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2022-158 PO 20230058-DOWL, LLC
Purchase Order IT RFiscal Year 2023 Page: 1 of: 1 � B City of Ashland - ATTN: Accounts Payable20 E. Main Purchase Q L Ashland, OR 97520 Order# 20230058 T Phone: 541/552-2010 O Email: payable@ashland.or.us V H C/O Public Works Department E DOWL, LLC I 51 Winburn Way N 920 COUNTRY CLUB RD SUITE 100B p Ashland, OR 97520 DEUGENE, OR 97401 Phone: 541/488-5347 O O Fax 541/488-6006 R . al _ �z -7E4. =re. ScottFleury 06/29/2022 5270City Accounts P¢ ayable 63i�g On-call Inspection Services 1 On-call inspection services for public works permits and special 1.0 $75,000.00 $75,000.00 projects Personal Services Agreement (Greater than $35,000.00) Completion date: June 30, 2023 Project Account: ,.**************GL SUMMARY*************** 088100-604100 $75,000.00 J By: lDate: (d1 araN $75 000.00 Authorized Signature ` `8 , • • FORM #3 �'D�� CITY O A request fcty a Put'46�4 -e Order � `� � � ASHLAND REQUISITION Date of request: 06116/2022 Required date for delivery: Vendor Name DOWL LLC , Address,City,State,Zip ,8410 154th Avenue NE Suite 120 Redmond,WA 98052 Contact Name&Telephone Number Ken Nichols knichols@dowl.com Email address SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Invitation to Bid ❑ Emergency O Reason for exemption: Date approved by Council: 0 Form#13,Written findings and Authorization ❑ AMC 2.50. (Attach copy of council communication) 0 Written quote or proposal attached O Written quote or proposal attached (If council approval required,attach copy of CC) ❑ Small Procurement 0 Request for Proposal Cooperative Procurement Not exceeding$5,000 Date approved by Council: 0 State of Oregon ❑ Direct Award _(Attach copy of council communication) Contract# O Verbal/VVritten bid(s)or proposal(s) 0 Request for Qualifications(Public Works) 0 State of Washington , Date approved by Council: Contract# _(Attach copy of council communication) 0 Other government agency.contract Intermediate Procurement 0 Sole Source Agency GOODS&SERVICES ❑ 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&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 ❑ Less than$35,000,by direct appointment 0 Special Procurement City Administrator.AMC 2.50.070(4) It (3)Written proposals&solicitation attached 0 Form#9,Request for Approval 0 Annual cost to City exceeds$25,000,Council . Al Form#4,Personal Services$5K to$75K ❑ Written quote or proposal attached approval required.(Attach copy of council communication) Date approved by Council:_ Valid until: _ (Date) • Description of SERVICES Total Cost On-call inspection services for public works permits and special projects :$ 75;000;09. • Item# Quantity Unit Description of MATERIALS Unit Price Total Cost I Per attached quotelproposal TOTAL1COST Project Number _ _ _ Account NumberO t t 00 -609-1 DO , 1 . Account Number • Account Number - *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: 1T•Director. Date• Support-Yes/No By signing this requisition form,I certify that the City's public contracting requirements have been satisfied. ' e, za Employee:\D� Ce Department Head:,itjt ual toor greater than$5,000) Department Manager/Supervisor: City Manager: A& JUVP / i ' (Equaltoorgreater al ;,1�0 Funds appropriated for current fiscal year YES / NO 4 a 4 a .t •i - Fi .nce Dire tor-(Equal to or greater $5,000) D. • Comments: Form#3-Requisition • • CITY OF HLAN D TO: Scott Fleury,PE,Director of Public Works FROM: Kaylea Kathol,Public Works Sr.Project Manager DATE: 5/24/22 . RE: Proposals for On-Call Inspection Services,Project No.2022-09 On April 20,2022,Public Works sent an Intermediate Procurement Request for Proposals for On-Call Inspection Services to five engineering firms. Responses are as follows: • Civil West—submitted a responsive proposal • Dowl—submitted a responsive proposal , • Thornton Engineering—declined to propose due to limited staff availability. Phone conversation on April 21,2022. • GEI Engineering—declined to propose due to limited availability of staff. Email communication on May 10,2022 - • • RH2 Engineering—did not submit a proposal. No reason provided. The project management group reviewed the two responsive proposals on May 24,2022. Both firms are qualified and bring unique skill sets to the table. Dowl appears to be a good fit for right-of-way inspections,and Civil West has ample experience inspecting pipeline,water,and wastewater capital projects. Our department does not have the staff to provide public works inspection, so there is ample need for inspection services over the next year provided by both firms., We recommend awarding two • $75,000 on-call inspection services contracts to Dowl and Civil West. j • • • CITY OF ASHLAND . . 20 East Main Street , Tel:541-488-6002 Ashland,Oregon 97520 Fax:541-488-5311 www.ashland.or.us TTY: 800-735-2900 Kariann Olson From: Karl Johnson Sent: Tuesday,June 28,2022 1:09 PM To: , Tami Campos;Kariann Olson Cc: Scott Fleury;Chance Metcalf Subject:. RE:POs for on-call inspection services f FY213,is.finalither of the contractors have been used to date • K.10h—_nson E:L.K,Associate Engineer •h City of Asla�nd;P tic Works/Engineering 20 East Main St,Ashland,Oregon 97520 P: (541)488-5587,TTY(800)'735-2900 F: (541)488-6006 • This email transmission is official business of the City of Ashland,and it is subject to Oregon Public Records Law for disclosure and retention. ,If you have received this message in error,please contact me at(541)488-5587. Thank you If you spend too much time thinking about a thing,you'll never get it done:—Bruce Lee • From:Tami Campos<tami.campos@ashland.or.us> • Sent:Tuesday,June 28,2022 12:58 PM To: Kariann Olson<kari.olson@ashland.or.us>; Karl Johnson<karl.johnson@ashland.or.us> • Cc:Scott Fleury<scott.fleury@ashland.or.us> • Subject: Re: POs for on-call inspection services I don't think we've utilized either one in FY22. Karl do you know? • On Jun 28,2022 at 12:41 PM,<Kariann Olson>wrote: Hello, - • Do you want the two (2) POs for on-call inspection services issued in FY 22 or FY 23? • Please advise. • Thank you. • Kariann • Kariann Olson • • Purchasing Specialist City of Ashland . 90 N. Mountain Ave. • Ashland, Oregon 97520 • Tel 541-488-5354 Fax 541-488-5320 TTY 800-735-2900 i kari.olsonOashland.or.us Visit the City's web site at: www.ashlanthor.us • 1 PERSONAL SERVICES AGREEMENT (GREATER THAN$35,000.00). CONSULTANT: DOWL LLC CITY OF CONSULTANT'S CONTACT: Jaime Jordan ASHLAND 20 East Main Street ADDRESS: 831 O'Hare Parkway Ashland,Oregon 97520 Medford, OR 97501 Telephone: 541/488-5587 TELEPHONE: 541-774-5590 Fax: 541/488-6006 This Personal Services Agreement (hereinafter"Agreement") is entered into by and between the City of Ashland,an Oregon municipal corporation(hereinafter"City")and DOWL LLC,a foreign limited liability company("hereinafter"Consultant"),for on-call inspection services for public works permits and special projects. NOW THEREFORE, in consideration of the mutual covenants contained herein,the City and Consultant hereby agree as follows: i 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 on-call inspection services for public works permits and special projects as more fully set forth in the Consultant's Proposal dated May 18,2022, • which is attached hereto as"Exhibit A"and incorporated herein by this reference. Consultant's services are collectively referred to in this Agreement as the"Work." 3. Compensation: City shall pay Consultant the hourly rates effective 5/25/2022 as specified in the SUPPORTING DOCUMENTS. In no event shall Consultant's total of all compensation and reimbursement under this Agreement exceed the sum of$75,000.00 (seventy-five thousand six hundred ninety-one dollars and thirty-three cents)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 thirty(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. 4. Supporting Documents/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 whiwch cannot be so resolved,the provisions of this J • Page 1 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND DOWL LLC • . • • Agreement itself shall control over any conflicting provisions in any of the exhibits or supporting documents. 5. 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. 6. 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 services to which they will be assigned in a skilled manner and, if required to be registered, licensed;or bonded bythe State of Oregon, are so registered, licensed, or bonded. 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 an other protected intellectual property right shall vest in and is hereby assigned YSnch docmuents arc not intended or represented Co be suitable for reuse •the Cn•or udiers cent any oilier project.Ani•diodificnlion'or raise scithaut written to the City. < ,cnreaiion of Consultant sill bo of CIIe's tole nsl Cr'sit fi indent it and het t hanulcss CamuIi o and Consultant's CnnsnIt us feom nll clo ms,damages, losses,and espenses including attorney fees arising out ofor resulting.therefore. 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$22,002.43 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 r in death),or damage(including loss or destruction)to property,of wh tsoever tutu Ito the extent caused by the negligent i..,,..b en 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, claims,costs,judgments, or other damages, caused solely by the gross . Consultant's dcfeuse obligotioiis under this indemnity paragraphs mean only the reimbursement of reasonable defense costs to Ilre negligence of City. pmponionelccte!t of Consultant's actual liability obligation hereunder. 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 Page 2 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND DOWL LLC • continued at levels sufficient to allow for the purchase of the indicated quantity of services; 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. e. Obligation/Liability of Parties. Termination or modification of this Agreement pursuant to subsections a,b, or c above shall be without prejudice to any obligations or liabilities of either party already accrued prior to such termination or modification. However,upon receiving a notice of termination(regardless whether such notice is given pursuant to Subsection a,b, c, or d of this section,Consultant shall immediately cease all activities under this Agreement, unless expressly directed otherwise by City in the notice of termination.Further,upon termination, Consultant shall deliver to City all documents, information,works-in-progress and other property that are or would be deliverables had the Agreement been completed. City shall pay Consultant for Work performed prior to the termination date if such Work was performed in accordance with this Agreement. 12. Independent Contractor Status: Consultant is an independent contractor and not an employee of the City for any purpose. Consultant.shall have the complete responsibility for the performance of this Agreement. Consultant shall provide workers' compensation coverage as required in ORS Chapter 656 for all persons employed to perform Work pursuant to this Agreement. Consultant is a subject employer that will comply with ORS 656.017. Page 3 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND DOWL LLC the Other party,whtch shall not be unreasonably INeiltier party \ withheld: shall 13. Assignment: -e .. - assign this Agreement or subcontract any portion of the Work without the written consent of City. Any attempted assignment or subcontract without written the other fparty consenCity shall be void. Consultant shall be fully responsible for the-acts or omissions of . - _• .. - - • - . - -. - - -. - •-• :etween the 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. Worker's Compensation insurance in compliance with ORS 656.017,which requires subject employers to provide Oregon workers' compensation coverage for all their subject workers 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 t 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 prior to commencing the Work under this Agreement. The certificate will specify all of the parties who are Additional Insureds. Insuring companies or entities are subject to the City's acceptance. e- - e, -- - --- - •-- • • - -e -- _ -- -, -• - be provided to the City. The Consultant shall be financially responsible for all pertinent deductibles, self-insured retentions,and/or self-insurance. • • Page 4 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND DOWL LLC • • 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; (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. 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,by mailing using registered 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 Attn:Kaylea Kathol 20 East Main Street Ashland, Oregon 97520 With.a copy to: City of Ashland—Legal Department Page 5 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND DOWL LLC 20 E.Main Street Ashland, Oregon 97520 Phone: (541)488-5350 . If to Consultant: DOWL LLC Jaime Jordan 831 O'Hare Parkway Medford, OR 97501 19. Governing Law. This Agreement shall be governed by the laws of the State of Oregon without regard to conflict of laws principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is in federal court,in which case exclusive venue shall be in the federal district court for the district of Oregon. Each party expressly waives any and all rights to maintain an action under this Agreement in any other venue, and expressly consents that,upon motion of the other party,any case may be dismissed or its venue transferred, as appropriate,so as to effectuate this choice of venue. 20. Amendments. This Agreement may be amended only by written instrument executed by both parties with the same formalities as this Agreement. 21. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and authorized for expenditure to finance the costs of this Agreement within the City's fiscal year budget. Consultant understands and agrees that City's payment of amounts . under this Agreement attributable to Work performed after the last day of the current fiscal year is contingent on City appropriations,or other expenditure authority sufficient to allow City in the exercise of its reasonable administrative discretion,to continue to make payments under this Agreement. In the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this Agreement without penalty or liability to City, effective upon the delivery of written notice to Consultant,with no further liability to Consultant. 22. THIS AGREEMENT AND THE ATTACHED EXHIBITS CONSTITUTE THE ENTIRE UNDERSTANDING AND AGREEMENT BETWEEN THE PARTIES. NO WAIVER, CONSENT,MODIFICATION OR CHANGE OF TERMS OF THIS AGREEMENT SHALL BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT,MODIFICATION OR CHANGE,IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS,AGREEMENTS, OR REPRESENTATIONS, ORAL . OR WRITTEN,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. 23. Certification. Consultant agrees to and shall sign the certification attached hereto as"Exhibit C"and incorporated herein by this reference. Page 6 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND DOWL LLC 1 " 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 0 P1 . D: .spcG12% '— DOWL LLC(CONSULTANT): pDigttagy stgnod byJaimo Jordan ,,,DN:�CN"JaImo Jordan, Jaime Jordan o;,son a 0 o�=coM By: . ,� By: -D e:2o1011 :Dg:z4.O `esetlit4s iQ MManager— Ot„pt t 1, Signature We{;7a0a- ___ Jaime Jordan Date Printed Name LLC Member Title Purchase Order No. 6.15.2022 Date (W-9 is to be submitted with this signed Agreement) APPROVED AS TO FORM: Douglas M McGeary Assistant City Attorney 05-31-2022 Date Page 7 of 7: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND DOWL LLC . i EXHIBIT B CITY OF ASHLAND, OREGON City of Ashland LIVING ALL employers described WAG E below must comply with City of Ashland laws regulating as ment of a livin. was e. $15.96 per hour, effective June 30, 2021. �Ga . The Living Wage is adjusted annually every /r, June 30 by the Consumer Price Index. 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 assistance for the project or the employee. D For all hours worked under a business from the City of service contract between their Ashland in excess of > Note: For temporary and employer and the City of $22,3.10.46. part-time employees,the Ashland if the contract Living Wage does not apply exceeds$22,310.46 or more. D If their employer is the City of to the first 1040 hours worked Ashland,including the Parks in any calendar year. For D 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 working on a project or 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, Oregon 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 1 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 the location of the business. �✓ (2) Commercial advertising or business cards or a trade association membership are purchased for the business. . ✓ (3)Telephone listing is used for the business separate from the personal residence listing. ✓ (4)Labor or services are performed only pursuant to written contracts. V (5)Labor or services are performed for two or more different persons within a period of one year. ✓ (6)Consultant assumes financial 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. • (1 Cr pDiCsnmedemeJordan Jordan, Jaime Jordan:Olktstandard'oll=llsers, OUVtatt,DC:11355 DC=COM r 1 te:2022.g6.1515:15:58-07'00' Consultant's signature 6.15.2022 Date Page 1 of 1: EXHIBIT C ! • • Supporting documents t TRANSMITTAL LETTER ® r `N D o W L May 18, 2022 City of Ashland Public Works Department Kaylea Kathol,,PMPSenior Project Manager • 51 Winburn Way Ashland,OR 97520 • Subject: Request for Proposals (RFP)for On-Call Construction Inspection Services Dear Members of the Selection Committee: DOWL is aware that the City of Ashland (City) does not currently have the staffing capacity to provide in-house inspection services to meet project needs this year.The City is seeking to establish a term contract with a trusted consultant partner to provide inspection support on public works construction, maintenance,and improvement projects for both City and private development projects.We are ideally suited to complete this work because we provide the City with: • A reliable partner with decades of City project experience. DOWL has successfully delivered more than 60 City projects in the past 22 years.Key members of the DOWL team have provided on-call and project- specific inspection services on roadway improvements, railroad crossings,and bridge projects.This combined experience has given our team in-depth knowledge of local transportation infrastructure,as well as a detailed understanding of the City's construction processes and protocols. • A local team of highly qualified experts. All key staff are located in DOWL's Medford office (office contact information is found below), including Principal-in-Charge (PIC)Jaime Jordan,PE,and Construction Project Manager (PM)Shane Javernick, PE.They will oversee our experienced,Medford-based inspectors who are ' well-positioned to provide high-quality inspection services while eliminating travel,lodging, and per diem expenses. • In-house quality expertise. Also based in Medford,Tim Owings,a certified Quality Control Compliance Specialist(QCCS), has more than 20 years of experience monitoring public works construction to verify compliance with applicable standards and contract documents. ■ Additional capacity to supplement the City's in-house inspection capabilities. Shane uses Deltek Vision's resource planning tools to provide real-time updates of staff availability.Our locally based inspection team can mobilize anywhere within City boundaries within one business day of notification. DOWL will also leverage our statewidedepth of resources to meet sudden fluctuations in workload demand,if needed. As PIC,Jaime will serve as the City's point of contact for communications during the solicitation phase and her • contact information is shown below. Both Jaime and Senior Quality Assurance and Quality Control (QA/QC) Lead Jim Albin, PE,are authorized to represent DOWL in contract negotiations/execution.As PM,Shane will be the City's primary point of contact once the contract has been executed; he can be contacted directly via phone (541.494.0583) or email (sjavernick@dowl.com).We appreciate the opportunity to submit our qualifications for your consideration and look forward to working with the City on this important on-call contract.Please contact us if you have any questions or comments. Respectfully submitted, DOWL — danet— Jaime Jordan, PE Jim Albin, PE Principal-in-Charge Senior QA/QC Lead 541.494.0595 458.206.7993 jjordan@dowl.com jalbin@dowl.com 541.774.5590 • 800.865.9847(fax) : 831 O'Hare Parkway • Medford,OR 97504 1 2. RATE SHEET Hourly Labor Rates ' Table.1 illustrates hourly labor rates for the labor classifications we anticipate using on this on-call contract. Personnel will be identified.on our invoices by name and labor category. • Table 11: Hourly Labor Rates Labor Classification Hourly Labor Rate Labor Classification Hourly Labor Rate Accounting Technician $95 Professional Land Surveyor III $115 • Administrative Assistant $75 Professional Land Surveyor IV $125 Administrative Manager $100 Professional Land SurveyorV $135• Contract Administrator I $135 - Professional Land Surveyor VI $140 Contract Administrator 11 $160 Professional Land Surveyor VII $150 Crew Chief I $95 Professional Land Surveyor VIII $160 Crew Chief II $105 Professional Land Surveyor IX $185 Crew Chief III $110 Professional Land SurveyorX $195 Crew Chief IV • $120 Professional land Surveyor XI $210 Crew Chief V $130 Project Administrator $110 Engineer I $105 Project Controller $140 • Engineer II $120 Project Manager 1 $135 • Engineer III $145 Project Manager ll $150 Engineer IV $165 • Project Manager III $165 EngineerV $175 Project Manager IV $175 Engineer VI $190 Project ManagerV $195 Engineer VII $200 Project Manager VI $210 , Engineer VIII $210 Project Manager VII $225 Engineer IX $225 Survey Crew Surveyor l $65 . Engineer X - $240 Survey Crew Surveyor ll $75 Engineering Technician! $85 Survey Crew Surveyor III $85 Engineering Technician li $95 Survey Crew Surveyor IV $95 Engineering Technician III $105 Survey Crew SurveyorV $105 Engineering Technician IV $120 SurveyTechnician I $65 Engineering Technician V $135 SurveyTechnician II $70 - Engineering Technician VI $150 Survey Technician III $75 Field Representative! $105 Survey Technician IV' $90 Field Representative II $115 Survey Technician V $95 r Field Representative III $145 Survey Technician VI $105 Field Representative IV $160 Survey Technician VII $120 Professional Land Surveyor I • $95 Survey Technician VIII $130 Professional Land Surveyor II $105 • SurveyTechnician IX $145 tO0 W L City of Ashland On-Call Construction Inspection Services 1 2 • 3. STATEMENT OF QUALIFICATIONS utionvg lmatui Specialized Experience &Capability to Perform CITY OF ASHLAND Plc For the past 60 years, DOWL has provided both on-call and Kaylea Kathol,PMP P.Jaime Jordan,PE project-specific construction engineering and inspection (CE&I)services for all types of transportation projects. DOWL PM SR.QA/QC Shane Javernick,PE,will serve as DOWL's PM and the City's ly Shane Javernick,PE Jim Albin,PE single point of contact throughout the contract's duration. He has assembled a Medford-based team of qualified INSPECTION ADMINISTRATIVE SUPPORT inspection staff(see Figure 1)that have worked together . Kyler Morgan Rachel Parks,CAPM on City projects,as well as comparable on-call contracts for IP.Jess Oswald ADDITIONAL RESOURCES ODOT and local agencies throughout southern Oregon.The QCCS 14 dedicated CE&I staff continuity of our team and our local presence will allow us to to Tim Owings provide cost-effective inspection services.Table 2 illustrates . relevant experience and qualifications of all key staff. Ow Key Staff (Qualifications Included) Table 2: Key StaV4Qualiflcati.oris&lRelevartt,Exp-erience ►Shane Javernick,PE I Role:PM I Availability:40% • 9 years of Shane will be responsible for overall contractmanagement,as well as assigning experience staffing resources to meet the City's needs.He has a thorough understanding Relevant Experience: • BS,Civil of standard engineering practices for construction activities and a record of • Southern Oregon Seismic Bridges Engineering preventative troubleshootingand constructionproblem diagnosis.Prior to • ODOT Region 3 ADA Curb Ramps • OR PE#97512 g • ODOT Certified joining DOWL,Shane worked as a resident engineer for the City of San Antonio, • Eagle Point National Cemetery Insp.#51880 Texas,where he managed more than$115M worth of construction projects. ► Jaime Jordan,PE I Role:PIC I Availability:20% Jaime is a long-time resident of the Rogue Valley and has provided senior-level ■ 22 years of oversight and management of dozens of City projects.Her extensive experience Relevant Experience: experience with road and site development designs,hydraulics design and analysis,and • Hersey Street Improvements • BS,Civil utility coordination combined with her knowledge of local standards will allow ■ ODOT Region 3 ADA Curb Ramps Engineering P #65498 • ORRPE her to provide low-volume but high-value involvement at key stages of City • Laurel/Hersey Railroad Crossing construction projects.She will also conduct periodic check-ins,as appropriate, • Ashland Bridge Inspections with City staff to confirm that DOWL is meeting your expectations. Kyler Morgan I Role:Inspection I Availability:50% Kyler is a certified inspector in:general construction,traffic signal,Americans • 7 years of with Disabilities Act(ADA)compliance,drilled shaft,and asphalt concrete Relevant Experience: experience pavement.In the past year,he has provided inspection services on six southern • Southern Oregon Seismic Bridges • BS,Civil Oregonprojects,including reviewing traffic control plans,inspecting right-of-way • ODOT Region 3 ADA Curb Ramps Engineering • ODOT Certified (ROW)and construction permits,monitoring site-specific safety requirements, • Eagle Point National Cemetery Insp.#51932 and inspecting erosion and pollution controls measures for compliance with • Molalla Avenue Improvements 1200-C permit requirements. l ► Jess Oswald I Role:Inspection I Availability:50% Jess is a certified inspector in:general construction,traffic signal,bridge • 9 years ofRelevant Experience: construction,drilled shaft,and asphalt concrete pavement He has spent the experience • Hersey Street Improvements last three years inspecting transportation infrastructure projects,reviewing ■ ODOT-Certified Stevens Road Improvements Insp.