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HomeMy WebLinkAbout2025-050 AGRMT - J&A Concrete Construction LLC - Lithia Park Band Shell `C I T Y 0 F Goods and Services Agreement City Information Contractor Information City of Ashland Firm Name: J&A Concrete Construction LLC Attn: Wes Casale Contact: Abel Castaneda 20 E. Main St. Address: 7600 Truax Rd. Ashland, Oregon 97520 Central Point, OR 97502 Phone: 202-552-2294 Phone: 541-951-4009 Email: wes.casale@ashland.or.us Email: jna.cast2003@gmail.com Contract Summary Procurement Method: Small Procurement Completion Date: 6/30/2025 Contract Amount: $12,361.00 Twelve-thousand-three-hundred-sixty-one-dollars. Description of Services: Lithia Park Band Shell Concrete Project Supporting Documents: Estimate#403 Dated: 01/06/2025 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[AC 1 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 J&A Concrete Construction LLC 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 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 $2,000,000 (two million dollars) per occurrence and $3,000,000 (three 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 5.2. Commercial Automobile Liability -- with a combined single limit, or the equivalent of not less than $2,000,000 (two 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: Self employed Contractor initials if exempt: AC Date: 01/08/2025 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 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 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 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: (CONTRACTOR): � � By: By: r�c� II-�o�a���n�(.J;�in��,�ry��1.3(a�Ir���) 2 Signature Rocky Houston, Director Signature Abel Castaneda Printed Name 01/08/2025 Printed Name Date Owner Title 01/08/25 Date Purchase Order No. is to be submitted with this signed Agreement) APPROVED AS TO FORM: City Attorney Page 7 of 8: Goods and Services Agreement between the City of Ashland and CITY OF ASHLAND, OREGON City of Ashland LIVING 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 of health care, retirement, their employer, if the 401 K, and IRS eligible employer has ten or more cafeteria plans (including employees, and has received childcare) benefits to the y For all hours worked under a financial assistance for the employee's amount of wages. service contract between their project or business from the employer and the City of City of Ashland over y Note: For temporary and Ashland if the contract $26,429.65; part-time employees, the Living Wage does not apply exceeds $26,429.65 or more. If their employer is the City of to the first 1040 hours worked ➢ For all hours worked in a Ashland, including the Parks in any calendar year. For month, if the employee and Recreation Department. more details, please see spends 50% or more of the Ashland Municipal Code employee's time in that month In calculating the living wage, Section 3.12.020. working on a project or employers may add the value additionalFor 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. I I E Service Address Prepared For Lithia Park Wes Casale 340 S Pioneer St. Ashland, OR 97520 CONCRETE C ON STR U CTI 0 W (541) 324-9788 J&A Concrete Construction LLC. Estimate # 403 CCB#237481, 7600 Truax Rd. Date 01/06/2025 Central Point, OR 97502 Phone: (541) 951-4009 Email: jna.cast2003@gmaii.com Description Total Expenses and Labor $12,361.00 Sidewalk(Exposed)-30'x1 6', 17'x1 0'6" Curb and Gutter-47' Includes: -Prep work and Framing -Pour and Finish -Demo/Excavation -Concrete -Rebar -Rock(3/4-) Subtotal $12,361.00 Total $12,361.00 Notes: Any unforeseen items or obstacles will be charged extra. This price does not include traffic or pedestrian control. F:Iage 1 of 2 By signing this document, the customer agrees to the services and conditions outlined in this document. F:bage 2 of 2 ............ ........... Form W1111119 Request for Taxpayer Give Fom to the (Rev.Wober2018) Identification Number and Certification irequeolter.Do not =M,t-fr -Y send to 1 r the IRS. UM S= 10 Go to www 1m9ovFbmW fo kn&uodo ne on.and the latest Womad I Nam Qis shown on yaw Inoome tax retum).Name is; on We fine,do not isaveiiWilne'blank. 