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HomeMy WebLinkAbout2022-162 PO 20220347- Ashland Chamber of Commerce !FA Purchase Order ,ta .+ FIECtRa, Fiscal Year 2022 , Page: 1 of: 1 B City of Ashland f a d; i 1.=-L1AWi�aff[ galli�1 � ATTN:Accounts Payable Purchase 20 E. Main L Ashland, OR 97520 Order# 20220347 T Phone: 541/552-2010 0 Email: payable@ashland.or.us • V H C/O Fire and Rescue Department E ASHLAND CHAMBER OF COMMERCE I 455 Siskiyou Blvd N PO BOX 1360 p Ashland, OR 97520 ASHLAND, OR 97520 R 'Fax:5541/488-5318 541/482-2770 EF-411 l_�_ �il �I a eI � � i(a�p 3® ala} IE � ' — e1 ➢ Z 9_ - — 541 482-3486 Chris Chambers F j 3II lfl la �]®I� lTcl If �}.k -'_.791I�G € ��3 laf �lt 14a[ 8 19 i 05/24/2022 13 FOB ASHLAND OR/NET30 Cit Accounts Pa able Emergency Preparedness 1 Planning and producing business communication, outreach, and 1.0 $9,350.00 $9,350.00 training emergency preparedness, including evacuations and promotion 1 Smokewise Ashland. Personal Services Agreement(less than $35,000) Completion date: 07/15/2022 Project Account: E-G00021-400 •{ ****,***********GL SUMMARY*************** , 072900-610355 $9 350.00 - c By: Y-Pfic.„--- Date: �:� . Authorized Signature ab _ - t iir 1 G �� � �= �/ FORM #3 CITY OF • 1::- :/ �- ASHLAND A request fora Purchase Order i� REQUISITION ' 7-, ,P D etreq request: 05/19/2022 ' Vendor Name Ashlan Chamber of Commerce , Address,City,State,Zip 110 E.Main Street ) J Contact Name Sandra Slattery Telephone Number 541-482-3486 • Email address sandra a(�,ashiandchamber.com SOURCING METHOD • ❑ Exempt from Competitive Bidding ❑ invitation to Bid ° ❑ Emergency • ❑ Reason for exemption: Date approved by Council:• 0 Form#13,Written findings and Authorization ❑ AMC 2.50 `(Attach copy of council communication) -❑ Written quote or proposal attached . DI 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# ❑ Verbal/Written quote(s)or proposal(s) ❑ Request for Qualifications(Public Works) 0 State of Washington Intermediate Procurement Date approved by Council: Contract# • GOODS&SERVICES (Attach copy of council communication) 0 Other government agency contract Greater than$5,000 and less than$100,000 0 Sole Source • Agency - ❑ (3)Written quotes and solicitation attached 0 Applicable Form(#5,6,7 or 8) Contract# PERSONAL SERVICES 0 Written quote or proposal attached Form Intergovernmental Agreement I Greater than$5,000 and less than$75,000 0 Form#4;Personal Services>$5K&<$75K Agency 0 Direct appointment not to exceed$35,000 0 Annual cost to City does not exceed$25,000. ❑ Special Procurement 0(3)Written proposals/written solicitation Agreement approved by Legal end approved/signed,by • J ❑ Form#9,Requestfor Approval. ❑Form#4,Personal Services>$5K&<$75K City Administrator.AMC 2.50.070(4) ❑ Written quote or proposal attached • Annual cost to Cit exceeds$25,000,Council ° Date approved by Council: 0 Y Valid until:. ' (Date) approval required.(Attach copy of council communication) . Description of SERVICES • Total Cost Planning and producing business communication,outreach,and training for emergency preparedness including evacuations and promotion of Smokewise Ashland. , • .$.9,350.00 - - Item# Quantity Unit Description of MATERIALS Unit Price Total Cost ® Per attached quotelproposal• TOTAIi:'^COST=:. Expenditure must be charged to the appropriate account numbers forthe finandats to reflect the actual expenditures accurately, - $9;350.00 Project Number G00021 - 400 Account Number 072900 - 610355 $ ,_ _ _,_ _ _ _ _ Project Number _ _ Account Number - $ , Project Number _ _ _ Account Number - $ , 0 ,_ _ _._ IT Director in collaboration with department to approve all hardware and software purchases: By signing this requisitio s.form,I certify that f,•City's public contracting requirements have been satisfied. IT Director Date Support-Yes/No Employee: —.I Department Department Head: ( Sr-(Equal to or mater than$5,000) Department Manager/Supervisor: City Administrator: • (Equal to or greater than$25,000) Funds appropriated for current fiscal year: /NO ,/,(,__—%.. � �Z , Fina ce Director-(Equal to or greater rthan$5,000) i7 ate ( 9 g Comments: ' Form#3-Requisition ' • v r . • PERSONAL SERVICES AGREEMENT (LESS THAN$35,000) • PROVIDER: Ashland Chamber of Commerce CITY OF • PROVIDER'S CONTACT: Sandra Slattery A.SHL.A,N D • 20 East Main Street ADDRESS: 110 E. Main Street,Ashland OR 97520 Ashland,Oregon 97520 - Telephone: •541/552-2066 PHONE: 541-482-3486 - • Fax: 541/552-5318 • • • EMAIL: sandra@ashlandchamber.Com • • This Personal.Services.Agreement(hereinafter"Agreement")is entered into by and between the City of Ashland; an Oregon municipal corporation (hereinafter "City") and Ashland Chamber of Commerce, a nonprofit organization ("hereinafter "Consultant"), for business smoke & wildfire emergency preparedness outreach and education. NOW THEREFORE, in consideration of the mutual covenants contained herein,the City and Consultant hereby agree as follows: • 1. Effective Date and Duration: This Agreement shall become effective on the date of execution on behalf of the City,as set forth below(the"Effective Date"), and unless sooner terminated as specifically provided herein,shall terminate upon the City's affirmative acceptance of Consultant's Work as complete and Consultant's acceptance of the City's final payment therefore,but not later than 7/15/2022. 2. . Scope of Work: Consultant will provide staff resources,planning support,website and printed •material design,.videography,printed outreach materials, and business community communications and outreach as more fully set forth in the Consultant's Proposal dated 4/15/2022,which is attached Hereto as"Exhibit A"and incorporated herein by this reference. Consultant's services are collectively referred • to herein as the "Work." • 3. Supporting Documents/Exhibits; Conflicting Provisions: This Agreement and any exhibits or other supporting documents shall be construed to be mutually complementary and supplementary wherever possible. In the event of a conflict which cannot be so resolved,the provisions of this Agreement itself shall control over any conflicting provisions in any of the exhibits or supporting documents. 4. All Costs-Borne by Consultant: Consultant shall, at its own risk,perform the Work described above and,unless otherwise specified in this Agreement, furnish all labor, equipment, and materials required • for the proper performance of such Work. 5. Qualified Work: Consultant has represented, and by entering into this Agreement now represents,that all personnel assigned to the:Work to be performed under this Agreement are fully qualified to perform ' the service to which they will be assigned in a skilled and worker-like manner and,if required to be registered, licensed•or bonded by the State of Oregon, are so registered,licensed and bonded. Page 1 of 6: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OFASHLAND AND Ashland Chamber of Commerce. • 6. Compensation: City:shall pay Consultant the sum of$9,350.00 as full compensation for Consultant's performance of all Work under this Agreement. In no event shall Consultant's total of all compensation and reimbursement under this Agreement exceed the sum of nine thousand three hundred and fifty dollars without the express,written approval from the City official whose signature appears below, or such official's successor in office. Payments shall be made within thirty (3 0) days of the date of receipt by the City of Consultant's invoice.-Should this Agreement be terminated prior to completion of all Work,payments will be made for any phase of the Work completed and accepted as of the date of termination. 7. Ownership of Work/Documents: All Work,work product, or other documents produced in furtherance of this Agreement belong to the City; and any copyright,patent,trademark proprietary or any other protected intellectual property right shall vest in and is hereby assigned to the City. • 8. Statutory Requirements: The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220,279B.230 and 279B.235. 9. Living Wage Requirements: If the amount of this Agreement is$22,310.46 or more, Consultant is required to comply with Chapter 3.12 of the Ashland Mimi cipal Code by paying a living wage, as defined in that chapter,to all employees performing Work under this Agreement and to any Subcontractor who performs 50% or more of the Work under this Agreement. Consultant is also required to post the notice attached hereto as"Exhibit B"predominantly in areas where it will be seen by all employees. 10. Indemnification: Consultant hereby agrees to defend,indemnify,save, and hold City, its officers, employees, and agents harmless from any and all losses, claims, actions, costs,expenses,judgments,.or other damages resulting from injury to any person(including injury resulting in death), or damage • (including loss or destruction)to property, of whatsoever nature.arising out of or incident to the performance of this Agreement by Consultant(including but not limited to, Consultant's employees, agents, and others designated by Consultant to perform Work or services attendant to this Agreement). However, Consultant shall not be held responsible for any losses,expenses, actions,costs, or other damages, caused solely by the gross negligence of City. 11. Termination: • a. Mutual Consent. This Agreement may be terminated at any time by the mutual consent of both parties. b. City's Convenience. This Agreement may be terminated by City at any time upon/not less than thirty (30) days' prior written notice delivered by certified mail or in person. c. • For Cause. City may terminate or modify this Agreement,in whole or in part,effective upon delivery of written notice to Consultant, or at such later date as may be established by City under any of the following conditions: • i. If City funding from federal, state, county or other sources is not obtained and continued at levels sufficient to allow for the purchase of the indicated quantity. of services; 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 Page 2 of 6: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND Ashland Chamber of Commerce. Agreement or are no longer eligible for the funding proposed for payments authorized by this Agreement; or iii. If any license or certificate required by law or regulation to be held by Consultant to provide the services required by this Agreement is for any reason denied,revoked, suspended, or not renewed. d. For Default or Breach. i. Either City or Consultant may terminate this Agreement in the event of a breach of the Agreement by the other. Prior to such termination the party seeking termination shall give to the other party written notice of the breach and its intent to terminate. If the party committing the breach has not entirely cured the breach within fifteen(15) days of the date of the notice, or within such other period as the party giving the notice may authorize in writing, then the Agreement may be terminated at any time thereafter'by a written notice of termination by the party giving notice. ii. Time is of the essence for Consultant's,performance of each and every obligation and duty • under this Agreement. City,by written notice to Consultant of default or breach,may at any time terminate the whole or any part of this Agreement if Consultant fails to provide the Work called for by this Agreement within the time specified herein or within any extension thereof. iii. The rights and remedies of City provided in this subsection(d) are not exclusive and are in addition to any other rights and remedies provided by law or under this Agreement. • 12. Independent Contractor Status: Consultant is an independent contractor and not an employee of the City for any purpose. . 