Loading...
HomeMy WebLinkAbout2026-099 AGRMT Calle Guanajuato Restaurant Commercial Use Agreement - Greenleaf Calle Guanajuato Restaurant Commercial Use License Agreement This RESTAURANT COMMERCIAL USE..LICENSE (also referred to herein as"License") is made and entered into this_21_day of AVrl 1 2026, by and between the City of Ashland, a municipal corporation of the State of Oregon, by and through the Ashland Parks and Recreation Commission ("Parks"), (hereinafter collectively referred to as"City"), and �0 (hereinafter referred to as" Licensee"). 1. SCOPE OF LICENSE: Licensee is licensed to operate and maintain an outdoor dining site in the location depicted in Exhibit A(hereinafter"Site"). a. This License conveys no estate or interest in the Site, is revocable and not assignable. b. This License does not otherwise waive,modify or grant or affirm compliance with federal,state,or local laws applicable to Licensee or its business, c, Without unreasonably interfering with the license granted to Licensee,City retains all rights to use and maintain the Site for any of the purposes for which it holds the property licensed. 2. COMMENCEMENT: The term of this License shall commence upon approval and execution by both City and Licensee, unless terminated early as provided for herein. 3, DURATION INTERVAL OF USE: The duration and scope of this revocable License is for one season, beginning on the Commencement date and ending on,V)ef- (1 , 2026,and in accordance with the use limitations in Section 5. 4, PAYMENT OF LICENSE FEES: Licensee shall pay a license fee based upon the square footage of the Site. The square footage awarded shall be determined each year by written order of Parks and shall be set forth precisely in Exhibit A&B. a. For the seasonal period of to ,( I/&the fee shall be$ ., per square foot for 7 days a week and tA _per square foot for 5 days per week for 2026, b. Any payments for fees,taxes or assessments required or in arrears or disputed must be made by Licensee before it will be issued a new license. 5. USE OF PREMISES AND OPERATION LIMITS: a. Compliance with Law. Licensee must comply with all federal,state and local laws, rules, and regulations applicable to public health and safety and licensing related to food and food handling and doing business in the State and City of Ashland; b. Maintenance and Safety. Licensee must maintain all the grounds, improvements, facilities, assets equipment and fixtures contained within the Site in good repair and in safe, sanitary, clean, and attractive condition that is approved acceptable by the City, such approval not to be unreasonably withheld. c, Improvements and Placement of Restaurant Equipment. Unless otherwise set forth herein, Licensee may make physical Improvements or alterations to the site location or install structures or fixtures thereon only after express written authorization of the Parks and Recreation Director,such approval not to be unreasonably withheld. I. Licensee may place tables and chairs, serving tables or host podium stand or other(restaurant equipment) items reasonably related to outdoor dining in the Site, ii. Restaurant equipment must be of sturdy and durable construction, movable by one person, and shall be self-supporting,and at no time attached,tied or locked to trees,fire hydrants,poles,fences or other fixed features. III. Licensee must not allow its equipment or other materials or restaurant Calle Guanajuato Restaurant Outdoor Dining License f employees to block or in any way impede pedestrian access or fire and emergency vehicle access to the Calle Guanajuato. d. Licensee is permitted to prepare, operate,and shall terminate use of the Site for outdoor dining operation between the period beginning. , 2026 and ending_[ 3�_,20,!�q with the following hourly schedules as set forth below. e. No restaurant equipment,supplies or materials and no Licensee employees shall block, impede or in any way hamper vehicular traffic on Calle Guanajuato during the following hours except in compliance with a permit issued pursuant to Ashland Municipal Code 10.68A00 Monday through Friday Saturday and Sunday Prior to 11:30 a.m. Prior to 8:00 a.m. &after 10:00 p,m. &after 10:00 p.m. f. Licensee must promptly remove any offensive, hazardous or dangerous restaurant equipment,furniture,or solid waste within the Site. g. Pilot Project: For 2026,some restaurants will be allowed to expand per the boundary map(Exhibit E) 6. FIRE AND LIFE SAFETY. Licensee shall comply with