#51318 traffic control plans,inspecting ROW and construction permits,monitoring • Southern Oregon Seismic Bridges site-specific safety requirements,and inspecting erosion and pollution controls • Vilas Road Improvements measures for compliance with 1200-C permit requirements. ► Tim Owings I Role:QCCS I Availability:60% • 21 years of Tim is a skilled and experienced QCCS.He is adept at managing all aspects Relevant Experience: experience 1 of the field-tested materials,including asphalt,concrete,aggregates,and • Southern Oregon Seismic Bridges • ODOT-Certified embankments.Tim also has experience reviewing submittals,attending • Asphalt Pavement Support QCCS&Insp. preconstruction meetings,leading QC meetings,and reviewing test reports,test • Ferry Street Bridge Rehabilitation #43649 summaries,and pay notes. • ODOT Region 3 ADA Curb Ramps a \I D p W L City of Ashland On-Call Construction Inspection Services 13 . Capacity&Availability Cost of the Services As part of any on-call contract,we understand that we may be Shane has carefully organized our team structure to called upon to provide services on short notice or immediately leverage staffing resources closest to the City,which will In the event of an emergency.When necessary,we will respond enhance team communication,collaboration,efficiency, within 24 hours,if not sooner.DOWL is experienced at providing and cost-effectiveness. Each member of our team brings CE&I services,often on short timeframes and in sites that a full understanding of construction inspection needs and require specialized access.As PM,Shane will monitor internal services.Team members have been selected with the resources by tracking upcoming work on an individual employee following strategies in mind: basis,using Deltek Vision,our detailed resource planning • ■ Balancing Level of Effort. Our deep bench of CE&I software.Our management team regularly meets to critique staff allows us to leverage inspection staff with rates and adjust these forecasts to establish a high level of confidence commensurate with the complexity of any task order in our team commitments.With this tool,we can confirm CE&I assignment,from confirming permit compliance to staff availability for the duration of your task order assignment, providing full CE&I services.This will minimize overall which will allow us to deliver responsive inspection services. costs while still maintaining a high level of quality. Table 2(see page 3)shows the availability of our proposed ■ Responsiveness.We have strategically staffed our team with key staff;we do not foresee any issues with maintaining their local professionals located 16 miles,or a short 20 minute availability for the duration of your on-call contract. drive,from your office.Shane and Jaime can commit to Past Record of Performance & Local Familiarity being available to you at your office or on-site as the project DOWL has provided CE&I services on almost all 60 City requires,providing you with active,engaged services. projects that we have delivered in the past 22 years,including Additionally,Shane will have a deep pool of inspection roadway improvements(Hersey Street,Walker Avenue, resources at his disposal with 14 dedicated inspection staff Plaza Avenue,and Peachey Road Improvements),railroad statewide able to respond to workload fluctuations. crossings(Laurel/Hersey Street and Oak Street Railroad ■ Minimizing Travel,Lodging,and Per Diem. Our use of crossings),and bridge projects(Ashland Bridge Inspection local inspectors will eliminate travel, lodging,and per and Seismic Analysis).Our local presence gives our team diem costs. If we need to leverage inspectors from other unique insight on City infrastructure.Furthermore,several DOWL offices,we will minimize these expenses to the key staff live in the area and have a personal,vested interest furthest extent possible. in successfully constructing improvements that will enhance ■ Contractor Coordination.Due to our relationships City communities.Our past record of performance and our with local contractors,,we can provide proactive and familiarity with the City allow us to deliver inspection services consistent communication with the contractor. It is not with the following tenets in mind: uncommon for contractors to change schedules on a ■ Quality of Work.Working with the contractor to confirm moment's notice.To avoid unnecessary trips when work all work has been completed in accordance with all is cancelled or rescheduled, it will be important to check applicable standards and contract documents will be in with the contractor's staff regularly at the beginning of a top priority for the City.Our expertise and our City every shift prior to deploying for the day. construction experience will allow us to maintain a high Please refer to Section 2.Rate Sheet for details on our standard of quality,which will reduce the need for costly hourly rates and the cost of our services. rework by the contractor or City Maintenance following completion of the contract. Other Relevant Factors • Ability to Meet Schedules.As an extension of City In addition to our highly.qualified CE&I staff,DOWL has in-house CE&I staff,our inspectors will routinely review the expertise in virtually every discipline thatmay be involved in a contractor's construction schedule and provide feedback given construction project.A few key areas include: • to optimize construction activities,sequence of work, • Design Support during Construction.We can leverage and overall project timeline with the goal of reducing the our design experts to provide a full-service perspective construction schedule and associated travel costs. to constructionby providing review and critique of design • Contract Administration. If needed, DOWL has the staff, drawings, permit documentation,and traffic control expertise,and experience to provide administrative plans,among other items. support on any given task order.Given the nature of the • Bridge and Structural Inspection. Our team of ODOT- work,we anticipate leveraging Medford-based Project and Federal Highway Administration-certified bridge Administrator Rachel Parks, CAPM,on an as-needed inspectors have inspected thousands of bridges of all basis. Rachel has experience providing construction types.We can leverage their intimate knowledge of contract administration on a diverse cross-section of local inspection standards to add value to our team. agency infrastructure projects,which will allow her to . Surveying Support.Our survey team routinely provide efficient support to the City and our team. provides construction staking on transportation and • Cost Control.The subsequent section details our civil construction projects. Our qualified surveyors are approach to delivering cost-effective inspection services. available to integrate with our inspection team to provide added benefit to the City. 't.p OWL. City of Ashland On-Call Construction Inspection Services 14 CITY OF FORM #2 ' ,S H LAND • REQUEST FOR PROPOSAL—114DIN©}NALRSM'GIC $ INTERMEDIATE PROCUREMENT Release date:April 20,2022 • Requested by(name/dept/telephone/fax/email):Kaylea Kathol,Public Works,541-552-2419,kaylea.kathol@ashland.or.us Proposals are due by(time/day/date):May 18,2022/2:00 PM • • Project Name:On-Call Construction Inspection Services Project completion required by(date):One year from contract execution • Preferred method of shipment for materials/equipment(if applicable): FOB Ashland—Freight Prepaid Proposals may be faxed,emailed or hand delivered.Proposers shall submit their proposal on their company letterhead. Informal email proposals and/or late proposals will not be accepted.Terms or discounts which are conditioned upon payment within a certain time will not be considered for purposes of comparison of proposals. The successful proposer will be required to enter into a contract with the City for the services and provide insurance certificates,in their own name,for General Liability,Professional Liability,Automobile,and Workers' Compensation.Subcontracting will not be permitted. SCOPE OF SERVICES The City of Ashland Public Works Department is seeking to retain a qualified engineering firm to provide on-call construction inspection services. The City will select and issue one contract based upon rate structure and qualifications and for an amount not to exceed$75,000. The term ' • of the contract will be one(1)year from date of contract execution. The work will be assigned on an as-needed basis for a variety of projects and programs. Typical duties of the successful consultant may include,but may not be limited to: • Inspect public works construction,maintenance, and improvement projects for both City and private development projects to ensure compliance with City standards and specifications • • Review traffic control plans, inspect right-of-way permits and miscellaneous construction permits • • Monitor safety requirements at construction sites as needed • Monitor sampling and testing of construction Materials including density testing of base materials,concrete and pavement surfaces, and trench backfill,as well as pressure and mandrel testing of piping systems and vacuum and hydrostatic testing of manholes ' . • • Inspect erosion and pollution control measures and BMPs for compliance with 1200-C permit requirements • PROPOSAL SUBMITTAL REQUIREMENTS 1. Transmittal letter identifying the firm's contract information (physical address,telephone number,email)for the point of contract for the City on all correspondence and Form#2—Intermediate Procurement,Request for Proposal,Personal Services,Page 1 of 2,4/20/2022 • communications pertaining to this solicitation • 2. Rate sheet, including hourly labor rates and fee structure (if applicable): 1 page maximum 3.. Statement of qualifications. In providing qualifications,Proposer may address any applicable selection criteria listed below under"Method of Award". Proposers are : encouraged to use discretion in determining applicability,as this section is limited.to 2 . page maximum. • • • Maximum page length for proposals is 3 pages,excluding cover letter. - • .The successful proposer will be expected to enter into an agreement for personal services substantially similar to the form provided in Attachment A. . Questions regarding this invitation to bid should be addressed to: - Kaylea Kathol, Sr.Project Manager, 541-552-2419,kaylea.kathol@ashland.or.us • Any addenda that may be issued related to this RFP will be emailed directly to proposal holders • •The City of Ashland reserves the right to cancel this procurement or reject any and all proposals in accordance with ORS 279B.100. . Please note: Pioposnls are required to include relevant information that will appropriately satisfy the scope of services and adequately satisfy the selection criteria,that is applicable far the scope of services,listed below tinder Method of Award. Method ofAsvard: • • I In accordance with AMC 2.50.120(C),personal services selection criteria shall include: ' I. Specialized experience in the type ofwork to be performed; 2. Capacity and capability to perform the work,including any specialized services within the time limitations for the work; 3. Educational and professional record, including pdst record of performance on contracts with governmental agencies and private parties with respect to cost control, quality of work, ability to meet schedules, and contract administration where applicable; • 4. Availability to perform the assignment and familiariry with the area in which the specific work is located, including knowledge • of designing or techniques peculiar to it,where applicable; 5. Cost of the services;and . 6. Any other factors relevant to the particular contract. • In accordance with ORS 279B.070 and AMC Section 2.50.120(A),Intermediate Procurement(4)If a contract is mvar ded,the • contracting agency shall award the contract to the offeror whose quote or proposal will best serve the interests of the contracting . • agency,taking into account price as well as considerations including,but not limited to,experience,expertise,product functionality, • suitability for a particular propose and contractor responsibility under ORS279B.110.• I • • • • � . • • • • • G:1pub wrks\eng\2022 23 PW Inspector On Call\RFP On Call Inspector Services 04.20.22.doc • 2 � I Terra Insurance. Company T E RRA (A Risk Retention Group) Two Fifer Avenue, Suite 100 INSURANCE COMPANY Corte Madera, CA 94925 BATE CERTIFICATE OF INSURANCE 03/28/22 CERTIFICATE HOLDER City of Ashland(OR) 20 East Main St. ' Ashland, OR 97520 • This certifies that the"claims made"insurance policy(described below by policy number)written on forms in use by the Company has been issued: This certificate Is not a policy or a binder of insurance and is issued as a matter of information only,and confers no rights upon the certificate holder. This certificate does not alter, amend or extend the coverage afforded by this policy. The policy of insurance listed below has 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 policy described herein is subject to all the terms,exclusions and conditions of such policy. Aggregate limits shown may have been ' reduced by paid claims. • TYPE OF INSURANCE Professional Liability POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE 222089 01/01/22 12/31/22 LIMITS OF LIABILITY $2,000,000 EACH CLAIM $2,000,000 ANNUAL AGGREGATE PROJECT DESCRIPTION DOWL Project Number:2752.80159.00 DOWL Project Name:North Mountain Avenue Overlay-I-5 to E.Main Renew until 6/30/2026 CANCELLATION: If the described policy is cancelled by the Company before its expiration date, the Company will mail written notice to the certificate holder thirty(30)days in advance,or ten (10)days in advance for non-payment of premium. If the described policy is cancelled by the insured before its expiration date,the Company will mail written notice to the certificate holder within thirty(30)days of the notice to the Company from the insured. ISSUING COMPANY: NAME AND ADDRESS OF INSURED TERRA INSURANCE COMPANY DOWL,LLC operating as (A Risk Retention Group) DOWL • 8410-154th Avenue,N.E. b2J. a(24— Redmond,WA 98052-3864 President .