13. Assignment: Consultant shall not assign this Agreement or subcontract any portion of the Work without the written consent of City. Any attempted assignment or subcontract without.written consent of City shall be void. 14. Default. The Consultant shall be in default of this Agreement if Consultant: commits any material breach or default of any covenant,warranty, certification, or obligation under the Agreement;institutes an action for relief in bankruptcy or has instituted against it an action for insolvency;makes a general assignment for the benefit of creditors; or ceases doing business on a regular basis of the type identified in its obligations under the Agreement; or attempts to assign rights in, or delegate duties under,this Agreement. 15. Insurance. Consultant shall, at its own expense,maintain the following insurance: a. Workers' Compensation. Consultant shall obtain and maintain Workers' Compensation insurance in compliance with ORS 656,017,which requires subject employers to provide Oregon Workers' • Compensation coverage for its subject workers,unless such employers axe exempt under ORS 656.126. If exempt under ORS 656.126, Consultant shall certify such exemption to the City. • 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. Page 3 of 6: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND Ashland Chamber of Commerce. r • • ' 1 c. General Liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 (two million dollars)per occurrence for Bodily Injury,Death, and Property Damage. d. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than $1,000,000 (one million dollars)for each accident for Bodily Injury and Property Damage,•including coverage for owned,hired or non-owned vehicles, as applicable. e. Notice of cancellation or change. There shall be no cancellation,material change,reduction of limits or intent not to renew the insurance coverage(s)without thirty (30) days'prior written notice from • the Consultant or its insurer(s)to the City. f. Additional Insured/Certificates of Insurance. Consultant shall name the City of Ashland, Oregon, and its elected officials, officers and employees as Additional Insureds on any insurance policies, • excluding Professional Liability and Workers' Compensation,required herein,but only with respect to Consultant's services to be provided under this Agreement. The consultant's insurance is r. primary and non-contributory.As evidence of the insurance coverages required by this Agreement, the Consultant shall furnish acceptable insurance certificates and endorsements prior to commencing the Work under this Agreement. • 16. Nondiscrimination: Consultant agrees that no person shall, on the grounds of race, color,religion, creed,sex,marital status,familial status or domestic partnership,national origin, age,mental or physical disability, sexual orientation, gender identity or source of income,suffer discrimination in the performance of any Work under this Agreement when employed by Consultant. Consultant agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes,rules and regulations. Further, Consultant agrees not to discriminate against a disadvantaged business enterprise,minority-owned business,woman-owned business, a business that a service-disabled veteran owns or an emerging small business enterprise certified under ORS 200.055,in awarding subcontracts as required by ORS 279A.110. • 17. Consultant's Compliance With Tax Laws: 17.1 Consultant represents and warrants to the City that: 17.1.1 Consultant shall,throughout the term of this Agreement,including any extensions hereof, comply with: (i)All tax laws of the State of Oregon,including but not limited to ORS 3.05.620 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 his 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. Page 4 of 6: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND Ashland Chamber of Commerce. 18. Governing Law; Jurisdiction: This Agreement shall be governed and construed in accordance with the laws of the State of Oregon without regard to conflict of laws principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless 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. • 19. 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: Wildfire Division Attn: Chris Chambers 455 Siskiyou Blvd Ashland, Oregon 97520 • With a copy to: • • City of Ashland-Legal Department • 20 East Main Street • Ashland, Oregon 97520 If to Consultant: Sandra Slattery,Executive Director 110 E. Main Street Ashland OR 97520 • • 20. Amendments. This Agreement may be amended only by written instrument executed by both parties • with the same formalities as this Agreement. . • 21. THIS AGREEMENT AND THE ATTACHED EXHIBITS CONSTITUTE THE ENTIRE UNDERSTANDING BETWEEN THE PARTIES. THERE ARE NO'UNDERSTANDINGS, AGREEMENTS, OR REPRESENTATIONS,EITHER ORAL OR WRITTEN,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. • • 22. Certification. Consultant shall execute the certification attached hereto as "Exhibit C"and incorporated herein by this reference. Page 5 of 6: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND Ashland"Chamber of Commerce. • , • IN WITNESS WHEREOF the parties have caused this Agreement to be signed in their respective names by their duly authorized representatives as of the dates set forth below. CITY OF ASHLAND: Ashland Chamber of Commerce(CONSULTANT): By: Signature $A-re--r/ By: Printed Name Signature R„ C1,<<r Sandra Slattery Title Printed Name 7 - Zo2-2_ Executive Director ,D ate Title April 18,2022 • - _ Date Purchase Order No. e<2- (W-9 is to be submitted with this signed Agreement) • • • Page 6 of 6: PERSONAL SERVICES AGREEMENT BETWEEN THE CITY OF ASHLAND AND Ashland Chamber of Commerce. • • • EXHIBIT B CITY OF ASHLAND, OREGON City of Ashland • LIVING • ALL employers described WAG E below must comply with City of Ashland laws regulating ' la ,went of a livin a wase. $15.96 per hour, effective June 30, 2021. The Living Wage is adjusted annually every Ir, 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 D Note: For temporary and employer and the City of $22,310.46 part-time employees,the Ashland if the contract Living Wage does not apply exceeds$22,310,46 or more. 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 Cod 50%or more of the D 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, OR 97520, or visit the City's website at. • 1Notice to Employers:This notice must be posted predominantly in areas where it can be seen by all employees. • CITY OF -• ASHLAND • Page 1 of 1: EXHIBIT B EXHIBIT C • CERTIFICATIONS/REPRESENTATIONS: Consultant,by-and through its authorized representative,under penalty of perjury, certifies that(a)the number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be issued to it and(b) Consultant is not subject to backup withholding because: (i) it is exempt from backup withholding, or(ii)it has not been notified by the Internal Revenue Service (IRS)that it is subject to backup withholding as a result of a failure to report all interest or dividends, or.(iii)the IRS has notified it that it is no longer subject to backup withholding. Consultant further represents and warrants to City that: (a)it has the power and authority to enter into this Agreement and perform the Work, (b)the Agreement,when executed and delivered,shall be a valid and binding obligation of Consultant enforceable in accordance,with its terms, (c)the work under the Agreement shall be performed in accordance with the highest professional standards, and(d) Consultant is qualified,professionally competent, and duly licensed(if applicable)to perform the Work. Consultant also certifies under penalty of perjury that its business is not in violation of any Oregon tax laws,it is an independent contractor as defined in the Agreement,it is authorized to do business in the State of Oregon, and Consultant has checked four or more of the following criteria that apply to its business. (1) Consultant carries out the work or services at a location separate from a private residence or is in a specific portion of a private residence, set aside as the location of the business. /' (2) Commercial advertising or business cards or a trade association membership are purchased for the business. „7 (3)Telephone listing is used for the business separate from the personal residence • listing. a/ (4)Labor or services are performed only pursuant to written contracts. (5)Labor or services are performed for two or more different persons within a period of one year. ,/ (6) Consultant assumes financial responsibilityfor defective workmanship or for service not provided as evidenced by the ownership of perfoirance bonds, • warranties, errors and omission(professional liability)insurance or liability insurance relating to the Work or services to be provided. `J / • ,. • Consultant's signature • April 18,2022 Date • • • Page 1 of 1: EXHIBIT C • rL 0 ❑ ❑❑ o0 110 East Main St.•PO Box1360 ASHLAND Ashland OR 97520 (541) 482-3486 CHAMBER OF COMMERCE ` Program: Emergency Preparedness Program Dates: April 11, 2022 • Partners: Ashland Chamber of Commerce . Ashland Fire &Rescue Description: The Ashland Chamber of Commerce working in partnership•with Ashland Fire & Rescue are developing a marketing program for Emergency Preparedness to share with visitors, residents,employees and business owners on available resources.This will include tent cards and flyers for distribution at local businesses, a website landing page to direct users to various resources, a smoke preparedness workbook for business preparedness and two 30 videos to share through social media. Budget: . • Smoke and preparedness -writing &design,web design,hosting. $2,000 • Smoke workbook - design,web posting, business outreach 1,500 • Videos -Two 30 second videos for social media & promotion 2,000 • Tent cards - design, printing, distribution,outreach 2,500 • Flyers - design, printing, distribution, outreach 500 • Administration 10% 850 • • Total budget: ' $9,350 1 Sandra Slattery Executive Director ashlandchamber.com • travelashland.com • ACCORD® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 0 E(MMID 022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND ORALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Rebecca McGregor ' Reinholdt&0'Harra Insurance • 1756 Ashland Street • A/c ONE FAX (541)482-1921 Mx,No);(541)488-4458 Ashland,OR 97520 ADDRESS: rmcgregor@reinholdtins.com License#: 800442 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Philadelphia Indemnity Insurance Company INSURED INSURER B: Ashland Chamber of Commerce INSURER C: P O Box 1360 ' INSURERD: \ Ashland,OR 97520 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 00000660-1063268 REVISION NUMBER: 34 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED"BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, • EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W /YLIMITS LTR INSD VD POLICY NUMBER (MMIDDYYY) (MMIDD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y PHPK2359067 02/03/2022 02/03/2023 EACH OCCURRENCE $ 1,000,000 DAMAGE RENED CLAIMS-MADE X OCCUR PREMISESO(Ea occu r nce) $ 100,000 . MED EXP(Any one person) $ 5,000 . PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 6ENERALAGGREGATE $ 2,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: ' . $ • A AUTOMOBILE LIABILITY PHPK2359067 02/03/2022 02/03/2023 {E°aBcldeD SINGLE LIMIT $ 1,000,000 ANY AUTO • BODILY INJURY(Per person) $ OWNED -SCHEDULED BODILY INJURY(Pei accident) $ . AUTOS ,AUTOS ONLY AUTOS • HIRED NON-OWNED PROPERTY DAMAGE • $ X AUTOS ONLY X AUTOS ONLY (Per accident) $ A X UMBRELLA LIAB X OCCUR PHUB796269 02/03/2022 02/03/2023 EACH OCCURRENCE _ $ 3,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 3,000,000 DED X RETENTION$ 10000 • $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY • Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? . (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ l DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached If more space is required), Certificate holder is listed as additional insured with respect to general liability when required by written contract as per form PI-GLD-HS(10111). • CERTIFICATE HOLDER CANCELLATION r SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE • THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Ashland • , ACCORDANCE WITH THE POLICY PROVISIONS. .20 East Main St • Ashland,OR 97520 • AUT2tLe_._ IZEDREPRESENTATIVE I ��l�-�,(/� (REB) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered, marks of ACORD Printed by REB on 05/10/2022 at 02:31 PM ' 7 PI-AS-010 (04/2004) 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED: OWNERS AND /'OR LESSORS OF PREMISES, LESSORS OF LEASED EQUIPMENT, SPONSORS OR CO-PROMOTERS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART • This policy is amended to include as an additional Insured any person or organization of the types • designatedbelow, but only with respect to liability arising out of your operations: y_. 1. • Owners and/or lessors of the premises leased, rented, or loaned to you,subject to the following additional exclusions: a. This insurance applies only to an"occurrence"which takes place while you are a tenant in • the premises; b. This insurance does not apply to"bodily injury"or"property damage" resulting from structural alterations, new construction or demolition operations performed by or on behalf of the owner and/or lessor of the premises; c. This insurance does not apply to liability of the owners and/or lessors for"bodily injury"or "property damage"arising out of any design defect or structural maintenance of the premises or loss caused by a premises defect. With respect to any additional insured included under this policy,this insurance does not applyto the sole negligence of such additional insured. 2. Lessor of Leased Equipment, but only with respect to liability for"bodily injury", "property damage" or"personal'and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s)or organization(s)subject to the following additional exclusions: a. This insurance does not apply to any"occurrence"which takes place after the equipment lease expires. • 3. Sponsors 4. Co-Promoters • • Page 1 of 1 • • PI-GLD-HS (10/11) • • (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (h) "Bodily injury"or"property damage"arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However,this exclusion does not apply to: • (i) The exceptions contained in Sub-paragraphs (d)or(f); or • (ii) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing. • j. Franchisor—.Any person or organization with respect to their liability as the grantor of a franchise to you. - k. As Required by Contract—Any person or organization where required by a written contract • executed prior to the occurrence of a loss. Such person or organization is an additional insured for"bodily injury,""property damage"or"personal and advertising injury" but only for liability arising out of the negligence of the named insured. The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement. These limits are included within and not in addition to the limits of insurance shown in the Declarations 1 I. Owners, Lessees or Contractors—Any person or organization, but only with respect to liability for"bodily injury,""property damage"or"personal and advertising injury"caused, in whole or in part, by: • (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured when required by a contract. • With respect to the insurance afforded to these additional insureds,the following additional exclusions apply: • • This insurance does not apply to"bodily injury"or"property damage"occurring after: • (a) All work, including materials, parts or equipment furnished in connectionwith such work, on the project(other than service, maintenance or repairs)to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or • • . (b) That portion of"your work"out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or • subcontractor engaged in performing operations for principal as a part of the same project. • • Page 9 of 12 • - Includes copyrighted material of Insurance Services Office, Inc., with its permission. • ' • ©2011 Philadelphia Indemnity Insurance Company • • Philadelphia Indemnity Insurance Company PI-SE-001 (07/18) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SPECIAL EVENTS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. This insurance applies to"bodily injury", "property damage",and"personal and advertising injury" arising out of all of your special events with the following exceptions unless scheduled in paragraph C. SCHEDULE OF SPECIAL EVENTS below: • Parades sponsored by the Insured • Shooting activities J • • Fireworks • Carnivals and fairs with mechanical rides sponsored by the Insured • Hip-Hop or Rap concerts • Events including contact sports • Rodeos sponsored by the Insured • Political Rallies " • Any event with greater than 2,500 people at any one time(including otherwise acceptable events) • Any event with liquor provided by the Insured if a license is required for such activity. B. Section II—Who Is An Insured is amended to include as an additional insured the person(s)dr organization(s)related to your special events, 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. C. SCHEDULE OF SPECIAL EVENTS: Event(s) Date(s) • • • • This endorsement is not intended to replace,supersede or provide additional coverage or limits for a special event(s) if there is a separate policy in place providing coverage for the same special event(s). • • PI-SE-001 (07/18) , Page 1 of 1 . • 38 www.saif.com aiF :t . November 27, 2021 • ASHLAND CHAMBER OF COMMERCE. PO BOX 1360 ASHLAND, OR 97520-0046 SAIF policy: 464434 • • r Thank you for again choosing SAIF as your workers' comp carrier. Enclosed you'll find your workers' compensation policy, effective January 01, 2022. Included with this.letter is a policy information page that shows your estimated payroll, premium modifiers, and premium. amount. All previous policy endorsements continue to apply unless they have been cancelled or amended. , We've also provided some key information below. You'll find everything else you need to know about your policy, workplace safety, filing and managing a claim, and more on salf.com in our "Employer Guide." You can request printed information on topics that interest you and•your workers by calling us • at 800.285.8525, or by emailing uwpayroll@saif.com. Payroll reporting I At the end of each Annual reporting period, we'll send your a form to report the actual actual payroll for your covered workers for that period. For your convenience, you can also report your payroll and make-your payments online. Visit the Employer Guide on saif.com for more details. For more on payroll reporting, visit these pages on salf.com: • Learn how to complete your payroll report: saif.com/instructions • • View details on the requirements for reporting your payroll by class: saif.com/class • See an explanation of who is covered (also called "subject workers") and who is not: •saif.com/whomiscovered . • Learn when to report a worker in multiple classifications: saif.com/vtr , Your premium I Payment options based•on your estimated'premium of $420.91 are listed below. Installment payment plan Due date Amount - 12/25/2021 $420.91 Important: Changes in your payroll, classifications, or number of locations during the policy year can result in an adjustment to your installment amounts. Please notify us right away of any changes in your business. • Premium audits I We want you to pay only what you're required to pay. Premium auditors verify • your payroll and classification. Learn more about the premium audit process at saif.com/premiumaudit. • • 400 High Street SE • Salem,0R 97312 P:800.285.8525 Pol_PCI_REN F:503.373.8020 • • Ashland Chamber of Commerce November 27, 2021 • Page 2 Nondisabling claim reimbursement I This program could help you reduce or eliminate costs that are considered when determining your future experience rating modification factors. Learn more about the program and billing options at saif.com/ndr. Workplace safety and health I You may request workplace safety and industrial hygiene assistance by contacting our team of•safety and health experts at 877.242.5211 or by email at SafetyServices@saif.com. Safety professionals will assist you in analyzing your operations, hazards, injury records, and management controls. • In addition, they will help you: • • Improve workplace safety culture • Learn how to conduct onsite health and safety surveys • Assess your safety and health programs • Learn to Identify and evaluate safety training requirements, best practices, and available resources • Understand your responsibilities and the rules which pertain to your workplace under the Oregon Safe Employment Act (OSEA) and the Oregon Occupational Safety and Health Divisions (OR-OSHA). OSEA and OR-OSHA require employers to provide a safe and healthful _workplace and to do everything reasonably necessary to protect the life, health, and safety of their employees. Learn more at www.orosha.org or 800.922.2689. • You also can find workplace safety information on saif.com/safetyandhealth. As a policyholder you have access to.the SAIF Learning Center, which provides safety and health training at saif.com/Iearningcenter. To request safety and health services contact our safety team at 87.7.242.5211. Your policy information page Includes any changes that may have been made to your policy. Please review it and let us know if any information needs to be updated. Remember to notify us of any changes to your business, Including ownership, operations, and address. Here at SAIF, our goals are to provide you exceptional service at an affordable price, and to help you make your workplace as safe as possible. We appreciate the confidence you have placed in us in the past andlook forward to working with you during the coming policy year. Do you have any questions or need help? Please contact SAIF at the phone number or email address below. I Sincerely, • • /s/ Portland Service Center Service Center . P: 503.673:5283 • SERVIC@saif.com . c: SAIF Corporation • • • • 464434 Ashland Chamber of Commerce • • • • www.saih.com . ■ • • • sa I W . �e.ork Oregon. • • • Carrier no: 20001 • • Endorsement no: WC000424 . (Ed. 290) • • • SAIF policy: 46.4434 Ashland Chamber of Commerce • • Audit Noncompliance Charge Endorsement • Part Five - Premium, Section G. (Audit) of the Workers Compensation and Employers Liability Insurance Policy is revised.by adding the following: • If you do not allow