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HomeMy WebLinkAbout2023-187 PO 20240179- Advanced Media Technologies P Purchase:Order. raAft CISH Fiscal Year 2024 Page:'1 of 1 • ' _ B City of Ashland I ATTN: Accounts Payable Purchase L 20 E. Main 20240.179 Ashland, OR 97520 . Order# T Phone: 541/552-2010 O Email: payable@ashland.or.us E • ADVANCED MEDIA TECHNOLOGIES H C/O Ashland Fiber Network N PO BOX 934327 I 90 North Mountain Ave , D ATLANTA, GA 31193=4327 P Ashland, OR 97520 • OR Email:ACCOUNTSRECEIVABLE@AMT.COM Phone: 541/552-2222 Fax: 541/552-2436 QI'�1--�12G14a _g! .-ar, .6,.a ea...-:_-ter=ia�j [ F13 gEis - '�'n 3"' �� r E1--1are- - - —_ (888)293-5856 0 Chad Sobotka (.= = = saltqliiill 10/26/2023 894 F FOB ASHLAND OR/NET30 City Accounts Payable Site Survey and Review 1 Professional service video application site survey and review 1.0 - $6,400.00 $6,400.00 Personal Services Agreement(Less than $35,000) Completion date:"11/30/2023 Project Account • *************** GL SUMMARY*************** 0 ' 024700-604100/ $6,40.0,00 V r v.-STP -i By: Dater Authorized Sign-6 6 400.00 FORM #3 C1.TY OF )l' it--'e---a---1"--'°- ii ' • ASHLAND A i'aguest fol. Et Purchase Order • • REQUISITION � q , ,- to ( date of request; Oct 3,2023 Required date for delivery: Nov 3,2023. e Vendor Name Advanced Media Technologies,INC. fir,- Q i Address,City,State,Zip 3150 SW 15th Street,Deerfield Beach,FL 33442 • 1, Contact Name&Telephone Number Torn Burns,954-427-5711 x252 9 g Email address tburns@amt.com L/- ti ev SOURCING METHOD :h • k...,e, t� L O Exempt from Competitive Bidding ❑ Emergency •• 0 Reason for exemption: 0 Invitation to Bid 0 Form#13,Written findings and Authorizatio ❑ AMC 2.50 Date approved by Council:_ CI Written quote or proposal attached El Written quote or proposal attached _(Attach copy of council communication) (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 Stale of Oregon ❑ Direct Award _(Attach copy of council communication) Contract# ' ' O VerbaWVritten bid(s)or proposal(s) 0 Request for Qualifications(Public Works) 0 State of Washington Date approved by Council: Contract# (Attach copy of council communication)' 0 Other government agency contract Intermediate Procurement ❑ Sole Source Agency . GOODS&SERVICES 0 Applicable Form(#5,6,7 or 8) Contract#_ Greater than$5,000 and less than$100,000 CIWritten quote or proposal attached ,Intergovernmental Agreement . ❑ (3)Written bids&solicitation attached 0 Form#4,Personal Services$5K to$75K Agency PERSONAL SERVICES Date approved by Council: • 0 Annual cost to City does not exceed•$25,000. Greater than$5,000 arid less than$75,000 Valid until:. (Date) Agreement approved by Legal and approved/signed by ® Less than$35,000,by direct appointment 0 Special Procurement ' City Administrator.AMC 2.50.070(4) ' • 0 (3)Written proposals&solicitation attached 0 Form#9,Request for Approval 0 Annual cost to City exceeds$25,000,Council ❑ Form#4,Personal Services$51(to$75K 0 Written quote or proposal.attached approval required.(Attach copy of council communication) Date approved by Council: Valid until: •(Date) •• Description of SERVICES . • ' TOTAL COST • Professional service video application site survey and review $640.0:00 • Item# Quantity Unit Description of MATERIALS Unit Price Total Cost • ® Per attached quote/proposal TOTAL COST . • $6400.110 Project Number • __ _ Account Number 024700.604100 • Account Number - Account Number - 'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: 'I/' IT 're Date • Support-Yes/No By signing this requisition form,I certify that the City's public contracting requirements have been satisfied. Employee: Department Head: J',�'�",v 1 air........., (Equal to dror greater than$5,000) - Department Manager/Supervisor: City Manager: . ' (Greaterthan$35, 0) Funds appropriated for current fiscal year: ®, 0 l to -, i Flt}•ance.iireptor(E11 .,rgreaterthan$5,000) t D e' ' Comments: Form#3-Requisition . t i PERSONAL SERVICES AGREEMENT (LESS THAN $35,000) CONSULTANT: Advanced Media Technologies • C z Y OF CONTACT: Tom Burns �1S H LAND ADDRESS: 3150 SW 15th St, Deerfield Beach, FL 33442 20 East Main Street Ashland,Oregon 97520 TELEPHONE: 954-427-5711 x252 Telephone: 541-552-2402 • EMAIL: tbums@amt.com • This Personal Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland;an Oregon municipal corporation (hereinafter "City") and Advanced Media Technolgies, Inc., a foreign profit corporation (hereinafter "Consultant"), for professional service video application site survey and review. 