2 Business nameldlaregivdad entity name,N different from above J&A QoncreteQoOhVgfiw 3 Chock approprials box lor federal tax classification of the persm whose name is ardwed an line 1.Check ordy me of ihe 11 4 Exemptions(codes apply only to following amen box e& entities.not Individuals:am KX Instructions an page 3): 0 Individualisol,poi.1stor or 0 C COMM5011 0 S Corporation Partriehip 0 Trust/estaft single-member LLD ExerwPalf"FoOle(fany)- Umllad liability comperiy.Enter the tax Olessification(C-C corporation,"corporation,P-Partnersh1p)IO, Now.Check the appropriate box In the line above for the tax classification of the single-member owner- Do riot check ExempWn tom FATCA mporling LUD If the LUO,is clawffied as a sMgb-mwnber LLC that le disregarded from the owner unless the owner of the LLO i$ coo F any) another LLC that Is not disregarded from the owner for U.S.ftxWW tax purposes.Othiinvise,a sin me ULC fful is disregarded irom the owner should check the appropriate box for the tax d"Beation of Its owner. Other�m instniallons)10- Oppowinammmm amae 60 usl 5 Ad&m(humW straK and apt orsulte no.)See Instructions. RectuestWe nam and address{P-tfonao 600 Truax Rd 6 City:state,and ZIP code Central Point QMgM_!L7502 7 Ust amount number(s)here(OptlorwD Towaver Identlff--�-n Number MN) Enter your TIN in the appropriate box.The TIN provided must match the name given on fine I to avoid social seau"number backup withholding.For Individuals,this is generally your soda]security number(SSNp.However,for a resident alien,scile proprietor,or disregarded entity,see the Instructions for Part 1,later.For other entities,it Is your ernployer identification number(EIN).If you do not have a number,see How to get a HE -LiJ TIN,later. or Now.If the account is in more than one name,seethe Instructions for line I.Also see WhatAbrimand EmployarklinMeation num r Number To Give the Requesterfor guidelines on whose number to enter. CertMeMon Under penalties of peijury.I that., 1.The number shown on this form is my correct taxpayer Identification number(or I am walling for a number to be issued to me);and 2.1 am not subject to backup withholding becauw.(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service UPS)that I am subject to backup withholding as a result of a fallure to report all Interest or dividends,or(c)the IRS'has nortifted me that I am no tonger subject to backup withholding;and 3.1 am a U.S.Citizen or of U.S.person(defined below);and 4.The FATcA code(s)entered on Wis form(if any)Indicating that I am exempt torn FATCA reporting Is Correa Certification Instructions.You must cross out It 2 above I you have been notified by the IRS that you am currently subject to backup withholding because you have failed to report all Interest and dividends on your tax return.For real estate transactions,it 2 does not apply.For mortgage interest paid, acquisition or abandonment of red property,carwMation of debts contributions to an individual retirement arangement QRA4,and generally,payments other then interest and dividends,you am not required to sign the cerfification,but you Must provide your CorW'nN.See the inSUMMS for Pan:II.later. , n General Inst Section references are to the Internal Revenue Code unkm otherwise e Form 1099-MM(various- of income,prizes,awards,or gross noted. proceeds) Future developments.Fort latest Information about developments a Form 1 099-B(stock or mutual fund sales and certain other related to Form ®g and its instructions,such as legislation enacted transactions by brokem) after they were published,go to ww _ors gov1FonnW9. *Form 1 099-S(prooseds from real estate transactions) Purpose of Form &Form 1099-K(merchant card and third party network transactions) An Individual or entity(Form W-9 requests*who is required to No an *Form 1098(home mortgage Interest),1098-E(student loan interest), information return with the IRS must obtain your correct talcpayer 1098-T(tuition) Identification number MN)which may be your social security number *Form 1099-0(carmled debt) (SSN).Individual taxpayer identification number(17171N),adoption a Form 1099-A(acquisition or abandonment of secured property) taxpayer Identification number"".or employer Identification number (EIN),to report on an Information return the amount paid to you,or other Use Form W-9 only I you are a U.S.person(including a resident amount reportable on an Information naturn Examples of Information alien),to provide your correct TIN. returns Include,but are not limited to,the following. ffyou do not refurn Fbim W-9 to Me requester with a 77N,you might Form 1099-INT(1nterest earned or pakO be sublect to backup withholding.See What is backup withholding, later Cut.No.10231X Form W-9 Fay.10-2018) wwmu �ywu�u um um mu wm) ��� ,,,II ��������� and�� ��IIIIIw��� �������� �r IIIII '���� ��wm Ire ������� ern ��������II I��� , ��������������� ��................IIIII��� ���'� IIIII ����w ,. ' ����w ,.IId Canarle te ")j ER' t Final Audit Report 2025-01-08 Created: 2025-01-08 By: Brandon Terry(brandon.terry@ashland.or.us) Status: Signed Transaction ID: CBJCHBCAABAAb2XzWy6XUS8rVR_Ig6liEUkQvv_e9QgH "Goods and Services Agreement - Lithia Park Band Shell Concr ete Project" History Document created by Brandon Terry (brandon.terry@ash land.or.us) 2025-01-08-9:04:50 PM GMT Document emailed to Rocky Houston (rocky.houston@ashland.or.us) for signature 2025-01-08-9:04:59 PM GMT o Email viewed by Rocky Houston (rocky.houston@ashland.or.us) 2025-01-08-9:06:09 PM GMT Document e-signed by Rocky Houston (rocky.houston@ashland.or.us) Signature Date:2025-01-08-9:06:43 PM GMT-Time Source:server Agreement completed. 