- , ® DATE(MMIDD/Y1fYY) ACS o CERTIFICATE OF LIABILITY INSURANCE DATE 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 be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). . PRODUCER CONTACT NAME: Parker,Smith&Feek,LLC. (Am.Ho.Ext1:509-789-8350 (NC.Nol:509-931-0794 16201 E Indiana Ave,Suite 1000 E-MAIL Spokane Valley,WA 99216 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC S INSURER A: American Casualty Co.of Reading,PA ) INSURED INSURER B: National Fire Ins.Hartford • DOWL,LLC 5000 Meadows Road,Suite 420 INSURER c: Continental Casualty Company Lake Oswego,OR 97035 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. INSRTRTYPE OF INSURANCE N R wvo POLICY NUMBER (MM/DDY/YYW) (MMIDDIYYYY) LIMITS A GENERAL LIABILITY 6080818241 05/01/2022 05/01/2023 EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED K COMMERCIAL GENERAL LIABILITY X X PREMISES Ea occurrence) $ 500,000 CLAIMS-MADE K OCCUR _MED EXP(Any one person) $ 15,000 K BI/PD DED:$10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT AP�PLIESPER: PRODUCTS $ 2,000,000 n JEC Fri —I POLICY I I LOC $ B AUTOMOBILE LIABILITY 6080881839 05/01/2022 05/01/2023 (EeaecINEDOSINGLELIMIT $ 1,000,000 K ANY AUTO X X BODILYINJURY(Perperson) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _AUTOS _ " TY HIRED AUTOS _AUTOS NON-OWNED (Perraccident) DAMAGE $ $ • C UMBRELLA LIAB K OCCUR 6080818255 05/01/2022 2023 EACH OCCURRENCE $ 2,000,000 K EXCESS LIAB CLAIMS-MADE X X AGGREGATE $ 2,000,000 DED K RETENTIONS$10,000 $ WORKERS COMPENSATION WC680818238 K WCSTATU- K OTH- B AND EMPLOYERS'LIABILITY YIN 05/01/2022 05/01/2023 TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE USL&H,WC,Stop Gap _ E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? n N/A X Included (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under • **USL&H,WC,Stop Gap1,000,000 DESCRIPTION OF OPERATIONS below , , �_-, E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Project Number:2747.80434.00 , City of Ashland and Oregon,and its elected officials,officers and employees are additional insureds on the general liability,automobile,and excess liability policies per the attached endorsements/forms... (See Attached Description) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. . City of Ashland . 20 East Main Street - AUTHORIZED REPRESENTATIVE Ashland,OR 97520 • " ,��i� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD •1 of 34 (RAG01) • DESCRIPTIONS (Continued from Page 1 ,) Coverage is primary and non-contributory on the general liability,automobile,and excess liability policies per the attached endorsements/forms. Waiver of subrogation applies on the general liability,automobile,workers compensation,and excess liability policies per the attached endorsements/forms. Notice of cancellation for the general liability,automobile,workers compensation,and excess liability policies per the attached forms. • ' I 2 of 34 (RAG01) - i CNA Blanket Additional Insured -Owners, Lessees or • Contractors-with Products-Completed Operations Coverage Endorsement. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows: I. WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required by written contract to add as an additional insured on this coverage part,but only with respect to liability for bodily injury,property damage or personal and advertising injury caused in whole or in part by your acts or omissions,or the acts or omissions of those acting on your behalf: A. in the performance of your ongoing operations subject to such written contract;or B. in the performance of your work subject to such written contract,but only with respect to bodily Injury or property damage included in the products-completed operations hazard,and only if: 1. the written contract requires you to provide the additional insured such coverage;and 2. this coverage part provides such coverage. II. But if the written contract requires: A. additional insured coverage under the 11-85 edition, 10-93 edition,or 10-01 edition of CG2010,or under the 10-01 edition of CG2037;or B. additional insured coverage with"arising out of language;or C. additional insured coverage to the greatest extent permissible by law; then paragraph I.above is deleted in its entirety and replaced by the following: • WHO IS AN INSURED is amended to include as an Insured any person or organization whom you are required • by written contract to add as an additional insured on this coverage part,but only with respect to liability for bodily injury,property damage or personal and advertising injury arising out of your work that is subject to such written contract. III. Subject always to the terms and conditions of this policy,including the limits of insurance,the Insurer will not provide such additional insured with: A. coverage broader than required by the written contract;or B. a higher limit of insurance than required by the written contract. IV. The insurance granted by this endorsement to the additional insured does not apply to bodily injury,property damage,or personal and advertising injury arising out of: A. the rendering of,or the failure to render,any professional architectural,engineering,or surveying services, including: 1. the preparing,approving,or failing to prepare or approve maps,shop drawings,opinions,reports, surveys, field orders,change orders or drawings and specifications;and 2. supervisory, inspection,architectural or engineering activities;or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. { V. Under COMMERCIAL GENERAL LIABILITY CONDITIONS,the Condition entitled Other Insurance is amended to add the following,which supersedes any provision to the contrary in this Condition or elsewhere in this coverage part: Primary and Noncontributory Insurance CNA75079XX(10-16) Page 1 of 2 Insured Name:DOWL,LLC Copyright CNA All Rights Reserved. Includes copyrighted material or Insurance Services.Office,Inc,with its permission. ii cNA . Blanket Additional.Insured - Owners, Lessees or • Contractors -with Products-Completed Operations Coverage Endorsement With respect to other insurance available to the additional insured under which the additional insured is anamed insured,this insurance is primary to and will not seek contribution from such other insurance,provided that a written contract requires the insurance provided by this policy to be: 1. primary and non-contributing with other insurance available to the additional insured;or 2. primary and to not seek contribution from any other insurance available to theadditional insured. But except as specified above,this insurance will be excess of all other insurance available to the additional insured. VI. Solely with respect to the insurance granted by this endorsement,the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: • The Condition entitled Duties In The Event of Occurrence,Offense,Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer'written notice of any claim,or any occurrence or offense which may result in a claim; 2. send the Insurer copies of all legal papers received,and otherwise cooperate with the Insurer in the investigation,defense,or settlement of the claim;and 3. • make available any other insurance,and tender the defense and indemnity of any claim to any other insurer or self-insurer,whose policy or program applies to a loss that the Insurer covers under this coverage part. However,if the written contract requires this insurance to be primary and non-contributory,this paragraph 3. does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. VII.Solely with respect to the insurance granted by this endorsement,the section entitled DEFINITIONS is amended • to add the following definition: Written contract means a written contract or written agreement that requires you to make a person or organization an additional insured on this coverage part,provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy;and B. was executed prior to: 1. the bodily injury or property damage or 2. the offense that caused the personal and advertising injury; for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged, • This endorsement,which forms a part of and is for attachment to the Policy issued by the designated.Insurers,takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below,and expires concurrently with said Policy. I . CNA75079XX(10-16) Page 2 of 2 Insured Name:DOWL, LLC, Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. • CNA • CNA PARAMOUNT • Architects, Engineers and Surveyors General Liability Extension Endorsement 2. the permitted or authorized operations performed by a Named Insured or on a Named Insured's behalf. The coverage granted by this paragraph does not apply to: a. Bodily injury,property damage or personal and advertising injury arising out of operations performed for the.state or•governmental agency or subdivision or political subdivision;or b. Bodily injury or property.damage included within the products-completed operations hazard. With respect to this provision's requirement that additional insured status must be requested under a written contract or agreement, the Insurer will treat as a written contract any governmental permit that requires the Named Insured to add the governmental entity as an additional insured. I. Trade Show Event Lessor 1. With respect to a Named Insured's participation In a trade show event as.an exhibitor,•presenter or displayer, any person or organization whom the Named Insured Is required to include as an additional insured,but only with respect to such person or organization's liability for bodily injury, property damage or personal and advertising injury caused by: ', a. the Named Insured's acts or omissions;or I ` b. the acts or omissions of those acting on the Named Insiired's behalf, • In the performance.of•the Named Insured's ongoing operations at the trade show event premises during the tradeshow event, 2. The coverage granted by this paragraph does not apply to bodily injury or property damage included within the products-completed operations hazard. 2. ADDITIONAL INSURED.•PRIMARY AND NON-CONTRIBUTORY TO ADDITIONAL INSURED'S INSURANCE The Other Insurance Condition in the COMMERCIAL GENERAL LIABILITY CONDITIONS Section is amended to add the following paragraph: If the Named Insured has agreed in writing in a contract or agreement that this insurance is primary and non- contributory relative to an additional Insured's own•insurance, then this insurance is.primary, and the Insurer will nol seek contribution from that other insurance. For the 'purpose of this Provision 2., the additiohal insureds own insurance means insurance on which the additional insured is a named insured. Otherwise, and notwithstanding anything to the contrary elsewhere in.this Condition,the insurance provided to such person or organization is excess :of any other insurance'available to such person or organization. I $. ADDITIONAL INSURED—EXTENDED COVERAGE ' • • When an additional insured is added by this or any other endorsement attached to this Coverage Part,WHO IS AN INSURED is amended to make the following natural persons Insureds. 1 If the additional Insured is: • a. An individual,then his or her spouse is an Insured; b. A partnership or joint venture,then its partners,members and their spouses are.Insureds; c. A limited liability company;then its members and managers are Insureds;or d. An organization other than'a partnership, joint venture or limited liability company, then its executive officers, • directors and shareholders are Insureds; ' l CNA74858XX(1-15) Page•4 of 18 • Nat'l Fire Ins Co of Hartford Insured Name:DOWL, LLC • Copyright CNA All Rights Reserved. Includes copyrighted material or Insurance Services Office,Inc..with its permission. fi • CNA Architects, Engineers and Surveyors General Liability Extension Endorsement services performed for the Named Insured under the Named Insured's direct supervision. All limitations that apply to employees andvolunteer workers also apply to anyone qualifying as an Insured under this Provision. 24. SUPPLEMENTARY PAYMENTS ' The section entitled SUPPLEMENTARY PAYMENTS—COVERAGES A AND B is amended as follows: A. Paragraph 1.b. is amended to delete the$250 limit shown for the cost of bail bonds and replace it with a$5,000. limit;and B. Paragraph 1.d. is amended to delete the limit of$250 shown for daily loss of earnings and replace it with a $1,000. limit. • 25. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS If the Named Insured unintentionally fails to disclose all existing hazards at the inception date of the Named Insured's Coverage Part,the Insurer will not deny coverage under this Coverage Part because of such failure., 26. WAIVER OF SUBROGATION-BLANKET Under CONDITIONS,the condition entitled Transfer Of Rights Of Recovery Against Others To Us is amended to add the following: The Insurer waives any right of recovery the Insurer may have against any person or.organization because of payments the Insurer makes for injury or damage arising out of: 1. the Named Insured's ongoing operations;or • 2. your work included in the products-completed operations hazard. However, this waiver applies only when the Named Insured has agreed in writing to waive such rights of recovery in a written contract or written agreement, and only if such contract or agreement: 1. is in effect or becomes effective during the term of this Coverage Part;and 2. was executed prior to the bodily injury, property damage or personal and advertising injury giving rise to the claim. 27. WRAP-UP EXTENSION: OCIP,CCIP,OR CONSOLIDATED(WRAP-UP)INSURANCE PROGRAMS Note: The following provision does not apply to any public construction project in the state of Oklahoma, nor to any construction project in the state of Alaska, that is not permitted to be insured under a consolidated (wrap-up) • insurance program by applicable state statute or regulation., If the endorsement EXCLUSION — CONSTRUCTION WRAP-UP is attached to this policy, or another exclusionary endorsement pertaining to Owner Controlled Insurance Programs (O,C.I.P.) or Contractor Controlled Insurance Programs(C.C.I.P.)is attached,then the following changes.apply: A. The following wording is added to the above-referenced endorsement: With respect to a consolidated (wrap-up) insurance program project in which the Named Insured is or was involved, this exclusion does not apply to those sums the Named Insured become legally obligated to pay as damages because of: 1. Bodily injury, property damage, or personal or advertising injury that occurs during the Named Insured's ongoing operations at the project, or during such operations of anyone acting on the Named Insured's behalf; nor 2. Bodily injury or property damage included within the products-completed operations hazard that arises out of those portions of the project that are not residential structures. - B. Condition 4.Other-Insurance is amended to add the following subparagraph 4.b.