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 November 30, 2023 J 2. Scope of Work: Consultant will provide professional service video application site survey and review as more fully set forth in the Consultant's Proposal dated October 3, 2023,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 andworker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are so registered, licensed and bonded. 6. Compensation: City shall pay Consultant the fees as outlined in"Exhibit A"not to exceed the sum of six thousand four hundred dollars ($6,400) 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 six thousand four hundred dollars ($6,400)without the express,written approval from the City official whose signature appears below, or such official's successor in office.Payments shall be made within thirty (30)days of the date of receipt by the City of Consultant's invoice. Should this Agreement be terminated prior to completion of all Work,payments will be made for any phase of the Work completed and accepted as of the date of termination. 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 $25,335.05 or more, Consultant is required to comply with Chapter 3.12 of the Ashland Municipal Code by paying a living wage, as defined in that chapter,to all employees performing Work under this Agreement and to any Subcontractor who performs 50%or more of the Work under this Agreement. Consultant is also required to post the notice attached hereto as "Exhibit B"predominantly in areas where it will be seen by all employees. . 10. Indemnification: Consultant hereby agrees to defend, indemnify, save, and hold City, its officers, employees, and agents harmless from any and all losses, claims, actions, costs, expenses, judgments, or other damages resulting from injury to any person(including injury resulting in death), or damage (including loss or destruction)to property, of whatsoever nature arising out of or incident to the performance of this Agreement by Consultant(including but not limited to, Consultant's employees, agents, and others designated by Consultant to perform Work or services attendant to this.Agreement).However, Consultant shall not be held responsible for any losses, expenses, actions, costs, or other damages, caused solely by the gross negligence of City. 11. Termination: V 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 servicesare no longer allowable or appropriate for purchase under this Agreement or are no longer eligible for the funding proposed for payments authorized by this Agreement; or iii. If any license or certificate required by law or regulation to be held by Consultant to provide the services required by this Agreement is for any reasondenied, revoked, suspended, or not renewed. d. For Default or Breach. i. Either City or Consultant may terminate this Agreement in the event of a breach of the Agreement by the other.Prior to such termination the party seeking termination shall • give to the other party written notice of the breach and its intent to terminate. If the party committing the breach has not entirely cured the breach within fifteen(15) days of the date of the notice, or within such other period as the party giving the notice may authorize in writing,then the Agreement may be terminated at any time thereafter by a written notice of termination by the party giving notice. ii. Time is of the essence for Consultant's performance of each and every obligation and duty under this Agreement. City,by written notice to Consultant of default or breach, may at any time terminate the whole or any part of this Agreement if Consultant fails to provide the Work called for by this Agreement within the time specified herein or within any extension thereof. iii. The rights and remedies of City provided in this subsection(d)are not exclusive and are in addition to any other rights and remedies provided by law or under this Agreement. 12. Independent Contractor Status: Consultant is an independent contractor and not an employee of the City for any purpose. 13. Assignment: Consultant shall not assign this Agreement or subcontract any portion of the Work without the written consent of City.Any attempted assignment or subcontract without written consent of City shall be void. . 14. Default. The Consultant shall be in default of this Agreement if Consultant: commits any material breach or default of any covenant,warranty, certification, or obligation under the Agreement; institutes an action for relief in bankruptcy or has instituted against it an action-for insolvency; makes a general assignment for the benefit of creditors; or ceases doing business on a regular basis of the type identified in its obligations under the Agreement; or attempts to assign rights in, or delegate duties under,this Agreement. 15. Insurance. Consultant shall, at its own expense, maintain the following insurance: a. Workers' Compensation. Consultant shall obtain and maintain Workers' Compensation insurance in compliance with ORS 656.017,which requires subject employers to provide Oregon Workers' Compensation coverage for its subject workers, unless such employers are exempt under ORS 656.126. If exempt under ORS 656.126, Consultant shall certify such exemption to the City. • b. Professional Liability insurance with a combined single limit, or the equivalent, of not less than$1,000,000 (one million dollars)per occurrence. This is to cover any damages caused by error, omission or negligent acts related to the Work to be provided under this Agreement. c. General Liability insurance with a combined single limit, or the equivalent, of not less than $1,000,000 (one million dollars)per occurrence for Bodily Injury,Death, and Property Damage. d. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than $1,000,000 (one million dollars)for each accident for Bodily Injury and Property Damage, including coverage for owned,hired or non-owned vehicles, as applicable. e. Notice of cancellation or change. There shall be no cancellation, material change, reduction of limits or intent not to renew the insurance coverage(s)without thirty (30) days' prior written notice from the Consultant or its insurer(s)to the City. f. Additional Insured/Certificates of Insurance. Consultant shall name the City of Ashland, Oregon, and its elected officials, officers and employees as Additional Insureds on any insurance policies, excluding Professional Liability and Workers' Compensation,required herein,but only with respect to Consultant's services to be provided under this Agreement. The consultant's insurance is primary and non-contributory. As evidence of the insurance coverages required by this Agreement,the Consultant shall furnish acceptable insurance certificates and endorsements prior to commencing the Work under this Agreement. • 16. Nondiscrimination: Consultant agrees that no person shall, on the grounds of race, color,religion, creed, sex,marital status,familial status or domestic partnership,national origin, age,mental or . physical disability, sexual orientation, gender identity or source of income, suffer discrimination in the performance of any Work under this Agreement when employed by Consultant. Consultant agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes,rules and regulations.Further, Consultant agrees not to discriminate against a disadvantaged business enterprise, minority-owned business,woman-owned business, a business that a service-disabled veteran owns or an emerging small business enterprise certified under ORS 200.055, in awarding subcontracts as required by ORS 279A.110. 17. Consultant's Compliance With Tax Laws: 17.1 Consultant represents and warrants to the City that: • 17.1.1 Consultant shall,throughout the term of this Agreement, including any extensions hereof, comply with: (i)All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS Chapters 316, 317,and 318; • (ii) Any tax provisions imposed by a political subdivisionofthe State of Oregon applicable to Consultant; and (iii) Any rules,regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 17.1.2 Consultant, for a period of no fewer than six(6)calendar years preceding the Effective Date of this Agreement,has faithfully complied with: (i) All tax laws of the State of Oregon,including but not limited to ORS 305.620 and ORS Chapters 316, 317, and 318; - (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Consultant; and (iii) Any rules,regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 18. 