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HomeMy WebLinkAbout2021-208 PO 20210283- Bugs Northwest Purchase Order MIS Fiscal Year 2021 Page: 1 of: 1 B City of Ashland , ,I ATTN:Accounts Payable Purchase 20 E. Main 202/ 0283 Ashland, OR 97520 Order# T Phone: 541/552-2010 O Email: payable@ashland.or.us . V H C/O Facilities Maintenance Div E BUGS NORTHWEST i 90 North Mountain Ave N 561 SW G STREET p Ashland, OR 97520 O GRANTS PASS, OR 97626 Phone: 541/488-5358 R O Fax: 541/552-2304 T�m David,Arnold ��J:(:?'3 G8:)::�2 •_5 it�E' �i{65�3�. 2�- u. _1=13 -15. =E- _ -�1-�` '��f�. y__ t __ 02/18/2021 1287 • FOB ASHLAND OR/NET30 City Accounts Pa able 1 . • FORM #3 " �( �� � CITY OF:;\ t'c�C�11S,tii;' r7i',t �rtlf't,i)i.ls,s' ll)'rl,?i' s ! LAND •• I''.EQ'.f RSHTf fir N Date of request: 2/11/21 • Required date for delivery: • Vendor Name Bugs Northwest Address,City,State,Zip 661 SW 0 Street,Grants Pass,OR 97626 • Contact Name&Telephone Number . Susan I<lekar 641.472.6003/bugsnorthwesl2013 ungmall.com Email address SOURCING METHOD • ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption; . ❑ invitation to Bid ❑ Form#13,Written findings and Authorization ❑ AMC 2,50 Dale approved by Council: ❑ Written quote or proposal attached ❑ Written quote or proposal attached (Attach copy of council communication) `(If council approval required,attach copy of CC) ® Small Procurement ❑ Retry est for Proposal Cooperative Procurement r Not exceeding$5,000 Date approved by Council: 0 Stale of Oregon ® Direct Award (Attach copy of council communicalion) Contract II • ❑ Verbal/Written quote(s)orpraposal(s) DI ,Request for Qualifications(Public Works) ❑ Stale of Washington •. Dale approved by Council: Contract!! (Attach copy of council communication) 0 Other government agency contract intermediate Procurement 0 Sole Source Agency GOODS&SERVICES 0 Applicable Form(115,6,7 or 0) Contract/1 Greater than$5,000 and less than$100,000 0 Written quote or proposal attached . , Intergovernmental Agreement O (3)Written quotes and sollcilalion attached' ❑.Form 114,Personal Services>$5I<&<$751< Agency PERSONAL SERVICES ❑ Special Procurement 0 Annual cost to City does not exceed$25,000, • Greater than$5,000 and less than$75,000 0 Form 119,Request for Approval Agreement approved by Legal and approved/signed by ❑ Direct appointment not to exceed$35,000 0 Written quote or proposal attached R,Administrator,AMC 2.50.070(4) ❑ (3)Written proposals/written solicitation Dale approved by Council: C) Annual cost to City exceeds$25,000,Council ❑ Form 114,Personal Services>$51<&<$75K Valid until: (Dale) approval required.(Attach copy of council communication) Description of SERVICES . Total Cost • Pigeon Control $4,370.00 • • Item# Quantity Unit Description of MATERIALS ' Unit Price Total Cost ' ❑ Per attached quote!proposal TOTAi,COST . Project Number. • _ Account Number 002400.602400 'Expenditure must be charged to the appropriate account numbers for the flnanclafs to accurately reflect the actual expenditures. IT Director In collaboration with department to'approve all hardware and software purchases: IT•Dlrector Date Support-Yes/No By signing this requisition form f certify that the City's pu to cant doling requirements have been satisfied�������� Employee: / ' —, Department Head: tti'Jr a• I t1ZH2-1 . (E, alto'r eater than 55,000) Department Manager/Supervisor: Cit di nistrato • �—� ,717/2;7-7or Oreator than$25,000) Funds appropriated for current fiscalysar.—'t't;S/NO ,/''�,epu y Finance Director-(Equal to orurair Date Comments: • Form 113-Requisition ' • GOODS&SERVICES AGREEMENT PROVIDER: Bugs Northwest CITY OF PROVIDER'S AS H LAN D CONTACT: Susan Klekar 20 East Main Street Ashland,Oregon 97520 ADDRESS: 551 SW G Street Telephone: 541/488-5587 Grants Pass, OR 97526 Fax: 541/488-6006 PHONE: 541-472-5003 This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and Bugs Northwest, a domestic business corporation("hereinafter"Provider"),for pigeon control. 1. PROVIDER'S OBLIGATIONS 1.1 Provide pigeon control as set forth in the"SUPPORTING DOCUMENTS" attached hereto and,by this reference, incorporated herein. Provider expressly acknowledges that time is of the essence of any completion date set forth in the SUPPORTING DOCUMENTS,and that no waiver or extension of such deadline may be authorized except in the same manner as herein provided for authority to exceed the maximum compensation. The goods and services defined and described in the "SUPPORTING DOCUMENTS"shall hereinafter be collectively referred to as"Work." 1.2 Provider shall obtain:and maintain during the term of this Agreement and until City's final acceptance of all Work received hereunder, a policy or policies of liability insurance including commercial general liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 (two million dollars)per occurrence for Bodily Injury and Property Damage. 