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Home My WebLink About1997-046 License - Ambulance Operators CITY OF ASHLAND APPLICATION FOR AMBULANCE OPERATOR LICENSE AMC Ch. 6.40 Applicant's Name: ASHLAND FIRE & RESCUE Trade Name, if any: Address: 455 SISKIYOU BLVD. ASHLAND, OREGON 97520 Telephone number: (541) 482-2770 Ambulance descriptions: Manufacturer VIN # License # 1. 1992 FORD LIFELINE LIFELINE 1 FDKE3 EXEM PT 2. 1996 FORD LIFELINE OM7PH A05945 3. 1992 WHEELED COACH LIFELINE 1 FDKE3 EXEMPT OF8THA 2. 1985 BRAUN 48282 WHEELED 1FDJS3 EXEM PT COACH 4M4NH A34394 BRAUN 1FDJE3 EXEMPT OL8FHA 49888 Addresses and descriptions of the premises at and from which it is proposed to maintain and operate such ambulances: 1. 455 SISKIYOU BLVD. ASHLAND, OREGON 97520 2. 1860 HIGHWAY 66 ASHLAND, OREGON 97520 ./~ Attach Information showing that every proposed dnver, attendant, and dnver- attendant is qualified as required in Ashland Municipal Code Chapter 6.40 and as required by the laws of the state of Oregon. o Enclose with the application, the initial license fee of $300 plus $100 per ambulance. PAGE 1-APPLlCA TION (pfirelambulanapp) 1 If corporation also give date and place of incorporation, address of its principal place of business and the names of its principal officers, together with their respective residence addresses; or if a partnership, association or unincorporated company, the names of the partners. or of the persons comprising such association or company, and the business and residence address of each partner or person Attach additional pages as necessary. Attach additional pages as necessary. Explain any box not checked. Submit your application and required enclosures to Barbara Christensen, City Recorder, City Hall, 20 East Main Street, Ashland, Oregon 97520. I certify that each ambulance listed above is adequate and safe for the purposes for which it is to be used and that it is equipped as required by Ashland Municipal Code Chapter 6.40 and the laws of the state of regon. x/ Print name: ~SUJf) f.J IY.. SHut.- T t:t6 Title: ~ U is ION LH i~F f:7UJ I ~~E fPJf-(l<Jt,(.J(" Date: L( -.:2 5,--- ~"7 k~~~ ~/9/ ~d~..k- ~ ~ '2. '5 '997 PAGE 2-APPLlCA TION (p firelambulan app) Ashland Fire & Rescue Application for Licensure PERSONNEL Ashland Fire & Rescue......... making a difference in our Community. ASHLAND FIRE & RESCUE EMERGENCY MEDICAL TECHNICIAN ROSTER EMT BASIC PARAMEDIC Anders, Walt L. #112485 Bums, Kelly W. #120248 Caswell, Tim #102447 Case, Greg I. #113788 Curtis, Danny O. #104195 Cockell, Robert C. #123943 Eaton, Wesley M. #100386 Formolo, Curt J. #118901 J ones, Gregory R. #110972 Freiheit, Matthew E. #121237 Robbins, Robb L. #118250 Frentress, Kenny M. #121159 ***Robinson, William N. #100384 Hanstein, David C. #111814 Saurman, Daniel R. #109202 Hollingsworth, Scott #113607 White, Daniel R. #116422 Rosenlund, Derek A. #121067 *** Currently on Inactive Status Sallee, Dana S. #116336 Shepard, David #123197 Paramedic/Management Shulters, Susan M. #115694 Stephens, Robert #123787 Stoy, John T. #118911 Ashland Fire & Rescue Application for Licensure Oregon State EMT Certificates Ashland Fire & Rescue......... making a difference in our Community. ---r--------.--------------------------------------------r------------------------------------------------- , I , , , , , I , , , , : ~ 'i : 8 :~ , 4 :~ STATE OF OREGON - DEPARTMENT OF HUMAN RESOURCES OREGON HEALTH DIVISION EMERGENCY MEDICAL TECHNIOAN : CERT. # 112485 BASIC EXPIRES 06130/1997 ANDERS. WALT L 23 Wilson Rd. Ashland. OR 97520 The IndMdual named above and desCfb)d on the reve= 01 this card haS rompIeled the reqJirements sel torth in ORS 623.010 e1 SJ:g and is certified as an Eme<gency Medical Technocian at the level ,ndicated ~ rt\oQl ~rno,..,o -'_ I~ /1;.t.~ I P_<;;b...L- Michael R. Skeels. Ph.D.. MP.H. Atir'ntnic::tr:.tnr (),.~ Ht'I~1fh nn,.;c:.inn STATE OF OREGON EMERGENCY MEDICAL TECHNICIAN IDENTIACATJON EMT-B CERT. # 112485 Walt Anders HT: 6' 2" WT: 198 HAIR: Blonde NO EYES: Hazel - ATTACH PHOTO HERE 10874 EXPIRES 06/30/1997 Th<s certlficale is the properly of the Oegon Hea/fh o.....s..oo and must be C:"rT~ hv "- ~t"V'1 rlr:o.r-n:wv1 STATE OF OREGON EMERGENCY MEDICAL TECHNICIAN , , , , I ~ :~ '0 ,~ '0 " '0 19 IDENTIACATJON EMT-P CERT. # 120248 Signature of Certifocale Holde< STATE OF OREGON. DEPARTMENT OF HUMAN RESOURCES OREGON HEALTH DIVISION , ----------------------------------------------r------------------------------------------------- EMERGENCY MEDICAL TECHNIOAN : CERT. # 120248 PARAMEDIC EXPIRES 06/30/1997 BURNS, KELLY W 443 Williamson Way Ashland, OR 97520 The 'nd,vdJal named above and desCribed on !he reve= 01 this card has completed the requ"ements setlQrth on ORS 823010 eJ ~ and IS cert,fied as an Emergency Medical Tecnn.c;an at the level U'')(jlca~ed /1;t.. I ,f?_sL. L- _._~------~---_._- M,chael R. Skeels. Ph.D. MPH AdtTlfOf5rr.r1k>t' Oreoon Health o.VI~n Kelly Burns HT: 6' 4" WT: 200 HAIR: Dark Brot.m EYES: Blue I \j .=. ATIACH PHOTO HERE 10656 EXPIRES 06/30/1997 r"" cerlrf.cate is the ~ 01 /he Oregon Heaffh o.v.sKXJ and must be SUfTendered bv me ho/dl>r on defT"li'lnd , , , , , , , , , , , , :~ 'i :~ :~ . ~ :~ STATE OF OREGON EMERGENCY MEDICAL TECHNICIAN IDENTIACATJON EMT-B CERT. # 104337 Martin Burns HT: 6' 04 HAIR: Dark B~ WT: 175 EYES: Brown I ~ .:. ~~S::a~ -- ._~- ---- STATE OF OREGON. DEPARTMENT OF HUMAN RESOURCES OREGON HEALTH DIVISION -,' -----------------------------------------------------r------------------------------------------------- , , , EMERGENCY MEDICAL TECHNIOAN : CERT. # 104337 BASIC EXPIRES 06130/1997 BURNS, MARTIN E 1286 Munson Drive Ashland, OR 97520 The individual named above and described on !he reverse of !his card haS ~ed!he requorements setlorth in ORS 823.010 !:I SJ:g and is oertijied as an Emergency Medical TechniCian at the level ondocaled. ~-~ _a< ~~.J<~ }(.t.~ I p~.L- Michael R. Skeels. Ph.D.. MPH. STATE OF OREGON - DEPARTMENT OF HUMAN RESOURCES OREGON HEALTH DIVISION EMERGENCY MEDICAL TECHNIOAN : CERT. # 113788 PARAMEDIC EXPIRES 06130/1997 CASE, GREG I 816 Voris Avenue Ashland, OR 97520 The ondovidual named above and descf1bed on !he reverse 01 thIS card has completed the requorements set lorth in OAS 823 010 eJ ~ and IS certrlied as an Emergency Me<j;cal Technioan at the level .ndocate<J ~t~ ~"~~ C~~fi~~' Jr. ~I ~n~~rn~ /1;.t../,2sL.L- Michael R. Skeels. Ph.D. MP H ^............;"';...I......''''~ n..................... I-In...l.h "..~~:...,~ :~ S.gnalure of Certificate Ho&der ATTACH PHOTO HERE 10591 EXPIRES 06/30/1997 Th<s ce<1i1.cate is the properly of /he Oregon Health Diviscn and fT>JSr be STATE OF OREGON EMERGENCY MEDICAL TECHNICIAN IDENTIACATJON EMT-P CERT. # 113788 Greg Case HT: 5' 9" WT: 180 HAIR: Dark B~YOl EYES: Green 1'1_ ------.--r-----------------------------------------------------r--------------------------------------------------- , , , , , , , I , , , , :~ :j '8 :~ '4 SognatUfe 01 Certil;cate Holder EXPIRES 06/30/1997 ATIACH PHOTO HERE ---- 107 1 L .r~~_-I~_........-J""" ........ ,._,,,,,_ ~_ ~____~ rlvS ret1rlic<Jre OS me property 01 me Oregon Heaffh o.visKx> and must be STATE OF OREGON - DEPA-~;~~~~ ~~ ~U- -M-A- - - - - - - - - - - - - - - - r - - - - - - - - - - - - - - - - - - - N RESOURCES ' - - - - -- -- - - - - - OREGON HEALTH DIVISION : STATE OF OREGON - - - - - - -- : EMERGENCY MEDICAL TECHNICIAN , , , , , , : ~ 'ji :5 :~ '. '" ,.Q , EMERGENCY MEDICAL TECHNIOAN : CERT. # 102447 BASIC EXPIRES 06130/1997 CASWELL. TlMOTHY 0 739 Pennsylvania Ave Ashland, OR 97520 The ,nd;V>dual named above and card has completed !he . descnbed on lhe reverse 01 Ih<s ~. and IS Ger1doed as :'::0.':::;"'5 setlor1h ,n ORS823.010 f1 level ;ndicated gency Medocal Technocian al the ~ !!::;':"~~" .. .. Administrator. Oregon Heallh ~ - - - =-r ~TATEOF OREGON - DEPARTMENTOF HUMA~I;::::;uUHvr:.;:) . I OREGON HEALTH DIVISION I EMERGENCY MEDICAL..T,ECHNICIAN I ,) ~ . . .', "<:"~', FERT. # 123943 PARAMEDIC,~xP~:06130/1997 I ..' "--~-~."--~". 'c-, : ~~~:;\~~d~~~T<C{'; The ind;v,dual named above and deSCfibed on the reverse of this I card has completed the requirements set forth in ORS 823.010 e.t I ~ ~1S"'"''' '" Em",.o~:~~ : ~;d .~ ~--~ Elinor Hal. MPH I Q)tef. Emergency Medical ServtCes Administra1or. Oregon Heatth Division STATE OF OREGON. DEPARTMENT OF HUMAN RESOURCES OREGON HEALTH DIVISION EMERGENCY MEDICAL TECHNIOAN CERT.1104195 BASIC EXPIRES 06130/1997 CURTIS. DANNY 0 455 Siskiyou Boulevard Ashland. OR 97520 The oncIMdual named above and deSCnt>ed on the reverse 01 Ih<s card has completed 'he requrrements sellor1h '" ORS 823.0tO 1:1 ~. and os cer1rloed as an Emer9<"'CY MedocaI Technician at !he level .ndocated /1.,;.t..I/?:h.L- ~~ How Ki<1<Wood. J< ChoeI Emerge I Serv>ees MochaeI R. Skeels. Ph.D.. M.P.H. AdmmOSlratOf. Oregon Health ()ivisioo STATE OF OREGON. DEPARTMENT OF HUMAN RESOURCES OREGON HEALTH DIVISION EMERGENCY MEDICAL TECHNIOAN CERT. # 100386 BASIC EXPIRES 0613011997 EATON. WESLEY M 1131 N Main Ashland, OR 97520 The ondMdual named above and descnbed on the reo<erse 0I1h<s card has completed the requrrements sellorth in ORS 823.010 1:1 ~ and " cert.1oed as an Emergency MedocaJ Technocian al the level U-Qc..ated ==:::, /{t..12~.L- M,Chael R Skeels. Ph.D. M P.H Adm.olstratOf. Oregon Hearth [kvts,.on , , , , , , , , , , , , , : i ,i , 8 :~ , . , I IDENTlRCATION EMT-B CERT. # 102447 Timothy Caswell HT: 5' 10" WT: 167 HAIR: Dark: B~ f.. -- EYES: Green I \j :: '\ -J~*<Z4~~ Y Sognatur <Ai !Gale Holder ATTACH PHOTO HERE 1 064 1 EXPIRES 06/30/1997 This certificate <S the property 01 the Oc SUrrendered by the holder on demand. egO<> Healrtl 0Ms.i0n and rT>.Jsl be - -~. - - I I I~ I~ I~ I~ I~ I I I I I I EMERGENCY MEDICAL TECHNICIAN ',~< ';'~~~" ~.::~;'''''~' '~-''''' RobertC.@~1 II.J~r.~.., .:i~,:_~\~~.> HT: 5', 10"fHAIR~iBlonde WT: 175E~_;'~'lue ATTACH PHOTO HERE ~---~--- Signature of CertjflCate Holder ~~~~<S ~t.~!J227 Oregon Hea~ ~ aoo~~ 306 surrendered by the holder on demand. STATE OF OREG9N EMERGENCY MEDICAL TECHNICIAN IDENTlFICA nON EMT-B CERT. # 104195 Danny Curtis HT: 5' 9" WT: 180 HAIR: Gray No EYES: Blue -----~~ Sognalure 01 Cer1,frcate Holder ATTACH PHOTO HERE 10645 EXPIRES 06/30/1997 This cer1iIicale <S the property 01 the Oregon Healrtl [)ivis,on and must be surrendered by the _ on demand STATE OF OREGON EMERGENCY MEDICAL TECHNICIAN IDENllRCATION EMT-B CERT. # 100386 ~ ,i '& :~ , . :~ , Wesley Eaton HT: 5' 6" HAIR: White NO WT: 200 ~I- ~ ~--- Sognalure 01 CeMocate Holder ATTACH PHOTO HERE 10516 EXPIRES 06/30/1997 This cerrd<eate " me fJ'UPC'1Y 01 rt>e On'gO" flea"" O""SXJf' and must t>e surrendered by II>c I>oIde< ()fl demand STATE OF OREGON - DEPARTMENT OF HUMAN RESOURCES OREGON HEAlTH DIVISION EMERGENCY MEDICAL TECHNIOAN ..:ERT. I ll8901 PARAMEDIC EXPIRES 06130/1997 FORMOLO, CURT J 5\ Mallard Lane Ashland, OR 97520 The in:ividuaI named above and descroed on the reve<se c:/. ttvs can:! has ~!he requirements set Iortt1 in ORS 823010 d seg. W is oe<1ified as an Emeroeocy t.Aedic.aI Technician at the level ir"6ated. /{.c../ i?~.'-- ~~ (;h;eI. E Kioi<Wood. Jr. SeMces Michael R SI<eets. Ph.D.. M.P H ~ato<. 0<"90" HealU> Di""""" , . , , , , :~ :) :i :1 STATE OF OREGON EMERGENCY MEDICAL TECHNICIAN IDENTlACATlON EMT-P CERT. 1118901 AITACH PHOTO HERE Curt Formolo HT: 6' I" HAIR.: Dark: BI'OfoU1. WTo '" :;;;;::'YES;!"'" IL ~~~ 10917 EXPIRES 06/30/1997 This OOf1ifica/e is /he pmpetTy 01.... 0-"9"" HeaJtf1 0Vis.00 ard musl be sumJnCJerod by /he holder on demand. STATE OF OREGON. DEPARTMENT OF HUMAN RESOURCES OREGON HEALTH DIVISION - -- ---------------------------- --- -- - -- -- -----------r--------...-- --------------- - -- - - - --- , STATE OF OREGON EMERGENCY MEDICAL TECHNICIAN EMERGENCY MEDICAL TECHNIOAN : CERT. I 121231 PARAMEDIC EXP[RES 06/30/1997 FRElliEIT. MAlTHEW E PO Box 535 Ashland. OR 97520 The fl""ldMcJual named above and described on the re....erse oC this card has rompIeIed the reQu<remen" sel tonn on ORS 82) 010 eI ~ and IS certdoed as an Emergency Medoea. recnn.oan at lhe level ondocaled ~-~ _ u. _ __ Howar KOf1o.WOOO. Jr . .. Cn.et En_ t Se<VoQ,s /iJ / /:}<<L- M.chacl R S....C'1...I~ Ph 0 M PH A(1m.r'\1S1t ,U()4' OU"OOf' H~!,l'1h o.Vt5tQn STATE OF OREGON - DEPARTMENT OF HUMAN RESOURCES OREGON HEALTH DIVISION EMERGENCY MEDICAL TECHNIOAN CERT. # 121159 PARAMEDIC EXPIRES 06130/1997 FRENTRESS. KENNY M 15139 S. Leland Rd. Beavercrcek, OR 91004 The indivOJaI named above and descri>ed on the reverse ot IhoS card has ~ the requitemenIs set Ior1h in ORS 823010 d zg. and is oeI1ifoed as an Emeroeocy Medical Te<:tndan at the IewI incicated. /{L / i?~.L- ~-~ . Jr: Qo;eI. . .. SeMces . -v . ..'~ Michael R SI<eeIs. PhD. M.P.H. hlnVnistrator. 0<"90" Health DMsion IOENllRCATlON EMT-P CERT. # 121237 A IT ACH PHOTO HERE Matthew Freiheit HT: 6' 0" WT: 180 HAm: Blonde N C EYES: Blue - 10467 '.-- $.gnalore 01 Ce<tdocate HoIOcr EXPIRES 06/30/1997 rhrs ceq,fGifle IS the propetty oI1t1(" Ote<.JDO ~'cltt' ().'''''VIf ,Itl(j r''t"r (,I(' ..:;,,,rrendelcd by rllC hoIf:Jc.t.on ~m..1f1Cf . - .--. --,-. - . - .- - - - - . - - - - - - - - - . - - - - - - - - - - - , , I , , , . . , , , , . : ~ : I . : i : ~ I . , . . , , , , . , . , STATE OF OREGON EMERGENCY MEDiCAl TECHNICIAN AITACH PHOTO HERE IDENT1ACA1lON . . EMT-~:b~T.11.11~S9' . '~;.".:i(.'.. ;;:;D:~ 12164 EXPIRES 06130/1997 This e>srfIT.caes is ~ property 01 t>e Q-egon HeaJrh 0Vis.00 ard rrvsr be surrendsred by ~ hok19r on ds1nari bj __ \.. U~ d f.;dJ. d.l I J 1 --tV 1 1 ~ sskkltcr.osnll95 ______________________________________________________----r---------------------------------------- - . : STATE OF OREGON - DEPARTMENT OF HUMAN RESOURCES STATE OF OREGON : OREGON HEALTH DIVISION EMERGENCY MEDICAL TECHNICIAN EMERGENCY MEDICAL TECHNIOAN :CERT. # 111814 PARAMEDIC EXPIRES 06/30/1997 HANSTEIN, DAVID C 1516 Larkspur Medford. OR 97501 The individual named above and (lescrobed on the 'eve,se at thoS card has completed !he requirements sel lor1n ,n ORS 823 0 1 0 e1 ~. and is certdied as an Emergency Medo<;al Tecnn,oan al the ",,,,,I ondicated. ~i~~~ ~ }[{,.12-c;L,.~ __~ Michael R Skeels Ph D . M P H IDENTIACATlON EMT-P CERT. # 111814 , , ~ 'i :8 :~ , . ,,. ," , David Hanstein HT: 6' 2" HAIR: Dark Br<:<<11 WT: 245 EYES: Hazel I'll:'" ATTACH PHOTO HERE 1 3 1 9 0 ~gJ;m ~6~q2~ Oregon Hea~h Oovosoon dnd must be STATE OF OREGON EMERGENCY MEDICAL TECHNICIAN IDENTIACATlON EMT-P CERT. # 113607 Scott Hollingsworth HT: 6' 2" HAIR: Black No WT: 195 EYES: Brown - Signature 01 Certifica1e Holder STATE OF OREGON - DEPARTMENT OF HUMAN RESOURCES OREGON HEALTH DIVISION ----------------------------------------------------r--------------------------------------------.~----~ EMERGENCY MEDICAL TECHNIOAN : CERT. # 113607 PARAMEDIC EXPIRES 06130/1997 , HOLLINGSWORTH. SCOTT M 455 Siskiyou Blvd. Ashland, OR 97520 The indivdJal named above and described on the reverse 01 In,S card has completed !he requirements set forth on ORS 823 01 0 eI ~. and is certified as an Emergency Medical Tec1"V\,aan al lhe Ievej indicated. ~-~ ~ar Kirl<Wood' Jr~ . /{,t. / ~:c;L,L- Michaet R Skeels, PhO MPH STATE OF OREGON - DEPARTMENT OF HUMAN RESOURCES OREGON HEALTH DIVISION EMERGENCY MEDICAL TECHNIOAN :CERT. # 110972 BASIC EXPIRES 06130/1997 JONES, GREGORY R 455 Siskiyou Boulevard Ashland. OR 97520 The individual named aboYe and described 00 the reverse 01 thos card has completed !he requirements set for1h in ORS 823010 eI ~. and is certdied as an Emergency Medical Technician at the level ondicated. /L.t', / i?5Z... L- Michaet R Skeels. Ph D.. MPH Administrator. Oregon Hea"n DiVlSoOn ~-~ Howa A KJ , Ch",1 E MOO. I Services , . , , , . , :r 'i :8 :r " :~ Signalure 01 Certificale Holder ATTACH PHOTO HERE ~-,-- 10620 EXPIRES 06/30/1997 This certificate is the property 01 the Oregon Health D<v.s.<X1 and must be STATE OF OREGON EMERGENCY MEDICAL TECHNICIAN IOENTlACATION EMT-B CERT. # 110972 Gregory Jones HT: 6' O' WT: 180 HAIR: Dark Btom! EYES: Hazel 1'1':'" Signarure 01 Certificate Holder ATIACH PHOTO HERE 13043 ~~ P.e6f)J)jJ2CJ1 Oregon Heal/h IJMsion and must be surrendered by the holder on demand OREGON HEAlTH DIVISION EMERGENCY MEDICAL TECHNlaAN : CERT. # 117802 BASIC EXPIRES 0613011997 PAUL. DON 455 Siskiyou Blvd. Ashland. OR 97520 The individual named above and descri>ed on 1he reverse 01 !his caro has ~ed 1he requirements set kx1h in ORS 823.010 eI Sf!j. and is certified as an Emergency Medical Technician at 1he Ieve1 indicaled. ~ =::> ChOo,I E . Kic1<Wood. Jr. I SeMces /1.;.C.1 ~.L- Michael R Skeels, Ph.D., M.P.H. Administrator. Oreoon HP.~~h ~ , , , , I . , , . : t '~ :~ :r . 4 '~ EMERGENCY MEDICAL TECHNICIAN IDENTIACATlON EMT -B CERT. # 117802 ATIACH PHOTO HERE Don Paul HT: 6' 2" WT: 210 HAIR: Dark Bru.m EYES: Blue I .. .:. 10922 Signature of Cer1iIicate Holder EXPIRES 06/30/1997 This cet1ificale is /he propelty of /he Qegon HeaIlh DMsion arrJ rrost be surrendered bv the hoJder on demand OREGON HEALTH OIVISION IS~EOFOREGON~E~RTMENTOFHUMANRESOURCESI----S~EOFOREGON---- EMERGENCY MEDICAL TECHNICIAN ----- I I I I CERT. # 118250 I I I I I I I I I ~ I~ I! ROBBINS, ROBS L I~ PO Box 3315 Ashland. OR 97520 I~ The individual named above and described on the reverse of this I card has completed Ihe requirements set forth in ORS 623.010!tl ~ and's cert,hed as an Emergency Medical Technician at the I ~ fZ~ ~n__: EMERGE~CY MEDICAL,~CHNICIAN BASIC' EXPIREs 0613011997 STATE OF OREGON. DEPARTMENT OF HUMAN RESOURCES OREGON HEALTH DIVISION EMERGENCY MEDICAL TECHNlaAN CERT. # 100384 BASIC EXPIRES 0613011997 ROBINSON. WILLIAM N 33 l Bridge Slreet Ashland, OR 97520 The ondMdual n<lmed abow and described on !he rl!Yl:!rSe 01 !his card has completed !he requi<ements set Io<1h in ORS 823.010 eI S!:!I and os certdied as an Emergency Medical Technician at 1he level "'<kaled ~~ How KitIoNood. .1<. Chief. E . I SeMc:es /1.;.(,~ I j?~.L- Michael R. Skeels. Ph.D.. M.P.H. Administrator. Oregon Health 0Msi0n STATE OF OREGON. DEPARTMENT OF HUMAN RESOURCES OREGON HEAlTH DIVISION EMERGENCY MEDICAL TECHNIOAN CERT. , UI067 pARAMEDIC EXPIRES 06130/1997 ROSENLUNI;>. DEREK A 642 Wilson Rd., Ashland, OR '91520 . The indivdIaI named atxMI and desai>ed on It>e ~ 01 !his ~Ied 1he requirements set forth in ORS 823.010 e1 card has ~''''''' .. at 1he S!:!I and is certified as an Emergency Me6caI Tec:;hnoaan ~ indocated . ~_-o f Kir'<Wood. J( Chief. Erne . Services J!.LIi?~.L- Michaet R. Skeels. Ph.D. M.P.H. Administrator. Oregon Health DivisIon . . I , , I I I I I , 1 , 'l : I : ,r . 4 : ~ , , , , . , , , , , I , , , , IDENTIFICATION ATTACH PHOTO HERE EMT-B CERT. # 118250 Robb Robbins HT: 5' 11. HAIR: Dark Brown 9-) 190, b? /7 EYES: Blue ./~a~~ Signature of Certificate Holder . N~ 14999 EXPIRES 06;30/1997 STATE OF OREGON EMERGENCY MEDICAL TECHNICIAN I . I , . :~ 'i : ~ :r 14 :~ IOENTlRCATION EMT-B CERT. # 100384 ATIACH PHOTO HERE William Robinson HT: 6' 6" HAIR: Gray WT: 284 EYES: Blue M.lJ.L:,,-c.- JJ . K~ s.gn<lIUl"e 0/ Certifocate Holder N~ 10689 EXPIRES 06/30/1997 This oerrifcale 1$ /he ptt1peffy oI/he Orl!gon Hea/lh 0Msi0n and ~ be sumJt1dered by If>e '- on demand. STATE OF OREGON EMERGENCY MEDICAL TECHNICIAN IDENllACATlON EMf-P CERT.' UI067 Derek Rosenlund HT: 6' I" HAIR: Dark Br~ 1 0665 WT: 202 EYES: Blue - 0"402- - ~j' Signature of Certif ocate Holde< EXPIRES 06/301l997 [)Msion and must be This certificare is /he property of /he Oregon Healrh surrenderod by /he holder on demand STATE OF OREGON - DEPARTMENT OF HUMAN RESOURCES OREGON HEALTH DIVISION EMERGENCY MEOI9AL TECHNlaAN CERT.11l6336 PARAMEDIC EXPIRES06f301l997 SALLEE, DANA S 170 BrierwOQd Drive Talent. OR 9754D The irdMO.JaJ named ~ and ~ on 1he .-..-,;e d 1his card has ~ 1he ~ S<\t Io<1h ... ORS 823.otO iii S!jQ. and is ce<1ifoed as an Eme<Q<!ncy MecScaI Tedrician .. the 1eYeI irdca1ed. ~-~ Kir1<Wood. Jr. ChieI. SeMces /{L/?~'-- Mic:Ne! R. SI<ooIs. Ph.O~ M.P H ~. Oregon Health 0Msi00 EMERGENCY MEDICAL TECHNICIAN CERT. # 109202 BASIC EXPIRES 06130/1997 SAURMAN. DANIEL R PO Box 24 Talent. OR 97540 The individual named above and described on the reverse of this card has completed the requirements set forth in ORS 823.010 ID ~. and IS certified as an Emergency Medical Technician at the le~._ ;2~ ~ ~ Chtef, Emergency Medical SefV'<:es IDENTIFICATION STATE OF OREGON EMERGENCY MEDICAL TECHNICIAN EMIT-P CERT.#116336~ '.f~J.{' r I i j Dana Sallee HT: 6~ O. ". .'~~ ~ ,k: BIOM1 WT:200 A. E- . e j'C. ..~, ... 10531 Signature d Certificate Holder EXPIRES 06/30/1997 T1is C8tfjfic;alS is ",.. ~ 01 ",.. CXeg:Jn Health DMsion srd nx.rst be SurTende<9d by /tle _ en demard ----- IDENTlACATION ATTACH PHOTO HERE ,- STATE OF O~-GON ~DEPARTMENT OF HUMA;~ESOURCES ,- - - - STATEC>F OREGO;- - - - - OREGON HEALTH DIVISION I EMERGENCY MEDICAL TECHNICIAN I I~ I~ I~ I~ .., 1:2 I I I I EIono( Han. MPH I Ad".,.ntstra1Of. Oregon Health Oivistoo I EMT-B CERT. # 109202 Daniel Saurm.an HT:5' 10" WT: 190 HAIR: Dark Brown EYES: Brown Signature of Certificale Holder N~ 15430 ~~Q,{J.glJ..me90t'1 Health Division and must be surrendered by the hokJer on demand ---- ---" ---- r- - - - - - - - - - - - -- - - - - - - ;;- i - - - - ST^lE OF onEGON STATE OF OREGON. DEPARTMENT OF HUMAN RESOURCF.", I ('MEfH"FNCY MFDICAl. TECHNICi^N OREGON HEALTH DIVISION :.' - .. EMERGENCY MEDICAL TECHNICIAN CERT. It 123197 BASIC EXPIRES 06/3011997 SHEPHERD, DA vlD G 921 Chestnut ^ ve. Medford, OR 97501 The individual ('lamed above and described on the reverse of IhJ~ card has completed Ihe requirements set lorlh '" ORS 823010 9! ~. and IS cerlilied as an Emergency Med,cn' TechnIcIan al the 'evel.ndlcated. ~ ~/ ~VA~~!,q-:w . /)/~-7A'/ Howar{1 ~~. Jr Elinor Hall, MI')1 Ch1el. Emergency Medical Sen'lccs Adr'11ntSIr,11(}r ()r~oon Ilco.llth ()'V1S'OI\ STATE OF OREGON" DEPARTMENT OFHUMAN RESOURCES OREGO~ H6ALTH DP~SION ;>: ". EMERGENCY ,MEDICAL T€CHNIClAN ,.. 'r.. . .,~ , CERT. #:115694: ;.p~JC ~ 0613011997 , -. .~.". . , ' - .<, t~' SHVL THRS, SUSAN M 29403 Peori;i ~d' , ,:; , Hal~ey, Ot:t '9./'3:4,8 ~, 'rh~ j~dividual na';'ed above and desertbed 6n: the reverse of this . card h~completed the requirements set forth in qRS 823..010!tl ", ,'. " .~. and is certified as an Emergency Medicat Technician at the . i ~ \~ leyel indicated. . 5 .,,' /1;,tdP~.L- Michael R. Skeels, Ph.D., M.P.H Administrator, Oregon Health Division I I I ~. I" I~ ! I~ I \ I IDENTIFICATION Ei\1T-1I CERT. It 123197 David Shepherd HT: 6' 0" HAIR: D;iit 81<1\\'1I WI"; 175 . . EYES' GY:CII .,.~l/'riJJi~0:..2 ;CZ.{,_ SIC)nalure of Certlfical~-:' -.---- ATl '\CH PH')TO HERE N~ ,EXl~'[R~S."().<1I"3,PJMn.l,~,,,, 11.,.,/(1, an' "", ..,,", ","s' I" 14g77 SII,fl...'t}(1nrtyl by Ihe '1(lldt.~r Oll dL'nl.lr1(! " I I I I , I I I I . I I I I I I I . , I I I , I I I I I I I I . I . STATE OF OREGON EMERGENCY MEDICAL TECHNICIAN IDENTIFICATION EMf .PCERT. # 1'(5694:. ~, -- Susan SlmIters H'1~ or fT . .. . HAIR: Dark BI'<1Wn ~. .. ... EYES: Brown I \j":' nt~ Signature of Certfficate Holder ATTACH PHOTO HERE 12351 EXPIRES 06/30/1997 This certificate is the property of the Oregon Health Division and must be surrendered by the holder on demand. ;S~EOFOREGON~EMRTMENTOFHUMANRESOURCE~I----~~EOFOREGO~----r----- , OREGON HEALTH DIVISION I EMERGENCY MEDICAL TECHNICIAN I EMERGENCY MEDICAL TECHNICIAN I IDENTIFICATION \ I~ I ! I L. CERT. # L23787 PARAMEDIC EXPIRES 061301L997 STEPHENS, ROBERT W' 10290 Bucre Falls Hwy Eagle Point, OR 97524 The Individual named above and described on (he reverse of Ihis card has completed the requirements sel forth In ORS 823 010 ~ ~_ and is certified as an Emergency Medical Techrliclan at Ihe "ot+Aw' a'."d ~-. "~:',;'JiC, ~I~:/ /2;~.;{~" ;:~ Elinor Hall, MPH Chlel E-me(gcocy Medica.l Services Adml(uSlr,310r. Oregon He'd;;n D.vlSlon I~ I! I~ I~ I I I ! EMT-P CERT. # 123787 Robert Stephens HT: 6' O' HAIR: Light Brown WT: 219 EYES: Brown '~~ EX~ ij fjfrjf!>~ er N~ J '"'.5 ceffo(-ciHe ,s the properTy of the Ore<;J(}(1 Hcall"" OIVI$lon a(1~'1 mus! (>(' Sv,,<->ndered by rhe hOlder on dem.1nd 19106 ATTACH PHOTO HERE _______________________________________________r______--- . . , , , , , , . , , , , , . , . . . STATE OF OREGON ..DEPARTMENT OF HUMAN RESOURCES OREGON HEALTH DIVISION EMERGENCY MEDICAL TECHNIOAN CERT. # 118911 PARAMEDIC EXPIRES 06130/1997 STOY. JOHN T 955 Grandview Dr. Ashland. OR 97520 The 'ndMdual named above and described on the reverse of this card has completed the requirements set to<th in ORS 823.010 eI ~. and IS certified as an Emergency Medical Technician at the level onOcated. It.t. / ?5Iv.L- Michael R. Skeels. Ph D.. MPH. Administrator. Oregon Health a.visoon STATE OF OREGON - DEPARTMENT OF HUMAN RESOURCES OREGON HEAlTH DIVISION EMERGENCY MEDICAL TECHNIOAN : CERT. # 116422 BASIC EXPIRES 06130/1997 WHITE, DANIEL R 945 N. Mountain Ashland, OR 97520 The .ndividual named above and described on the reverse oIlhis card has completed the requirements set torth on ORS 823.010 eI ~ and is certified as an Eme<gency Medical Technician at the level indicated. ~~ /i.t.1 ,l:.~~.'-- =:--:. Michael R SI<eeIs. Ph.D.. M.P.H STATE OF OREGON EMERGENCY MEDICAL TECHNICIAN . . , :i 'i :8 :r , . :~ , . . , , IDENT1ACATION EMT-P CERT. /I 118911 ATTACH PHOTO HERE John Stoy HT: 6' I" HAIR: Dark Brol.m WT: 195 EYES: Blue I \I':' i~. .1~ .~ Signature Certifoc..,,, 1 2 6 G 1 EXPIRES 06/30/1997 1)1;5 ce<ldicale is the property of the Oregon Hea/ltl Division and must be surrendered by the holder on demand. ------------------------------------------ STATE OF OREGON EMERGENCY MEDICAL TECHNICIAN IDENT1ACATlON EMT-B CERT. # 116422 ATTACH PHOTO HERE Daniel White ~2- IlAIR~"" (._:~5 ~ kli 1\1':' _ ;---i::.-1,r . Signature of Certificate Holde< 1093L EXPIRES 06/30/1997 TI-.s cer1iIcare is /fie property 01 /fie Oregon Hea/ltl (Ms<Qn and muSI be Ashland Fire & Rescue Application for Licensure Dept. of Human Resources Oregon Health Division Ambulance License Ashland Fire & Rescue......... making a difference in our Community. MUST BE POSTED IN A CONSPICUOUS PLACE NOT TRANSFERABLE }) ~ (> 462 31001 04/26/6 3340 I ___---.J City of Ashla.nd Keith E. Woodley, Chief 455 Siskiyou Blvd L_ Ash I and OR 97520 ADMINISTRATOR State Health Division JUN :30 97 I I I EXPIRATION DATE MO DAY YR GROUND I TYPE III LICENSE NO. E186951 1993 FORD 368810 $45.00 PAYMENT RECEIVED 1501-E1:36951 - CERT NO DEPARTMENT OF HUMAN RESOURCES OREGON STATE HEALTH DIVISION AUDIT NO EMERGENCY MEDICAL SERVICE SECTION - AMBULANCE LICENSE g(331 " MUST BE POSTED IN A CONSPICUOUS PLACE. NOT TRANSFERABLE () 462 31001 04/26/6 3341 I __-.J City of' Ashland Keith E. Woodley, Chief 455 Siskiyou Blvd L Ash I and OR 9752:0 ADMINISTRATOR State Health DIvIsion JUN :30 97 MQ DAY Vf1 EXPIRATION DATE GROUND I TYPE II LICENSE NO. E195689 1- 1992 FORD $45 . (II) PAYMENT RECEIVED i50i -Ei 95~.89 CERT NO 368855 AUDIT NO DEPARTMENT OF HUMAN RESOURCES OREGON STATE HEALTH DIVISION EMERGENCY MEDICAL SERVICE SECTION - AMBULANCE LICENSE g - ........~...~.... -. liB/B) ~'a 318\11J3;1SN\H:I.l .lON 3:>\11d SnOn:>tdSNO:> \1 Nt 03.lS0d 38 .lSnV'/ o 1001::: Z'::'t- 0:::::':,9 9/01/'::'0 UOISI^'O LweaH alelS tJOIVtHSINIV'JOV 02g.LI;. :=10 plJ"E 1'-15\;1' -l P^18 noAI~SIS ggt- Ja14~ ,AaIPOOM "3 4~la~ P Ij -e I 4 S \;1' J (. A ~ I :J ~/_~. O:~ !'In r 1j). .wu Uv~ 31\10 NOl1'o'tJtdX 3 09gS613 'ON 3SN3~I~ III 3dAl ! GNnO:=JlJ L___ a~o.:::! 9661 .J 03^'3:J3tJ 1N3V'j^'o'd (jO"S1:>$ ON ltJ3:J (Y,'S:=:/~. I :=3 - I OS I 81E69E ON 110f'i\1 :=3':=::r\I3J I -, 3JNV'PIfl:JI.J'i - NI='l.l YJ'=.: ..3): ;'.::j3c..''d) I 03W f.JN38::t31.J3 NOISIAIO H1l'13H 31'11S N083CJO S3~)tJnOS.3t:J N\fV'mH :::10 IN.3VUt:J\fd.30 Y8t'~/rzw o .318\1tJ.3:JSNVtJl 10N 3:JV;" '011UILJldSNU:J v NI 031S0d .38 lsnv; 10018 Z9t- 6€:8::.: 9/92/ toO UOISI^tO LweaH aWlS tJOl'lttJIS INIV'JOV 1-- OZ9L6 ~O pu~ 14s\>, I P^18 noA,~s!S ggt- ja!4J 'AaIPOOM "3 4~!a~ PIJ~14S\>, ,to A~IJ Lt:., 08 Nnr <1!- Ave \.J~'~ 31'o'U NUI1'o'tJldX 3 LL60L13 'ON 3SN3~I~ III 3dAl L.. aNnO~8 m:JO.::I S~;6 1 _J OJAI3:J3tJ .lN3V'j^'o'd. 00"91:>$ ON lU J:J LL60L13-10g1 6SL89E ON 110n'o' 3SN3JI~ 3JN~~n8WV' - NOI1J3S 3JIA~3S ~VJIa3~ ^JN38~31.J3 NOISIAIO HJ.l'13H 31'1l.S N083~O S3:JtHiOS.3t:J N\fVIJnH :::10 IN.3V1JH:Nd.30 0/7# Ashland Fire &' Rescue Application for Licensure Certificate of Insurance Ashland Fire & Rescue......... making a difference in our Community. 455 SISKIYOU BOULEVARD ASHLAND, OREGON 97520 Ashland Fire & Rescue (541) 482-2770 FAX (541) 488-5318 r""<':'-. _. ( CERTIFICATE OF AUTOMOBILE LIABILITY COVERAGE This certifie5);~tjhe p~~lic bOdy listed below is a Member of City/County Insurance Services Trust, a ~roup sel?ijs~)~9ce..fund for third-party bOdilY. i.njury, persona) injury a...n. d property damage claims aflSlOg ~1J1~,8.JI/o"peratlOns of Member public bodies. . _ _ /l;/I/ .. .~ / III/" "'i ME"ffM':/ CITY OF ASHLAND ",7" . f f I (,I .~ _.}" "'. )' VE~f~m: A II vehicles registered to or leased by above nim~~. &Ub~. cf body M.ember. :dil .<.-... ST Ami' ' R Y ,.~ ? ~ (-r'1I ,W":J; , \ . ~ I.. -, AUl:, P\~TY: ORS 30.282(2) '.;l\ .~ '.~;,' it/ '. \ \ '" COV~' ,~ ' VIces TERM'~~UIY I, 1996 - June 30, l~.~~ . "' #" . DESCRIPit~ ~~" . P-EE.A...I!.QN~:]9 ~.WJi(CH THIS CER TIFICA TE APPLIES: Officers, employees ancf'-a")ent,s .or:niD:n.~Dec-public .b-bdy, driving a vehicle registered to or leased by the Member public bodY;;Whi!~:;ri11ie.s.-co'pe of their employment or duties or authorization, are covered for automobile liability for ~-otT~;s than the limits set forth in ORS 806.070(2). ~~ July I, 1996 Date \ [ This certificate issued by City/County Insurance Services Trust; 1212 Court Street NE, Suite 30 I, Salem, Oregon 97301. Tel. (503) 585-1121 or 1-800-922-2684. CERTIFICATE OF MEMBERSHIP No. 96LASH CITY/COUNTY INSURANCE SERVICES TRUST LIABILITY RISK SHARING POOL This certifies that Ashland is a Member of the City/County Insurance Services Trust for liability coverage during the period set forth below. Period: Limit of Liability: July 1, 1996 to June 30, 1997 $1,000,000 In accordance with and subject to the Trust Agreement, Bylaws and Rules of the Trust, and in consideration of the contribution for which this coverage agreement is written, except where specifically provided otherwise within this agreement, the Trust will pay on behalf of the Member all sums which the Member shall be legally obligated to pay as damages because of: Coverage A: Coverage B: Coverage C: Coverage D: Coverage E: Liability arising under Oregon Revised Statutes 30.260 to 30.300 and caused by an occurrence; Liability arising under 42 U.S. Code, 9 1983, 42 U.S. Code 9 2000e et seq. (Title VII of the Civil Rights Act of 1964), 29 U.S. Code ~ 621 et seq. (Age Discrimination Employment Act of 1967); The Americans With Disabilities Act; The Civil Rights Act of 1991; 42 U.S. Code ~ 1981; or any law amendatory thereof, provided such liability is caused by an occurrence; Bodily Injury, Personal Injury and Property Damage for which the Member is legally liable under the laws of any jurisdiction other than the State of Oregon to which this coverage agreement applies caused by an oeeu rrenee; Uninsured Motorists Coverage as defined by ORS 742.504, pursuant to ORS 278.215. The Limits of Liability of such coverage shall be those set forth as minimums under ORS 806.070 ($10,000 property damage/$25,000 per person bodily injury or death/$50,OOO aggregate bodily injury or death). The property damage coverage under Coverage D is subject to the conditions and limitation of ORS 742.510; Liability of others assumed by the Named Member under contract, except as hereinafter limited in the definition of the term "Member." In accordance with and subject to the Trust Agreement, Bylaws and Rules of the Trust, and in consideration of the contribution for which this coverage agreement is written, and independent of Coverages A - E above. the Trust will pay: Coverage F: Legal expenses reasonably incurred by a public official of the Named Member arising out of defense of a complaint alleging violation of ORS 244.040 or 244.120-.135, subject to the terms and conditions set forth on page 7 below. 1 of 7 7/01/96 The Trust shall have the right and duty to defend any claim or suit against the Member seeking damages, even if any of the allegations of the suit are groundless, false or fraudulent, and may make such investigation and settlement of any claim or suit as it deems expedient. The Trust shall not be obligated to pay any claim or judgement or to defend any suit or action after the applicable limit of the Trust's liability has been exhausted by payment of judgements or settlements. LIMITS OF LIABILITY The limit of liability assumed by the Trust on any claim covered under this agreement shall not exceed $500,000 per occurrence. EXCLUSIONS The coverage agreement does not apply: a) To the ownership, maintenance, operation, use, loading or unloading of I) any aircraft owned, or operated by, or rented, or loaned to the Member or 2) any other aircraft operated by any person in the course of their employment by the Member; b) To damages arising out of the Nuclear Energy Liability Hazard; c) To the ownership, maintenance or use of watercraft, where other liability coverage is valid at the time of loss; d) to injury or damage to or destruction of any property owned by the Member or any of its departments, agencies, boards or commissions; e) To any obligation for which the Member or any carrier as its insurer, may be held liable under any workers' compensation, unemployment or disability benefits law, or other similar law, including the Jones Act; . f) To bodily injury to any employee of the Member, including any volunteer or inmates for whom the Member could elect to provide Workers' Compensation coverage under ORS 656.031 or ORS 656.041, arising out of and in the course of the employee's, volunteer's, or inmate's employment by the Member; g) To any liability arising out of or in any way connected with the operation of the principles of eminent domain, condemnation proceedings, or inverse condemnation, by whatever called, whether such liability accrues directly against the Member or by virtue of any agreement entered into, by or on behalf of the Member. h) To liability at any hospital owned or operated by the Member, or to any such liability assumed by the Member under contract, arising out of or in connection with the care, treatment, rendering of professional services or provision of any associated products or devices to any person admitted on an inpatient or outpatient basis or to any person entering or brought to such hospital with the intention that care, treatment, professional services or associated products and devices be provided. i) To any claim against a Hospital Financing Authority created pursuant to ORS 441.525 to .596 arising out of the issuance of, use of proceeds from, repayment or dcfault on financial instruments, bonds or revenue bonds. ;) I) To actual, alleged, or threatened bodily injury, pc,'sonal II1Jury, IH'opcrty 2 of 7 7/01/96 damage, or any other loss or damage whether or not expected or intended from the standpoint of the Member, arising out of the actual, alleged, threatened, accidental, inadvertent, or intentional discharge, dispersal, release, escape or use of pollutants. 2) To any loss, cost, or expense arising out of any directive or obligation imposed by law that a Member test for, monitor, clean up, remove, contain, treat, detoxify, or neutralize any pollutants. 3) To wrongful entry or eviction, whether or not expected or intended from the standpoint of the Member: i) Arising out of the accidental, inadvertent or intentional discharge, dispersal, release, escape or use of pollutants; or ii) Arising out of any ditective or obligation imposed by law that a Member test for, monitor, clean up, remove, contain, treat, detoxifY or neutralize any pollutants. Pollutants mean any solid, liquid, gaseous, or thennal IrrItant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals or waste. Waste includes materials to be recycled, reconditioned or reclaimed. This exclusion shall not apply to liability otherwise covered by this agreement for property damage arising out of the Member's response to an emergency away from any premises owned, rented or occupied by the Member, and in the course of Member's fire fighting or law enforcement activities necessary for the protection of property. "Emergency" for the purposes of this coverage agreement shall mean any incident from which any property is in immediate danger of harm from the discharge, dispersal, release or escape of pollutants within the 72 hours preceding the Member's response. Further, this exclusion shall not apply to liability otherwise covered by this agreement resulting from the leakage of fluids including fuel, hydraulic fluid, coolant or lubricants, other than such fluids carried as cargo, from any vehicle designed for land transportation, whether or not licensed for highway use, and owned or operated by the Member, and where such leakage is caused by collision or upset of such vehicle. k) To Bodily Injury, Personal Injury, or Property Damage caused by, resulting from, or arising out of: I) Asbestos, asbestos fibers or asbestos products or to any obligation of the Member to indemnify another and/or contribute with another because of liability arising out of, or as a result of such Bodily Injury, Personal Injury, or Propert)' Damage, or; 2) Any supervision, instruction, recommendation, notice, warning or advice given or which should have been given in connection with asbestos, asbestos fibers or asbestos products. 3 of' 7 7/01/96 In addition, the Trust shall not be obligated to investigate, to pay any claim or judgemcnt or to defend any suit for Bodily Injury or Property Damage caused by, resulting from or arising out of asbestos, asbestos fibers or asbestos rroducts. CONDITIONS Action Against the Trust: As a condition precedent to action against the Trust the Member shall have fully complied with all the terms of this coverage agreement and the amount of the obligation shall have been finally determined either by judgement after actual trial or by written agreement between tbe Member, the clajmant and the Trust. Judgement shall not be deemed final until the suit shall have been finally determined in any appeal prosecuted therefrom. Any person or organization or legal representative thereof having secured such judgement or written agreement, shall be entitled to recover under this coverage agreement to the extent of the coverage afforded hereby. No person or organization shall have the right under this coverage agreement to join the Trust as a part to any action against the Member to determine the Member's representative. Bankruptcy or insolvency of the Member or of the covered estate shall not relieve the Trust of any of its obligations hereunder. Subrogation: In the event of any payment under this coverage agreement, the Trust shall be subrogated to all the Member's rights to .recovery thereof against any person or organization and the Member shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights: The Member shall do nothing after loss to prejudice such rights. Changes: The terms of this coverage agreement shall not be waived or changed, except by an endorsement issued to form a part of this coverage agreement signed by the Trust's authorized representative and delivered to the Member. Cancellation: This coverage agreement may be canceled by the Member upon such notice as n:~quired by the Trust Bylaws, in which event the end of such notice period shall become the end of coverage period. The Trust agrees to remain on the risk for three years or during the term of the Membership resolution adopted by the Member, whichever is shorter, subject to the termination provisions of the Trust Bylaws. Notice to the Member of any action taken pursuant to such provisions shall be sixty days, except in the event of non-payment of any contribution due and owing, in which case notice shall be ten days. Notice shall be in writing to the Member at the address of the Member shown on the latest available edition of the Oregon Blue Book. Non-Assignable: The interest of the Member under this coverage agreement shall not be assignable. Contribution: The initial contribution paid in the consideration of this coverage agreement is not subject to audit adjustment. Covcl'agc Pel"iodfferritory: This coverage agreement applies to occurrences during the coverage period which take place anywhere, provided that resulting claims or suits are asserted within the United States of America, its territories or possessions, or Canada. GOVCl"IIlI1Cllt Instrumentality: The issuance of this coverage shall not be deemed a waiver of 4 of 7 7/01'96 any statutory immunltlcs as to any Mcmber nor of any statutory limits on thc monCtary amount of liability applicablc to any Member were this coverage agrcement not in effect. Thc Trust expressly reserves any and all rights to deny liability by reason of such immunity, and to assert any limitation provided by law as to amount of liability. Other Coverage: It is a condition of this coverage agreement that if at the time of loss, there is other collectable insurance available to the Member of any kind, this coverage shall become excess coverage and in no event contributing coverage and then only for the amount due the Member under such forms of coverage. In no event, however, shall the liability hereunder exceed the limit of liability set forth herein. DEFINITIONS a) "Damages" means all sums recoverable by law from any liability covered under this coverage agreement, including punitive damages if awarded, but not including any sums awarded for plaintiffs attorney fees or expert fees under 42 U.S. Code, 9 1988 in any case in which monetary damages are not sought or not awarded, and not including the costs of complying with injunctions. b) "Personal Injury" means false arrest, detention, imprisonment, malicious prosecution, libel, slander, or publication or utterance in violation of the individual's right of privacy, wrongful entry or eviction, or invasion of the right of private occupancy. c) "Property Damage" means injury to or destruction of tangible property. d) "Occurrence" means an event, act, error or omission or a continuous or repeated exposure to conditions, any of which occurs during the coverage agreement period. e) "Named Member" or "Member" means its officers, employees and agents including volunteers, authorized to act on behalf of the Named Member, all acting within the scope of their employment or duties whether arising out of a governmental or proprietary function. "Member" shall include any party whom a public body covered under this coverage agreement has agreed to hold harmless, indemnify or defend pursuant to a contract or other agreement lawfully entered into by such public body. However, in no event shall coverage under this coverage agreement extend to such party for any claim arising out of an occurrence after the expiration of this coverage agreement or the expiration of the contract or agreement entered into by the public body, whichever shall occur first. Further, in no event shall coverage under this coverage agreement extend to such party for any claim, however or whenever asserted, arising out of such party's sole negligence. Except as specified in this paragraph, such party shall have no rights under the Trust Agreement, Bylaws or Rules of the Trust. t) "Nuclear Energy Liability Hazard" means injury, sickness, disease, death or destruction I) with respect to which an Member under this coverage agreement is also an Insured under a nuclear energy liability policy issued by Nuclear Energy Liability Insurance Association, Mutual Atomic Energy Liability Underwriters or Nuclear Insurance Association of Canada, or would be an Insured under any such policy but for its termination upon exhaustion of 5 1..11' 7 7/01/96 its limits of liability; or 2) resulting tr"OIl1 the hazardous properties of nuclear material and with respect to which i) any person or organization is required to maintain financial protection pursuant to the Atomic Energy Act of 1964, or any law amendatory thereof, or ii) the Member is, or had such policy not bccn issued, would be entitled to indcmnity from the Unitcd States of America, or any agency thereof, under any agreement entered into by the United States of America, or any agency thereof, with any person or organization; 3) resulting from the hazardous properties of nuclear material, if i) the nuclear material is at any nuclear facility owned by, or operated by or on behalf of any Member, or has been dispersed therefrom; ii) the nuclear material is contained in spent fuel or waste at any time possessed, handled, used, processed, stored, transported, or disposed of, by or on behalf of a Member; or iii) the injury, sickness, disease, death or destruction arising out of the furnishing by a Member of services, materials, parts or equipment in connection with planning, construction, maintenance, operation or use of any nuclear facility, but if such facility is located within the United States of America, its territories or possessions or Canada, this part (iii) applies to only injury or destruction of or loss of property at such nuclear facil ity. As used in this definition "Hazardous properties" include radioactive, toxic or explosive properties; "Nuclear material" means source material, special nuclear material, or byproduct material; "source material," "special nuclear material" and "byproduct material" have the meanings given them in the Atomic Energy Act of 1964, or in any law amendatory thereof; "Spent fuel" means any fuel element or fuel component, solid or liquid, which has been used or exposed to radiation in a nuclear reactor; "Waste" means any waste material 1) containing byprodust material and 2) resulting from the operation by any person or organization of any nuclear facility included withirl the definition of nuclear facility under paragraph a) or b) thereof; "Nuclear facility" means a) any nuclear reaction, b) any equipment or device designed or used for 1) separating the isotopes of uranium or plutonium, 2) processing or utilizing spent fuel or 3) handling, processing or packaging waste, c) any equipment or device used for the processing, fabricating or alloying of special nuclear material if at any time the total amount of such material in the custody of the Member at the premises where such equipment or device is located consists of or contains more than 25 grams of plutonium or uranium 233 or any combination thereot: or more than 250 grams of uranium 23:5. d) any structure, basin, excavation, premises or place prepared or used for the storage or disposal of waste, and includes the site on which any of the foregoing is located, all operation conducted on such site and all premises for such operation; "N uclcar reactor" means any apparatus designed or used to sustain nuclear fiss ion in a se I f- supporting chain reaction or to contain a critical mass of fissionable material. With respect to "injury" or to "destruction" of property, the word injury or destruction includes all form of radioactive contamination 01' property. () of 7 7/0196 . . ETHICS LEGAL EXPENSE COVERAGE I. The amount the Trust will pay shall be limited to $2,500.00 for any individual public official for all complaints arising in anyone Fund Year. 2. The amount the Trust will pay shall be limited to $5,000.00 for all public officials of any one Named Member for all complaints arising in anyone Fund Year. 3. The Trust shall have no obligation to pay for legal expenses under this section unless the public official notifies the Trust of a complaint within 30 days of first communication with the Oregon Governmental Standards and Practices Commission. 4. The Trust shall have no obligation to pay for legal expenses under this section unless defense counsel has been selected by the Trust or, if selected by the public official, approved by the Trust. Such approval shall not be unreasonably withheld. 5. The Trust shall have the right, but not the duty, to independently investigate any complaint alleging violation of ORS 244.040 or 244.120-.135. As a condition precedent to any right to payment under this section, the public official shall fully and completely cooperate with such investigation. The costs, if any, of such investigation shall not reduce the payments otherwise payable under this section. 6. Payments for legal expenses shall normally be made as such costs are incurred, upon receipt by the Trust of adequate documentation. However, the Trust, in its sole discretion, shall have the right at any time to withhold payment until final resolution of a complaint. In such a case, no payment shall be made unless the public official shall have prevailed. 7. The Trust shall be subrogated, to the extent of any payments made under this section, to any amounts recoverable by the public official from the public body, other collectible insurance or pursuant to ORS 244.400. ~/~ Chairman, CIS Board of Trustees 7/01/96 7 or 7 CERTIFICATE OF MEMBERSHIP No. 96APDASH CITY /COUNTY INSURANCE SERVICES TRUST AUTO PHYSICAL DAMAGE SELF-INSURANCE POOL This certifies that Ashland is a Member of the City/County Insurance Services Trust for auto physical damage coverage during the period set forth below. Period: July 1, 1996 to June 30, 1997 Deductible: Collision Comprehensive $ 500.00 $5,000.00 The City/County Insurance Services Trust (CIS), subject to the terms and conditions of this certificate including any deductible stated above, and in accordance with and subject to the terms of the Trust Agreement, Bylaws and Rules of CIS, and in consideration of the contribution for which this coverage agre~ment is written shall pay auto physical damage losses arising during the period stated above. PART I -- WORDS AND PHRASES The following words and phrases have special meaning throughout this certificate. A. "You" and "your" mean the public body shown in the caption of this certificate. B. "We", "us" and "our" mean City/County Insurance Services Trust (CIS). C. "Vehicle" means a land motor vehicle, trailer or semi-trailer. D. "Loss" means direct and accidental damage or loss. PART II -- WHICH VEHICLES ARE COVERED. A. Covered vehicles are those shown in the schedule of vehicles for which a contribution assessment has been charged and paid. B. OWNED VEHICLES YOU ACQUIRE AFTER THE COVERAGE BEGINS. 1. We will cover all vehicles acquired after the coverage begins under this certificate if: a. The vehicle is a replacement for a vehicle already covered, or; b. The vehicle is an additional vehicle owned by you, or rented or leased by you for and we are notified not later than thirty (30) days after the expiration of the coverage period noted above that you want us to cover it under this certificate. 2. If any replacement, additional, rented or leased vehicle represents an increase in the risk or values covered under this certificate, we reserve the right to charge an additional contribution commensurate with such increase. 1 of 5 7/01/96 PART III-- WHERE AND WHEN THIS CERTIFICATE APPLIES. We cover losses which occur during the coverage period: A. In the United States of America, its territories or possessions, Puerto Rico or Canada; or B. While the covered vehicle is being transported between any of these places. PART IV -- PHYSICAL DAMAGE INSURANCE A. WE WILL PAY. 1. We will pay for loss to a covered vehicle or its equipment under: a. Comprehensive Coverage. From any cause except the covered vehicle's collision with another object or its overturn. b. Collision Coverage. Caused by the covered vehicle's collision with another object or its overturn. c. Specified Perils Coverage. Caused by: (1) Fire or explosion; (2) Theft; (3) Windstorm, hail or earthquake; (4) Flood; (5) Mischief or vandalism; (6) The sinking, burning, collision or derailment of any conveyance transporting the covered vehicle. B. WE WILL NOT COVER -- EXCLUSIONS. This coverage does not apply to: 1. Wear and tear, freezing, mechanical or electrical breakdown unless caused by other loss covered by this certificate. 2. Blowouts, punctures or other road damage to tires unless caused by other loss covered by this policy. 3. Loss caused by declared or undeclared war or insurrection or any of their consequences. 4. Loss caused by the explosion of a nuclear weapon or its consequences. 5. Loss caused by radioactive contamination. 6. Loss to tape decks or other sound reproducing equipment not permanently installed in a covered vehicle. 7. Loss to tapes, records or other sound reproducing devices designed for use with sound reproducing equipment. 8. Loss to any sound receiving equipment designed for use as a citizens' band radio, twO way mobile radio or telephone or scanning monitor receiver, including its antennas and other accessories, unless permanently installed in the dash or console opening normally used by the vehicle manufacturer for the installation of a radio. 2 of 5 7/01/96 C I.IOW WE WILL PAY FOR LOSSES -- THE MOST WE WILL PAY. l. At our option we may: a. Pay for, repair or replace damaged or stolen property, or b. Return the stolen property, at our expense. We will pay for any damage that results to the vehicle from the theft. 2. Except as provided under 3. below, the most we will pay for loss is the smaller of the following amounts: a. The actual cash value of the damaged or stolen property at the time of loss. b. The cost of repairing or replacing the damaged or stolen property with other of like kind or quality. 3. If the property is a private passenger vehicle or a light commercial vehicle, up to and including one ton rated capacity, and is not more than 6 (six) model years old at the time of loss (a model year being deemed to begin on October 1 of each preceding year), and a larger payment would not apply under 2. above, we will pay the smaller of the following amounts: a. The replacement cost value of the stolen or damaged vehicle at the time of loss. b. The cost of repairing the stolen or damaged vehicle. c. $20,000 (Twenty Thousand Dollars). 4. For each covered vehicle, our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by the applicable deductible shown in the caption of this certificate. Any Comprehensive Coverage deductible shown in the declarations does not apply to loss caused by fire or lightening. D. GLASS BREAKAGE -- HITTING A BIRD OR ANIMAL -- FALLING OBJECTS OR MISSILES. We will pay for glass breakage, loss caused by hitting a bird or animal or by falling objects or missiles under Comprehensive Coverage if you carry Comprehensive Coverage for the damaged covered vehicle. However, you have the option of having glass breakage caused by a covered vehicles' collision or overturn considered a loss under Collision Coverage. PART V -- CONDITIONS The coverage provided by this certificate is subject to the following conditions: A. YOUR DUTIES AFTER ACCIDENT OR LOSS. 1. You must promptly notify. us or our agent of any loss. You must tell us how, when and where the loss happened. 2. Additionally, you must: a. Cooperate with us in [he investigation or settlement of any loss. You shall not voluntarily make any paymem, assume any obligation or incur any expense except as provided in this certificate. 3 of 5 7/0 1/96 b. Immediately send us copies of any notices or legal papers received in connection with (he Joss. c. Permit us to inspect and appraise the damaged property before its repair or disposition. d. Do what is reasonably necessary after loss at our expense to protect the covered vehicle from further loss. e. Submit a proof of loss when required by us. t'. Promptly notify the police if the covered vehicle or any of its equipment is stolen. B. OUR IUGHT TO RECOVER FROM OTHERS. If we make any payment, we are entitled to recover what we paid from other parties. Any person to or for whom we make payment must transfer to us his or her rights of recovery against any other party to the extent of such payment. This person must do everything necessary to secure these rights and must do nothing that would jeopardize them. C. CANCELING THIS CERTIFICATE DURING THE COVERAGE PERIOD. 1. You may cancel your coverage by giving us written notice not less than 60 days prior to the date cancellation is to take effect. 2. We may cancel your coverage for nonpayment of any contribution due. Such cancellation shall be by written notice not less than 10 days prior to the date cancellation is to take effect. Cancellation or nonrenewal for any other reason set forth in the Bylaws of CIS shall require 60 days written notice. Proof of mailing of any notice to your last address known to us shall be sufficient proof of notice. 3. If this certificate is canceled, you may be entitled to a contribution refund. However, making or offering to make the refund is not a condition of cancellation. The refund, if any, will be computed pro rata. D. LEGAL ACTION AGAINST US. No legal action may be brought against us until there has been full compliance with all the terms of this certificate. E. INSPECTION. At our option we may inspect your property and operations at any time. By our right to inspect or by our making any inspection we make no representation that your property or operations are safe, not harmful to health or comply with any law, rule or regulation. F. CHANGES. This certificate contains all the agreements between you and us regarding this coverage. Its tem1S may nOi be changed or waived except by amendment issued by us pursuant to the Bylaws of CIS. If a change requires a contribution adjustment. we will adjust the contribution as of the effective date of change. G. TRANSFER OF YOUR INTEREST IN THIS CERTIFICATE. Your rights and duties under this certificate may not be assigned without our written consent. 4 of 5 7/01 c)() 1-1. NO BENEHT TO BAILEE. We will not recognize any assignment or grant any covcragc for thc bcnefit of any pcrson or organization holding, storing or transporting property for a fee. I. APPRAISAL. 1. If you and we fail to agree as to the amount of loss either may demand an appraisal of the loss. In such event, you and we shall each select a competent appraiser, and the appraisers shall select a competent and disinterested umpire. The appraisers shall state separately the actual cash value and the amount of loss, and, failing to agree, shall submit their differences to the umpire. An award in writing of any two shall detennine the amount of loss. You and we shall each pay the chosen appraiser and shall bear equally the other expenses of the appraisal and umpire. 2. We shall not be held to have waived any of our rights by any act relating to appraisal. ~~ Chainnan, CIS Board of Trustees 5 of 5 7/01/96