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: IT Department Attn: Chad Sobotka • 90 N Mountain Ave Ashland, Oregon 97520 Telephone: 541-552-2402 - With a copy to: City of Ashland-Legal Department 20 East Main Street Ashland, Oregon 97520 Telephone:,541-488-5350 If to Consultant: • Advanced Media Technologies, Inc. 3150 SW 15th Street Deerfield Beach, FL 33442 Telephone: 954-427-5711 x252 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. 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: ADVANCED MEDIA TECHNOLOGIES: ` ,I By By:Jason W er(o tzf,2023 10:17 PDT) Signa re Signature Jason Wegner Tom McLaughlin g.. Printed Name Printed Name President & CEO Director of Innovation and Technology Title Title • 10/25/2023 Oct 27,,2023 Date Date (W-$is to be submitted with this signed Purchase Order No. Agreement) EXHIBIT B CITY OF ASHLAND, OREGON CityOfAshlañd LIVING ALL employers described WAGE below must comply with Gity of Ashland laws regulating • payment of a Living wage_ $1.8.12 per hour,effective June 30,2023. The Living Wage is adjusted annually every FAO June 30 by the Consumer Price Index. Employees must be paid a wain ofihehusking of of health care,rel6remer% living wages thea emplaeyer,if the 4101K,and IRS edigihle employer has tenor more cafeteria plans(including eanplayees,and has received ch dare)benefits tote > Fee a9 hours worked under a financial assistance for the employee's amount of wages. oled service contract btweenth ®ress from the e lmyer and the Cityof - ofl end over r Note_ For temporary and Ashland lithe w-nfeact $25,335.05; ,.rt-time em�J, ees,the exceeds$25,335.05 or more. Luing Wage does not agbly if their employer is the City of tothe trust 1a,r l hours worked i For..ds hams worked in a Ashland,inclucring the Parks in any calendar year. For month,if the employee orad Recreation Department. move Marls,please see spends aoor'more ofthe aamdhnicipalC.cride eoopl ids time inthat month Incalcu 1..41,4,, 4, wvege, Section 312.020. waking ors a proles or employers may add the valve For additional,information:: Call the.r ud City Managafs office at 541-48B-9002 or write to die City Manager, City Kg,20 East Main Sheet,Ashland,OR 97520,or visitthe City's website at wnlrw.ashland.or.us. . Notice to Employers: This notice must be posted in areas aaere it can be seen by all ernp1ay . CITY OF ASHLAND 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 df the business. (2) Commercial advertising or business cards or a trade association membership are purchased for the business. (3) Telephone listing is used for the business separate from the personal residence listing. 74701 (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 responsibility for defective workmanship or for service not provided as evidenced by the ownership of performance bonds, warranties, errors and omission (professional liability) insurance or liability insurance relating to the Work or services to be.provided. Consultant's signature 10/25/2023 Date • • EXHIBIT A C,rig; • advanced media technologies QUOTE Advanced Media Technologies,Inc. Page 1 of 2 3150 SW 15th Street Deerfield Beach,FL 33442 • QUOTE NUMBER: SQ0205196 USA DATE: October 3,2023 Phone: -954-427-5711 - SALES PERSON: Torn Burns Fax: 954-427-9688 Toll Free: 888-293-5856 CUSTOMER NO: CUST007216 REQUESTED BY: CITY OF ASHLAND Bill to: • Ship to: • City of Ashland .City of Ashland Accounts Payable 20 E Main Street 20 E Main Street Ashland,OR 97520 Ashland,OR 97520 _ • USA USA • CUSTOMER P.O. SHIP VIA SHIPMENT METHOD TERMS FOB-SP NET DUE 30 DAYS • QUANTITY ITEM NUMBER DESCRIPTION UNIT PRICE •AMOUNT • USD • 1 PSI VIDEO Professional Service Video Application' 6,400.00 6,400.00 AMT Deliverables: - , >SITE SURVEY-1 Resource,2 Days On-Site • *These steps will be required to determine what • • further steps are needed to make the system • function without the video carrier channel load >Review current-and projected downstream channel • plans • >Review current headend combiner design- *This may require a redesign to support any ' increase in RF level required for the optical transmitters. >Determine current optical transmitter config *This may require a change if needed >Review optical and RF design with customer, if available >Measure and record the RF levels at various • ( • points in the system, * Forward'RF Combiner *Optical Transmitter Input • *Node Optical Receiver • *Node Output ' • *Reverse Input • *Reverse Receiver Outputs ' • Total USD 6,400.00 • • AMT Standard Terms and Conditions of Sale apply to this quote and all purchase orders placed with AMT. Continued on next page Sales Tax,Use Tax,Tariffs and Other Duties May Apply Special Order Items are Non Returnable and Non-Cancellable • - All Shipments will be insured,unless otherwise specified by customer. Unless otherwise specified,the above quote does not include shipping charges,which will be the full responsibility of the customer. Prices quoted are firm for 30 days.Company reserves the right to correct any and all errors or omissions at any time. Company is not responsible for any errors or omissions herein or for any loss or damage resulting from reliance on them. Please Visit us at www.amt.com • • • r►c j • advanced media technologies QUOTE Advanced Media Technologies,Inc. Page 2 of 2 3150 SW 15th Street Deerfield Beach,FL 33442 QUOTE NUMBER: SQ0205196 USA DATE: October 3,2023 • Phone: 954-427-5711 SALES PERSON: Tom Burns • Fax: 954-427-9688 Toll Free: 888-293-5856 CUSTOMER NO: CUST007216 REQUESTED BY: CITY OF ASHLAND • Bill to: • Ship to: City of Ashland City of Ashland Accounts Payable 20 E Main Street 20 E Main Street Ashland,OR 97520 Ashland,OR 97520 USA USA • • • • • • • • • • AMT Standard Terms and Conditions of Sale apply to this quote and all purchase orders placed with AMT. • Sales Tax,Use Tax,Tariffs and Other Duties May Apply . Special Order Items are Non Returnable and'Non-Cancellable All Shipments will be insured,unless otherwise specified by customer. Unless otherwise specified,the above quote does not include shipping charges,which will be the full responsibility of the customer. Prices quoted are firm for 30 days.Company reserves the right to correct any and all errors or omissions at any time. Company is not responsible for any errors or omissions herein or for any loss or damage resulting from reliance on.them. • Please Visit us at www.amt.com ® A`� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)11/08/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED • REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must•have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). • PRODUCER • . . CONTACT • MARSH USA,LLC. • NAME: PHONE FAX 1166 Avenue of the Americas INC.No.Ext): (NC,No): New York,NY 10036 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# CN102238245-AMT-Prof-23-24 INSURER A:Tokio Marine America Insurance Company 10945 INSURED INSURER B:Mitsui Sumitomo Insurance Company Of America 20362 Advanced Media Technolgies 3150 SW 15th Street INSURER C N/A N/A Deerfield Beach,FL 33442 • INSURER D: • INSURER E: • INSURER F: COVERAGES CERTIFICATE NUMBER: NYC-011840573-02 REVISION NUMBER: 3 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 LIMITS . LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A, X COMMERCIAL GENERAL LIABILITY X CLL6403455-13 06/30/2023 06/30/2024 EACH OCCURRENCE $ 1,000,000 • DAMAGE RENTED CLAIMS-MADE X OCCUR PREM SESO(Ea occurrence) $ 1,000,000 MED EXP(Any one person) $ .5,000 . PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PROT LOC PRODUCTS-COMP/OP AGG $ 1,000,000 JEC OTHER: $ B AUTOMOBILE LIABILITY X BVR8302197 01/01/2023 01/01/2024 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS • X HIRED X NON-OWNED PROPERTY DAMAGE $" AUTOS ONLY AUTOS ONLY (Per accident) AX UMBRELLALIAB X OCCUR X CU6406757-10 06/30/2023 06/30/2024 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE • AGGREGATE $ 5,000,000 DED X RETENTION$10,000 $ • B WORKERS COMPENSATION WCP9108740 01/0112023 01/01/2024 x PER 0TH AND EMPLOYERS'LIABILITY • ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1'0001000 OFFICER/MEMBEREXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached if more space is required) City of Ashland,Oregon,and its elected officials,officers,and employees are included as additional insured where required by written contract with respect to General Liability and Auto Liability. • • • • CERTIFICATE HOLDER CANCELLATION • City of Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 East Main St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ashland,OR 97520 • ACCORDANCE WITH THE POLICY PROVISIONS. • AUTHORIZED REPRESENTATIVE ylgiieazcic ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD