HomeMy WebLinkAbout2011-291 Contract - 2011 Asphalt Patching - Pacific Paving CITY RECC IDER
Contract for Asphalt Patching
` CITY OF CONTRACTOR: Pacific Paving
ASHLAND CONTACT: Bonnie Verstegen
20 East Main Street
Ashland, Oregon 97520 ADDRESS: PO Box 2370, White City, OR 97503
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-772-4616
DATE AGREEMENT PREPARED: Oct. 14, 2011 FAX:
BEGINNING DATE: October 17, 2011 COMPLETION DATE: October 16, 2012
COMPENSATION: To be determined by competition for jobs based on per unit price quotes submitted every
60 days or as needed for jobs exceeding $2,500.00
GOODS AND SERVICES TO BE PROVIDED: Asphalt Patching Services
ADDITIONAL TERMS: Special Procurement (Alternative contracting process) approved by City Council on
September 6, 2011. Valid until June 30, 2016.
NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the
CITY AND CONTRACTOR AGREE as follows:
1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and
expense, perform any work described above and, unless otherwise specified, furnish all labor, equipment and
materials required for the proper performance of such work.
2. Qualified Work: Contractor has represented, and by entering into this contract now represents, that any personnel
assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned
in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are
so registered, licensed and bonded. Contractor must also maintain a current City business license.
3. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no later
than the date indicated above and start performing the work under this contract by the beginning date indicated
above and complete the work by the completion date indicated above.
4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and
expenses, the sum specified above. Payments shall be made within 30 days of the date of the invoice. Should the
contract be prematurely terminated, payments will be made for work completed and accepted to date of termination.
Compensation under this contract, including all costs and expenses of Contractor, is limited to $25,000.00, unless a
separate written contract is entered into by the City.
5. Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of
City.
6. Statutory Requirements: ORS 279B.220, 2796.225, 2796.230, 27913.235, ORS Chapter 244 and ORS 670.600 are
made part of this contract.
7. Living Wage Requirements: If contractor is providing services under this contract and the amount of this contract
is $18,890 or more, Contractor is required to comply with chapter 3.12 of the Ashland Municipal Code by paying a
living wage, as defined in this chapter, to all employees performing work under this contract and to any subcontractor
who performs 50% or more of the work,under this contract. Contractor is also required to post the notice attached
hereto as Exhibit B predominantly in areas where it will be seen by all employees.
8. Indemnification: Contractor agrees to defend, indemnify and save City, its 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 the performance of this contract by Contractor(including but not limited
to, Contractor's employees, agents, and others designated by Contractor to perform work or services attendant to this
contract). Contractor shall not be held responsible for any losses, expenses, claims, subrogations; actions, costs,
judgments, or other damages, directly, solely, and proximately caused by the negligence of City.
9. Termination:
a. Mutual Consent. This contract may be terminated at any time by mutual consent of both parties.
b. Citv's Convenience. This contract may be terminated at any time by City upon 30 days' notice in writing
and delivered by certified mail or in person.
C. For Cause. City may terminate or modify this contract, in whole or in part, effective upon delivery of
written notice to Contractor, or at such later date as may be established by City under any of the following
conditions:
i. If City funding from federal, state, county or other sources is not obtained and continued at levels
Contract for Goods and Services Less than $25,000, Revised 06/30/2011, Page 1 of 5
sufficient to allow for the purchase.of the indicated quantity of services;
ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way
that the services are no longer allowable or appropriate for purchase under this contract or are
no longer eligible for the funding proposed for payments authorized by this contract; or
iii. If any license or certificate required by law or regulation to be held by Contractor to provide the
services required by this contract is for any reason denied, revoked, suspended, or not renewed.
d. For Default or Breach.
i. Either City or Contractor may terminate this contract in the event of a breach of the contract by
the other. Prior to such termination the party seeking termination shall give to the other party
written notice of the breach and intent to terminate. If the party committing the breach has not
entirely cured the breach within 15 days of the date of the notice, or within such other period as
the party giving the notice may authorize or require, then the contract may be terminated at any
time thereafter by a written notice of termination by the party giving notice.
ii. Time is of the essence for Contractor's performance of each and every obligation and duty under
this contract. City by written notice to Contractor of default or breach, may at any time terminate
the whole or any part of this contract if Contractor fails to provide services called for by this
contract within the time specified herein or in any extension thereof.
iii. The rights and remedies of City provided in this subsection (d) are not exclusive and are in
addition to any other rights and remedies provided by law or under this contract.
e. Obligation/Liability of Parties. Termination or modification of this contract pursuant to subsections a, b, or
c above shall be without prejudice to any obligations or liabilities of either party already accrued prior to such
termination or modification. However, upon receiving a notice of termination (regardless whether such notice is
given pursuant to subsections a, b, c or d of this section, Contractor shall immediately cease all activities under
this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination,
Contractor shall deliver to City all contract documents, information, works-in-progress and other property that are
or would be deliverables had the contract been completed. City shall pay Contractor for work performed prior to
the termination date if such work was performed in accordance with the Contract.
10. Independent Contractor Status: Contractor is an independent Contractor and not an employee of the City.
Contractor shall have the complete responsibility for the performance of this contract.
11. Non-discrimination Certification: The undersigned certifies that the undersigned Contractor has not discriminated
against minority, women or emerging small businesses enterprises in obtaining any required subcontracts.
Contractor further certifies that it shall not discriminate in the award of such subcontracts, if any. The Contractor
understands and acknowledges that it may be disqualified from bidding on this contract, including but not limited to
City discovery of a misrepresentation or sham regarding a subcontract or that the Bidder has violated any
requirement of ORS 279A.110 or the administrative rules implementing the Statute.
12. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an
asbestos abatement license.
13. Assignment and.Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work
without the written consent of City. Any attempted assignment or subcontract without written consent of 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 City of any assignment or subcontract shall not create any
contractual relation between the assignee or subcontractor and City.
14. Use of Recyclable Products: Contractor shall use recyclable products to the maximum extent economically feasible
in the performance of the contract work set forth in this document.
15. 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 it owes under the Contract; if it loses its QRF status pursuant to
the QRF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a
QRF if Contractor has qualified as a QRF for this 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 Contract; or attempts to assign rights in,
or delegate duties under, the Contract.
16. Insurance. Contractor shall at its own expense provide the following insurance:
a. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to
provide Oregon workers' compensation coverage for all their subject workers
b. General Liability insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000,000, $2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property
Damage. It shall include contractual liability coverage for the indemnity provided under this contract.
C. Automobile Liability insurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, $1,000,000, or Not Applicable for each accident for Bodily Injury and Property Damage,
including coverage for owned, hired or non-owned vehicles, as applicable.
d. 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 Contractor or its insurers to
Contract for Goods and Services Less than $25,000, Revised 06/30/2011, Page 2 of 5
the City.
e. Additional Insured/Certificates of Insurance. Contractor shall name The City of Ashland. Oregon, and its
elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only
with respect to Contractor's services to be provided under this Contract. As evidence of the insurance coverages
required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to commencing work
under this contract. The contractor's insurance is primary and non-contributory. The certificate will specify all of the
parties who are Additional Insureds. Insuring companies or entities are subject to the City's acceptance. If
requested, complete copies of insurance policies, trust agreements, etc. shall be provided to the City. The
Contractor shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self-
insurance.
17. Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws
of the State of Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines. Any claim, action, suit or
proceeding (collectively, "the claim") between the City (and/or any other or department of the State of Oregon) and
the Contractor that arises from or relates to this contract shall be brought and conducted solely and exclusively within
the Circuit Court of Jackson County for the State of Oregon. If, however, the claim must be brought in a federal
forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the
District of Oregon filed in Jackson County, Oregon. Contractor, by the signature herein of its authorized
representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this section be
construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United
States Constitution, or otherwise, from any claim or from the jurisdiction.
18. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE
PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT 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 CONTRACT.
CONTRACTOR, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT
HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND
CONDITIONS.
19. Nonappropriations Clause. Funds Available and Authorized: City has sufficient funds currently available and
authorized for expenditure to finance the costs of this contract within the City's fiscal year budget. Contractor
understands and agrees that City's payment of amounts under this contract attributable to work performed after the
last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow
City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract. In
the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this
contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further
liability to Contractor.
20. Prior Approval Required Provision. Approval by the City of Ashland Council or the Public Contracting Officer is
required before any work may begin under this contract.
21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by
reference.
Contract r: City of Ashland
By W l By 1Q2:
Signature Department Head
�pe Ru
W. S r m C-o1E tl�c1nAZ,—
Print Name Print Name
F�5t1 mADero R V\u � k r
Title Date
W-9 One copy of a W-9 is to be submitted with
the signed contract. Purchase Order No.
Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 3 of 5
EXHIBIT A
CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the
number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be
issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from
backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is
subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS
has notified it that it is no longer subject to backup withholding. Contractor further represents and
warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the
Contract, when executed and delivered, shall be a valid and binding obligation of Contractor
enforceable in accordance with its terms, (c) the work under the Contract shall be performed in
accordance with the highest professional standards, and (d) Contractor is qualified, professionally
competent and duly licensed to perform the work. Contractor also certifies under penalty of perjury
that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on
behalf of the entity designated above and authorized to do business in Oregon or is an independent
Contractor as defined in the contract documents, and has checked four or more of the following
criteria:
(1) 1 carry out the labor or services at,a location separate from my residence or is in a
specific portion of my residence, set aside as the location of the business.
(2) Commercial advertising or business cards or a trade association membership are
purchased for the business.
(3) Telephone listing is used for the business separate from the personal residence listing.
17 (4) Labor or services are performed only pursuant to written contracts.
(5) Labor or services are performed for two or more different persons within a period of one
/ year.
(6) 1 assume financial responsibility for defective workmanship or for service not provided
as evidenced by the ownership of performance bonds, warranties, errors and omission
insurance or liability insurance relating to the labor or services to be provided.
Contractor (Date)
Contract for Goods and Services Less than $25,000, Revised 06/30/2011, Page 4 of 5
CITY OF ASHLAND , OREGON
EXHIBIT B
City of Ashland
LIVING
WAGE
. .
per hour effective June 30, 2011
=, (Increases annually every June 30 by the
Consumer Price Index)
portion of business of their cafeteria plans(including
employer, if the employer has childcare) benefits to the
ten or more employees, and amount of wages received by
has received financial the employee.
assistance for the project or
➢ For all hours worked under a business from the City of ➢ Note: 'Employee"does not
service contract between their Ashland in excess of$18,890. include temporary or part-time
employer and the City of employees hired for less than
Ashland if the contract ➢ If their employer is the City of 1040 hours in any twelve-
exceeds $18,890 or more. Ashland including the Parks month period. For more
and Recreation Department. details on applicability of this
➢ For all hours worked in a
policy, please see Ashland
month if the employee spends ➢ In calculating the living wage, Municipal Code Section
50%or more of the employers may add the value 3.12.020.
employee's time in that month of health care, retirement,
working on a project or 401 K and IRS eligible
For additional information:
Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator, 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 predominantly in areas where it can be seen by all
employees.
CITY OF
ASHLAND
Contract for Goods and Services Less than $25,000, Revised 06/30/2011, Page 5 of 5
CERTIFICATE OF LIABILITY INSURANCE DATE
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 policypes)must be endorsed. H 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).
NITA
PRODUCER NAME: Susan Wilson, AAI, AIC
Beecher Carlson Insurance Agency T-1 PHONE (5d1)772-1111 AC No: (341)172-3785
707 Murphy Rd pp a .Susan.wilson8beelhercarlson.com
PRO cE 00005034
Medford OR 97504 I S AFFORDNOCOVERAOE NAM*
INSURED INSURERA:Travelers PrOP CAS CO Of AM 25674
esumsCharter Oak Fire Insurance Co 25615
Pacific Paving Inc JNEuRERc:1ndemnity Company of CA
PO Box 2370
INSURER o
INSURER E
White City OR 97503 :=RLF:
COVERAGES CERTIFICATE NUMBER:CL1131799660 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.
NTR TYPE OF INSURANCE POLICY NBER M
CI(EF POLIDrYYY
L UM LIMITS
GENERAL UAaILRY EACH OCCURRENCE S 1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES Me oau $ 300,000
A CLAIMS-MADE OCCUR ITC0526DS417TIL11 /20/2011 /20/2012 MED EXP(Any one person) $ 5,000
PERSONAL B ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG F 2,000,000
X POLICY PRO ECT- LOC $
AUTOMOBILE LIABILITY COMBNEO SINGLE LIMIT I 1,000,000
(Ea acdtlerd)
ANY AUTO —
B ALL ONNED AUTOS T810526D8417COP'll /20/2011 /20/2012 BODILY INJURY(Per person) i
BODILY INJURY(Pm ecadeN) i
X SCHEWLEDALITOS PROPERTY DAMAGE
X HIREDMITOS (Pwecddwt) s
X NON-OVAEDAUTOS Medoal Peymen5 $ 5,000
Collsion $
X UMBRELLA LM9 OCCUR EACH OCCURRENCE $ 1,000,000
EXCESS LIAB CLNMSMPDE AGGREGATE $ 1,000,000
DEDUCTIBLE f
A X RETENTION $ 10,000 1 rITSMUP526118417TIL11 /20/2011 /20/2012 t
AND EMPS COYPELI ATOM VrC STATIl- OTR-
ANOEMPLOYERS'LIA&CITY YIN LIM
ANY PROPRIEfORFARTNERIFJECUTIME E.L.EACH ACCIDENT $
OFFICEFYMEMBER EXCLUDED? NIA
(Mandetory In NH) E.L.DISEASE-EA EMPLO YE t
If yes,desaibe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LMIT i
C SOLI Bond (Statutory) 785448C /14/2011 /14/2012 LIMI 630,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHX:LES(Apart ACORD iN,Addlbonel Ibrrmea Schedule,If more spaaa le noul,.0
Certificate holder included as additional insured per attached endorsement eC('.D2460805 where required by written
contract. Subject to policy terms, conditions and exclusions.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Ashland, its elected officials, ACCORDANCE WITH THE POLICY PROVISIONS.
officers 6 employees
20 ]East Main Street AUTHORIZED REPRESENTATIVE
Ashland, OR 97520
S Wilson, AAI, AIC/SU �-- Lw.` t-�• /'2•ii�•�+��
ACORD 25(2009/09) O 1988-2009 ACORD CORPORATION. All rights reserved.
INS025(2001109) The ACORD name and logo are registered marks of ACORD
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
BLANKET ADDITIONAL INSURED
(CONTRACTORS)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. WHO IS AN INSURED—(Section II) is amended c) The insurance provided to the additional in-
to include any person or organization that you sured does not apply to "bodily injury" or
agree in a "written contract requiring insurance "property damage" caused by "your work"
to include as an additional insured on this Cover- and included in the "products-completed op-
age Part, but: erations hazard" unless the "written contract
a) Only with respect to liability for"bodily injury", requiring Insurance" specifically requires you
"property damage'or"personal injury; and to provide such coverage for that additional
insured, and then the insurance provided to
b) If, and only to the extent that, the injury or the additional insured applies only to such
damage Is caused by acts or omissions of "bodily Injury" or "properly damage" that oc-
you or your subcontractor In the performance curs before the end of the period of time for
of "your work° to which the "written contract which the "written contract requiring insur-
requiring insurance" applies. The person or ance" requires you to provide such coverage
organization does not qualify as an additional or the end of the policy period, whichever is
insured with respect to the independent ads earlier.
or omissions of such person or organization. 3. The insurance provided to the additional insured
2. The insurance provided to the additional insured by this endorsement is excess over any valid and
by this endorsement is limited as follows: collectible "other insurance, whether primary,
a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is
this Coverage Part shown in the Declarations available to the additional insured for a Ices we
exceed the limits of liability required by the cover under this endorsement. However, if the
'written contract requiring insurance", the in- 'written contract requiring Insurance" specifically
surance provided to the additional insured requires that this insurance apply on a primary
shall be limited to the limits of liability re- basis or a primary and non-contributory basis,
quired by that "written contract requiring in- this insurance is primary to "other insurance"
surance". This endorsement shall not in- available to the additional insured which covers
crease the limits of insurance described in that person or organization as a named insured
Section III—Limits Of Insurance. for such loss, and we will not share with that
b "other insurance". But the insurance provided to
) The insurance provided to the additional in-
sured does not apply to"bodily Injury", "prop- the additional insured by this endorsement still is
-
erty damage" or "personal injury" arising out excess over any valid and collectible tither in-
of the rendering of, or failure to render, any on any whether primary, excess, contingent i-
professional architectural, engineering or sur- on any other basis that is available a the on is
veying services, including: an adnsured when that person c organization is
an additional Insured under such "other insur-
1. The preparing, approving, or failing to ance".
prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the
ings, opinions, reports, surveys, field or- additional insured by this endorsement:
ders or change orders, or the preparing,
approving, or failing to prepare or ap- a) The additional insured must give us written
prove, drawings and specifications; and notice as soon as practicable of an "occur-
rence"
Supervisory, inspection, architectural or or an offense which may result in a
engineering activities. daim. To the extent possible, such notice
should include:
CG D2 46 08 05 0 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2
COMMERCIAL GENERAL LIABILITY
I. How, when and where the "occurrence" any provider of"other insurance"which would
or offense took place; cover the additional insured for a loss we
II. The names and addresses of any injured cover under this endorsement. However, this
persons and witnesses; and condition does not affect whether the insur-
ance provided to the additional insured by
III. The nature and location of any injury or this endorsement is primary to "other insur-
damage arising out of the"occurrence" or ance" available to the additional insured
offense. which covers that person or organization as a
b) If a claim is made or"suit" is brought against named insured as described in paragraph 3.
the additional insured, the additional insured above.
must: 5. The following definition is added to SECTION V.
I. Immediately record the specifics of the —DEFINITIONS:
claim or"suit'and the date received;and "Written contract requiring insurance" means
II. Notify us as soon as practicable. that part of any written contract or agreement
The additional insured must see to It that we under which you are required to include a
receive written notice of the claim or "suit" as person or organization as an additional at
soon as practicable. sured on this Coverage Part, provided that
the "bodily injury" and "property damage" oc-
c) The additional insured must immediately curs and the "personal injury" Is caused by an
send us copies of all legal papers received In offense committed:
connection with the claim or "suit", cooperate a. After the signing and execution of the
with us In the investigation or settlement of contract or agreement by you;
the claim or defense against the "suit", and
otherwise comply with all policy conditions. b. While that part of the contract or
d) The additional insured must tender the de- agreement is in effect; and
fense and Indemnity of any claim or "suit' to c. Before the end of the policy period.
Page 2 of 2 0 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05
4 � regon Department of Consumer and Business Services
l Insurance Division
350 Winter St NH
Th.,d.re K K.I.Wg 4 Coverour PO Box 14480,Salem,OR 97309-0405
503-947-7980
Fax:503-378-4351
www.insuranm.oregm.gov
CERTIFICATE OF INSURANCE ARTICLE
April 22,2010
Oregon insurance producers and industry representatives have advised the Insurance Division
that they are concerned about continuing pressure to modify certificates of insurance to satisfy
contracts that require a much broader extension of coverage than the policy will provide.
Certificates of insurance state that they are issued as a matter of information only, and confer no
rights upon the certificate holder. A certificate does not amend,extend or alter the coverage
afforded by the policies represented.
Oregon Revised Statute(ORS)742.003 addresses the filing and approval of policy forms.
Certificates of insurance are not considered part of the policy contract and are not required to be
filed. If a document is issued that alters the contract agreement in any way, an admitted
company would be required to have filed the change in the contract and have it approved prior to
changing the policy language and issuing a certificate.
The information on a certificate should represent the contract of insurance. There should be no
variation in the information presented on the certificate from the coverage or conditions that are
a part of that contract.
An insurance producer who issues a certificate of insurance that is not a representation of the
policy contract could be in violation of ORS 744.074(1)(e). The director has the authority to
place a producer on probation, or to suspend or revoke the license of a producer who
intentionally misrepresents the terms of an actual or proposed contract of insurance.
^ ,
^ BEECH
ER',, RLSO/ n
Why We Are Using the Latest ACORD 25 Certificate mfInsurance
In September 2009, ACORD revised the ACORD 25 Certificate of Insurance form. One of the major changes was
the removal of the cancellation notice provision. For the following reasons, we are unable to issue an older edition of
this form, modify the current form, or complete a proprietary form you provide:
versions can no longer be used. Therefore, it is illenal for us to issue anything other than the currently approved
• ACORD certificate forms must be filed and approved for use in our state. When a new form is approved, prior
• Notice of cancellation is a policy right, not an unregulated service. No insurer shown on this Certificate is able to
provide the cancellation notice you desire by endorsement. For example, the insured can cancel immediately, so
i1 would be impossible for the insurer to give you the notice you request. State law also grants the insurer the
right tn cancel for reasons such us nonpayment with less notice than you require.
• For the reason just cited, if our agency was to issue a certificate that provides the cancellation notice you
request, we would do so with the full knowledge that it would be impossible to actually give that amount of notice
under certain circumstances. As such, the certificate could be alleged to constitute a misrepresentation or fraud
which could subject our agency and staff tn serious civil and criminal penalties.
• If a certificate purports to provide a policy right different from that provided by the policy itself, then the certificate
effectively purports to be a policy form- Policy forms must be filed and approved by our state department of
insurance- Use of nonfiled policy forms is illegal and could result in legal sanctions distinct from the assertion
that the certificate isfraudulent.
• Under the ACORD Corporation's licensing agreement, the prior editions of superseded forms ran be used for
one year from the time the new forms are introduced. Beginning in September 2010, this is another reason we
cannot use an older edition of the ACORD 25. Doing so would violate ACORD's licensing agreement and, as a
copyrighted document, federal copyright law.
• Likewise, we are unable to modify the new certificate to add a notice of cancellation. ACORD forms are
designed to be completed, not altered. ACORD's Forms Instruction Guide says that a certificate should not be
used "To waive rights...To quote wording from a contract...To quote any wording which amends a policy unless
the policy itself has been omended."Also. since our state requires ACORD forms to be filed, any alteration to a
filed form would require As refilino. In addition, our insurance company contracts only allow us to issue unaltered
8QORDfbrmn.
• We are often asked to issue proprietary certificates provided by the certificate requestor. Again, our insurance
company contracts only allow untn issue unaltered A(}ORDforms. In addition, our state reouires the filina of all
certificates of insurance and has very specific reaulatory nuidelines;n certificate lannuane- Many proprietary
certificates include broad, vague ov ambiguous language that may nr may not be|nnomp|iunuewrth state laws,
regulations, and insurance department directives. Therefore, we cannot issue any proprietary certificates that
have not been reviewed by our state insurance department.
Several states have voiced strong concern over certificates as evidenced In below links:
• Oregon Insurance Dept:
• Atlanta, Georgia: See detailed study they Conducted in2O08
• Click following link for current update bystate:
We appreciate your understanding of the legal restrictions on our ability to fully comply with your request.
22VNN/2nd Ave Ste 800 Pmftou,OR 97209-1831 (503)222-1831 Main (503)274-0323 Fax
CA License won0961o0R License*w1aa07 WA License*2522o4
www.saif.com
OREGON WORKERS COMPENSATION �� sai F
CERTIFICATE OF INSURANCE ,corporation
CERTIFICATE HOLDER:
CITY OF ASHLAND
ATTN: KARI OLSON PURCHASING
90 N. MOUNTAIN AVE.
ASHLAND, OR 97520
The policy of insurance listed below has been issued to the insured named below for the
policy period indicated. The insurance afforded by the policy described herein is subject to
all the terms, exclusions and conditions of such policy.
POLICY NO. POLICY PERIOD ISSUE DATE
812919 10/01/2011 to 10/01/2012 11/02/2011
INSURED: BROKER OF RECORD:
PACIFIC PAVING INC KPD INSURANCE INC
PO BOX 2370 PO BOX 29
WHITE CITY, OR 97503-0370 SPRINGFIELD, OR 97477
LIMITS OF LIABILITY:
Bodily Injury by Accident $500,000 each accident
Bodily Injury by Disease $500,000 each employee
Body Injury by Disease $500,000 policy limit
DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS:
IMPORTANT:
The coverage described above is in effect as of the Issue date of this certificate. It is subject to change
at any time in the future.
This certificate is issued as a matter of information only and confers no rights to the certificate
holder. This certificate does not amend, extend or alter the coverage afforded by the policies above.
AUTHORIZED REPRESENTATIVE
President and CEO
400 High Street SE
Salem,OR 97312
P:800.285.8525
F:503.373.8020
Polity_certifimtes_certinute0nnsumnm
www.saii.mm
OREGON WORKERS COMPENSATION Sal
CERTIFICATE OF INSURANCE lcorporation
MAIL TO: CERTIFICATE HOLDER:
PACIFIC PAVING INC CITY OF ASHLAND
PO BOX 2370 ATTN: KARI OLSON PURCHASING
WHITE CITY, OR 97503-0370 REPRESENTATIVE
90 N. MOUNTAIN AVE.
ASHLAND, OR 97520
The policy of insurance listed below has been issued to the insured named below for the
policy period indicated.The insurance afforded by the policy described herein is subject to
all the terms, exclusions and conditions of such policy.
POLICY NO. POLICY PERIOD ISSUE DATE
812919 10/01/2011 to 10/01/2012 11/02/2011
INSURED: BROKER OF RECORD:
PACIFIC PAVING INC KPD INSURANCE INC
PO BOX 2370 PO BOX 29
WHITE CITY, OR 97503-0370 SPRINGFIELD, OR 97477
LIMITS OF LIABILITY:
Bodily Injury by Accident $500,000 each accident
Bodily Injury by Disease $500,000 each employee
Body Injury by Disease $500,000 policy limit
DESCRIPTION OF OPERATIONS/LOCATIONS/SPECIAL ITEMS:
IMPORTANT:
The coverage described above is in effect as of the issue date of this certificate. It is subject to change
at any time in the future.
This certificate is issued as a matter of information only and confers no rights to the certificate
holder. This certificate does not amend, extend or alter the coverage afforded by the policies above.
AUTHORIZED REPRESENTATIVE
3r69e!P. f> R444i►—�
President and CEO
400 High Street SE
Salem,OR 97312
P:800.285.8525
F:503.373.8020
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