2025-01-08-9:06:43 PM GMT Adobe Acrobat Signs Client#: 189672 JACONC2 DATE(MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 1 8/27/2024 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jaime Hinkley Propel Insurance PHONE g00 499-0933 FAX 866 577-1326 1201 Pacific Avenue; Suite 1000 MA Lo,Ext: (A/c,No): ADDRESS: jaime.hinkley@propelinsurance.com COM Small Business INSURER(S)AFFORDING COVERAGE NAIC# Tacoma,WA 98402-4321 INSURER A:Western National Mutual Insurance Co. 15377 INSURED INSURER B: J &A Concrete Construction, LLC INSURER C 7600 Truax Road Central Point, OR 97502 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. ADDLSUBR LTR TYPE OF INSURANCE NSR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY CPP127018803 08/01/2024 08/01/2025 EACHOCCURRENCE $1,000,000 CLAIMS-MADE *OCCUR PREMI6ESOEa oNcurrDence $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 JECT LOC PRODUCTS-COMP/OPAGG $2,000,000 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 Per accident A X UMBRELLA LAB X OCCUR CPP127018803 08/01/2024 08/01/202 EACH OCCURRENCE $1 000000 EXCESS LAB CLAIMS-MADE AGGREGATE $1 OOO 000 DED X RETENTION$10000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION City f Ashland SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y o THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 East Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Ashland, OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S6850449/M6850448 JLH02 CERTIFICATE OF LIABILITY INSURANCE DADD/YYYY) 12/04/2/04/2024 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 NAME:Progressive Commercial Lines Customer and A ent Servicing World of Insurance LLC PHONE FAX 1091 MEDFORD CENTER,MEDFORD,OR 97504 A/C No Ext:1-800-444-4487 A/C No): E-MAIL ro ressivecommercial email. ro ressive.com ADDRESS:p 9 @ P 9 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Artisan and Truckers Casualty Company 10194 INSURED INSURER B: ABEL CASTANEDA DBA:J&A CONCRETE CONSTRUCTION LLC 7600 TRUAX RD INSURER C: CENTRAL POINT,OR 97502-0000 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 125161922390919542Dl2O424T234742 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE1-1 OCCUR PREMISES(ERENTED rrrence) $ MED EXP(Any one person) PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- PRODUCTS-COMP/OP AGG $ POLICY JECT LOC OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $2 000 000 ANY AUTO BODILY INJURY Perperson) $ A OWNED SCHEDULED AUTOS ONLY X AUTOS N N 03584112 11/02/2024 05/02/2025 BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION YIN H- AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ yes,describe under D E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below See ACORD 101 for additional coverage details. $ A N N 03584112 11/02/2024 05/02/2025 DESCRIPTION OF OPERATIONS/LOCATIONS/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 City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main St Ashland,OR 97520 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: A�EP ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED World of Insurance LLC ABEL CASTANEDA DBA:J&A CONCRETE CONSTRUCTION LLC POLICY NUMBER 7600 TRUAX RD CENTRAL POINT,OR 97502-0000 03584112 CARRIER NAIC CODE Artisan and Truckers Casualty Company 10194 EFFECTIVE DATE:11/02/2024 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Description of LocationNehicles/Special Items Scheduled autos only ............................................................................................................................................................................................................ 2021 CHEVROLET SILVERADO C2500 1GC4YPEY9MF102093 ............................................................................................................................................................................................................ 2003 GMC SIERRA 1 GTHC29113E140115 ............................................................................................................................................................................................................ 2022 RAM 3500 3C7WRTCL6NG357440 Liability coverage may not apply to all scheduled vehicles. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD