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HomeMy WebLinkAbout2025-012 PO 20250298 and AGRMT - Fontana Roofing, IncB City of Ashland L ATTN: Accounts Payable L 20 E. Main Ashland, OR 97520 T Phone:541/552-2010 O Email: payable -_ashland.or.us V E FONTANA ROOFING, INC N 6465 CRATER LAKE HIGHWAY D CENTRAL POINT, OR 97502 O R 20250391 Purchase Order S C/O Nature Center North Mountain Park H 620 N Mountain Ave P Ashland, OR 97520 Email: wes.casalea-ashland.or.us T Phone: 541 /488-6606 O Fax: 541 /488-6607 02/13/2025 9122 06/30/2025 Roof Replacement - Nature Center 1 Labor/Material 1.0 EACH Project Account: E-000549-999 *************** GL SUMMARY *************** 128625 - 602220 $23,920.00 Parks Department $23,920.001 $23,920.00 By: Date: Authorized Signature $23,920.00 r �`SH LAND City Information City of Ashland Attn: Wes Casale 20 E. Main Street Ashland, Oregon 97520 Goods and Services Agreement Contractor Information Firm Name: Fontana Roofing Inc. Contact: Address: Phone: (541) 552-2294 Phone Email: wes.casale@ashland. or. US Email: Contract Summary Procurement Method: Intermediate Procurement Completion Date: 06/30/2025 Marco Fontana 6465 Crater Lake Highway Central Point, OR 97502 (541) 944-5386 fontanaroofing@msn.com Contract Amount: $ 23,920.00 Twenty -three -thousand -nine -hundred -and -twenty Description of services: Roof Replacement - Nature Center Supporting Documents: Job: Wes Casale Dated: 11/14/2024 Dated: Dated: Dated: This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and the Contractor listed under Contractor Information above, (hereinafter "Contractor"), for the services listed under Description of Services and the Supporting Documents as noted in the Contract Summary above. This Agreement and the Supporting Documents shall be construed to be mutually complimentary 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 Supporting Documents. In the event of conflict between provisions of the Supporting Documents, the Supporting Documents shall be given precedence in the order listed above. The Contractor's initials [,,,,,,,,'P4] herein signify acknowledgment and agreement to this provision, if applicable, or if not sign "N/A". The goods and services defined and described in the Supporting Documents shall hereinafter be collectively referred to as "Work." Page 1 of 8: Goods and Services Agreement between the City of Ashland and Fontana Roofing Inc. 1. Term and Termination 1.1. Term. This Agreement shall be effective from the date of execution on behalf of the City as set forth below (the "Effective Date") and shall continue in full force and effect until the Completion Date indicated in the Contract Summary on page one of this Agreement unless sooner terminated as provided in Subsection 1.2. 1.1. Time is of the essence. Time is of the essence for Contractor's performance of each and every obligation and duty under this Agreement. City, by written notice to Contractor of default or breach, may at any time terminate the whole or any part of this Agreement if Contractor fails to provide the Work called for by this Agreement within the time specified herein or within any extension thereof. 1.2. Termination 1.2.1. The City and Contractor may terminate this Agreement by mutual agreement at any time. 1.2.2. 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. 1.2.3. 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. 2. Compensation 2.1. City shall pay Contractor the sum listed as the "Contract Amount" in the Contract Summary on page one of this Agreement as provided herein as full compensation for the Work as specified in the supporting documents. 2.2. In no event shall Contractor's total of all compensation and reimbursement under this Agreement exceed the "Contract Amount" listed in the Contract Summary without express, written approval from the appropriate Department Head or City Manager. Contractor acknowledges that any work delivered, or expenses incurred without authorization as provided herein is done at Contractor's own risk and as a volunteer without expectation of compensation or reimbursement. 3. Contractor's Obligations 3.1. Performance. Provide the goods or services as set forth in the Supporting Documents attached hereto and, by this reference, incorporated herein. 3.2. Nondiscrimination. Contractor 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 Contractor. Contractor agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. Further, Contractor 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 Page 2 of 8: Goods and Services Agreement between the City of Ashland and Fontana Roofing Inc. business enterprise certified under ORS 200.055, in awarding subcontracts as required by ORS 279A.110. 