us to examine and audit all of your records that relate to this policy, and/or do not provide audit information as requested, we may apply an Audit Noncompliance Charge. The method for determining the Audit Noncompliance Charge by state, where applicable, is shown in the Schedule below. If you allow us to examine and audit all of your records after we have applied an Audit Noncompliance Charge, we will revise your premium in accordance with our manuals and Part 5 - Premium, E. (Final Premium) of this policy. • Failure to cooperate with this policy provision may result in the cancellation of your insurance coverage, as specified under the policy. • Note: For coverage'under state-approved workers compensation assigned risk plans, failure to cooperate•with this policy provision may affect your eligibility for coverage. __..w.._. _ ... .... ......:'_. .. _._. Schedule • • • Basis of audit noncompliance ' Maximum audit noncompliance • State(s) charge • charge multiplier • • Oregon Estimated annual premium Up to two times • Effective date: January 0.1, 2022 • • • This endorsement changes the policy to which it is attached and is effective on the date issued unless . otherwise stated. •• . CCoounntterrsigned November 27, 2021 at Salem, Oregon • • • • WC000424 • • Chip Terhune (Ed. 290) President and Chief Executive Officer • • • • • 400 High Street SE • Salem.OR 97312 P:800.285.8525 F:503.373.8020 • • Pol_PC1_E290 • www.saif.com , 38 ■ • sailWork: Life. Oregon. • Carrier no: 20001 Endorsement,no: WC990616 • • (Ed. 444) SAIF policy: 464434 Ashland Chamber of Commerce • Confidentiality Endorsement SAIF furnishes policyholder with certain Information that includes confidential documentation. SAIF makes this Information available to policyholder for the sole purpose of assisting SAIF to manage, defend or adjust claims. . • Policyholder agrees to hold all Information provided by SAIF in trust and confidence. • .• Policyholder and its employees shall not disclose confidential information about an injured worker to anyone.except SAIF unless required to do so'by,law or with the written consentof the injured worker. Policyholder will take steps necessary to protect the confidentiality of information about injured workers, Including obtaining specific contractual promises from its employees and agents not to disclose any confidential information except as provided in this endorsement. Policyholder • shall not use confidential information for purposes other than those necessary to directly further the purposes of this endorsement. • • Policyholder shall not use confidential Information In such a manner that is likely to allow other persons to know the name or identity of an injured worker, or allow other persons to know any other particulars of a worker's injury claim, except for those matters over which policyholder as an employer has the ability and the right to-direct and control. In no case shall policyholder use confidential information either singly or in concert.to discriminate unlawfully against any injured worker. • • As used in this endorsement, "confidential Information" means any and all medical and vocational claim records and Information about an injured worker. Effective date: January 01, 2022 • This endorsement changes the policy to which it Is attached and is effective on the date issued unless otherwise stated. CountersignedCo _ November 27, 2021 at Salem, Oregon V� WC990616 ' Chip Terhune • (Ed. 444) President and Chief Executive Officer • • • • • 400 High Street SE Salem.0R 97312 P:800.285.8525 F:503.373.8020 Pot_PCi E444 www.saif,corp saiFt . • Carrier no: 20001 Endorsement no: WC360304 (Ed. 441) • SAIF policy: 464434 Ashland Chamber of Commerce • Oregon Amendatory Endorsement This endorsement applies because Oregon is shown•in Item 3.A. of the Information Page. Part Two - Employers Liability Insurance, Section C. (Exclusions), Item 5. of the policy is replaced by the.foliowing:. 5. :.:Any bodily,injury intentionally caused or aggravated by you, or that is the result of your •engaging in in conduct equivalent to an intentional tort, however defined., including as described by. = . - ORS 656.156, or other tortious conduct, or conduct or activity as described by ORS 656.018(3), such that you lose your immunity from civil liability under the workers'compensation laws of Oregon; • • Part Two - Employers Liability Insurance, Section C. (Exclusions) of the policy is revised by adding the• • • • •_ • following:. • . • 13; Any'cause'of'action or remedy arisrng out of or under ORS 656.019 or ORS 654.305 through ' ORS 654.336. . Effective date:January 01, 2022:. :..:_ ...._ . . . . . . This endorsement changes the policy to which It is attached and is effective on the date issued unless otherwise stated. Countersigned November 27, 2021 at Salem, Oregon V -. 7 .. . . . . WC360304 Chip Terhune (Ed. 441) President and Chief Executive Officer • • • • • • • • 400,High Street SE • Salem,0R 97312 P:800.285,8525 F:503.373.8020 Pol_PC1_E441 SAW policy: 464434 , • 38 • Subject Officer Payroll Requirement Endorsement • Page 2 Effective date: January 01, 2022 • This endorsement changes the policy to which It Is attached and is effective on the date Issued unless otherwise stated. Countersigned November 27, 2021 at Salem, Oregon Vv` 7 Z• WC990602 Chip Terhune (Ed. 32101) President and Chief Executive Officer • • • • • • • www.saif.com saiF ;;• n. • • • Carrier no: 20001 Endorsement no: WC990602 • (Ed. 32101) SAIF policy: 464434 Ashland Chamber of Commerce • • Subject Officer Payroll Requirement Endorsement -. • NON-PROFIT CORPORATION _...._ • An officer of a non-profit corporation vifio is employed by the corporation for Oregon-work ;_• • considered a.subject worker and is.cove e_0 for compensable injuries. The officer's payroll is to be. -_•:•_-:;•,••_ -•.--_:•• reported on your payroll report within the following minimum and maximum annual reportable payroll am9.v.Ots fQi fu.►152.-week,policy.perlo(;-.._ ....:••_..•• _.... ---Anniiai Reportabie [Sayrbll: •-"-- ""'" Minimum of: $65,000.00 .. .. . ..... • . .. _..- —._.. Maximum of: $260,000.00. _.__....... _ _._. "-` If your policy period is more or less-tfiari 52"inreefis tri feogth;•d!vlde the minim um'andnia'xfinurir:'— ":' T" Y"' • amounts 61;52 and multiply the result by the total number of full and partial weeks in the policy period• . - to obtain the minimum and maximum amounts that apply for a subject officer who is covered for the . ' whole policy period. •' • -' .-•- Use these steps.to determine the amou,nt•to,report for a•subject officer who is not•covered for all of a . • " • . '• •• policy period: a) divide the minimum and maximum annual reportable payroll amounts by 52 to obtain the • weekly minimum and maximum reportable payroll amounts - - — • b) count the number of full and partial calendar weeks that the officer was covered during the policy period c) multiply'the number of weeks In step b) by the weekly minimum and maximum reportable �- payroll amounts in step a) to obtain.the minimum and maximum limitations on reportable _ .. .. payroll for the officer- • • d) compare the officer's actual payroll for the time he or she was covered as an officer during the• ••••••----•-•-• policy period to the minimum and maximum limitations in step c) and report•the minimum if actual payroll is less than the minimum, otherwise report the actual payroll but no more than•• -•""--•--- • the maximum Reportable payroll for subject officers must be Included in the appropriate classification(s) listed on the • payroll report. If two or more classifications apply to an officer's duties the reportable payroll amount may be split between the classifications provided verifiable time records are maintained for the actual time spent working in each classification as indicated In the payroll reporting instructions provided with your policy. If two or more classifications apply but verifiable time records are not maintained you must use the highest rated classification. • • • • 400 High Street SE Salem,OR 97312 P:800.285.8525 • F:503.373.8020 • Pol PC1 E32101 • i • www.saif.com 38 • sai1z . • Carrier no: 20001 Endorsement no: WC360406 (Ed. 235) SAIF policy: 464434 Ashland Chamber of Commerce • Premium Due Date Endorsement Section D of Part Five of the policy is replaced by this provision. D. Premium is amended to read: You will pay all premium when due. You will pay the premium even if part or all of a workers' compensation law is not valid. The due date for audit and retrospective premiums is the date specified in the billing invoice for that policy. Effective date: January 01, 2022 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Countersigned November 27, 2021 at Salem, Oregon e/e _- 1.7 e WC360406 Chip Terhune . (Ed. 235) President and Chief Executive Officer • • • • • • • )00 High Street'SE Salem.OR 97312 P:800.285.8525 F:503.373.8020 Pol_PC1_E235 . Www.saif.com ._... .... • saiFt; . Carrier no: 20001 Endorsement no: WC990402E • -- ..._.._.. _..___.... ._.._.—_ _...._..— __._.._......_.._. . . (Ed. 2238) SAIF policy: 464434 Ashland Chamber of Commerce Claim Rating Plan Endorsement • You are eligible for tfie Claim Rating Plan, your net premium costs are determined by the number •- : . •.•• _:_.of claims during• the first three of the.last four policy years,•The rate modification factor, if any is shown on the Inforrnaticin.Page-of-this policy.The number of ciaims required for each level is:• - • ••• • Rate levet ••••• •• • • •• _- • . ..._ _....•_._ Number of claims in rating period • • -=Your assigneftrate•tlerrninus iQ°/ .7:::---;__. zerrcrclaimsr�- _—�- = -- -=�=:-:=-=:-- : .•-•-• _• _-_--- Your assigned rate tier_-. ; One or more total claims- ••. •• • •= . • • -• -• • ...... -The plan only:. appilesto,firms that.a}have had-continuous_workers' compensation coverage -. •- •• .• •.• .. -- fexfsiuEiearEfmmedlateiy prior -tv•tfieappiicabfe-renewatifate; agdbj-have'-reported--payroif. -.- •r" in.each year of the rating period; and c) are not eligible for the Experience Rating Plan of the • • National Council on Compensation Insurance. • Effective date:,January 01,,2022, _, " ` --Shis endorsement changes-Ake-policy:ter which-it Is•:attached:and is_effective ori-.,b&date issued unless_:-.::.---••-: otherwise stated: Countersigned November 27, 2021 at Salem,, Oregon , 7• • T • - • •• WC990402E - C Terhune (Ed. 223B) . President and Chief Executive Officer • • . • • • • 400 High Street SE • Salem.OR 97312 P:800.285.8525• F:503.373.8020 • Pol PC1_E2238 www.saif.com 38 • sai1 :: . • Carrier no: 20001 Endorsement no: WC000406A (Ed. 218) • SAIF policy: 464434 Ashland Chamber of Commerce Premium Discount Endorsement The premium for this policyand the policies, if any, listed In Item'3 of the Schedule may be eligible for a discount. This endorsement shows your estimated discount in Items 1 or 2 of the Schedule. The final calculation of premium discount will be determined by our manuals and your premium basis as determined by audit. Premium subject to retrospective rating is not subject to premium discount. • Schedule • 1. State - Oregon • Estimated eligible premium Discount First $5,000 0.00% Next $10,000 10.50% • Next $35,000 • 16.50'% Over $50,000 ' 18.00% Effective date: January 01, 2022 This endorsement changes the policy to which it Is attached and is effective on the date issued unless otherwise stated. Countersigned November 27, 2021 at Salem, Oregon • VVI— 7 e . WC000406A Chip Terhune (Ed. 218) President and Chief Executive Officer • • • • • 400 High Street SE Salem,OR 97312 P:800.285.8525 _ F:503.373.8020 Pol_PC1_E218C • www.salf.com • sail Work. • Life. • Oregon. • • • • • Carrier no: 20001 Endorsement no: WC990401C •• • (Ed. 217B) • SAIF policy: 464434 Ashland Chamber of Commerce • Premium Payment Rating Plan Endorsement . At the inception of your policy period, we estimate your premium based on anticipated payroll for your • business. The issued 'policy's estimated premium will be the basis for calculating the credit. Your premium will be reduced by a prepay factor shown in the schedule below. The factor Is applied as a multiplier to total estimated premium after experience rating,Oregon Contracting Classification Premium Adjustment, Oregon Group Supplemental Experience Rating, and other like adjustments, if _ .any-ebut before premium•.discount. You pay your premium in one or more installments. • • The prepayrs a- credit with no premium cap. The prepay credit will not be applied to adjustments in.premium during the policy period or premium paid after policy expiration. The credit will not apply if it reduces premium below minimum premium. When the policy cancels prior to the policy expiration date, we will recalculate the prepay credit using final premium for the cancelled policy period. • Premium Payment Rating Plan Rating Factor ' Annual • - 0.99 . • • • Effective date: January 01, 2022 This endorsement changes the policy to which it is attached and is effective on the date issued unless • otherwise stated'. • Countersigned November 27, 2021 at Salem, Oregon .._._.. 1 l WC990401C • Chip Terhune • (Ed. 21.78) President and Chief Executive Officer• . • • • • • • • • • • • • • • • • • • • 400 High Street SE Salem.OR 97312 •• P:800.285.8525 • F:503.373.8020 Pol_PC1_E2178 • . • www.saif.com ,. ' 38 sai1 ::.• Carrier no: 20001 Endorsement no: WC000414A (Ed. 213A) SAIF policy: 464434 Ashland Chamber of Commerce 90-Day Reporting Requirement-Notification of Change in Ownership Endorsement You must report any change in ownership to us in writing within 90 days of the date of the change. Change in ownership includes sales, purchases, other transfers, mergers, consolidations, dissolutions, formations of a new entity, and other changes provided for in the applicable experience rating plan. Experience rating is mandatory for all eligible insureds. The experience rating modification factor, if any, applicable to this policy, may change if there is a change in your ownership or in that of one or more of the entities eligible to be combined with you for experience rating purposes. Failure to report any change in ownership, regardles's of whether the change is reported within 90 days of such change, may result in revision of the experience rating modification factor used to determine your premium. This reporting requirement applies regardless of whether an experience rating modification is currently applicable to this policy,• • Effective date: January 01, 2022 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. • Countersigned November 27, 2021 at Salem, Oregon • WC000414A Chip Terhune (Ed. 213A) President and Chief Executive Officer • • • • 400 High Street SE Salem,0R 97312 P:800.285.8525 F:503.373.8020 Pol_PC1 E213A • SAIF policy: 464434 - Terrorism Risk Insurance Program Reauthorization Act Disclosure endorsement. [Sage 2 Policyholder Disclosure Notice 1. Insured'Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured Losses occurring in any calendar year exceed $200,000,000, the • United States Government would pay 80% of our Insured Losses that exceed our Insurer Deductible. ' 2. Notwithstanding item 1 above, the United States Government will not make any payment under the Act for any portion of Insured Losses that exceed $100,000,000,000. 3. The premium charge for the coverage your policy provides for Insured Losses is included in • the amount shown in Item 4 of the Information Page or in the Schedule below. Schedule 'State Rate per $100 of payroll Oregon • 0.005 • Effective date: January 01, 2022 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. • Countersigned November 27, 2021 at Salem, Oregon WC000422C Chip Terhune (Ed. 212C) President and Chief Executive Officer •www.saif.com - 38 ■ SaIfw°k. Life. Oregon. • Carrier no: 20001 Endorsement no: WC000422C (Ed. 212C) • SAIF policy: 464434 Ashland Chamber of Commerce Terrorism Risk Insurance Program Reauthorization Act Disclosure endorsement. • •This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2019. It serves to notify you of certain limitations under the Act, and that your insurance carrier is charging a premium for losses that may occur in the event of an Act of Terrorism. Your policy provides coverage for workers' compensation losses caused by Acts of Terrorism, including workers' compensation benefit obligations dictated by state law. Coverage for such tosses;is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. - Definitions The definitions provided in this endorsement are based on and have the same meaning as the - definitions in the Act. If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply'. V V "Act" means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments thereto, including any amendments resulting from the Terrorism Risk Insurance - Program Reauthorization Act of 2019. "Act of Terrorism" means any act that-is certified by the Secretary of the Treasury, in consultation with.the Secretary of Homeland Security, and the Attorney General of the United States as meeting all of the following requirements:. a. The act is an act of terrorism. b. The act Is violent or dangerous to human life, property or infrastructure. • c. The act resulted in damage within the United States, or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels. - d. The act has been committed by an individual or individuals as part of an effort to coerce the • civilian population of the United States or to Influence the policy or affect the conduct of the United States Government by coercion. "Insured Loss"- means any loss resulting from an act of terrorism (and, except for Pennsylvania, including an act of war, in th,e case of workers'compensation) that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. "Insurer Deductible" means, for the period beginning on January 1, 2021, and ending on December 31, 2027, an amount equal to 20% of our direct earned premium, during the immediately preceding calendar year. Limitation of Liability The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a calendar year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we will pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury. - • 400 High Street SE • Salem,OR 97312 P:800.285.8525 F:503.373.8020 Pol PC1 E212C • SAIF policy: 464434 Cptbstrophe (other than Certified Acts of Terrorism) Premium Endorsement Page 2 • 1 • Effective data: January 01, 2022 This endorsement changes the policy to which It is attached and is effective on the date issued unless otherwise stated. Countersigned November 27, 2021 at Salem, Oregon •r WC000421E Chip Terhune (Ed. 211D) President and Chief Executive Officer . , • • • - . • • • • • • . , • • • • • • • • • www.saif.com 38 • salk.• • Carrier no: 20001 Endorsement no: WC000421E • (Ed. 211D) •SAIF policy: 464434 Ashland Chamber of Commerce Catastrophe (other than 'Certified Acts of Terrorism ) Premium Endorsement • • This endorsement is notification that your insurance carrier is charging premium to cover the losses that may occur in the event.of a Catastrophe (Other Than Certified Acts of Terrorism) as that term is •defined below. Your policy provides coverage for workers'compensation losses caused by a Catastrophe•(0ther Than Certified Acts of Terrorism). This premium charge does not provide funding for Certified Acts of Terrorism contem plated under the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC000422C), attached to this policy. For purposes of this endorsement, the following definitions apply: Catastrophe (Other Than Certified Acts of Terrorism): Any single event,.resulting from an • • Earthquake, Noncertified Act of Terrorism, or Catastrophic Industrial Accident, which results in aggregate workers' compensation losses in excess of $50 million. Earthquake: The shaking and vibration at the surface of the earth resulting from underground movement along a fault plane or from volcanic activity. • • Noncertified Act of Terrorism: An event that is not certified as an Act of Terrorism by the Secretary of the Treasury pursuant to•the Terrorism Risk Insurance Act of 2002 (as amended) but that meets all of the following criteria: a. It is an act that is violent or dangerous to human life, property, or infrastructure; b. The act results in damage within the United States, or outside of the United States in the case of the premises of United States missions or air carriers or vessels as those terms are defined in the Terrorism Risk Insurance Act of,2002 (as amended); and c. It is an act that has been committed by an individual or individuals as part of ari effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. Catastrophic Industrial Accident: A chemical release, large explosion, or small blast that is localized in nature and affects workers in .a small perimeter the size of a building. The premium charge for the coverage your policy provides for workers'compensation losses caused by a Catastrophe•(Other Than.Certified Acts of Terrorism) is shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate per $100 of payroll • Oregon 0.01 • 1 • • 600 High Street SE Salem,OR 97312 P:800.285.8525 F:503.373.8020 PoL_PC1_E2110 • • www.saif.com saifz. Carrier no: 20001 Endorsement'no: WC360601E (Ed. 210A) SAIF policy: 464434 Ashland Chamber of Commerce Oregon Cancellation Endorsement • • 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 maii'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 takeeffect..• : • . • 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 least 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 12:01 AM 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. Effective date: January 01, 2022 . • This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Countersigned November 27, 2021. at Salem, Oregon z • WC360601E Chip Terhune • (Ed. 210A) President and Chief Executive Officer • • 400 High Street SE Salem,OR 97312 P:800.285.8525 F:503.373.8020 Pol_PC1_E210A • www.saif.com ^ 38 sai1t . Carrier no: 20001 Endorsement no: WC360402 (Ed. 208) • SAIF policy: 464434 Ashland Chamber of Commerce • Oregon Contracting Classification Premium Adjustment Endorsement The premium for the policy may be adjusted by an Oregon Contracting Classification•Premlum • Adjustment factor. The factor was not available when the policy was Issued. If you qualify, or if an estimated factor has been applied, we will issue an endorsement to show the proper premium adjustment factor after it is calculated. • • • Effective date: January 01, 2022 This endorsement changes the policy to which It.is attached and is effective on the date issued unless otherwise stated. • Countersigned November 27, 2021 at Salem, Oregon • WC360402 Chip Terhune (Ed. 208) President and Chief Executive Officer � • • • • • • • • • • • 400 High Street SE Salem,0R 97312 P:800.285.8525 F:503.373.8020 Pol_PC1_E208 • • SAIF policy: 464434 • Page 2 of 2 Classification addendum Relations/Sales/Promotion; Escrow Service-Field Employees; Stockbroker-Field Representatives; Title Company-Field Employees; Outside Sales/Field Representative • Class 8742 applies to employees who are acting as salespersons; field representatives,outside public relations personnel, collectors away from your premises. Class 8742 also applies to employees who • • . - perform bid-estimating duties away from your premises, with no exposure to job hazards. Class 8742 does not apply to job site visits•once construction work has begun. Class 8742 includes the demonstration of products being sold, such as calculators, cosmetics or cleaning supplies, when- performed hen•performed by your outside sales personnel. Class 8742 does'not apply to employees who . . . demonstrate products such as farm, mill or road construction machinery or to the delivery of merchandise. Employees who deliver merchandise are properly assigned to the classification applicable to drivers, even if they also collect or sell. If those employees walk or use public transportation, they shall be assigned to the class producing the.highest payroll, other than Classes.8810, 87.42 or 7380. . ..• . . . . . • . . .Time spent in-the office performing_clerlcal duties or. phone sales may be separately classed as _= • • • • Office Clerical;only Itthe workers are located In an'area that s physically separated from the rest-af" - •-- ouzo eratioiis• there is••no" h'sical.contact with ou•r customers and adequate payroll'records are Y P , P Y Y Q P Y maintained. 8810 03 Office Clerical • 8810 - Office Clerical; Boy/Girl Scout Council Non-Camp Employees; Drafting Employees; Secretaries ' " • • and Bookkeepers; Key Punch•Operators; Telecommuter-Clerical Employees Class 8810 applies to office employees who only perform bookkeeping, drafting and other clerical work • in-a physlcally'erielosed (by structural partitions) area devoted exclusively to these specific activitlesi-:-.i=:•:. _- - . It also applies to.artists, designers, electronic typesetters, proofreaders, and editors who work in a• physically enclosed office area where bookkeeping and clerical activities are also performed. • r Class 8810 also applies to employees engaged in clerical telecom muter activities. The duties of clerical telecommuter employees include creation or maintenance of financial or other employer records, handling correspondence, computer composition, technical drafting and telephone duties, including sales by telephone: Class 8810 applies to depositing of funds at the bank, purchase of office supplies and pick-up or delivery of mail provided the activities are incidental and directly related to the employees duties performed in their residence office. A residence office is a clerical work area located within the dwelling of the clerical employee and must be separate and distinct from the.location of their employer. . • • • • • • 38 www.saii.com S a I Woife.rk. L Oregon. SAIF policy: 464434 Classification Addendum • Verifiable time records Oregon Administrative Rules require you to report wages under the highest rated classification ' applicable to any part of the worker's duties if you choose not to keep verifiable time records. In most instances, if you have more than one classification on your Insurance policy and your workers shift duties between those classifications, you can use verifiable time records to separate the payroll of the workers and report it in more than one classification on the payroll report. • Verifiable payroll records must be supported by original entries from other records, including, but not limited to, time cards, calendars, planners, or daily logs prepared by the employee or the employee's direct supervisor or manager. Estimated percentages or ratios will not be accepted. For more information on how,to keep verifiable time records, visit salf.com and choose: I am: An Employer > Reporting Payroll > Verifiable Time Records. • The following classifications will become effective on your policy January 01, 2022: 5102 30 Door/W-indow-Instl-All--Rsdntl/Cmrcl 5102 - Door and Window Installation-All Types-Residential and Commercial; Fire Door Installation; Iron-Steel Installation-Interior By Specialty Contractor. Includes specialty contractors performing installation of all types of interior and exterior doors and windows-commercial and residential- including.but not limited to, aluminum, vinyl, wood, composite, fiberglass, and steel. Class 5102 is also assigned to the installation of shower doors and enclosures made from materials other than glass; refer to class 5462 for the installation of glass shower doors or enclosures. Overhead door installation to be separately rated as class 3724. The installation of doors and windows in connection with the construction of residential dwelling or commercial buildings to be separately rated. Class 5102 applies to your employees Involved In direct labor and supervision who are engaged in the installation of decorative or artistic iron, brass or bronze; the installation of interior non-structural iron,.brass or bronze items; and the installation of light gauge metal frames. Items in this category include interior iron, brass, or bronze staircases, balconies or mezzanines, railings, window gratings, bank cages; decorative or artistic iron, brass, or bronze elevator entrances and doors, memorial plaques, bronze wall facades, wrought Iron facings, and similar decorative items; steel prison cells, and fire doors. Operations involve the placing of the particular product and securing same by bolting, welding, or riveting. Class 5102 also applies to the repair or maintenance of your equipment used for this work only if performed at the job site. If you maintain a permanent yard for the purpose of storage or maintaining your vehicles, equipment, buildings, or structures, class 8227 - Contractors - Permanent Yards would apply to that operation. Installation of light gauge interior framing in conjunction with the installation of wallboard or blueboard, both class 5445 - Wallboard Installation, and 5102 may be used provided • adequate payroll records are maintained. Class 5102 does not apply to shop fabrication. 8742 Al Salesperson-Outside-No Delivery 8742 - Salesperson-Outside-No Delivery; Estimator-No Job Hazards; Collectors/Sales-Outside; Field Representative; Employment Agency-Field Employees; Real Estate Agency-Agent/Sales Personnel; • Real Estate Appraisal Company-Outside Employees; Data Processing Service-Field Employees; Public 400 High Street SE Salem,OR 97312 Pal PC1 CLaDD P:800.285.8525- • •F:503.373.8020 said 38 Carrier no:20001 Information Page • Policy no:. 464434 Employer identification no: 93-0115140 NCCI Risk ID no: Item 1.. The Insured: Entity Type: ASHLAND CHAMBER OF COMMERCE Non-Profit Corporation Mailing address: Agent: ASHLAND CHAMBER OF COMMERCE SAIF CORPORATION PO BOX 1360 400 HIGH ST SE ,ASHLAND, OR 97520-0046 SALEM, OR 97312-0700 Other workplaces not shown above:. ) Ashland Chamber of Commerce 110E Main St •. • Ashland,OR 97520-1829 Item 2. The policy period is from 01/01/2022, 12:01 A.M.to 01/01/2023,12:01 A.M.at the insured's mailing address. • Item 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here:OREGON. B. Employers Liability Insurance:Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident$500,000 each accident • Bodily Injury by Disease $500,000 each employee, • Bodily Injury by Disease $500,000 policy limit C. Other States Insurance:Part Three of the policy applies to the states,if any,listed here: • NONE ; D. This policy includes these endorsements and schedules: . WC990602 Subject Officer,Payroll Requirement Endorsement WC000424 Audit Noncompliance Charge Endorsement • WC990616 . Confidentiality Endorsement WC360304 Oregon Amendatory Endorsement WC360601E Oregon Cancellation Endorsement WC990401C Premium Payment Rating Plan Endorsement WC000414A 90-Day Reporting Requirement-Notification of Change.in Ownership Endorsement WC360402 Oregon Contracting Classification Premium Adjustment Endorsement WC000421 E Catastrophe(other than Certified Acts of Terrorism)Premium Endorsement WC000422C Terrorism Risk Insurance Program Reauthorization Act Disclosure endorsement. WC000406A Premium Discount Endorsement WC990402E Claim Rating Plan Endorsement • WC360406 Premium Due Date Endorsement Item 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans.The experience rating modification factor and other rating plan factors,if any,may change on your rating effective date of 1/1/2023.All information required below is subject to verification and change by audit. • • 400 High Street SE Salem,OR 97312 P:800.285.8525 Pol_PC1 P401 F:503.373.8020 SAIF policy:464434 Page 2 • • • • •Rating period: 01/01/2022 to 01/01/2023 Location 1: Ashland Chamber of Commerce Subject Classification description Class payroll Rate • Premium Door/Window-Fnsti-A11--Rsdntl/Cmrcl 5102 . $0.00 3.52 $0.00 Salesperson-Outside-No Delivery 8742 $36,418.00, 0.19 $69.19 Office Clerical 8810 $a32,206.00 0.09 $298.99 • Total manual premium $368,624.00 $368.18 Total subject premium $368.18 Total modified premium $368.18 Description Basis Factor Premium Claim Rating $368.18 0.9 -$36.82 , Pre-pay credit $331.36 0.99 -$3.31 Total standard premium $328.05 Description Basis Factor Premium Oregon Total Premium $328.05 Terrorism Premium $368,624.00 0.005 $18.43 Catastrophe Premium $368,624.00 0.01 $36.86 DCBS Assessment $383.34 1.098 $37.57 Total premium and assessment $420.91 • Policy Minimum Premium: $192 • • Your policy premium is based on your current estimated premium and may be prorated for policies in effect for less than a full year or adjusted based on actual payroll by classification. Terrorism Premium Is In addition to Policy Minimum Premium. Catastrophe Premium is in addition to Policy Minimum Premium. - • Payroll Reporting Frequency: Annual • This Information page is part of your policy. Countersigned on November 27,2021 at Salem,Oregon CAA. r Chip Terhune President and Chief Executive Officer WC000001A • 38 STANDARD WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY PARTICIPATING • • GENERAL SECTION In return For the payment of the premium and subject to all terms of this policy,we agree with you as follows: • A. The Policy This policy includes at its effective date the Information Page and all endorsements and schedules listed there.It is a contract of insurance•between you(the employer named in Item 1 of the Information Page]and us(the insurer named on the Information Page].The only agreements relating to this insurance are stated in this policy.The terms of this policy may not be changed or waived except by endorsement issued by us to be part of this policy. B. Who Is Insured You are insured if you are an employer named in Item 1 of the Information Page.If that employer is a partnership,and if you are one of its partners,you are insured,but only in your capacity as an employer of the partnership's employees. C. Workers Compensation Law Workers Compensation Law means the workers or workmen's compensation law and occupational disease law of each state or territory named in Item 3.A.of the Information Page.It includes any amAndments to that law which are in effect during the policy period.Jt does not include any federal.workers or workmen's compensation law,any federal occupational disease law or the provisions of any law that provide nonoccupational disability benefits. D. State - State means any state of the United States of America,and the District of Columbia. • E. Locations • This policy covers all of your workplaces listed in Items 1 or 4 of the Information Page;and it covers all other workplaces in Item 3.A.states unless you have other insurance or are self-insured for such workplaces. PART ONE-WORKERS COMPENSATION INSURANCE • A. How This Insurance Applies • • This workers compensation insurance applies to bodily injury by accident or bodily injury by disease.Bodily injury includes resulting death. 1. Bodily injury by accident must occur during the policy period. 2. Bodily injury by disease must be caused or aggravated by the conditions of your employment.The employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. B. We Wilt Pay • • We will pay promptly when due the benefits required of you by the workers compensation law. • C. We WjLL Defend We have the right and duty to defend at our expense any claim,proceeding or suit against you for benefits payable by this insurance.We have the right to investigate and settle these claims,proceedings or suits.We have no duty to defend a claim, • proceeding or suit that is not covered by this insurance. D. We Will Also Pay We will also pay these costs,in addition to other amounts payable under this insurance,as part of any claim,proceeding or suit we defend: ' • 1. reasonable expenses Incurred at our request,but not loss of earnings; -' ' 2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the amount payable under this • insurance; 3. litigation costs taxed against you; 4. interest on a judgment as required by law until we offer the•amount due under this insurance:and 5. expenses we incur. E. Other Insurance We will not pay more than our share of benefits and costs covered by this insurance and other insurance or self-insurance. Subject to any limits of liability that may apply,all shares will be equal until the loss is paid.If any insurance or self-insurance' is exhausted,the shares of all remaining insurance will be equal until the loss Is paid. F. Payments You Must Make • . You are responsible for any payments in excess of the benefits regularly provided by the workers compensation law including those required because: • • 1. of your serious and willful misconduct; 2. you knowingly employ an employee in violation of law; 3. you fail to comply with a health or safety law or regulation;or 4. you discharge,coerce or otherwise discriminate against any employee in violation of the workers compensation law. If we make any payments in excess of the benefits regularly provided by the workers compensation law on your behalf,you will • reimburse us promptly. • Includes copyright material of the National Council on Compensation Insurance,Inc.used with its permission. Copyright 2013 National Council on Compensation Insurance,Inc.All rights reserved. Pot_PC1 BPVOLA SAIF Policy:464434 Page 2 , G. Recovery From Others We have your rights,and the rights of persons entitled to the benefits of this insurance,to recover our payments from anyone liable for the injury.You will do everything necessary to protect those rights for us and to help us enforce them. H. Statutory Provisions These statements apply where they are required by law. 1. As between an injured worker and us,we have notice of the injury when you have notice. 2". Your default or the bankruptcy or insolvency of you or your estate will not relieve us of our duties under this insurance after an injury occurs. , 3. We are directly and primarily liable to any person entitled to the benefits payable by this insurance.Those persons may enforce our duties;so may an agency authorized byrlaw.Enforcement may be against us or against you and us. 4. Jurisdiction over you,is jurisdiction over us for purposes of the workers compensation law.We are bound by decisions against you under that law,subject to the provisions of this policy that are not in conflict with that law. 5. This insurance conforms to the parts of the workers compensation law that apply to: a. benefits payable by this insurance: b. special taxes,payments into security or other special funds,and assessments payable by us under that law. 6. Terms of this insurance that conflict with the workers compensation law are changed by this statement to conform to that law. _ _Nothing in these paragraphs relieves you of your duties under this policy. PART.TWO-EMPLOYERS LIABILITY INSURANCE A. How This Insurance Applies • This employers liability insurance applies to bodily injury by accident or bodily injury by disease.Bodily injury includes resulting death. ' t. The bodily Injury must arise out of and in the course of the injured employee's employment by you. 2. The employment must be necessary or incidental to your work in a state or territory listed in Item 3.A.of the Information " Page. ' " 3. Bodily injury by accident must occur during the policy period. 4. Bodily Injury by disease must be caused or aggravated by the conditions of your employment.The employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. 5. If you are sued,the original suit and any related legal actions for damages for bodily injury by accident or by disease must be brought in the United States of America,its territories or possessions,or Canada. • B. We Will Pay . _.._.._,. __— We will pay all sums that you legally must pay as damages because of bodily injury to your employees.provided the bodily injury is covered by this'Emptoyers Liability Insurance.The damages we will pay,where recovery is permitted by law,include damages: 1. For which you are liable to a third party by reason of a claim or suit against you by that third party to recover the damages . claimed against such third party as a result of injury to your employee; 2. For care and loss of services;and. 3. For consequential bodily injury to a spouse,child,parent,brother or sister•of the injured employee;provided that these _...... damages are the direct consequence of bodily injury that arises out of and in the course of the injured employee's employment by you;and 4. Because of bodily injury to your employee that arises out of and in the course of employment,claimed against you in a capacity other than as employer. C. Exclusions • This insurance does not cover: 1. Liability assumed under a contract,This exclusion does not apply to a warranty that your work willbe done in a workmanlike manner; 2. Punitive or exemplary damages because of bodily injury to an employee employed in violation of law; • 3. Bodily Injury to an employee while employed In violation of law with your actual knowledge or the actual knowledge of any of your executive officers; • 4. Any obligation imposed by a workers compensation,occupational disease,unemployment compensation,or disability. benefits law,or any similar law; . 5. Bodily injury intentionally caused or aggravated by you; 6. Bodily injury occurring outside the United States of America,its territories or possessions,and Canada.This exclusion • does not apply to bodily injury to a citizen or resident of the United States of America or Canada who is temporarily outside these countries; 7. Damages arising out of coercion,criticism,demotion,evaluation,reassignment,discipline,defamation,harassment, humiliation,discrimination against or termination of any employee,or any personnel practices,policies,acts or omissions; . 8. Bodily injury to any person in work subject to the Longshore and Harbor Workers'Compensation.Act(33 U.S.C.Sections 901 et seq.),the Nonappropriated Fund Instrumentalities Act(5 U.S.C.Sections 8171 et seq.l,the Outer Continental Shelf Lands Act(43 U.S.C.Sections 1331 et seq.),the Defense Base.Act(42 U.S.C.Sections 1651-1654),the Federal Mine Safety • and Health Act 130 U.S.C.Sections 801 et seq.and 901-9441,any other federal workers or workmen's compensation law or other federal occupational disease law,or any amendments to these laws; 9. Bodily injury to any person in work subject to the Federal Employers'Liability Act(45 U.S.C.Sections 51 et seq.),any other federal Laws obligating an employer to pay damages to an employee due to bodily injury arising out of or in the course of employment,or any amendments to those laws; . Includes copyright material of the National Council on Compensation Insurance,Inc.used with its permission. Copyright 2013 National Council on Compensation Insurance,Inc.All rights reserved. SAIF Policy:464434 38 Page • 10. Bodily injury to a master or member of the crew of any vessel,and does not cover punitive damages related to your duty or obligation to provide transportation,wages,maintenance,and cure under any applicable maritime law; • 11. Fines or penalties imposed'for violation of federal or state law;and 12. Damages payable under the Migrant and Seasonal Agricultural Worker Protection Act 129 U.S.C.Sections 1801 et seq.1 • and under any other federal law awarding damages for violation of those laws or regulations issued thereunder,and any amendments to those laws. D. We Will Defend • We have the right and duty to defend,at our expense;any claim,proceeding or suit against you for damages payable by this insurance.We have the right to investigate and settle these claims,proceedings and suits.We have no duty to defend a claim, proceeding or suit that is not covered by this insurance.We have no duty to defend or continue defending after we have paid our applicable limit of liability under this insurance. E. We Will Also Pay We will also pay/ these costs,in addition to other amounts payable under this insurance,as part of any claim,•proceeding or suit • we defend: - 1. Reasonable expenses incurred at our request,but not loss of earnings; 2. Premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our liability under this insurance; . ' 3. Litigation costs taxed against you; 4. Interest on a judgment as required by law until we offer the amount due under this insurance;and 5. Expenses we incur.• F. Other Insurance • We will not pay more than our share of damages and costs covered by this insurance and other insurance or self-insurance. Subject to any limits of liability that apply,all shares will be equal until the loss is paid'.If any insurance or self-insurance is exhausted,the shares of all remaining insurance and self-insurance will be equal until the loss is paid. G. limits of Liability Our liability to pay for damages is limited.Our limits of liability are,shown in Item 3.B.of the Information Page.They apply as explained below. 1. Bodily Injury by Accident.The limit shown for"bodily injury by accident-each accident"is the most we will pay for all damages covered by this Insurance because of bodily injury to one or more employees in any one accident.A disease is not bodily injury by accident unless it results directly from bodily injury by accident. 2. Bodily Injury by Disease.The limit shown for'bodily injury by disease-policy limit"is the most we will pay for all damages covered by this insurance and arising out of bodily injury by disease,regardless of the number of employees who sustain bodily injury by disease.The[limit shown for"bodily injury by disease-each employee-is the most we will pay for all damages because of bodily injury by disease to any one employee.Bodily injury by disease does not include disease that results'directly from a bodily injury by accident. . 3. We will not pay any claims for damages after we have paid the applicable limit of our liability under this insurance. • H. Recovery From Others We have your rights to recover our payment from anyone liable for an injury covered by this insurance.You will do everything necessary to protect those rights for us and to help us enforce them. I. Actions Against Us . • There will be no right of action against us under this insurance unless: 1. You have complied with all the terms'of this policy;and 2. The amount you oweha'sbeendeterminedwithourconsentorbyactualtrialandfinaljudgment. This insurance does not give anyone the right to add us as a defendant in an action against you to determine your liability.The bankruptcy or insolvency of you or your estate will not relieve us of our obligations under this Part. PART THREE-OTHER STATES INSURANCE • • A. How This Insurance Applies 1. This other states insurance applies only if one or more states are shown in Item 3.C.of the Information Page. 2. If you begin work in any one of those states after the effective date of this policy and are not insured or are not self- insured for such work,all provisions of the policy will apply as though that state were listed in Item 3.A.of the Information Page. . 3, We will reimburse you for the benefits required by the workers compensation law of that state if we are not permitted to . pay the benefits directly to persons entitled to them. 4. If you have work on the effective date of this policy in any state not listed in Item 3.A.of the Information Page,coverage will not be afforded for that state unless we are notified within thirty days. • B. Notice • Tell us at once if you begin work in any state listed in Item 3.C.of the Information Page. PART FOUR-YOUR DUTIES IF INJURY OCCURS • - . Tell us at once if injury occurs that may be covered by this policy.Your other duties are listed here. 1. Provide for immediate medical and other services required by the workers compensation law. • Includes copyright material of the National Council on Compensation Insurance,Inc.used with its permission. Copyright 2013 National Council on Compensation Insurance,Inc.All rights reserved. . • SAIF Policy:464434= __...._.. _•----.__..._:.:----_—....... ...... . . . . .. t Page 4 :. .:.. • 2. Give us or our agent the names and addresses of the injured persons and of witnesses,and other information we may need. 3. Promptly give us all notices;demands and legal papers related to the injury,claim',proceeding or suit. • 4. Cooperate with us and assist us,as we may request,in the investigation,settlement or defense of any claim,proceeding or suit. 5. Do nothing after an injury occurs that would interfere with our right to recover from others. 6. Do not voluntarily make payments, assume obligations or incur expenses ,except at your own cost. . FIVE-=PREMIUM- . '- - - • - _ .. .. . .. . . . . . .-. . All premium for this policy will be determined by our manuals of rules,rates,rating plans and classifications.We may change . - - •our manuals and apply the changes to this policy it authorized by law ore governmental agency regulating this insurance. B. Classifications •••��- Item 4 of the lnfnrmation Page shows the rate and premium basis for certain business or work classifications.These classifications were assigned based on an estimate of the exposures you would have during the policy period.If your actual exposures are not properly described by those'classifications,we_will assign proper classifications,rates and premium basis - - by endorsement to this pulley.':. ' ..- y•.::` C.- Remuneration :. _.... _ . Premium for each,workclassificatigAls determined by mulgty,ing,a rate times a prem •b iumasjs.,Remuneration is the most cotnnisn prem tun.basis _ _. — - - -_ -=: '—`.�:c':-:=.PFiis pr_emLtmbasix incudes payrQTCan&alE other remuneration'pa id.ar-payabte during the policy.iierioiLlai the services of: :.._ .... __..._.._..__ _t. . 'allaltyourofficersand employees engaged in work covered by this poLicy;and . . . ::=�:c 2_�_ attother persons•engaged In work that could make us-Liatite underpart One(Workers Compensation Insurance!of this :Ityouda;nothave payroltrecords lorthese ersons,thecontract price price for their zervIce and materials may be. . �::_: ,_:_ used as the premium basis.Thisparagraph 2 will not l if you give us proof that the em to ers_of thesepersons • PPY,.. ...-. _...__ P Y-. -'-'-""-".ar w.s__"'raWfaltytsecuPedMi' oFifar iSfipb itatidn'obltptianS:""- "`-`=-"-- • • ' '"' _ . . • b •P•remium Payments ' _Y_o4yritl pay.ajl premium when due.Ym ou_will pay the premium even if part or all of a wprkers,copensation law is not valid. E. Final Premium -_..._ The premium shown on the Information Page,schedules,and endorsements is an estimate.The final premium will be • determined after this policy ends by using the actual,not the estimated,premium basis and the proper classifications and ..:.i-=_.ir,":� sss•:,=,_ aies:ttrettawtul Ppbto.the.businots'an.d work covered.bY this pollq, _.the final premiuni.is more than the premium you,____.. ._.. ._... _ the paid to us,you must pay us the balance.If it is less,we will refund the balance to you.The final premium will not be less than _- highest minimum premium for the classifications covered by this policy.If this policy is cancelled,.final premium will be determined in the following way unless our manuals provide otherwise: • • 1. If we cancel,final premium will be calculated pro rata based on the time-this policy was in force.Final premium will not be less than the pro rata share of the minimum premium. 2. If you cancel,final premium will be more than pro rata;it will be based on the time this policy was In force,and increased by.our:short-rate cancellation.table_and procedure.Final premiurn.will not be less than the minimum premium... ....... F. Records • You will k•eep records of information needed to compute premium.You will provide us with copies of those records when we . • ask for them. • • Audit . „•_ ,._ ,You will let us examine and audit all your records that relate to this policy.These records include ledgers,journals,registers, -•• •••••--- vouchers,contracts,tax reports,payroll and disbursement records,and programs for storing and retrieving data.We may conduct the audits during regular business hours during the policy period and within three years after the policy period ends. • information developed by audit will be used to determine final premium.Insurance rate service organizations have the same rights we have under this provision. • PART SIX-CONDITIONS A. Inspection We have the right,but are not obliged to inspect your workplaces at any time.Our inspections are not safety inspections.They relate only to the insurability of the workplaces and the premiums to be charged.We may give you reports on the conditions we find.We may also recommend changes.While they may help reduce losses,we do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public.We do not warrant that your workplaces are safe or healthful or that they comply with laws,regulations,codes or standards-Insurance rate service organizations have the same rights we have under this provision. B. Long Term Policy • j If the policy period is longer than one year and sixteen days,ail provisions of this policy will apply as though a new policy were issued on each annual anniversary that this policy is in force. • Includes copyright material of the National Council on Compensation Insurance,Inc.used with its permission. Copyright 2013 National Council on Compensation Insurance,Inc.All rights reserved. • SAIF Policy:464434 38 • Page 5 • 1 , C. Transfer of Your Rights and Duties Your rights or duties under this policy may not be transferred without our written consent.If you die and we receive notice within thirty days after your death,we will cover your legal representative as insured. l ' 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 or deliver to you not less than ten days advance written 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. . 3. The policy period wilt end on the day and hour stated in the cancellation notice. 4. Any of these provisions that conflicts with a law that controls the cancellation of the insurance in this policy is changed by • this statement to comply with the law. E. Sole Representative The insured first named in Item 1 of the Information Page will act on behalf of all insureds to change this policy,receive return premium,and give or receive notice of cancellation. F. Participation Provision . •The Insured shall be entitledto participate in the distribution of dividends to the extent and under the conditions prescribed by the Board of Directors of the company if the Board in its sole discretion declares a dividend in accordance with law after expiration of the policy period to which the dividend is applicable. To comply with the Oregon law regarding dividends,the following statement expresses the intent of the Oregon Insurance Code:it is unlawful in Oregon for an insurer to promise to pay po(icyholder'dividends for any unexpired portion of the policy term or to misrepresent the conditions for dividend payment.Dividends will be due and payable only for a policy period that has expired;and only if declared by and under conditions prescribed by the Board of Directors of the Insurer: • ' In witness whereof,SAIF Corporation has caused this policy to be signed by its President at Salem.Oregon,but this policy shall • not be binding unless completed by the attachment hereto of an Information Page. • • Chip Terhune President and Chief Executive Officer • • • • • • • • • •} • • • • • • • • • Includes copyright material of the National Council on Compensation Insurance,Inc.used with its permission. 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November 27, 2021 • ASHLAND CHAMBER OF COMMERCE • PO BOX 1360 • ASHLAND, OR 97520-004.6 Re: Nondisabling Claims Reimbursement program enrollment form SAIF policy: 464434 • • • You are eligible to enroll in an optional Nondisabling Claims Reimbursement program. If you choose to enroll you must complete this form and return it to SAIF,Corporation. • Under this program, you may reimburse SAIF for medical expenses on accepted nondisabling claims, up to the maximum reimbursement amount set annually by the Oregon Department of Consumer and Business Services. Reimbursement of claims is generally not recommended if your annual premium is less than $15,000, since the reimbursement claim costs may exceed any premium savings. For • additional details about this program go.to saif.com\ndr. This reimbursement election will remain in effect until SAIF receives your written request to end it or until your coverage is cancelled. • If you have any questions or need assistance, please contact your agent or SAIF. We elect to participate in.the Nondisabling Claims Reimbursement program effective _ and understand that reimbursement is optional under this program. The evaluation frequency for policies with a cash flow retrospective rating plan will be quarterly. Policies with a guaranteed cost or regular retrospective rating plan must select a reimbursement frequency. Evaluation frequency for guaranteed cost and regular retrospective rating plans: Annual ____ Quarterly • • Signature of authorized representative Date Printed name Phone Return form to: SAIF Corporation, 400 High Street SE, Salem, OR 97312 • • • • • • • • 400 High Street SE Salem,OR 97312 P:800.285.8525 Pol_PCt_CLMRM F:503.373.8020