1.2.1 The insurance required in this Article shall include the following coverages: • Comprehensive General or Commercial General Liability, including personal injury, contractual liability,and products/completed operations coverage; and • Automobile Liability. 1.2.2 Each policy of such insurance shall be on an"occurrence"and not a"claims made"form,and shall: • Name as additional insured "the City of Ashland, Oregon, its officers, agents and employees" with respect to claims arising out of the provision of Work under this Agreement; • Apply to each named and additional named insured as though a separate policy had been issued to each,provided that the policy limits shall not be increased thereby; • Apply as primary coverage for each additional named insured except to the extent that two or more such policies are intended to "layer" coverage and, taken together, they provide total coverage from the first dollar of liability; • Provider shall immediately notify the City of any change in insurance coverage • Provider shallsupply an endorsement naming the City, its officers, employees and agents as additional insureds by the Effective Date of this Agreement; and • Be evidenced by a certificate or certificates of such insurance approved by the City. Page I of 5: Agreement between the City of Ashland and Bugs Northwest 1.3 All subject employers working under this Agreement are either employers that will comply with ORS 656.017 or employers that are exempt under ORS 656.126. 1.4 Provider 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 this Agreement when employed by Provider. Provider agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. Further, Provider 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. 1.5 In all solicitations either by competitive bidding or negotiation made by Provider for work to be performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Providers of the Provider's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider for its Work at the hourly rates and charges as set forth in Exhibit"X",entitled "Estimate,"which is attached hereto and incorporated herein by this reference,as full compensation for Provider's performance of all Work under this Agreement. 2.2 In no event shall Provider's total of all compensation and reimbursement under this Agreement exceed the sum of$4,370.00 without express,written approval from the City official whose signature appears below,or such official's successor in office. Provider expressly acknowledges that no other person has authority to order or authorize additional Work which would cause this maximum sum to be exceeded and that any authorization from the responsible official must be in writing. Provider further acknowledges that any Work delivered or expenses incurred without authorization. 3. GENERAL PROVISIONS 3.1 This is a non-exclusive Agreement. City is not obligated to procure any specific amount of Work from Provider and is free to procure similar types of goods and services from other providers in its sole discretion. 3.2 Provider is an independent contractor and not an employee or agent of the City for any purpose. 3.3 Provider is not entitled to,and expressly waives all claims to City benefits such as health and disability insurance,paid leave, and retirement. 3.4 This Agreement embodies the full and complete understanding of the parties respecting the subject matter hereof. It supersedes all prior agreements,negotiations,and representations between the parties, whether written or oral. 3.5 This Agreement may be amended only by written instrument executed with the same formalities as this Agreement. 3.6 The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220, 279B.230 and 279B.235. Page 2 of 5: Agreement between the City of Ashland and Bugs Northwest 3.7 This Agreement shall be governed by the laws of the State of Oregon without regard to conflict of laws principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is in federal court, in which case exclusive venue shall be in the federal district court for the district of Oregon. Each party expressly waives any and all rights to maintain an action under this Agreement in any other venue, and expressly consents that, upon motion of the other party, any case may be dismissed or its venue transferred,as appropriate,so as to effectuate this choice of venue. 