepared JUN 09 2022 090B-AE6 155-3866.2 04-2005(01502564) 01302540 145XON (01502510) This policy is issued by State Farm Mutual Automobile Insurance Company. MUTUAL CONDITIONS 1. Membership.While this policy is in force,the first insured shown on the Declarations Page is entitled to vote at all meetings of members and to receive dividends the Board of Directors in its discretion may declare in accordance with reasonable classifications and groupings of policyholders established by such Board. 2. No Contingent Liability. This policy is non-assessable. 3. Annual Meeting. The annual meeting of the members of the company shall be held at its home office at Bloomington, Illinois,on the second Monday of June at the hour of 10:00 A.M., unless the Board of Directors shall elect to change the time and place of such meeting, in which case, but not otherwise, due notice shall be mailed each member at the address disclosed in this policy at least 10 days prior thereto. In Witness Whereof, the State Farm Mutual Automobile Insurance Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. rn.) Secretary President B10 a. you;or 3. PERSONAL INJURY PROTECTION 6030GJ BUSINESS NAMED INSURED COVERAGE b. any of your agents,em- This endorsement is a part of the policy. Because of the type of named insured shown on the ployees, or business a. Additional Definitions T Declarations Page of this policy and the changes made below,all references to resident relatives partners Insured is changed to read: 0 and non-owned cars in the policy are deleted.Except for the changes this endorsement makes,all while maintaining or using Insured means: other provisions of the policy remain the same and apply to this endorsement your car,a newly acquired Any person who suffers bodilym N car,a temporary substitute - v 1. DEFINITIONS 3. any other person or organization car, or a trailer owned by jury while occupying or through be- m vicariously liable for the use of a o ; ing struck as a pedestrian by: (NIa You or Your is changed to read: Y vehicle by an insured as defined 1. your car;or c: You or Your means the named insured or in 1.or2.above,but only for such (3) The following exclusion is added: a`' named insureds shown on the Declara- vicarious liability. This provision THERE IS NO COVERAGE 2. a newly acquired car which is N o lions Page. applies only if the vehicle is: FOR AN INSURED FOR either the same type of vehicle Z" 2. LIABILITY COVERAGE a. neither owned b nor hired DAMAGES RESULTING as your car or is required to be Y> insured by the Personal Injury tit a. Additional Definition by,that other person or or- FROM: Protection Act. OA al aganization;and 1. THE HANDLING OF Insured is changed to read: Such vehicle must be operated by b. neither available for,nor be- PROPERTY BEFORE IT IS you or with your permission and its Insured means: ing used for, carrying per- MOVED FROM THE 1. you for: sons for a charge. C ACEDWHERE ITAC-THE nVt be within the scope of such E-ipermission. PA Insured does not include the United a, the ownership, maintenance, SURED FOR b. Exclusions or use of: States of America or any of its MOVEMENT INTO OR agencies. (1) Exclusion 3.is changed to read: O ONTO A VEHICLE FOR O (1)your car; b. Exclusions WHICH THE INSURED IS 3. LOSS OF INCOME OR LOSS (2) a newly acquired car, (1) Exclusion 4.is changed to read: PROVIDED LIABILITY OF SERVICES EXPENSES FOR ,V., or 4. FOR BODILY INJURY COVERAGE BY THIS A PEDESTRIAN STRUCK POLICY; OUTSIDE OF OREGON; r-7 (3) a trailer;and TO THAT INSURED'S O FELLOW EMPLOYEE 2. THE HANDLING OF (2) The language that reads: P-4 b. the maintenance or use of a WHILE THE FELLOW PROPERTY AFTER IT IS THERE IS NO COVERAGE temporary substitute car, EMPLOYEE IS IN THE MOVED FROM THE VE- FOR AN INSURED WHO IS O 2. any person for his or her use of: COURSE AND SCOPE OF HICLE DESCRIBED IN 1. OCCUPYING A VEHICLE HIS OR HER EMPLOY- ABOVE TO THE PLACE O a. your car, MENT; WHERE IT IS FINALLY WHILE IT IS: F" b. a newlyacquired car, a. MADE AVAILABLE;OR �, 4 (2) Exclusion 7.is changed to read: DELIVERED BY THE IN- V c. a temporary substitute car, 7. WHILE MAINTAINING SURED;OR b. BEING USED E., or OR USING A VEHICLE 3. THE MOVEMENT OF TO CARRY PERSONS FORA E-1 INT CONNECTION WITH PROPERTY BY MEANS CHARGE. This exclusion does d. a trailer while attached to a THAT INSURED'S EM- OF A MECHANICAL DE- not apply to: car described in a.,b.,or c. PLOYMENT IN OR EN- VICE, OTHER THAN A ra above. a. the use of a private passen- GAGEMENT OF ANY HAND TRUCK, THAT IS ger car on a share-the-ex- P4- Such vehicle must be used KIND IN A CAR BUSI- NOT ATTACHED TO THE basis;or a within the scope of your con- NESS. This exclusion does VEHICLE DESCRIBED pense sent,and not apply to: IN 1.ABOVE. Page 1 of 4 6030G1 Page 2 of 4 6030GJ ©,Copyright,State Farm Mutual Automobile Insurance Company,2015 6),Copyright,State Farm Mutual Automobile Insurance Company,2015 2 W P-7 2 Ri o W b. you and resident relatives (3) Exclusion 5.is changed to read: 2. you or any person entitled to re- 3. a temporary substitute car,and while occupying a non- cover compensatory damages as owned car as a passenger. 5. WHILE MAINTAINING a result of bodily injury to an in- 4. a camper that is designed to be ., OR USING VEHICLE IN sured defined in item 1.above. mounted on a pickup truck and M is changed to read: CONNECTION WITH is shown on the Declarations mo THERE IS NO COVERAGE THAT INSURED'S EM- b. Exclusions Page; 9 FOR AN INSURED WHO IS PLOYMENT IN OR EN- Exclusion 2.is deleted. including its parts and its equipment N OCCUPYING A VEHICLE GAGEMENT OF ANY WHILE IT IS: KIND IN A CAR BUSI- 6. PHYSICAL DAMAGE COVERAGES that are common to the use of the ve- N a. MADE AVAILABLE;OR NESS. This exclusion does Additional Definitions hick as a vehicle. However,parts '� nota 1 to anyof our: and equipment of campers must be u b. BEING USED apply y a. Covered Vehicle is changed to read: securely fixed as a permanent part of aTO CARRY PERSONS FOR A a. agents; Covered Vehicle means: the camper. M CHARGE. b. employees;or 1. your car; b. Insured is changed to read: 4. MEDICAL PAYMENTS COVERAGE c. business partners 2. a newly acquired car; Insured means you. a0 a. Additional Definitions while maintaining or using Insured is changed to read: your car,a newly acquired car,a temporary substitute Insured means any person while car, or a trailer owned by F, occupying: you; 1. your car; (4) Exclusions 7.and 9.are deleted. O 2. a newly acquired car; 5. UNINSURED MOTOR VEHICLE BOD- O 3. a temporary substitute car;or ILY INJURY COVERAGE and UNIN- SURED MOTOR VEHICLE BODILY ✓ 4. a trailer while attached to a car INJURY AND PROPERTY DAMAGE a described in 1.,2.,or 3.above. COVERAGE O Such vehicle must be used within a. Additional Definitions the scope of your consent. b. Exclusions Insured is changed to read: O (1) Exclusion 1.is deleted. Insured means: O (2) Exclusion 4.is changed to read: 1. any person while occupying: Z 4. THERE IS NO COVER- a. your car; ✓ AGE FOR AN INSURED b. a newly acquired car;or H WHO IS OCCUPYING A E,,, VEHICLE WHILE IT IS: c. a temporary substitute car. d a. MADE AVAILABLE; Such vehicle must be used FA OR within the scope of your con- b. BEING USED sent. Such person occupying a F=1 vehicle used to carry persons TO CARRY PERSONS for a charge is not an Insured; FORA CHARGE; and Page 3 of 4 6030GJ Page 4 of 4 6030GJ ©,Copyright,State Farm Mutual Automobile Insurance Company,2015 ©,Copyright,State Farm Mutual Automobile Insurance Company,2015 m R io N O 6771AP AMENDMENT OF NONRENEWAL This endorsement is a part of the policy. Except for the changes it makes,all other terms of the policy remain the same and apply to this endorsement. A GENERAL TERMS c\' v Nonrenewal is changed to read: cM� 7. Nonrenewal If we decide not to renew this policy,then,at least 45 days before the end of the current aN policy period,we will mail or deliver a nonrenewal notice to the most recent policy ad- dress that we have on record for the named insured. Proof of mailing shall be sufficient Z proof of notice. O O U " H a O O O w U H P64 • Page 1 of 1 6771AP 2 N LI 0 W CITY OF FORM #4 ASHLAND l�D l� mfromi Cif 00R(c °��7 OC U ZL D Bonn,clam= 000OD 5000 To: Joseph L.Lessard,City Manager From: Scott Fleury,PE,Director of Public Works Date: 7/7/2022 Re: DETERMINATIONS TO PROCURE PERSONAL SERVICES In accordance with AMC 2.50.120(A), for personal services contracts greater than $5,000, but less than $75,000, the Department Head shall make findings that City personnel are not available to perform the services, and that the City does not have the personnel or resources to perform the services required under the proposed contract. Background The department's intent is to hire Polaris Land Surveying. Polaris Land Surveying will provide surveying services for a Right- of-Way and Topographic Engineering Survey of an approximate 700 feet strip of Walnut Street between a point 100 feet south of the intersection of Walnut Street and Wiley Street to the intersection of Walnut& Grant Street. Pursuant to AMC 2.50.120(A), has a reasonable inquiry been conducted as to the availability of City personnel to perform the services, and that the City does not have the personnel and resources to perform the services required under the proposed contract? The City of Ashland Engineering Division does not have the adequate staff time or appropriate resources to provide the scope of service contemplated under this contract.In addition, no other Department in the City has the resources or technical knowledge to complete the work associated with this personal services contract. Requested by: 1014Date: ."7.202. Der•'""` 's Approved by: Date: City Manager Comments: Form#4-Department Head Determinations to Procure Personal Services,Page 1 of 1,7/7/2022