(1)(c): This insurance is excess over: CNA74858XX(1-15) 0 Policy No: =arum Page DO of m Endorsement No: ®Insured Name: 0❑ ®m Copyright CNA All Rights Reserved. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 6 of 34 (RAG01) •• • CNA CNA PARAMOUNT • Cancellation I Non-Renewal —Washington , Wherever used in this endorsement: 1) Insurer means"we","us","our"or the"Company"as those terms may be defined in the policy; and 2) Named Insured means the first person or entity named on the declarations page. and 3)"Insureds" means all persons or entities afforded coverage under the policy. Any cancellation, non-renewal or termination provisions in the policy are deleted in their entirety andreplaced with the following: CANCELLATION AND NON-RENEWAL - . • A. CANCELLATION 1. The Named Insured may cancel the policy at ariy time.To do so,the Named Insured must: • • a. return•the policy to the.Insurer or any of its authorized representatives indicating the effective date of cancellation:or • b. provide a written notice by mail fax or e-mail to the Insurer or any of its authorized • ti representative stating when the cancellation is to be effective; c. provide verbal notice to the Insurer or any of its authorized representative indicating when the cancellation is to be effective.' • • The Insurer will promptly cancel the policy upon notice of cancellation from the Named Insured the date, the Notice is received of the date the Named Insured requests cancellation. 2. The Insurer may cancel the.policy by mailing or delivering to the Named Insured and to its producer written notice of cancellation, including the actual reason for the cancellation,at the last mailing address known to the Insurer,at least: a. ten (10) days before the effective date of cancellation if the insurer cancels for non-payment of premium;or b. sixty (60) days before the effective date of cancellation if the Insurer cancels for any other reason. 3. Like notice of cancellation will also be mailed to any mortgage holder, pledge or other person shown in the policy with an interest in any loss which may occur thereunder,at theirlast mailing address known to• the Insurer. 4. Notice of cancellation will state the effective date of cancellation.The policy period will end on that date. If notice is mailed,proof of mailing willbe sufficient proof of notice. B. PREMIUM REFUND If this policy is canceled,the Insurer will send the Named Insured any premium refund due. If the Insurer cancels, the refund will be pro rata.If the,Named Insured cancels,the refund will be on a.short rate basis.The cancellation will be effective even if the Insurer has not made or not offered a.refund. • CNA62814WA.(9-12) • Page 1 of 2 Copyright CNA All Rights Reserved. -. ( 7/ /f • Business Auto Policy �7L`� Policy Endorsement ,•'f rj) i•.,'I 1�1F}Ilt'iA' ..li i .,,t4 •:E'. �'1- 'w' r.7- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. • Named Insured: DOWL, LLC Endorsement Effective Date: 05/u I/2022 SCHEDULE Insurance Company: National Fire Insurance Company of Hartford Policy Number: 6080881839 . 1 Effective Date: 05/01/2022 Expiration Date: 05/01/2023 Named Insured: DOWL, LLC Address: 8410 154TH AVE NE STE 120 REDMOND,WA 98053 _ • Additional Insured(Lessor): Address: Designation Or Description Of "Leased Autos": Coverages Limit Of Insurance Liability $1,000,000 Each"Accident" • Comprehensive Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus $1,000 Deductible For Each Covered "Leased Auto" Collision Actual.Cash Value Or Cost Of Repair, Whichever Is Less, Minus $1,000 Deductible For Each Covered "Leased Auto" Specified Causes Of Loss Actual Cash Value Or Cost Of Repair, Whichever Is Less, Minus Deductible For Each Covered "Leased Auto" Form No:CA 20 01 10 13 Endorsement Effective Date: Endorsement Expiration Dater Endorsement No: 10; Page: 1 oI 2 Underwriting Company• National Fire Insurance Company of Hartford. 151 N Franklin St.Chicago, IL 60606 Copyright Insurance Services Office.Inc.,2011 CN/ Business Auto Policy .II • Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Coverage 1. Any "leased auto".designated or described in,the Schedule will be considered a covered "auto" you own and not a covered "auto" you hire or borrow. 2. For a "leased auto" designated or described in the Schedule, the Who Is An Insured provision under Covered Autos Liability Coverage is changed to include as an "insured" the lessor named in the Schedule. However, the lessor is an "insured" only for "bodily injury" or "property damage" resulting from the acts or omissions by: a. You; b. Any of your "employees" or agents; or c. • Any person, except the lessor or any "employee" or agent of the lessor, operating a "leased auto" with the permission of any of the above. 3. The coverages provided under this endorsement apply to any "leased auto" described in the Schedule until the expiration date shown in the Schedule, or when the lessor or his or her agent takes.possession . of the "leased auto", whichever occurs first. B. Loss Payable Clause • 1. We will pay, as interest may appear, you and the lessor named in this endorsement for "loss" to a "• . leased auto". 2. The insurance covers the interest of the lessor unless the "loss" results from fraudulent acts or omissions on your part. ! 3. If we make any payment)to the lessor, we will obtain his or her rights against any other party. • C. Cancellation 1. If we cancel the policy, we will mail notice to the lessor in accordance with the Cancellation Common • Policy Condition. 2. If you cancel the policy, we will mail notice to the lessor. 3. Cancellation ends this agreement. • D. The lessor is not liable for payment of your premiums. E. Additional Definition As used in this endorsement: • "Leased auto" means an "auto" leased or rented to you, including any substitute, replacement or extra auto" needed to meet seasonal or other needs, under a leasing or rental agreement that requires you to provide direct primary insurancefor the lessor. ~ I Form No:CA 20 01 10 13 Endorsement Effective Date: Endorsement Expiration Date: Endorsement No: 10:Page:2 of 2 Underwriting Company: National Fire Insurance Company of Hartford, 151 N Franklin St,Chicago,IL 60606 • • Copyright Insurance Services Office. Inc.. 2011 4. Loss Payment—Physical Damage 5. Other Insurance Coverages a. For any covered "auto" you own, this At our option,we may: Coverage Form provides primary a. Pay for, repair or replace damaged or insurance. For any covered "auto"you don't own, the insurance provided by this stolen property; Coverage Form is excess over any other b. Return the stolen property, at our expense. collectible insurance. However, while a We will pay for any damage that results to covered "auto" which is a "trailer" is the"auto"from the theft;or connected to another vehicle, the Covered c. Take all or any part of the damaged or Autos Liability Coverage this Coverage stolen property at an agreed or appraised Form provides for the"trailer"is: value. (1) Excess while it is connected to a motor If we pay for the "loss", our payment will vehicle you do not own;or include the applicable sales tax for the (2) Primary while it is connected to a damaged or stolen property. covered"auto"you own. 5. Transfer Of Rights Of Recovery Against b. For Hired Auto Physical Damage Coverage, Others To Us any covered "auto" you lease, hire, rent or If any person or organization to or for whom we borrow is deemed to be a covered "auto" make payment under this Coverage Form has you own. However, any "auto" that is rights to recover damages from another, those - leased, hired, rented or borrowed with a rights are transferred to us. That person or driver is not a covered"auto". organization must do everything necessary to c. Regardless of the provisions of Paragraph secure our rights and must do nothing after a. above, this Coverage Form's Covered "accident"or"loss"to impair them. Autos Liability Coverage is primary for any B. General Conditions liability assumed under an "insured 1. Bankruptcy. contract". Bankruptcy or insolvency of the"insured"or the d. When this Coverage Form and any other "insured's" estate will not relieve us of any Coverage Form or policy covers on the obligations under this Coverage Form. same basis, either excess or primary, we will pay only our share. Our share is the 2. Concealment, Misrepresentation Or Fraud proportion that the Limit of Insurance of our This Coverage Form is void in any case of Coverage Form bears to the total of the fraud by you at any time as it relates to this limits of. all the Coverage Forms and Coverage Form. It is also void if you or any policies covering on the same basis. other "insured", at any time, intentionally 6. Premium Audit conceals or misrepresents a material fact a. The estimated premium for this Coverage concerning: • Form is based on the exposures you told us a. This Coverage Form; you would have when this policy began.We b. The covered"auto"; will compute the final premium due when c. Your interest in the covered"auto";or we determine your actual exposures. The estimated total premium will be credited d. A claim under this Coverage Form. against the'final premium due and the first 3. Liberalization • Named Insured will be billed for the IfCoverage provide balance, if any. The due date for the final we revise this Form to p premium or retrospective premium is the more coverage without additional premium date shown as the due date on the bill. If charge, your policy will automatically provide the estimated total premium exceeds the the additional coverage as of the day the final premium due, the first Named Insured revision is effective in your state. will get a refund. 4. No Benefit To Bailee—Physical Damage b. If this policy is issued for more than one Coverages , year, the premium for this Coverage Form We will not recognize any assignment or grant will be computed annually based on our any coverage for the benefit of any person or rates or premiums in effect at the beginning organization holding, storing or transporting of each year of the policy. property for a fee regardless of any other provision of this Coverage Form. ' 1 CA 00 01 10 13 ©Insurance Services Office, Inc.,2011 Page 9 of 12 10 of 34 (RAG01) POLICY NUMBER:6080881839 COMMERCIAL AUTO CA 04 44 10 13 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) ' This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: DOWL,LLC SCHEDULE Name(s)Of Person(s)Or Organization(s): ANY PERSON OR ORGANIZATION FOR WHOM OR WHICH YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER FROM US. YOU MUST AGREE TO THAT • REQUIREMENT PRIOR TO LOSS Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The Transfer Of Rights Of, Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, - . but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 10 13 ©Insurance Services Office, Inc.,2011 Page 1 of 1 • 11 of 34 (RAG01) • 1 . . ,.. t CNA . Business Auto Policy Policy Endorsement III (CANCELLdTI0IV1[B100 '7 `" ff THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS' COVERAGE FORM Paragraph 2. of Cancellation (Common Policy Conditions) is replaced by the following: ' 2. We may cancel this Coverage Part by mailing or delivering to the first Named Insured written notice of cancellation at least: a. 10 days before the effective date of cancellation if we cancel for non-payment of premium, or b. 60 days before the effective date of cancellation if we cancel for any other reason., All other terms and conditions of the policy remain unchanged This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers,. takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy. • i I . I • Form No:G•178�2.0 t12.20101 - --- ' - _ ------ -_- - - -. . --- —— __ i i 1 'Copyright CNA Alt Rights Hcserved. • CNA CNA Paramount Excess and Umbrella Liability Policy D. Coverage D- Key Employee Exclusions With respect to Coverage D — Key Employee, this insurance does not apply to any actual or alleged: 1. Death or Disability • death or permanent disability of a key employee relating to, or arising out of: a. nuclear reaction or radiation or radioactive contamination, however caused; b. sickness or disease, including mental illness or mental injury; c. pregnancy, childbirth, miscarriage or abortion; d. suicide, attempted suicide or self inflicted bodily injury, while sane or insane; e. the key employee's intoxication, impairment or otherwise being under the influence of alcohol or controlled substances; f. war, including undeclared or civil war; g. warlike action by a military force, including action in hindering or defending against an actual or expected attack, by any government, sovereign or other authority using military personnel or other agents; or • h. insurrection, rebellion, revolution, usurped power, or action taken by governmental authority in hindering or defending against any of these. 2. Other Expenses a. expenses the Named Insured incurs which the Named Insured would not have incurred if the Named Insured had used all reasonable means to: i. find a permanent replacement for the key employee; and ii. reduce or discontinue the key employee replacement expense; as soon as possible after the Named Insured's permanent loss of the services of the key employee caused by a covered accident. b. additional expenses incurred due to the Named Insured's loss of the services of a permanent replacement appointed.or hired to replace a key employee, however caused. However, this exclusion does not apply if the replacement employee is included in the definition as a key employee and the Named Insured's loss of the services of the replacement employee is caused oy a covered accident. - - IV. WHO IS AN INSURED ' The following persons or organizations are Insureds. • A. With respect to Coverage A - Excess Follow Form Liability, the Named Insured and any persons or organizations included as an insured under the provisions of underlying insurance are Insureds,and then only for the same coverage, except for limits of insurance, afforded under such underlying insurance. B. With respect to the Coverage B- Umbrella Liability: - 1. If the Named Insured is designated in the Declarations of this Policy as: a. an individual, the Named Insured and the Named Insured's spouse are Insureds, but only with respect to the conduct of a business of which the Named Insured is the sole owner. b. a partnership or joint venture, the Named Insured is an Insured. The Named Insured's members, the Named Insured's partners, and their spouses are also Insureds, but only with respect to the conduct of the Named Insured's business. • Form No:CNA75504XX 103-20151 Policy No: Policy Page: 14 of 32 Policy Effective Date: Underwriting Company: Continental Ins.Co,333 S Wabash Ave,Chicago,IL 60604 Policy Page: 25 of 51 • Copyright CNA All Rights Reserved ' I • • SHA CNA Paramount Excess and Umbrella Liability Policy or organization which may be liable to the Insured because of injury or damage to Which this insurance may also apply; and • vi. will not voluntarily make a payment, except at its own cost, assume any obligation, or incur any expense, other-than for first aid, without the Insurer's prior consent. 3. Cooperation • • • With respect to both Coverage A - Excess Follow Form Liability and Coverage B — Umbrella Liability, • • the Named Insured will cooperate with the Insurer in addressing all claims required to be reported to the Insurer in accordance with this paragraph O. Notice of Claims/Crisis Management Event/Covered Accident, and refuse, except solely at its own cost, to voluntarily, without the Insurer's approval, make any payment, admit liability, assume any obligation or incur any expense related thereto. P. Notices Any notices required to be given by an Insured shall be submitted in writing to the Insurer at the address set forth in the Declarations of this Policy. L Q. Other Insurance If the Insured is entitled to be indemnified or otherwise insured in whole or in part for any damages or • defense costs by any valid and collectible other insurance for which the Insured otherwise would have been indemnified or otherwise insured in whole or in part by this Policy, the limits of insurance specified in the Declarations of this Policy shall apply in excess of, and shall not contribute to a claim, incident or such event covered by such other insurance. With respect to Coverage A — Excess Follow Form Liability only, if: a. the Named Insured has agreed in writing in a contract or agreement with a person or entity that this insurance would be primary and would not seek contribution from any other insurance available; b. Underlying Insurance includes that person or entity as an additional insured; and c. Underlying Insurance provides coverage on a primary and noncontributory basis as respects that • person or entity; then this insurance is primary to and will not seek contribution from any insurance policy where that person or entity is a named insured. R. Premium All premium charges under.this Policy will be computed according to the Insurer's rules and rating plans that apply at the inception of the current policy period. Premium charges may be paid to the Insurer or its authorized representative, j S. In Rem Actions A quasi in rem action against any vessel owned or operated by or for a Named Insured, or chartered by or for a Named Insured, will be treated in the same manner as though the action were in personam against the Named Insured. T. Separation of Insureds Except with respect to the limits of insurance, and any rights or duties specifically assigned in this Policy to the First Named Insured, this insurance applies: 1. as if each Named Insured were the only Named Insured; and 2. separately to each Insured against whom a clalrn is made. • U. Transfef of Interest Form No:CNA75504XX(03-2015) Policy No: Policy Page: 21 of 32 Policy Effective Date: Underwriting Company: Continental Ins.Co.333 S Wabash Ave,Chicago,'IL 60604 Policy Page:32 of 51 c Copyright CNA All Rights Reserved. CNA CNA Paramount Excess and Umbrella Liability Policy Assignment of interest under this policy shall not bind the Insurer unless its consent is endorsed hereon. V. Unintentional Omission Based on Insurer's reliance on the Named Insured's representations as to existing hazards, if the Named Insured should unintentionally fail to disclose all such hazards at the effective date of this Policy, the Insurer will not deny coverage under this Policy because of such failure. W. Waiver of Rights of Recovery The Insurer waives any right of recovery it may have against any person or organization because of payments the Insurer makes under this Policy if the Named Insured has agreed in writing to waive such rights of recovery in a contract or agreement, and only if the contract or agreement: 1. is in effect or becomes effective during the policy period; and 2. was executed prior to loss. VII.DEFINITIONS For purposes of this Policy, words in bold face type, whether expressed in the singular or the plural; have the meaning set forth below. Advertisement means a notice that is broadcast or published to the general public or specific market segments about the Named Insured's goods, products or services for the purpose of attracting customers or supporters. For the purposes of this definition: A. notices that are published include material placed on the Internet or on similar electronic means of communication; and B. regarding web-sites, only that part of a web-site that is about the Named Insured's goods, products or• services for the purposes of attracting customers or supporters is considered an advertisement. Aircraft means any machine or device that is capable of atmospheric flight. • Arbitration proceeding means a formal alternative dispute resolution proceeding or administrative hearing to which an Insured is required to submit by statute or court rule or to which an Insured has submitted with the Insurer's consent. Asbestos means the mineral in any form whether or not the asbestos was at any time airborne as a fiber, particle or dust, contained in or formed a part of a product, structure or other real or personal property, carried on clothing, inhaled or ingested, or transmitted by any other means. Authorized Insured means any executive officer, member of the Named Insured's risk management or in-house general counsel's office, or any employee authorized by the Named Insured to give or receive notice of a claim. Auto means: A. a land motor vehicle, trailer or semitrailer designed for travel on public roads, including any attached machinery or equipment; or B. any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance law where it is licensed or principally garaged. However, auto does not include mobile equipment. • Bodily injury means bodily injury, sickness or disease sustained by a person, including death, humiliation, shock, mental anguish or mental injury sustained by that person at any time which results as a consequence of the bodily injury, sickness or disease. Claim means a: A. suit; or Form No:CNA76504XX{03.2015) Policy No: Policy Page:22 of 32 Policy Effective Date: Underwriting Company: Continental Ins.Co.333 S Wabash Ave,Chicago,IL 60604 Policy Page:33 of 51 0 Copyright CNA All Rights Reserved. CNA CNA Paramount Excess and Umbrella Liability Policy Endorsement (CAN"C tilitil IONaNDkNO_lV,'-'iIENEVatt,(001ifibatENT };lfN I ON Wherever used in this endorsement: 1) Insurer means "we", "us", "our" or the "Company" as those terms may be defined in the policy; and 2) Named Insured means the first person or entity named on the declarations page; and 3) "Insureds" means all persons or entities afforded coverage under the policy. Any,cancellation, non-renewal or termination provisions in the policy are deleted in their entirety and replaced with the following: CANCELLATION AND NON-RENEWAL I. CANCELLATION A. The Named Insured may cancel the policy at any time. To do so, the Named Insured must: 1. return the policy to the Insurer or any of its authorized representatives indicating the effective date of cancellation; or 2. provide a written notice by mail fax or e-mail to the Insurer or any of its authorized representative stating when the cancellation is to be effective; 3. provide verbal notice to the Insurer or any of its authorized representative indicating when the• cancellation is to be effective. The Insurer will promptly cancel the policy upon notice of cancellation from the'Named Insured the date the Notice is received or the date the Named Insured requests cancellation. B. The Insurer may cancel the policy by mailing or delivering to the Named Insured and to its producer written notice of cancellation, including the actual reason for the cancellation, at the last mailing address known to the Insurer, at least: • 1. ten (10) days before the effective date of cancellation if the insurer cancels for non-payment of premium; or 2. sixty(60) days before the effective date of cancellation if the Insurer cancels for any other reason. C. Like notice of cancellation will also be mailed to any mortgage holder, pledge or other person shown in the policy with an interest in any loss which may occur thereunder, at their last mailing address known to the Insurer. D. Notice of cancellation will state the effective date of cancellation. The policy period will end on that date. If notice is mailed, proof of mailing will be sufficient proof of notice. Il. PREMIUM REFUND If this policy is canceled, the Insurer will send the Named Insured any premium refund due. If the Insurer cancels,the refund will he pro rata. If the Named Insured cancels, the refund will be on a short rate basis. The cancellation will be effective even if the Insurer has not made or not offered a refund. III. NON-RENEWAL A. The Insurer can nen-renew the policy by giving written notice to the Named Insured and to itsproducer, at the last mailing address known, at least sixty (60) days before the expiration date: If notice is mailed, proof of mailing will be sufficient proof of notice. Copyright CNA All Rights Reserved. cwtCNA Paramount Excess and Umbrella Liability Policy Endorsement • H. The notice of non-renewal will state the actual reason for non-renewal. The Insurer will also mail written notice of non-renewal to any mortgage holder or other person shown in the policy with an interest in any loss which may occur thereunder, at their last mailing address known to the Insurer. C. The Insurer must provide to the Named Insured its renewal terms including the premium due at least twenty 120) days prior•to the expiration date of the current policy. If the Named Insured subsequently fails to pay the premium when due or procures coverage acceptable to it, then the coverage is nonrenewed. IV. OTHER PROVISIONS The Insurer will mail notice of any change in rates or coverage to the Named Insured at least sixty (60) days prior to the expiration date of the policy. • All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. • • • • • • • Copyright CNA All Rights Reserved. • CNA CNA Paramount Excess and Umbrella Liability Policy Declaralions • FSchedAicif----de lyingiffrfsucen �^ » Underlying Insurer Policy Number Policy Period Note: Underlying Insurance Coverages Limits of Insurance National Fire Insurance General Liability Each Occurrence Limit 51,000,000 Company of Hartford 6080818241 General Aggregate Limit $.2,000,000 05/01/2022 to PerLocation : yes 05/01/2023 - Per Project : yes Products/Completed Operations Aggregate Limit $2,000,000 Personal and Advertising Injury • Liability Limit $9;000,000 National Fire Insurance Auto Liability Combined Single Limit $1,000,000 Company of Hartford 6080881839 05/01/2022 to • • 05/01/2023 American Casualty Employers Liability Bodily Injury by Accident- Each Company of Reading, Accident Limit $1,000,000 Pennsylvania Bodily Injury by Disease - Policy 6080818238 Limit $1,000,000 05/01/2022 to Bodily Injury by Disease - Each 05/01/2023 Employee Limit $1,000,000 • • • • ' Copyright CNA All Rights Reserved. • CNA CNA Paramount•Excess and Umbrella.Liability Policy Declarations • Underlying'Indurer Policy Number • Policy Period Note: _ Underlying Insurance Coverages Liinits Of Insurance National Fire Insurance Employee BenefitS. Each Employee Limit $1,000,000 • Company of HartfOrd Liability. Aggregate Limit $2,000,000 •6080818241 • • 05/01/2022 to 05/01/2023 • • !National Fire Insurance Stop Gap Liability Company of Hartford Bodily injury by Accident- Each 6080818241 Addidontlimit $1;000,000 05/01/2022 to Bodily Injury,by Disease - Policy 05/01/2023 Limit $1,0.00,000 Bodily Injury by Disease - Each Employee Limit $1.:,200,000 • fe;F , • See SCHEDULEOF FORMS'AND ENDORSEMENTS _ - - • • • • 1 RUM No:CNA75501XX 103-20161 Policy No:CUE 60801318255 I Policy Eh:aerations PrKje: 3 Of 3Policy Elloctiim Date:05/01/2021 Underwriting Company: The Continental Msurance-Company. 151 N Franklin St.Chicago,11 60606 Policy Page: 9•ol 51 i • • Copyright CNA All Rights Rese/ved. • • �� Workers Compensation And Employers Liability Insurance //,\ `;°,A',\ Policy Endorsement rfmt.,21g, .4,5104 OUR 'I qH TO SOD* :1 O iIfIB S ' OR E�,MFN fi• '' 1 WAIN,„att y, I• �� �e1� .nt 4 � ' edict . ” . . `"',,`2Akkk We have the right to recover our payments from anyone liable for an injury covered.by this policy. We will not enforce our right against the person or organization named in the Schedule.This agreement applies only to the extent that you performwork under a written contract that requires you to obtain this agreement from us. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Any Person or Organization on whose behalf you are required to obtain this waiver of our right to recover from under a written contract or agreement. The premium charge for the endorsement is reflected in the Schedule of Operations. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. • I ' I Copyright 1983 National Council on Compensation Insurance. 20 of 34 (RAG01) • CNA Workers Compensation And employers Liability Insurance Policy Endorsement (COL-ORADOICANCELIATION,lENDO.RSEMEN11i' This endorsement applies only to the insurance provided by the policy because Colorado is shown in Item 3.A. of the Information Page. Part Six (Conditions) Condition D. Cancellation is replaced by the following: D. Cancellation 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is to take.effect. 2. We may cancel this.policy. We must mail by certified mail or deliver to you advance written notice stating when the cancellation is to take effect. If we cancel for any of the following reasons, we will mail or deliver not less than 10 days advance written notice: (1) Fraud; (2) Material Misrepresentation; (3) Non-payment of premium; or (4) Other reasons approved by the Commissioner. If we cancel for any other reason, we will mail or deliver not less than 30 days advance written notice. 3. The policy will end on the day and hour stated in the•cancellation notice. 4. Any of these provisions that conflict with a law that controls the cancellation of the insurance in this • policy is changed by this statement to comply with the law. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy. unless another expiration date is shown below. • 4 Copyright CNA All Rights Reserved. CNA Workers Compensation And Employers Liability Insurance Policy Endorsement LARIZONA.,CANCELLvAiTilONItAND)(NON iENEWA1:4NDO13SEM6(VTr This endorsement applies because Arizona is shown in Item 3.A. of the Information Page. Part Six-Conditions, Section D. (Cancellation), of the policy is replaced by the following: Da Cancellation and Nonrenewal 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the • cancellation is to take effect. 2. If you cancel or fail to renew this policy, we must promptly notify the Industrial Commission of Arizona. 3. We may cancel this policy if you fail to pay premium when due,or when one or both of the parties to a professional employer agreement terminate the agreement. 4. If we cancel or nonrenew this policy, we must mail or deliver to you and the Industrial Commission of Arizona at least 30 days' notice of the cancellation or nonrenewal. Mailing that notice to you at your mailing address shown in Item 1. of the Information Page will be sufficient to prove notice. If we, nonrenew this policy and fail to give you notice of nonrenewal, coverage will not extend beyond the policy period. 5. The policy period will end on the day and hour stated in the cancellation ornonrenewal notice. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the.Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. Copyright 2015 National Council on Compensation Insurance,inc.All Rights Reserved. i . , 1 . 1 CNA Workers Compensation And Employers Liability Insurance Policy Endorsement LI1hd.40.NAA`EIIakDAtQ.FtiYl(ENDORSMEN1Tr' This endorsement applies because Montana is shown in Item 3.A. of the Information Page. • General Section, Section C. (Workers Compensation Law) of the policy is changed by adding the following: The provisions of this policy conform to the minimum requirements of Montana law and control over any conflicting statutes of any state in which the insured resides on or after the effective date of this policy. Part Six-Conditions, Section D. (Cancellation) of the policy is replaced by the following: D. Cancelation 1. You may cancel this policy. You will mail or deliver advance written notice to us stating when the cancellation is to take effect. 2. We may cancel this policy. We will provide you and the Montana Department of Labor and Industry not less than 20 days advance written notice stating when the cancellation is to take effect. We will provide the notice to you via mail or via electronic delivery in accordance with the Electronic Delivery of Insurance Notices or Documents Act (MCA 33-15-601 et seq.). Mailing notice to you at your last known address or delivery via electronic means in compliance with the Electronic Delivery of Insurance Notices or Documents Act will be sufficient to prove notice. 3. If this policy has been in effect for 60 days or more, we•may cancel only for one of the following reasons: a. A nonpayment of premium; b. A material misrepresentation; . c. A substantial change in the risk we assumed under the policy unless it was reasonable for us to foresee the change or contemplate the risk when we issued the policy; d. A substantial breach of the duties, conditions or warranties under the policy; e. The Commissioner has determined that continuation of the policy would place us in violation of the laws of Montana; f. We are financially impaired; or g. Any other reason that is approved by the Commissioner. 4. Our notice of cancelation will state our reasons for canceling. Part Six-Conditions of the policy is changed by adding the following: F. Nonrenewal 1. We may elect not to renew. We will provide you and your agent not less than 45 days advance written notice stating our intention not to renew this policy. We will provide the notice to you via mail or via electronic delivery in,accordance with the Electronic Delivery of Insurance Notices or Documents Act. Mailing notice to you at your last known address or delivery via electronic means in compliance with the . Electronic Delivery of Insurance Notices or Documents Act will be sufficient to prove notice. 2. We do not have to renew the policy if you are insured elsewhere, accept replacement insurance, or request or agree to nonrenewal. or if the policy is expressly designated as being nonrenewable. 3. Our notice of nonrenewal will state our reasons for not renewing. Copyright 2015 National Council on Compensation•Irtsurancc.Inc.All Rights Reserved. CNA Woricers Compensation And Employers Liability Insurance Policy Endorsement All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy,issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. iff • Copyright 2015 National Council on Compensation Insurance,Inc.Ali Rights Reserved. I . . CNA Workers Compensation And Employers Liability Insurance Policy Endorsement NEVADA,:C'ANCELLATI,QN,j[A`NDXN:QNRENEWAL ENDORSEMENT This endorsement applies to the insurance provided by this policy, because Nevada is shown in Item 3.A. of the Information Page. Part Six—Conditions, D. Cancellation of the policy is replaced by the following: A. Midterm Cancellation 1. You may cancel this policy by mailing or delivering advance written notice to us stating when the cancellation is to take effect. 2. We will provide you not Tess than 10 days notice if this policy is cancelled because you failed to pay a • premium or remitan amount due because of an endorsement for a deductible when due. 3. We will provide you not less than 30 days•notice for any other cancellation reason permitted under Nevada law, including failure to pay additional premium charged due to an audit of any payroll under the terms of the current or previous policy. 4. No policy of industrial insurance that has been in effect for at least 70 days or that has been renewed may be cancelled, except on any one of the following grounds: a. A failure by the policyholder to pay a premium for the policy of industrial insurance when due, including the failure of the policyholder to remit,an amount due because of an endorsement for a deductible; b. A failure by the policyholder to: (11 Report any payroll; • 12) Allow the insurer to audit any payroll in'accordance with the terms of the policy or any previous policy issued by the insurer; or 13) Pay any additional premium charged because of an audit of any payroll as required.by the terms of the policy or any previous policy issued by the insurer; c. A material failure by the policyholder to comply with any federal or state order concerning-safety or any written recommendation of the insurer's designated representative for loss prevention; d. A material change in ownership of the policyholder or any change in the policyholder's business or operations that: (1) Materially increases the-hazard for frequency or severity of loss; (2) Requires additional or different classifications for the calculation of premiums; or (3) Contemplates an activity that is excluded by any reinsurance treaty of the insurer; e. A material misrepresentation made by the policyholder; or f. A failure by the policyholder to cooperate with the insurer in conducting an investigation of a claim. 5. We cannot cancel the policy when the referenced reasons are corrected by you within the•time Specified in the written notice of cancellation. B. Nonrenewal 1. Wemay elect not to renew the policy. We will provide to you a written notice of our intention not to renew at least 60 days before the expiration date. • I Copyright 2008 National Council on Compensation Insurance,Inc,All Rights Reserved. 1 CNA Workers Compensation And Employers Liability Insurance Policy Entlorsernent 2. We need not provide notice of our intention not to renew if you have accepted replacement coverage, if you have requested or agreed to nonrenewal, or if the policy is expressly designated as nonrenewable. C. Information About Claims Paid 1. If you request information for the renewal of the policy, we will provide you with information regarding claims paid on your behalf. 2. We will provide the information within 30 working days after we receive your written request. We may charge a reasonable fee far providing the information. D. Notices 1. We will provide advance written notice of cancellation or nonrenewal,as provided in A and 8 above.This notice must be served personally on or sent by first-class mail or electronic transmission to the employer. . 2. Notices will state the effective date of the cancellation or nonrenewal and will be accompanied by a written explanation of the specific reasons for the cancellation or nonrenewal. 3. A written notice of cancellation is not required if we mutually agree with youto,cancel the policy and reissue a new policy based upon a material change in the ownership or operation of your business. E. Compliance.With Law 1. Any of these provisions that conflict with a law that controls the cancellation or renewal or nonrenewal of the insurance in this policy is changed by this statement to comply with the law. All other terms and conditions of the policy remain.unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. . • =Copyright 2008 National Council on Compensation Insurance,Inc.All Rights Reserved. • CNA Workers Compensation And Employers Liability Insurance Policy Endorsement • i1i OKLAHOMAdCANCELLATI.ON;1NONRENE:INPi! W igEfe.NGfiIEN©ORSEII(IENiTi'• i! This endorsement applies to the insurance provided by the policy because Oklahoma is shown in Item 3.A.of the Information Page. The Cancellation Condition in Part Six (Conditions) of the policy is replaced by the following condition: D. Cancellation 1. You may cancel this policy. You must mail or deliver to us not less than 30 days advance written notice stating when'the cancellation is,to take effect. Cancellation of coverage will be effective at 12:01 a.rn. thirty (30) days after the date the cancellation notice is received by us, unless a later date is specified in the notice to us. You may cancel this policy effective less than 30 days-after written notice is received by us where•you have obtained other coverage or have become a self-insurer. 2. We may cancel this policy. We will mail to you advance written notice stating when the cancellation is to take effect. a. At any time during the policy period, we may cancel for nonpayment of premium. If we cancel for nonpayment of premium, we will mail notice of cancellation to you and to the Workers Compensation Commission at least 10 days before the cancellation is to take effect. b. If we cancel this policy for a reason other than nonpayment of premium, we will mail notice of cancellation to you and to the Workers Compensation Commission at least 30 days before the cancellation is to take effect. c. If this policy has been in effect for more than 45 business days or is a renewal policy, we may cancel for only one or more of the following reasons: • (1) Nonpayment of premium; (2) Discovery of fraud or material misrepresentation in the procurement of the insurance or with respect to any claimssubmitted under it; (3) Discovery of willful or reckless acts or omissions on the part of the named insured which increase any hazard insured against; (4) The occurrence of a change in the risk which substantially increases any hazard insured against afterinsurance coverage has beenissued or renewed; (5) A violation of any local fire, health, safety, building, or construction regulation or ordinance with respect to any insured property or the occupancy thereof which substantially increases any hazardinsured against; • (6) A determination by the Insurance Commissioner that the continuation of the policy would place theinsurer in violation of the insurance laws of this state; (7) Conviction of the named insured of a crime having as one of its necessary elements an act ncreasing any hazard insured against; or (8) Loss of or substantial changes in applicable reinsurance. 3. Mailing notice of cancellation to you at your mailing,address shown in Item 1 of the Information Page will be sufficient to,prove notice. 4. The policy period will end on the day and hour stated in the cancellation notice. Copyright 2013 National Council on Compensation Insurance, Inc.All RiDills Reserved. ' l CNA Workers Compensation And Employers Liability Insurance Policy Endorsement 5. Any of these provisions that conflict with a law that controls the cancellationof the insurance in this policy is changed by this statement to comply with the law. Part 6 IConditions) of the policy is amended by adding the following provisions: F. Nonrenewal . • 1. If we elect not to renew this policy, we will mail or deliver written notice of nonrenewal to you at least 45 days before: • a. The expiration date of this policy; or b. An anniversary date of this policy,ifit is written for a term longer than one year or with no fixed expiration date. 2. Any notice of nonrenewal will be mailed or delivered to you at the mailing address shown in Item 1 of ' the Information Page. If notice is mailed: a. It will be considered to have been given to you on the day it is mailed. b. Proof of mailing will be sufficient proof of notice. ' 3. If notice of nonrenewal is not mailed or delivered at least 45 days before the expiration date or an anniversary date of this policy, coverage will remain in effect until 45 days after notice is given. Earned premium for such extended period of coverage will be calculated pro rata based on the rates applicable to the expiring policy. 4. We will not provide notice of nonrenewal if: a. We, or another company within the same insurance group, have offered to issue a renewal policy; or b_ You have obtained replacement coverage or have-agreed in writing to obtain replacement coverage. 5. If we have provided the required notice of nonrenewal as described above, and thereafter extend the policy for a period of 90 days or less, we will not provide an additional nonrenewal notice with respect to the period of extension. G. Notice of Premium or Coverage Changes Upon Renewal 1. If we elect to renew this policy, we will give written notice of any premium increase, change in deductible, or reduction in limits or coverage, to you, at the mailing address shown in Item 1 of the Information Page. 2. Any such notice will be mailed or delivered to you at least 45 days before: a. The expiration date of this policy; or b: An'anniversary date of this policy, if it is written for a term longer than one year or with no fixed expiration date. 3. If notice is mailed: a. ' It will be considered to have been given to you on the day it is mailed. b. Proof of mailing will be sufficient proof of notice. 4. if you accept the renewal, the premium increase or deductible, limits or coverage changes will be effective the day following the prior policy's expiration or anniversary date. 5. If notice is not mailed or delivered at least 45 days before the-expiration date or anniversary date of this policy, the premium, deductible, limits and coverage in effect prior to the changes will-remain in effect until the earlier of Copyright 2013 National Council an Compensation Insurance;Inc:All Rights Reserved. • 4. CNA Workers Compensation And Employers Liability Insurance Policy Endorsement a. 45K days after notice is given; or b. The effective date of replacement coverage obtained by you. 6. If you then elect not to renew, any earned premium for the resulting extended period of coverage will be calculated pro rata at the lower of the new rates or rates applicable,to the expiring policy. 7, We will not provide notice of the following: . a. Changes in a rate or plan filed with or approved by the Insurance Commissioner or filed pursuant to • the Property and Casualty Competitive Loss Cost Rating Act and applicable to an entire class of business; or b. Changes based upon the altered nature of extent of the.risk insured; or c. Changes in policy forms filed with or approved by the Insurance Commissioner and applicable to an entire class of business. All other terms and conditions of the policy remain unchanged. • This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. • • • ' copyright 2013 National Council on Compensation lnsuance,Inc.All Rights Reserved. • • CNA Workers Compensation And Employers Liability Insurance Policy Enclorsemoni II (OREGOf11',CyANC£00.yTi10N11F;l1�DOf4SEMENT' This endorsement applies only to the insurance provided by the policy because Oregon is shown in Item 3.A. of the Information Page. The Cancellation Condition of the policy is replaced by this Condition: . D. Cancellation 1. You may cancel this policy. You must mail or deliver advance written notice to us. stating when the cancellation is to take effect. If you provide for other insurance or self-insurance, your cancellation of coverage will take effect upon the effective date of that insurance. 2. We may cancel this policy. We will mail to you advance written notice stating when the cancellation is to take effect. a. If we cancel based on our decision not to offer insurance to all employers within your premium • category, we will mail the notice of cancellation at least 90 days before the cancellation is to take effect. b. If we cancel for other reasons, we•will mail the notice of cancellation at least 45 days before the cancellation is to take effect. c. If we cancel for nonpayment, we will mail notice of cancellation at (east 10 days before the cancellation is to take effect. 3. Mailing notice to you at your last known mailing address will be sufficient to prove notice. 4. The policy period will end at 12:00 midnight on the day stated in the cancellation notice. • 5. When coverage is placed with another carrier as of the policy expiration date, a rejected renewal policy shall be withdrawn without charge, provided notice of nonrenewal is mailed and postmarked on or. • before the expiration date and is received from the insured by the insurer no later than 10 calendar days after said expiration date. All other terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy.at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below. • • • • • • I Copyright 2007 National Council on Compensation Insurance,Inc.All Rights Reserved. 4 CNA Workers Compensation And Employers Liability Insurance Policy Endorsement _ 1WISC0„f1TSINi(CANGaWfiilOfilANJ),�(NONRENEWAL ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Wisconsin is shown in Item 3.A. of the Information Page. The Cancellation Section (0) of the Part Six — Conditions is deleted and replaced by the following: A. Cancellation 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is to take effect. If you purchase replacement insurance, the cancellation becomes effective on the date the new coverage becomes effective. If no replacement coverage is purchased, the cancellation will be effective thirty(30) days after receipt of written notice by the Wisconsin Compensation Rating Bureau. 2. We may cancel this policy for any reason if the policy has been in effect for less than sixty(DO) days. If the policy is issued for a term longer than one year or for an indefinite term, we may cancel the policy for any reason on an annual anniversary of the policy effective date. We may cancel the policy at any other time for the following reasons: a. You fail to pay all premiums when due, however, we must deliver or mail, first class, not less than . thirty (30) days advance written notice stating when the cancellation is to take effect; b. A material misrepresentation; c.. A substantial breach of the obligations, conditions or warranties under the policy; or d. A substantial change in the risk we assumed under the policy unless it was reasonable for us to foresee the change or expect the risk when we issued the policy. 3. If we cancel for any permissible reason other than non-payment of premium, we must deliver or mail, first class, not less than `thirty (30) days notice stating when the cancellation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. , 4. The policy period will end on the day and hour stated in a notice of cancellation. B. Nonrenewal 1. You have the right to have the insurance renewed unless we deliver or mail to you not less than 'sixty (60) days advance written notice stating our intention not to renew this policy. 2. We do not have to renew the insurance if you do not pay the renewal premium billing by the due date or if you accept replacement insurance, are insured elsewhere, requested or agree to nonrenewal, or if the policy is expressly designated as.being nonrenewable. 3. If we renew the insurance,•we may use the policy forms, rates and rating plans we are then using for similar risks. We may limit the policy to a term equivalent to the term of the expiring policy or one year, whichever is less. 4. If we offer to renew the policy on less favorable terms, we will mail or deliver written notice of the new terms by first class mail to you, the policyholder, at least sixty (60) days prior to the renewal date. The definition of "terms" does not include manual rates, experience modification factors, or classification of risks. • Copyright 2002-National Council on Compensation Insurance.Inc.All Rights Reserved. •• CNA Workers Compensation And Employers Liability Insurance Policy Endorsement If we provide such notice within sixty (60) days prior to the renewal date, the new terms will not take effect until sixty (60) days after the notice is mailed or delivered, in which case, you, the policyholder, may elect to cancel the renewal policy at any time during the sixty (60)day period. The notice will, include a statement of your right to cancel. If you elect to cancel the renewal policy during the sixty (60) day period, the return premium or additional premium charges shall be calculated proportionally on the basis of the old premiums. We need not mail or deliver this notice if the only change adverse to you is a premium increase that; (a) is less than 25%; or, (b) results from a change based on your action that alters the nature and extent of the risk insured against, including, but not limited to, a change in the classifications for the business. ' Any written agreement attached to and made a part of the policy, between the insurance carrier and policyholder which extends the cancellation or nonrenewal notification timeframe, will supercede the aforementioned notification requirements found in items A.3., and 6.1., respectively. All other terms and conditions of the policy remain unchanged: • • This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy,unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy .unless another expiration date is shown below. • • • • • 'Copyright 2002 National Council on Compensation Inswance, Inc. All Rights Reserved. I - I V 1 • Workers Compensation And Employers Liability Insurance -I CNA Policy Endorsement . 1ALVASKA CAN081,41T1IQNiAND,;NO`NREN.EWAI IENDORSEMENTT -.- .. , _ .i This endorsement applies only to the insurance provided by the policy because Alaska is shown in Item 3.A. of the Information Page. The Cancelation Condition, as well as Part Five, Paragraph E.2., of the policy is replaced by this Condition: D. Cancelation/Nonrenewal ' _ 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to take effect. If you cancel, the final premium will be calculated pro rata based on the time the policy was in force, and increased by a cancefation fee equal to 7.5 percent of the unearned premium, provided that the final premium will not be lessthan the applicable minimum premium. 2. We may cancel this policy. We must mail or deliver to you andthe agent or broker of record advance written notice stating the reason for cancelation and when the cancelation is to take effect. Such notice. will be mailed or delivered not less than: a. 10 days before the effective date of cancelation if we cancel for conviction of the insured of a crime having as one of its necessary elements an act increasing a hazard insured against, or for discovery �. of fraud or material misrepresentation made by the insured or a representative of the insured in obtaining the insurance or by the insured in pursuing a claim under the policy; or b. 20 days before the effective date of cancelation if we cancel for nonpayment of premium, or for failure or refusal of the insured to provide the information necessary to confirm exposure or determine the policy premium;or c. 60 days before the effective date of cancelation if we cancel for any other reason.. 3. We will mail or deliver the notice to your last known address and the last known address of the agent or broker of record. 4. A post office certificate of mailing or certified mailing receipt will be sufficient to prove notice. 5. The policy period will end on the day and hour stated in the cancelation notice. 6. If we decide not to renew this policy, we will mail written notice of nonrenewal, by first class mail, to you and the agent or broker of record at least 45 days before: a. the'expiration date; or • b. the anniversary date if this policy has been written for more than one year or with no fixed expiration date. , 7. We need not mail notice of nonrenewal if: a. we have manifested in good faith our willingness to renew; or b. you have failed to pay any premium required for this policy; or c. you fail to pay the premium required for renewal of this policy. 8. Any notice of nonrenewal will be mailed to your last known addressand the last known address of the agent or broker of record. A post office certificate of mailing or certified mailing receipt will be'sufficient proof of notice.. Couyriyht 1995 National Council on Compensation Insurance. Inc. 4- • CNA Workers Compensation And Employers Liability Insurance Policy Endorsement. Allother terms and conditions of the policy remain unchanged. This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective Date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires-concurrently with said policy unless another expiration date is shown below. • • • ) Copyright 1995 National Council ou Compensation Insurance,Inc. •