3.8 Provider shall defend,save,hold harmless and indemnify the City and its officers,employees and agents from and against any and all claims, suits, actions, losses, damages, liabilities, costs, and expenses of any nature resulting from, arising out of, or relating to the activities of Provider or its officers, employees, contractors,or agents under this Agreement. 3.9 Neither party to this Agreement shall hold the other responsible for damages or delay in performance caused by acts of God,strikes,lockouts, accidents,or other events beyond the control of the other or the other's officers,employees or agents. 3.10 If any provision of this Agreement is found by a court of competent jurisdiction to be unenforceable, such provision shall not affect the other provisions,but such unenforceable provision shall be deemed modified to the extent necessary to render it enforceable,preserving to the fullest extent permitted the intent of Provider and the City set forth in this Agreement. 4. SUPPORTING DOCUMENTS The following documents are,by this reference,expressly incorporated in this Agreement,and are collectively referred to in this Agreement as the"SUPPORTING DOCUMENTS:" • The Provider's complete written Estimate dated January 22,2021 5. REMEDIES 5.1 In the event Provider is in default of this Agreement, City may, at its option,pursue any or all of the remedies available to it under this Agreement and at law or in equity, including,but not limited to: 5.1.1 Termination of this Agreement; 5.1.2 Withholding all monies due for the Work that Provider has failed to deliver within any scheduled completion dates or any Work that have been delivered inadequately or defectively; 5.1.3 Initiation of an action or proceeding for damages, specific performance, or declaratory or injunctive relief; 5.1.4 These remedies are cumulative to the extent the remedies are not inconsistent,and City may pursue any remedy or remedies singly,collectively, successively or in any order whatsoever. 5.2 In no event shall City be liable to Provider for any expenses related to termination of this Agreement or for anticipated profits.If previous amounts paid to Provider exceed the amount due,Provider shall pay immediately any excess to City upon written demand provided. 6. TERM AND TERMINATION 6.1 Term This Agreement shall be effective from the date of execution on behalf of the City as set forth below II_ (the "Effective Date"), and shall continue in full force and effect until June 30, 2021, unless sooner terminated as provided in Subsection 6.2. Page 3 of 5: Agreement between the City of Ashland and Bugs Northwest • 6.2 Termination 6.2.1 The City and Provider may terminate this Agreement by mutual agreement at any time. 6.2.2 The City may,upon not less than thirty(30) days' prior written notice,terminate this Agreement for any reason deemed appropriate in its sole discretion. 6.2.3 Either party may terminate this Agreement, with cause, by not less than fourteen (14) days'prior written notice if the cause is not cured within that fourteen (14) day period after written notice. Such termination is in addition to and not in lieu of any other remedy at law or equity. 7. NOTICE Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery, by sending via a reputable commercial overnight courier, or by mailing using registered or certified United States mail, return receipt requested, postage prepaid, to the address set forth below: If to the City: City of Ashland—Facilities Maintenance Department Attn: David Arnold 90 North Mountain Avenue Ashland, Oregon 97520 Phone: (541) 552-2292 With a copy to: City of Ashland—Legal Department 20 E.Main Street Ashland, OR 97520 • Phone: (541)488-5350 If to Provider: Bugs Northwest Attn: Susan Klekar 551 SW G Street Grants Pass, OR 97526 541-472-5003 8. WAIVER OF BREACH One or more waivers or failures to object by either party to the other's breach of any provision,term,condition, or covenant contained in this Agreement shall not be construed as a waiver of any subsequent breach,whether or not of the same nature. 9. PROVIDER'S COMPLIANCE WITH TAX LAWS 9.1 Provider represents and warrants to the City that: 9.1.1 Provider shall,throughout the term of this Agreement, including any extensions hereof, comply with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317,and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider; and (iii) Any rules,regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. Page 4 of 5: Agreement between the City of Ashland and Bugs Northwest 9.1.2 Provider,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 Provider; and (iii) Any rules,regulations,charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.2 Provider's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Provider's warranty, as set forth in this Article 9, shall constitute a material breach of this Agreement. Any material breach of this Agreement shall entitle the City to terminate this Agreement and to seek damages and any other relief available under this Agreement,at law,or in equity. 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: Bugs No • ••est(PR 6 / ; By: �� : • �j0111.4401 Si. : r 5cerr ciSUCLy � 11 '- Printed Name - Print•d N. , Ot c..Ctst— tic P'2ucr let424,1 Title Title 2II1 , 76 2-f yo-Zo L/ Dae Date (W-9 is to be submitted with this signed Agreement) Purchase Order No. e Page 5 of 5: Agreement between the City of Ashland and Bugs Northwest . 46i iv Bugs Northwest Estimate DATE: January 22, 2021 Owner: City of Ashland Billing Address: 90 N Mountain, Ashland OR 97520 Phone: 541-552-2292 Email: david.arnold@ashland.or.us Gas Pump Structure: Seal off gap underneath fascia on (4)sides of(2)structures to prevent birds from making nest $1,495.00 Shop Provide and install bird repellent gel to (5) roof vents on top of shop. The gel cups shall be placed 8"apart for day roosting site. $1,400.00 Equipment Storage Provide and install shock track to (3)support straps and 1/20 foot Beam. The charger shall be mounted underneath roof covering. Note: The City shall have their own electrician to connect charger to power source $1,150.00 Police Station Provide and install bird repellent gel to a 6 ft beam underneath parking cover at police station $325.00 TOTAL: $4,370.00 www. bugsnw. com 541.472.5003. 541.770.2920 551 SW "G"Street• Grants Pass,OR 97526 r CCB#200990 E k Ae 9/10/2 ® CERTIFICATE OF LIABILITY INSURANCE DATDNYYY) 9/10/2020 • 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 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 LIPCA Inc. CONTACT LIPCA, Inc. PO Box 80663 PHONE Baton Rouge,LA 70898 (A/C.No.Extl: (225)927-3283E-MFAX o,No):(225)927-3295 ADDRESS:IL info@lipca.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Gemini Insurance Company 10833 INSURED Green Line Corporation INSURER B: Bugs Northwest 551 SW G St INSURER C: Grants Pass,OR 97526 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: 67337 REVISION NUMBER: 20200910 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED ✓ COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 100,000 1 ✓ LGL0000759 07 9/10/2020 9/10/2021 CLAIMS-MADE ✓ OCCUR MED EXP(Any one person) $ 5,000 . A ./ Deductible 1,000 PERSONAL&ADV INJURY $ 2,000,000 "Pollution Liability Included at policy limits GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000,000 POLICY Ti jE81, n LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS NON-OHIRED AUTOS _ AUTOS�ED (PerracEcidentDAMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION OTH- AND EMPLOYERS'LIABILITY Y/N PER STATUTE! ER ANY PROPRIETORIPARTNERIEXECUTIVEN/A E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Pest and Wildlife Services City of Ashland is included as an additional insured including waiver of subrogation on a primary&non-contributory basis with respect general liability per • endorsement CG 78 27 02 13 when required by written contract. CERTIFICATE HOLDER CANCELLATION City of Ashland 20 E.Main St SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I) Ashland,OR 97520 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE is 3 l ACORD 25(2014/01) ©1988-2014 ORD C RPOR ION.All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: LGL0000759 07 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (INCLUDING COMPLETED OPERATIONS) AUTOMATIC STATUS WHEN REQUIRED IN WRITTEN AGREEMENT WITH YOU The insurance provided by this endorsement shall not serve to increase our limits of insurance as described in SECTION III-LIMITS OF INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section Il — Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or written agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for: 1. "bodily injury","property damage"or"personal and advertising injury"caused,in whole or in part,by: a. Your acts or omissions;or b. The acts or omissions of those acting on your behalf in the performance of your ongoing operations and for that additional insured. 