any and all fire and life safety guidelines, recommendations and requirements issued by the City of Ashland Fire Marshal, including,but not limited to: a. Maintain all required fire and emergency access areas; b. Ensure that permitted restaurant equipment does not encroach upon or obstruct public walkways or open space areas while maintaining a clear eight (8) foot pathway for emergency vehicles as approved by the City of Ashland Fire Marshal; c. Maintain a clear, unobstructed space around any fire hydrant as required for fire safety; d. Have available and maintain such fire extinguishers as determined by the Fire Marshal; e. Patrons and restaurant staff must strictly abide by the Park prohibition on smoking, and Licensee must so advise its patrons and restaurant staff;and f. Unless otherwise explicitly granted by the City, Licensee shall not use any bottled gas, electrical devices,or hazardous materials or hazardous substances without prior approval by the Parks and Recreation Director. [For purposes of this License "Hazardous Substance"or"Hazardous Material' means any hazardous,toxic, infectious,or radioactive substance,waste,or material as defined or listed by any local,state or federal environmental law.j 7. VEHICULAR ACCESS. Unless otherwise provided herein, Licensee must strictly comply with limitations in AMC 10,68,400 on vehicular access to the Calle Guanajuato. a. Parks,at its sole discretion, may issue revocable access permits to Licensee for limited purposes and for limited times to facilitate set up,take down, and removal of restaurant equipment and other materials allowable under this License. b. Vehicles must exclusively ingress and egress from Winburn Way, and must not enter or exit from the plaza end of Calle Guanajuato c. At no time may the Licensee interfere with the eight(8)foot path required for emergency vehicles; d. The Licensee must ensure that appropriate pedestrian safety precautions are maintained while vehicles using the access permits are in the vicinity. e. Licensee must procure and maintain insurance in accordance with the requirements of Exhibit C in full force and effect throughout the term of this License. Calle Guanajuato Restaurant Outdoor Dining License 2 3. .SERVICE OF ALCOHOL, Notwithstanding AMC 10.40,030 prohibiting public consumption of alcoholic beverages,during the term of this License Restaurant is authorized serve alcoholic beverages on the Site under the following conditions: a, Maintain in force a comprehensive liability insurance policy including an endorsement for liquor liability at it's own expense and at all times during the duration of the License; ,42-(lnit al from Lkensee) b, Serve alcoholic beverages only in conjunction with prepared meals. 9. INSURANCE: Licensee shall,at its sole cost and obligation, procure and maintain insurance in accordance with the requirements of Exhibit C in full force and effect throughout the term of this License. Licensee shall provide the City with copies of said insurance certificates and shall name the City of Ashland as an additional insured, 10. INDEMNITY AND HOLD HARMLESS: Licensee will defend,indemnify and hold City and/or Ashland Parks and Recreation Commission,their officers,employees and agents harmless from any and all losses,claims, actions,costs,expenses,judgments,subrogations,or other damages resulting from injury to any person(including injury resulting in death,)or damage (including loss or destruction)to property,of whatsoever nature arising out of or incident to this License or the activities that take place on licensed property. Licensee waives the right of subrogation regarding the insurance policy as described in the Insurance Section in this License. Licensee will not be held responsible for damages caused by negligence of City. a. The obligation to indemnify is expressly understood to survive termination of this License for any reason,and includes reasonable attorneys'fees, including attorneys' fees on appeal,and investigation costs and all other reasonable costs,expenses and liabilities incurred by city or its attorney from the first notice that any claim or demand is to be made or may be made. 11. TERMINATION: Notwithstanding any other provision herein,the City may terminate this license, in whole or In part,at any time for any reason considered by the City,in the exercise of its sole discretion,to reasonably be in the public interest. The City will provide Licensee seven (7) days prior written notice of a termination for public convenience, a. Licensee's recourse to contest termination of the license by City is provided in AMC 2,30, Uniform Administrative Appeals Process. b, Notwithstanding any other provision herein,City may order vacation of the Site or immediately remove the Licensee or any other person who may be occupying the Site area with or without a Court Order sanctioning such action. c. Upon failure to vacate,City is expressly authorized to remove all Licensee's property from the Site at the Licensee's expense. i. City will reasonably safeguard and maintain the property of the Licensee for at least 30 days and shall leave it reasonably available for Licensee to take possession.City may dispose of any property that remains unclaimed after 30 days.City may use reasonable discretion to immediately dispose of non-durable or solid waste,including but not limited to food and other putrescible waste. 12. SURRENDER: Upon the expiration of the original term or terms,as extended by the parties, Licensee shall surrender to the City the Site in as good or better condition and order as it was originally received,except for reasonable and typical wear and tear. 13, DISPUTE RESOLUTION AND ATTORNEY FEES: The preferred method of resolving disputes between the parties under this License shall be first by mediation.Mediation shall be conducted by a mediator chosen by mutual agreement of the parties;if there is no agreement,the mediator shall be appointed by an elected Jackson County Municipal Court Judge or Judge pro tem. Calle Guanajuato Restaurant Outdoor Dining License 3 a. Except for costs associated with building a case,for attorneys'fees,and for expert witnesses,any mutually incurred cost of mediation services shall be shared equally between the two parties. b. In any administrative appeal or litigation between the parties arising out of this License, the prevailing party shall recover its reasonable attorneys'fees incurred at trial and upon appeal, "Attorneys'fees"shall include the reasonable value of the services of in- house counsel. 14. MISCELLANEOUS PROVISIONS. a. Notice.Any notice affecting the rights of the parties under this License shall be delivered in writing either in person or to the following parties by first class mail: City: Rachel Dials, Deputy Parks Director Ashland Parks and Recreation Commission 340 South Pioneer Street Ashland,Oregon 97520 (Telephone 541-488-5340;FAX:541-488-5314) Copy to: Sabrina Cotta,City Manager City of Ashland 20 East Main Street Ashland,Oregon 97520 (Telephone: 541-552-2100; Fax:541-488-5311) Licensee Business Name:' �7rc.c+.Iz*t VZc,i-.v --r Attn: qi ry /s.N.t0% 6"t' Address: 5"ht 47a --X Po,$ Phone Number: Calle Guanajuato Restaurant Outdoor Dining License 4 b. Governing Law. This License, and all matters relating to this License, shall be governed by the laws of the State of Oregon in force at the time any need for interpretation of this License or any decision or holding concerning this License arises. The parties to this License do not intend to confer on any third party any rights under this License. c, Severability. If any provision of this License is held by a court of competent jurisdiction to be either invalid,void,or unenforceable,the remaining provisions of this License shall remain in full force and effect, d. Merger. THIS LICENSE CONTAINS THE ENTIRE AGREEMENT BETWEEN THE PARTIES HERETO AND SUPERSEDES ANY AND ALL PRIOR EXPRESS AND/OR IMPLIED STATEMENTS, NEGOTIATIONS AND/OR AGREEMENTS BETWEEN THE PARTIES, EITHER ORAL OR WRITTEN,AND MAY NOT BE AMENDED,CHANGED OR MODIFIED IN ANY WAY, EXCEPT BY WRITTEN GREEMENT SIGNED BY ALL PARTIES HERETO. DATED this 11 day of l ,2026 Licensee, Licensor/City of Ashland,Oregon: Parl nd Rec a ian Licensee Name Rachel Dials; Deputy Parks Director Ashland Pa ks and Recreation Rate: 13- ^U Date: �/ Z4 Sabrina Cotta, City Manager Approved as to form: 3.3.26 Carmel ran,Assistant City Attorney Calle Guanajuato Restaurant Outdoor Dining License 5 Exhibit A-License Area A simple site plan must be submitted with the application. AFRD staff has received each of the requests and will attach to the final application) Calle Guanajuato Restaurant Outdoor Dining License 6 Exhibit B Proposal Documents Ashland Parks & Recreation Commission REQUEST FOR COMMERCIAL USE SPACE ON CALLE GUANAJUATO NAME OF APPLICANT,_ W K PHONE` J' MESSAGE PHONESO , I —L120 1• -EMAIL ADDRESS L NAME OF AUTHORIZED REPRESENTATIVE 13 cb,'LL WHAT IS THE BEST WAY TO CONTACT'YOU? *(Circle oil iPpliolle MAILING ADDRESS'+1 IV CITY STATE ZIP CODE: Follow these steps, 1. PLEASE ATTACH A SIMPLE SITE PLAN SHOWING HOW RESTAURANT EQUIPMENT AND/OR CONCESSION STANDS WILL BE LOCATED WITHIN THE BOUNDARY OF THE SITE LOCATION. 2. PLEASE CIRCLE ON BOUNDARY MAP WHICH AREA IS REQUESTED a. WILL ALCOHOLIC BEVERAGES BE SERVED';) (Circle One) ESQ N 0 b. IS THIS A SHARED SPACE APPLICATION'?(Circle One)YES NO IF YES,WITH WHOM? This section to be filled out by A11RC Staff Total Scloare Footage x S Date Paid 3 jqe 5) NMIA01 Ste',10) The follouing items twist be obtained before permit can be isstied. 12 Copy of OLCC License for outdoor seating TOW k) to o fwo * Copy of Insurance Certificate naming City of Ashland as additional insureds I I vbt V4 * Signed copy of the waiver(to be provided later) -PA wth-Ira, 7,fo Exhibit A-License Area A simple site piaEl be st��brnity.4 'rrr:� rha ;,-�G apt,on, .�f 71 S �tt i4 1 � E Pr e E � 4 7S C-► f �. n � E ' J E f 3 1 1 - r r i Exhibit B- Proposal Documents Ashland Parks &Recreation.Commission. REQUEST FOR COMMERCIAL USE SPACE ON CALLE GUANAJUATO NAME OF APPLICANT WK PHONE MESSAGE PHONE EMAIL ADDRES NAME OF AUTHORI D REPRESENTATIVE WHAT IS THE BEST WAY CONTACT YOU? `(Circle one) mail/phone MAILING ADDRESS C Y STATE IP CODE; PLEASE ATTACH A SIMPLE S E PLAN SHOWI HOW RESTAURANT EQUIPMENT AND/OR CONCESS N STANDS LL BE LOCATED WITHIN THE BOUNDARY OF THE SITE LOCATI N. ARE YOU REQUESTING A NEW SPA i T T IS NOT CURRENLY A SEATING AREA? (Circle One ES NO WILL ALCOHOLIC BEVERAGES BE SE D?(Circle One)YES NO IS THIS A SHARED SPACE APPLIC ION?( 'rele One)YES NO IF YES,WITH WHOM? T s section to be filled out by APRC, aff Total Square Footage x$ = Date Paid The following items must be o tained before pert-nit can beissued; • Copy of current Business License • Copy of OLCC License for outdoor seating • Copy of Insurance Certificate naming City of Ashland as an additional insured • Two copies of the signed Comtnercial Use Contract Calle Guanajuato Restaurant Outdoor Dining license 7 Exhibit C Insurance Requiremelits The Concessionaire,at its sole cost and expense,commencing on the effective date of this License,shall procure and maintain insurance acceptable to the City in full force and effect throughout the term of this License. It is agreed that any insurance inaintairted by City shall apply in excess of,and not contribute with,insurance provided by Concessionaire, Concessionaire's Insurance shall be primary and non-contributory and have a cross-liability clause. During the term of this contract,Licensee shall nrahntain in fill[force,all the insurance coverage noted below with the City named as additionally insured: 1. Comprehensive General Liability insurance,with a general aggregate limit of not less than$2,000,000 and $2,000,000 per occurrence. Each policy shall contain a blanket contractual liability endorsement to cover the Licensee's indemnification and other obligations under this License as well as owners'and contractors'protective insurance,products and completed operations coverage,fire damage,personal and advertising injury coverage. It shall also include,if appropriate for the contract,coverage for Licensee's Site operations,explosion and collapse hazard, underground hazard,products,completed operations,contractual insurance,arid independent contractors. 2. Comprehensive Automobile Liability insurance,with a general aggregate limit of not less than$2,000,000 and $2,000,000 per occurrence,including coverage for owned,hired or non-owned vehicles. 3 Notice of cancellation or change. There shall be no cancellation,material change,reduction of limits or intent not to renew the insurance coverage(s)without 30 days written notice from the Licensee or its insurer(s)to the City, 4. Certificates of insurance. As evidence of the insurance coverage's required by this contract,the Licensee shall furnish acceptable insurance certificates to City at the time Licensee returns signed contracts, For general liability insurance and automobile liability insurance the certificate will provide that the City,Parks Commission,its officers, employees and agents are Additional Insureds. The certificate will include the 30-day cancellation clause,and will include the deductible or retention level. Insuring companies or entities are subject to City acceptance. If requested, complete copies of insurance policies shalt be provided to the City. The Licensee shall be financially responsible for all pertinent deductibles,self-insured retention's,and/or self-insurance.Certificates of Insurance shall be forwarded to Ashland Parks&Recreation:The Grove,1195 E Main St.,Ashland OR 97520, S. Workers Compensation insurance in compliance with Oregon Statutes,[ORS 656,017]which requires subject employers to provide Oregon workers'compensation coverage for all their subject workers.(Required of Licensees with one or more employees,unless exempt under ORS 656.027).) Only if Licensee does not employ workers subject to ORS Chapter 656,Licensee shall sign tire following affidavit: EXEMPTION AFFIDAVIT Licensee declares,under penalty of perjury and false swearing,that Licensee does not currently employ,and will not employ tiny individuals for work under this contract during the term this License is in force. Date: Licensee Calle Guanajuato Restaurant Outdoor Dining License 8 r n • T� . m kD CZ X r 0 w k • M I.J i O 7v UO rn C C D 3 ® m m p E— LO rn y --i 3 rc �' 3 r c- D � z rn -i z rn � . w rn o � Z m o y y® °. � � z D -R � G� � ► v L rn O o G rn r=' z z3 pz V (' a • LO r • z rt -IUl X N D M o m 0 C rn C CD 3 1- N < N crnn L m D D D OREGON LIQUOR & CANNABIS COMMISSION BUSINESS INFORMATION Please Print or Type BFLM, Group Applicant Name: p LLC Phone:541-482-2808 Trade Name (dba):Greenleaf Restaurant Business Location Address:49 N Main ST City-Ashland ZIP Code:97520 GTTVWT in • 111111=6116108FM MO Business Hours: Outdoor Area Hours: The outdoor area is used fu' 9:0 am Sunday 9:00 am t0 9:00 pm Sunday to 9:00 p : 0 m R Food service Hours: 9:00am to 9:00 pm Monday 9:00 am to 2:30 pm Monday 9:o0 am to 2:30 pm O Alcohol service Hours: 9:00 am to 9:00 pm Tuesday 9:00 am to 9:00 pm Tuesday 9:0o am to ::00 pm 0 Enclosed, how Wednesday 9:o0 am to 9:00 pm Wednesday 9:o0 am to 9:00 pm Thursday 9:0o am to 9:00 pm Thursday 9:00-am to ::00 pm The exterior area is adequately viewed and/or Friday 9:oo am to 9:00 pm Friday 9:00 am to 9:00 pm supervised by Service Permittees. Saturday 9:00 pm to 9:00 pm Saturday 9:00 am to 9:00 pm (Investigator's Initials) Seasonal Variations: 8 Yes ❑ NO If yes, explain:in Winter outside area usually closes from Novenber to February OMNI Check ALL that apply: ❑ Live Music ❑Karacke Sunday to ❑ Recorded Music ❑Coin-operated Games Monday to ❑ DJ Music ❑Video Lottery Machines Tuesday to Wednesday to ® Dancing ❑Nude Dancing ❑Social Gaming Thursday to ❑ Friday to Live Entertainment ❑Pool Tables Saturday to ❑ Minor Entertainers ❑Other: *Minor Entertainers in an area prohibited to minors need prior approval from the OLCC �® OLCC USE ONLY Investigator Verified Seating:_(Y)_(N) Restaurant: 60 Outdoor: so Lounge: Investigator Initials: Banquet: Other(explain): Total Seating: 110 Date: rApplicant erstand if my answers are not true and complete, the OLCC may deny my license application. Signature: Date: ( — DLL _ wINMoregon.gov/olcc Rev: 2.1.23 AC R" CERTIFICATE OF LIABILITY INSURANCE [_7ATE(MMIDD/YYYY) 09/25/2025 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 CONTACT Hart Insurance Agency NAME: Julie A Maphet PO Box 1240 A/ONNo Ext) _(541) 479-5521 FAAX —18IN E-MAIL 90 Grants Pass OR 97528 ADDRESS: jmaphet@hartinsurance.com INSURER(S)AFFORDING COVERAGE _ NAIC# — __ INSURER A:Monterey Insurance Company 23590 INSURED BFLM Group, LLC INSURERB: 99 N Main Street INSURER C: ---- -- INSURER D: Ashland OR 97520 INSURERE: INSURER F: COVERAGES JM CERTIFICATE NUMBER:Cert ID 33195 (7) 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. IN SR ADDL SUBR LTR TYPE OF INSURANCE S POLICY NUMBER MMLDDYY MMLDPOLID/EYYY LIMITS EFF A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE [:�]OCCUR 27SOP3070027833 11/20/2025 11/20/2026 DAMAGE TO RENTED PREMISES Ea occurrence $ 150,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY E C LOC PRODUCTS-COMP/OP AGG S 1,000,000 OTHER: Liquor Liability $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO Ea accident BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident— $ $ A X UMBRELLA X OCCUR 27SUL3070023993 11/20/2025 11/20/2026 EACHOCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? ❑ N/A _ (Mandatory in NH)If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ $ $ DESCRIPTION OF OPERATIONS I LOCATIONS]VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) The City, Parks Commission, its officers, employees and agents are listed as additional insured per attached form BP 0402 04/00 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. 340 S Pioneer Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1