3.3. Subcontractor Notification. In all solicitations either by competitive bidding or negotiation made by Contractor 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 Contractors of the Contractor's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 3.4. Living Wage Requirements. If the amount of this Agreement is $26,429.65 or more, Contractor 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. Contractor is also required to post the notice attached hereto as "Exhibit A" predominantly in areas where it will be seen by all employees. 4. Contractor's Compliance with Tax Laws 4.1. Contractor represents and warrants to the City that: 4.1.1. Contractor shall, throughout the term of this Agreement, including any extensions hereof, comply with: • All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317, and 318; • Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Contractor; and • Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 4.1.2. Contractor further certifies that contractor is not in violation of any Oregon tax laws referenced in ORS 305.380(4). 4.2. Tax Compliance Breach. Contractor'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 Contractor'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. 5. Insurance. Contractor 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 Each policy of such insurance shall be on an "occurrence" and not a "claims made" form, and shall include: 5.1. Commercial general liability -- with a combined single limit, or the equivalent, of not less than $1,000,000 (one million dollars) per occurrence and $2,000,000 (two million dollars) in the aggregate for Bodily Injury and Property Damage. Page 3 of 8: Goods and Services Agreement between the City of Ashland and Fontana Roofing Inc. 5.2. Commercial Automobile Liability -- 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 and non -owned vehicles. 5.3. Additional forms: (See Attached) 5.4. Worker's Compensation. Contractor shall, at its own expense, maintain Worker's Compensation Insurance in compliance with ORS 656.017, which requires subject employers to provide workers' compensation coverage for all of its subject workers. As evidence of the insurance required by this Agreement, the Contractor shall furnish an acceptable insurance certificate prior to commencing any Work with limits not less than $500,000. 5.4.1. Workers' Compensation Exemption: If applicable, Contractor affirms and certifies that it is exempt from providing Workers' Compensation per ORS 656.027. Exemption criteria: Contractor initials if exempt: Date: 6. Additional Insured/Certificates of Insurance. The Contractor shall name the City of Ashland, Oregon, along with its elected officials, officers, and employees, as Additional Insureds on all insurance policies (excluding Professional Liability and Workers' Compensation) necessary for this Agreement. This inclusion applies solely to the services provided by the Contractor under this Agreement. The Contractor's insurance must be primary and non-contributory. Before commencing work, the Contractor must provide acceptable insurance certificates as proof of the required coverage. These certificates must specify all parties included as additional Insureds, treating each named and additional named insured as if they were covered under separate policies, without increasing policy limits. Insuring companies or entities must be accepted by the City. Upon request, the Contractor must provide complete copies of insurance policies and trust agreements to the City. Additionally, the Contractor must provide an endorsement naming the City, its officers, employees, and agents as additional insureds by the Effective Date of this Agreement, accompanied by approved certificate(s) of insurance. 7. Indemnity. Contractor 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 Contractor or its officers, employees, contractors, or agents under this Agreement. 8. 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 addresses set forth above with a copy to: City of Ashland — Legal Department 20 E. Main Street Ashland, Oregon 97520 Phone: (541) 488-5350 Page 4 of 8: Goods and Services Agreement between the City of Ashland and Fontana Roofing Inc. 6. Remedies 6.1. In the event Contractor 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: 6.1.1. Termination of this Agreement. 6.1.2. Withholding all monies due for the Work that Contractor has failed to deliver within any scheduled completion dates or any Work that have been delivered inadequately or defectively. 6.1.3. Initiation of an action or proceeding for damages, specific performance, or declaratory or injunctive relief. 6.1.4. 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. 6.2. Default: The Contractor shall be in default of this Agreement if Contractor: 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, without written authorization by the City, attempts to assign rights in, or delegate duties under, this Agreement. 6.3. Liability Limitation. In no event shall City be liable to Contractor for any expenses related to termination of this Agreement or for anticipated profits. If previous amounts paid to Contractor exceed the amount due, Contractor shall pay immediately any excess to City upon written demand provided. 7. General Provisions 7.1. Non-exclusive Agreement. City is not obligated to procure any specific amount of Work from Contractor and is free to procure similar types of goods and services from other Contractors in its sole discretion. 7.2. Independent Contractor Status. Contractor is an independent contractor and not an employee or agent of the City for any purpose. 7.3. Statutory Requirements. The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220, 27913.230 and 27913.235 7.4. Assignment. Contractor shall not assign this Agreement or subcontract any portion of the Work to be provided hereunder without the prior written consent of the City. Any attempted assignment or subcontract without written consent of the City shall be void. Contractor shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all persons employed by them, and the approval by the City of any assignment or subcontract shall not create any contractual relation between the assignee or subcontractor and the City. Page 5 of 8: Goods and Services Agreement between the City of Ashland and Fontana Roofing Inc. 7.5. Force Majeure. 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. 7.6. Deliveries F.O.B destination. Contractor shall pay all transportation and handling charges for the Goods. Contractor is responsible and liable for loss or damage until final inspection and acceptance of the Goods by the City. Contractor remains liable for latent defects, fraud, and warranties. 7.7. Goods Rejection. The City may reject non -conforming Goods and require Contractor to correct them without charge or deliver them at a reduced price, as negotiated. If Contractor does not cure any defects within a reasonable time, the City may reject the Goods and cancel this Agreement in whole or in part. This paragraph does not affect or limit the City's rights, including its rights under the Uniform Commercial Code, ORS Chapter 72 (UCC). 7.8. Goods Warranty Representation. Contractor represents and warrants that the Goods are new, current, and fully warranted by the manufacturer. Delivered Goods will comply with Supporting Documents and be free from defects in labor, material and manufacture. Contractor shall transfer all warranties to the City. 7.9. 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. 7.10. Jurisdiction. 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. 7.11. Severance. 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 Contractor and the City set forth in this Agreement. 8. Merger. This agreement and the attached exhibits constitute the entire understanding and agreement between the parties. No waiver, consent, modification or change of terms of this agreement shall bind either party unless in writing and signed by both parties. Such waiver, consent, modification or change, if made, shall be effective only in the specific instance and for the specific purpose given. There are no understandings, agreements, or representations, oral or written, not specified herein regarding this agreement. Contractor, by signature of its authorized representative, hereby acknowledges that he/she has read this agreement, understands it, and agrees to be bound by its terms and conditions. Page 6 of 8: Goods and Services Agreement between the City of Ashland and Fontana Roofing Inc. WITNESS WHEREOF, the parties have executed this Agreement in their respective names by their duly authorized representatives as of the dates indicated below. This Agreement may be executed in two counterparts, each of which shall be deemed an original, with equal force and effect as if executed in a single document. CITY OF ASHLAND: By. hor„I7l lour on (ill"? § 707I1? 01, FIST) Signature Printed Name 01 /23/2025 Date Purchase Order No. APPROVED AS TO FORM: City Att0 y Carmel Zahran, 1.17.24 Fontana Roofing Inc. (CONTRACTOR): Signature Marco Fontana Printed Name Marco Fontana Title 01 /22/2025 Date is to be submitted with this signed Agreement) Page 7 of 8: Goods and Services Agreement between the City of Ashland and Fontana Roofing Inc. Y Fontana Roofing Inc. 6465 Crater Lake Highway Central Point, OR 97502 CCB#172675 Phone: (541) 826-5595 Wes Casale Ashland Parks & Recreation 620 North Mountain Avenue Ashland, OR 97520 (541) 324-9788 Composition Reroof Company Representative Marco Fontana Phone: (541) 944-5386 fontanaroofing@msn.com Job: Wes Casale Remove existing shingles down to deck. Re -nail any loose decking. Any damage to fascia, siding, or sheathing to be repaired at a rate of $105 per man hr. plus material costs. Install Malarkey synthetic roof underlayment. Install painted metal drip flashing on all eaves to properly flash gutters. Install starter shingles on eaves and gables. Install Malarkey Highlander Limited Lifetime Dimensional Shingles per high wind specifications using 1 114" roofing nails. Install Malarkey high profile 10" EZ ridge. Install pre -painted metal attic vents to ensure proper air flow. Install new painted metal flashing on all roof penetrations. Install 60 mil PVC membrane on low slope area. Clean up all job related debris. Clean and secure gutters and downspouts. Magnet sweep yard and driveway to ensure removal of any loose nails. Protect yard, decks, and landscaping throughout the job. Clean up job site daily. Leave property clean and undamaged. 20 YEAR WORKMANSHIP GUARANTEE ONCE WE START YOUR PROJECT WE DO NOT LEAVE UNTIL IT IS FINISHED. We are fully licensed, bonded, and insured. Crews will maintain proper safety requirements at all times during the construction process TOTAL 11 /14/2024 $23,920.00 All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to basic industry standards. Work crews will be compliant with OSHA safety requirements. We are fully bonded and insured as required by Oregon CCB. Acceptance of Proposal: I agree to the terms outlined and authorize Fontana Roofing Inc. to do this work. If you have questions or want to schedule the work please call the office at 541-826-5595. Company Authorized Signature Date Customer Signature Date Customer Signature Date City of Ashland LIVING ➢ For all hours worked under a service contract between their employer and the City of Ashland if the contract exceeds $26,429.65 or more. ➢ For all hours worked in a month, if the employee spends 50% or more of the employee's time in that month working on a projector WAGE per hour, effective June 30, 2024. The Living Wage is adjusted annually every June 30 by the Consumer Price Index. portion of the business of their employer, if the employer has ten or more employees, and has received financial assistance for the project or business from the City of Ashland over $26,429.65; ➢ If their employer is the City of Ashland, including the Parks and Recreation Department. ➢ In calculating the living wage, employers may add the value of health care, retirement, 401K, and IRS eligible cafeteria plans (including childcare) benefits to the employee's amount of wages. ➢ Note: For temporary and part-time employees, the Living Wage does not apply to the first 1040 hours worked in any calendar year. For more details, please see Ashland Municipal Code Section 3.12.020. Call the Ashland City Manager's office at 541-488-6002 or write to the City Manager, City Hall, 20 East Main Street, Ashland, OR 97520, or visit the City's website at www.ashland.or.us. Notice to Employers: This notice must be posted in areas where it can be seen by all employees. ,.CITY rr i� iir,,I , °°°111j a tau iiii ilium , iiii Final Audit Report Created: 2025-01-22 By: Brandon Terry (brandon.terry@ashland.or.us) Status: Signed Transaction ID: CBJCHBCAABAArNhQuhuKXfOT-Ms8bg95xPMHFJx7E0nf 2025-01-23 "Goods and Services Agreement Roof Replacement - Nature Ce nter" History "5 Document created by Brandon Terry (brandon.terry@ash land. or. us) 2025-01-22 - 7:39:16 PM GMT E Document emailed to mwilson.fontana@gmail.com for signature Email viewed by mwilson.fontana@gmail.com 2025-01-22 - 8:32:00 PM GMT Signer mwilson.fontana@gmail.com entered name at signing as Marco Fontana 2025-01-22 - 8:34:11 PM GMT 06, Document e-signed by Marco Fontana (mwilson.fontana@gmail.com) Signature Date: 2025-01-22 - 8:34:13 PM GMT - Time Source: server E Document emailed to Rocky Houston (rocky. housto n @ash land. or. us) for signature 2025-01-22 - 8:34:20 PM GMT Email viewed by Rocky Houston (rocky. houston @ash land. or. us) 2025-01-23 - 8:05:14 PM GMT 06, Document e-signed by Rocky Houston (rocky.houston@ashIand. or. us) Signature Date: 2025-01-23 - 8:05:35 PM GMT - Time Source: server Agreement completed. 2025-01-23 - 8:05:35 PM GMT 0� Adobe Acrobat Sign ACCORD® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1 /23/2025 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 HUB International Northwest, LLC P.O. Box 10167 OR 97440-2167 CONTACT NAME: Lynn Wray PHONE FAX A/C No Ext : 541-687-1117 A/C, No): 541-342-8280 E-MEugene ADDRESS: Lynn.Wray@HUBinternational.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Clear Blue Specialty Insurance Company 37745 INSURED FONTROO-02 INSURERB: ACUITY, A Mutual Insurance Company 14184 Fontana Roofing, Inc. 530 Bell Rd. wsuRERc: INSURERD: Talent OR 97540-9749 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 1051221754 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICYNUMBER POLICY EFF MM/DD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y AR01RS240226503 2/17/2024 2/17/2025 EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO - POLICY � ECT1:1 LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY Y Y ZU2711 2/17/2024 2/17/2025 COMBINED SINGLE LIMIT Ea accident $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Certificate Holder and all entities required by written contract are included as Additional Insured on a Primary and Noncontributory basis with Waiver of Subrogation with respects to the General Liability and Additional Insured with Waiver of Subrogation with respects to the Automobile Liability as required by written contract per attached endorsements. Subject to policy limits, terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 E. Main St. AUTHORIZED REPRESENTATIVE Ashland OR 97520-1814 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD www.saif.com Oregon Workers' Compensation Certificate of Insurance Certificate holder: CITY OF ASHLAND 20 E. MAIN STREET ASHLAND, OR 97520 ■ saifOregon. Work. Life. The policy of insurance listed below has been issued to the insured named below for the policy period indicated. The insurance afforded by this policy is subject to all the terms, exclusions and conditions of such policy; this policy is subject to change or cancellation at any time. Insured Producer/contact Fontana Roofing Inc Hart Insurance Agency 530 Bell Rd Tom Kaldunski Talent, Or 97540-9749 541.779.4232 tkaldunski@hartinsurance.com Issued 01/23/2025 Limits of liability Policy 781258 Bodily Injury by Accident $500,000 each accident Period 07/01/2024 to 07/01/2025 Bodily Injury by Disease $500,000 each employee Body Injury by Disease $500,000 policy limit Description of operations/locations/special items roofing work Important This certificate is issued as a matter of information only and confers no rights to the certificate holder. This certificate does not amend, extend or alter the coverage afforded by the policies above. This certificate does not constitute a contract between the issuing insurer, authorized representative or producer and the certificate holder. Authorized representative Chip Terhune President and CEO Policy_OLCA_CertificateOfl nsurance 400 High Street SE Salem, OR 97312 P: 800.285.8525 F:503.584.9812 Form ®9Request for Taxpayer Give Form to the ,D eartmen October of r Identification Number and Certification requester. Do not Department of the Treasury Internal Revenue Service ► Go to www.irs.9ov/FormW9 for instructions and the latest information, send to the IRS. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. Fontana Roofing, Inc. 6 o wriess nameiaisregarded entity name, if different from above m3 g Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes. 4 Exemptions (codes apply only to f2 certain entities, not individuals; see o Individual/sole proprietor or ❑ C Corporation 2 S Corporation ❑ Partnership ❑ Trust/estate instructions on page 3): C single -member LLC a o Z' ❑ Limited liability company. Enter the tax classification (C=C corporation, S=S Exempt payee code (if any) 0 i H corporation, P=Partnership) Do- Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check LLC if the Exemption from ): a = LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC Is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that FATCA reporting code (if any) is disregarded from the owner should check the appropriate box for the tax classification of its owner. Q ❑Other (see instructions) ► CL (Applies to accounts maintained outside the U.S.) 5 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional) rn 6465 Crater Lake Highway 5 City, state, and ZIP code Central Point, OR 97502 7 List account number(s) here (optional) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part 1, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter, number or © � Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2, 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. Sign Signature of Her® I U.S. person ► General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.Irs.gov1F6rmW9. Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following. • Form 1099-INT (interest earned or paid) Date ► 19 I;Z(/ • Form 1099-DIV (dividends, including those from stocks or mutual funds) • Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding, later. Cat. No. 10231 X Form W-9 (Rev. 10718)