2. bodily injury" or "property damage" included in the "products-completed operations hazard" (completed operations) in respect of"your work"performed for that additional insured B. This insurance shall be considered primary if any other valid and collectible insurance is available to any person or organization included as an additional insured under this endorsement and such other insurance shall be excess of and will not contribute to the insurance afforded by this endorsement. C. We will waive any right of recovery we may have against any person or organization whom you have agreed to waive such right of recovery in a written contract or written agreement because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included within the "products-completed operations hazard." D. With respect to the insurance afforded to these additional insureds,the following additional exclusion applies: This insurance does not apply to"bodily injury","property damage"or"personal and advertising injury"arising out of the rendering of,or the failure to render,any professional architectural,engineering or surveying services,including: 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications;or 2. Supervisory,inspection,architectural or engineering activities. All other terms,conditions and exclusions under the policy are applicable to this Endorsement and remain unchanged. CG 78 27 0213 ©2013 Gemini Insurance Company(A Berkley Company) Page 1 of 1 • POLICY NUMBER: LGL0000759 07 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations City of Ashland 20 E. Main St Ashland, OR 97520 All Locations Per Written Contract • Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for"bodily injury", "property This insurance does nota I to "bodilyinjury" or damage" or "personal and advertising injury" apply caused, in whole or in part, by: "property damage"occurring after: 1. All work, including materials, parts or equipment 1. Your acts or omissions; or furnished in connection with such work, on the 2. The acts or omissions of those acting on your project (other than service, maintenance or behalf; repairs) to be performed by or on behalf of the in the performance of your ongoing operations for additional insured(s) at the location of the the additional insured(s) at the location(s) covered operations has been completed; or designated above. 2. That portion of "your work" out of which the However: injury or damage ariseshas been put to its intended use by any person or organization 1. The insurance afforded to such additional other than another contractor or subcontractor insured only applies to the extent permitted by engaged in performing operations for a principal law; and as a part of the same project. 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 0413 ©Insurance Services Office, Inc., 2012 Page 1 of 2 • C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the applicable required by a contract or agreement, the most we Limits of Insurance shown in the Declarations. will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Page 2 of 2 ©Insurance Services Office, Inc., 2012 CG 20 10 04 13 aaisalrance&Financial Services Debbie Derenski,Agent/Financial Representative 205 Northwest"B Street,Grants Pass,OR 97526 Phone(541)479-0362 Fax(541)479-5366—Email,cicbbie.derenskiiicoiintn•financiaLcom a � Agent: Debbie Derenski Current Date: 02/04/2021 Policy No: AA4937882 Status: ACTIVE Account No: 0009988086 Policy Term: SEMI-ANNUAL Policy Effective Date: 10/10/2020 Policy Renewal Date: 04/10/2021 • Vehicles Unit Year Make Model VIN 3 2018 NISSAN NV2500 1N6AF0KY7JN818896 Coverages Unit-3 LIMITS BODILY INJURY 250,000/500,000 PROPERTY DAMAGE 250,000 UNINSURED/UNDERINSURED 250,000/500,00 PERSONAL INJURY PROTECTION 100,000 Drivers First Name Initial Last Name DAVID A MAYS — i Certificate Holder Unit Name Street City •State Zip 3 CITY OF ASHLAND 20 E.MAIN ST ASHLAND OR 97520 V AR o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 02/05/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS•CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. • IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACTNAME: House Account Siskiyou Insurance Marketplace,Inc. M.No.Extl: (541)479-6672 FAX No): (541)474-6632 704 Sw 4th Street ADDARESS: INSURER(S)AFFORDING COVERAGE NAIC# Grants Pass OR 97526 INSURER : SAIF CORP INSURED INSURER B: Green Line Corporation INSURER C: 551 Sw G Street INSURER D: INSURER E: Grants Pass OR 97526 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ITR TYPE OF INSURANCE ANnn yin POLICY NUMBER (MMIDDnYYY1 (MM/DD�YYI LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY _ AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Peraccidenl) _ $ UMBRELLA LIAR _ OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ • $ WORKERS COMPENSATION A AND EMPLOYERS'LIABILITY PER ERH OFFICER/MEMBER EXCLUDEDECUTIVE Y l N N/A 747737 04/01/2020 04/01/2021 E.L EACH ACCIDENT $ 500,000 (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under • DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CIN OF ASHLAND ACCORDANCE WITH THE POLICY PROVISIONS. 20 E.MAIN ST. . AUTHORIZED REPRESENTATIVE• 1 :' . ..•t__ '-+')!\v-v �..1..--- _L. , I Ashland OR 97520 1 Fax: Email: ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD