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HomeMy WebLinkAbout2021-017 PO 20210361- Jahnke Heating & Air • FrAll CITY RECSFIDtiiPurchase Order Fiscal Year 2021 Page: 1 of: 1 BCity of Ashland • iot;�+ t i- iii�r EATTN:Accounts Payable 20 E. Main Purchase r�O r� 0 Ashland, OR 97520 Order# L L T 361 Phone: 541/552-2010 • O Email: payable@ashland.or.us V E JAHNKE HEATING &AIR H C/O Facilities Maintenance Div 90 North Mountain Ave ND PO BOX 660 I TALENT, OR 97540 • p Ashland, OR 97620 p Phone:541/488-5358 R 0 Fax: 541/552-2304 t I I I ,-�LI I!e tKl�_I t= r1 Til t _ lr_! i'YI [- _ D_avid Arnold ll�_ 11.1 IT'mi I_t .t_i 05/21/2021 FOB SHLAND OR CI AccountsPavable Repair HVAC Fire Station#1 1 Repair of HVAC roof top Unit#5 at Fire Station#1 1.0 $4,500.00 $4,500.00 Goods and Services Agreement(less than$25;000) • Completion date: June 30,2022 Project Account: ***************GL SUMMARY******kk******* 082400-602400 $4,500.00 • J • • • By: Date:Ø7Cu12". Authorized Signature r, t:Tin _ =T= •.4 500.00 FORM #3 ( -- 6 CITY OF A row lli):;r,'ir))' i.p,,,,,.1.3,, t))'iI ;i' • REQUIISIITIION Date of request: 5/13/2021 { Required date for delivery: : i I Vendor Name Jahnke Healing and Alr Conditioning.inc. Address,City,State,Zi Y I 112 South Pacific Highway.Talent.OR 97640 Contact Name&Telephone Number Maureen Hunt 641-635-4470 Email address SOURCING METHOD ❑ Exempt from Competitive Dktdin11 El pmerrlency ❑ Reason for exemption: ❑ Invitation to Bic( ❑ Form 1113,Written findings and Authorization 0 AMC 2,60 Date approved by Council: ❑ Written quote or proposal attached flWritten quote or proposal attached (Attach copy of council communication) (If council approval required,attach copy of CC) Small Procuroment ❑ Rearrest for Proposal Coonerativo Procurement Not exceedinn$5.000 Dale approved by Coundl: 0 Slate of Oregon El Direct Award _(Attach copy of council communication) Contract 11 El VerbalIVVrlllen quole(s)or proposal(s) 0 Beeriest for Qualifications(Public Works) El Slate of Washington Date approved by Council: Contract 11 • (Attach copy of council communication) ❑ Other government agency contract Intermediate Procurement ❑ Sole Source Agency . GOODS&SERVICES • U Applicable Form(115,6,7 or 8) Contract II Greater than$ .000 and lass than$100.000 ❑ Written quote or proposal attached Intergovernmental Agreement . O (3)Men quotes and eolloitafon attached 0 Form 114,Personal Services>$61(&<$76K Agency PERSONAL SERVICES 0 Special Procurement [l Annual cost to City does not ekceed$25,000. Greater than S5.000 and less than$75.000 ❑ Form 119,Request for Approval Agreement approved by Legal and approved/signed by El Direct appointment not to exceed$35,000 ❑ Written quote or proposal attachedCity Administrator.AMC 2.60.070(4) • : El (3)Written proposals/written solicitation Date approved by Council: 0 Annual cosi to Clly exceeds$26,000,Council • ❑ Form 114,Personal Services>$5K&<$751( Valid until: (Date) approval required,(Attach copy of council commundoalton) • Description of SERVICES Total Cost . Repair of HVAC.Roof Top Unit#6 at Fire Station 1 $4,500,00 Item ft quantity Unit Description of MATERIALS Unit Price Total Cost •• • ❑ Per attached quote/proposal TOTAL COST $ Project Number _ Account Number 002400-602400 'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. . ' IT Director In collaboration with department to approv:all-hardware and software purchases: IT Director Date Support-Yes/No By signing this requisition 10SW that the CRy's p ; c con!doling requirements have been satisfied. Employee: . – - —di/ `. Deparhnent Heacl: "�-4 51��Z -j at loorgr ate rtitan$5,000) Department Manage 1Supervisor: City Administrator: r quarto rgroatertlran;28,000) Funds appropriated for current/!scat year. a NO r— 7 . Deputy Mance Director-(Equal to orfires calm ,000) Date Comments: • P01111113-Requisition • GOODS AND SERVICES AGREEMENT(LESS THAN$25,000) PROVIDER: Jahnke Heating and Air Conditioning,Inc. CITY OF PROVIDER'S ASH LAND CONTACT: Maureen Hunt 20 East Main Street Ashland,Oregon 97520 ADDRESS: 112 South Pacific Highway Telephone: 541/488-5587 Talent, OR 97540 Fax: 541/488-6006 PHONE: 541-535-4470 This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation(hereinafter "City") and Jahnke Heating and Air Conditioning,Inc., (a domestic/foreign business corporation) ("hereinafter"Provider"),for HVAC repair. 1. PROVIDER'S OBLIGATIONS 1.1 Provide repair of HVAC roof top unit #5 at Fire Station 1 as set forth in the "SUPPORTING DOCUMENTS" attached hereto and, by this reference, incorporated herein. Provider expressly acknowledges that time is of the essence of any completion date set forth in the SUPPORTING DOCUMENTS,and that no waiver or extension of such deadline may be authorized except in the same manner as herein provided for authority to exceed the maximum compensation. The services defined and described in the "SUPPORTING DOCUMENTS" shall hereinafter be collectively referred to as "Work." 1.2 Provider shall obtain and maintain during the term of this Agreement and until City's final acceptance of all Work received hereunder,a policy or policies of liability insurance including commercial general liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 (two million dollars)per occurrence for Bodily Injury and Property Damage. 1.2.1 The insurance required in this Article shall include the following coverages: • Comprehensive General or Commercial General Liability, including personal injury, contractual liability,and products/completed operations coverage; and • Automobile Liability. • Workers' Compensation 1.2.2 Each policy of such insurance shall be on an"occurrence"and not a"claims made"form,and shall: • Name as additional insured "the City of Ashland, Oregon, its officers, agents and employees" with respect to claims arising out of the provision of Work under this Agreement; • Apply to each named and additional named insured as though a separate policy had been issued to each,provided that the policy limits shall not be increased thereby; • Apply as primary coverage for each additional named insured except to the extent that two or more such policies are intended to "layer" coverage and, taken together, they provide total coverage from the first dollar of liability; • Provider shall immediately notify the City of any change in insurance coverage Page 1 of 6: Goods and Services Agreement between the City of Ashland and Jahnke Heating and Air Conditioning,Inc. 3 • Provider shall supply an endorsement naming the City, its officers,employees and agents as additional insureds by the Effective Date of this Agreement; and • Be evidenced by a certificate or certificates of such insurance approved by the City. 1.3 Provider shall, at its own expense, maintain Worker's Compensation insurance in compliance with ORS 656.017,which requires subject employers to provide workers' compensation coverage for all of its subject workers. 1.4 Provider agrees that no person shall, on the grounds of race, color, religion, creed, sex, marital status, familial status or domestic partnership, national origin, age, mental or physical disability, sexual orientation, gender identity or source of income, suffer discrimination in the performance of this Agreement when employed by Provider. Provider agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. Further,Provider agrees not to discriminate against a disadvantaged business enterprise, minority-owned business, woman- owned business, a business that a service-disabled veteran owns or an emerging small business enterprise certified under ORS 200.055,in awarding subcontracts as required by ORS 279A.110. 1.5 In all solicitations either by competitive bidding or negotiation made by Provider for work to be performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Providers of the Provider's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 1.6 Living Wage Requirements: If the amount of this Agreement is $22,002.43 or more, Provider is required to comply with Chapter 3.12 of the Ashland Municipal Code by paying a living wage, as defined in that chapter, to all employees performing Work under this Agreement and to any Subcontractor who performs 50%or more of the Work under this Agreement. Provider is also required to post the notice attached hereto as "Exhibit A" predominantly in areas where it will be seen by all employees. 1.7 Assignment: Provider shall not assign this Agreement or subcontract any portion of the Work to be provided hereunder without the prior written consent of the City. Any attempted assignment or subcontract without written consent of the City shall be void. Provider shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all persons employed by them,and the approval by the City of any assignment or subcontract shall not create any contractual relation between the assignee or subcontractor and the City. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider the sum of$4,500(could be hourly rate OR lump sum amount—please refer to Proposal) as provided herein as full compensation for the Work as specified in the SUPPORTING DOCUMENTS. 2.2 In no event shall Provider's total of all compensation and reimbursement under this Agreement exceed the sum of$5,000.00, five thousand dollars without express, written approval from the City official whose signature appears below,or such official's successor in office. Provider expressly acknowledges that no other person has authority to order or authorize additional Work which would cause this maximum sum to be exceeded and that any authorization from the responsible official must be in writing. Provider further acknowledges that any Work delivered or expenses incurred without authorization as provided herein is done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement. Page 2 of 6: Goods and Services Agreement between the City of Ashland and Jahnke Heating and Air Conditioning,Inc. 3. GENERAL PROVISIONS 3.1 This is a non-exclusive Agreement. City is not obligated to procure any specific amount of Work from Provider and is free to procure similar types of goods and services from other providers in its sole discretion. 3.2 Provider is an independent contractor and not an employee or agent of the City for any purpose. 3.3 Provider is not entitled to,and expressly waives all claims to City benefits such as health and disability insurance,paid leave,and retirement. 3.4 This Agreement embodies the full and complete understanding of the parties respecting the subject matter hereof. It supersedes all prior agreements,negotiations,and representations between the parties, whether written or oral. 3.5 This Agreement may be amended only by written instrument executed with the same formalities as this Agreement. 3.6 The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220,279B.230 and 279B.235. 3.7 This Agreement shall be governed by the laws of the State of Oregon without regard to conflict of laws principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is in federal court, in which case exclusive venue shall be in the federal district court for the district of Oregon. Each party expressly waives any and all rights to maintain an action under this Agreement in any other venue,and expressly consents that, upon motion of the other party, any case may be dismissed or its venue transferred,as appropriate,so as to effectuate this choice of venue. 3.8 Provider shall defend, save, hold harmless and indemnify the City and its officers, employees and agents from and against any and all claims, suits, actions, losses, damages, liabilities, costs, and expenses of any nature resulting from, arising out of, or relating to the activities of Provider or its officers,employees,contractors,or agents under this Agreement. 3.9 Neither party to this Agreement shall hold the other responsible for damages or delay in performance caused by acts of God, strikes, lockouts, accidents, or other events beyond the control of the other or the other's officers,employees or agents. 3.10 If any provision of this Agreement is found by a court of competent jurisdiction to be unenforceable, such provision shall not affect the other provisions, but such unenforceable provision shall be deemed modified to the extent necessary to render it enforceable, preserving to the fullest extent permitted the intent of Provider and the City set forth in this Agreement. 3.11 Deliveries will be F.O.B destination.Provider shall pay all transportation and handling charges for the Goods. Provider is responsible and liable for loss or damage until final inspection and acceptance of the Goods by the City. Provider remains liable for latent defects,fraud,and warranties. 3.12 The City may inspect and test the Goods. The City may reject non-conforming Goods and require Provider to correct them without charge or deliver them at a reduced price, as negotiated. If Provider does not cure any defects within a reasonable time, the City may reject the Goods and cancel this Page 3 of 6: Goods and Services Agreement between the City of Ashland and Jahnke Heating and Air Conditioning,Inc. Agreement in whole or in part. This paragraph does not affect or limit the City's rights, including its rights under the Uniform Commercial Code,ORS Chapter 72(UCC). 3.13 Provider represents and warrants that the Goods are new, current, and fully warranted by the manufacturer. Delivered Goods will comply with SUPPORTING DOCUMENTS and be free from defects in labor,material and manufacture. Provider shall transfer all warranties to the City. 4. SUPPORTING DOCUMENTS The following documents are, by this reference, expressly incorporated in this Agreement, and are collectively referred to in this Agreement as the "SUPPORTING DOCUMENTS:" • The Provider's hourly rate sheet. • The Provider's firm price bid(s)for each individual project. 5. REMEDIES 5.1 In the event Provider is in default of this Agreement, City may, at its option, pursue any or all of the remedies available to it under this Agreement and at law or in equity, including,but not limited to: 5.1.1 Termination of this Agreement; 5.1.2 Withholding all monies due for the Work that Provider has failed to deliver within any scheduled completion dates or any Work that have been delivered inadequately or defectively; 5.1.3 Initiation of an action or proceeding for damages, specific performance, or declaratory or injunctive relief; 5.1.4 These remedies are cumulative to the extent the remedies are not inconsistent, and City may pursue any remedy or remedies singly,collectively, successively or in any order whatsoever. 5.2 In no event shall City be liable to Provider for any expenses related to termination of this Agreement or for anticipated profits. If previous amounts paid to Provider exceed the amount due, Provider shall pay immediately any excess to City upon written demand provided. 6. TERM AND TERMINATION 6.1 Term This Agreement shall be effective from the date of execution on behalf of the City as set forth below (the "Effective Date") and shall continue in full force and effect until June 30, 2022, unless sooner terminated as provided in Subsection 6.2. 6.2 Termination 6.2.1 The City and Provider may terminate this Agreement by mutual agreement at any time. 6.2.2 The City may, upon not less than thirty(30)days' prior written notice,terminate this Agreement for any reason deemed appropriate in its sole discretion. 6.2.3 Either party may terminate this Agreement,with cause, by not less than fourteen(14)days' prior written notice if the cause is not cured within that fourteen (14) day period after written notice. Such termination is in addition to and not in lieu of any other remedy at law or equity. 7. NOTICE Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery, by sending via a reputable commercial overnight courier, or by mailing using registered or certified United States mail, return receipt requested,postage prepaid, to the address set forth below: If to the City: Page 4 of 6: Goods and Services Agreement between the City of Ashland and Jahnke Heating and Air Conditioning,Inc. City of Ashland Facilities Maintenance Department Attn: David Arnold 20 E.Main Street Ashland, Oregon 97520 Phone: (541)552-2292 With a copy to: City of Ashland—Legal Department 20 E.Main Street Ashland, OR 97520 Phone: (541)488-5350 If to Provider: Jahnke Heating and Air Conditioning,Inc. Attn:Maureen Hunt 541-535-4470 8. WAIVER OF BREACH One or more waivers or failures to object by either party to the other's breach of any provision, term, condition, or covenant contained in this Agreement shall not be construed as a waiver of any subsequent breach,whether or not of the same nature. 9. PROVIDER'S COMPLIANCE WITH TAX LAWS 9.1 Provider represents and warrants to the City that: 9.1.1 Provider shall,throughout the term of this Agreement, including any extensions hereof, comply with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317,and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider;and (iii) Any rules,regulations,charter provisions,or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.1.2 Provider,for a period of no fewer than six(6)calendar years preceding the Effective Date of this Agreement, has faithfully complied with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317,and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider; and (iii) Any rules,regulations,charter provisions,or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.2 Provider's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Provider's warranty, as set forth in this Article 9, shall constitute a material breach of this Agreement. Any material breach of this Agreement shall entitle the City to terminate this Agreement and to seek damages and any other relief available under this Agreement, at law,or in • equity. Page 5 of 6: Goods and Services Agreement between the City of Ashland and Jahnke Heating and Air Conditioning,Inc. IN WITNESS WHEREOF the parties have caused this Agreement to be signed in their respective names by their duly authorized representatives as of the dates set forth below. CITY OF ASHLAND: Jahnke Heating and Air Conditioning,Inc. (PROVIDER): By: ►'' By. afti A Signature Seer F'-EU I Printed Name rnOJ.-Y edit\ H Wnt-I- • Printed Name puouworms ¢tc-mL. CCP).C� In'101x�l (fv Title Title SI1712024 Date t • 1t ' 2_I Date (W-9 is to be submitted with this signed Agreement) Purchase Order No. /D 6 / Page 6 of 6: Goods and Services Agreement between the City of Ashland and Jahnke Heating and Air Conditioning,Inc. • r Jahnke Heating &Air Inc Estimate 22888179 • • Box 660 HEATING t' TalenOt, OR 97540 Job 5/10/20 5 Estimate Date 5/10/2021 AIR CONDITIONING Inc. 541-535-4470 541-779-8496 Customer PO Billing Address Job Address CITY OF ASHLAND OR FIRE STATION 1 20 E MAIN ST 455 Siskiyou Boulevard ASHLAND,OR 97520 Ashland,OR 97520 USA Estimate Details Replace Compressor Task# Description Quantity Your Price Your Total T610042 Compressor Change out- Package unit located on rooftop 1.00 $4,500.00 $4,500.00 Labor and materials to replace compressor-.Includes torch materials,recovery, evacuation,liquid line filter drier,conversion kit,and R-22 refrigerant. The compressor is the heart of an air conditioning system and it operates at very high temperatures and very high pressures.This stress on the system can cause electrical or mechanical failures and when that occurs the compressor needs to be replaced. • Potential Savings $675.10 Sub-Total $4,500.00 Tax $0.00 Total $4,500.00 We appreciate your business!Thank you for choosing Jahnke Heating&Air! .1,the undersigned,am owner/authorized representative of the premises at which the work described is to be done.I hereby authorize you to perform said work and to use such labor and materials as you deem advisable.I agree that the price given below is a complete price for all work stated,with no breakdown of material and labor to be provided.I agree to pay reasonable attorney's fees and court costs in the event of legal action.I have read and agree to all the terms set forth,and have received a copy of the contract and Notice to Owner(x)xxxx),I hereby authorize you to proceed with described work at a contract price of$4,500.00,which will be DUE UPON COMPLETION,unless a Purchasing Agreement has been approved,in which the terms of the Purchasing Agreement will apply. A CERTIFICATE OF LIABILITY INSURANCE DATEOS/tiozl1A/n021 YI OS/11/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS • CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR • PRODUCER,AND THE CERTIFICATE HOLDER. • IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have.ADDITIONAL INSURED provisions or be endorsed. If • SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PR NAME OT CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE:P.O.BOX 328 IA/C.tie.Ext):888-333-4949 FAX He):507-446-4664 OWATONNA,MN 55060 ADDRESS:CLIENTCONTACTCENTERaFEDINS.COM INSURERS)AFFORDING COVERAGE NAIL INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 366-839-9 INSURER B: JAHNKE HEATING&AIR CONDITIONING INC INSURER C: PO BOX 660 TALENT,OR 97540-0660 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:95 REVISION NUMBER:0 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. 1NSR ADDL SUER POLICY Eff POLICY EXP LTR TYPE OF INSURANCE (NSR WVD POLICY NUMBER (MMIDDIV & (MMIDDIYYW) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 �I�X� DAMAGE TO RENTED $100,000 CLAIMS-MADE 1"-1 OCCUR PREMISES(Ea occurmnee) MED EXP(Any one person) EXCLUDED A Y N 9089608 04/08/2021 04/08/2022 PERSONALS ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- X POLICY JECT I n I LOC PRODUCTS•COMP/OP AGO $2,000,000 OTHER: AUTOMOBILE LIABILITY (Ee erB-cldend INGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) —SCHEDULED A _OWNED AUTOS ONLY AUTOS Y N 9089608 04/08/2021 04/08/2022 BODILY INJURY(Per accldenilNON-O NED HIRED AUTOS ONLY _AUTOS ONLY PROPERTY DAMAGE AUTOS GNLY (Par eccidenil X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $1,000,000 A EXCESS LIAB CLAIMS-MADE N N 9089609 04/08/2021 04/08/2022 AGGREGATE $1,000,000 DED I (RETENTION WORKERS COMPENSATION 0TH- AND EMPLOYERS LIABILITY PER STATUTE ER Y/1 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? N I A (Mandatory In NH) EL DISEASE-EA EMPLOYEE It yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE•POLICY LIMIT DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached II mare space Is required) SEE ATTACHED PAGE CERTIFICATE HOLDER CANCELLATION 366-839-9 95 0 CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 E MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN ASHLAND,OR 97520-1814 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE • ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1 AGENCY CUSTOMER ID: 365-839-9 LOC##: ACORD® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AOENCY NAMED INSURED FEDERATED MUTUAL INSURANCE COMPANY JAHNKE HEATING&AIR CONDITIONING INC POLICY NUMBER PO BOX 660 SEE CERTIFICATE##95.0 TALENT,OR 97540-0660 CARRIER NAIL CODE SEE CERTIFICATE##95.0 EFFECTIVE DATE:SEE CERTIFICATE##95.0 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE ADDITIONAL INSURED ALSO INCLUDES THE CITY OF ASHLAND, OREGON, ITS OFFICERS, AGENTS AND EMPLOYEES THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT ENDORSEMENT FOR BUSINESS AUTO LIABILITY. INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. ACORD 101(2008101) ©2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. WHO IS AN INSURED for"bodily injury"and "property damage" liability is amended to include: Any person or organization other than a joint venture, for which you have agreed by written contract to procure bodily injury or property damage "auto" liability insurance arising out of operation of a covered "auto"with your permission. However,this additional insurance does not apply to: (1) The owner or anyone else from whom you hire or borrow a covered "auto". This exception does not apply if the covered "auto" is a "trailer"connected to a covered "auto"you own. (2) Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household. (3) Someone using a covered "auto" while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours. (4) Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees", while moving property to or from a covered "auto". (5) A partner (if you are a partnership), or a member (if you are a limited liability company) for a covered "auto"owned by him or her or a member of his or her household. B. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached. 'I In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any insured, or to procure insurance. C. The limits of insurance applicable to such insurance shall be the lesser of the limits required by the agreement between the parties, or the limits provided by this policy. D. Additional exclusions. The insurance afforded to any person or organization as an insured under this endorsement does not apply: 1. To "loss" which occurs prior to the date of your contract with such person or organization; 2. To "loss" arising out of the sole negligence of any person or organization that would not be an insured except for this endorsement. 3. To "loss" for any leased or rented "auto" when the lessor or his or her agent takes possession of the leased or rented "auto"or the policy period ends,whichever occurs first. Includes copyrighted material of Insurance Services Office, Inc. with its permission. CA-F-127 (03-03) Policy Number: 9089608 Transaction Effective Date:04-08-2021 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract Condition and supersedes any provision to the or agreement that this insurance would be contrary: primary and would not seek'contribution Primary And Noncontributory Insurance from any other insurance available to the This insurance is primary to and will not seek additional insured. contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and © Insurance Services Office, Inc., 2018 Page 1 of 1 CG 20 01 12 19 Policy Number: 9089608 Transaction Effective Date:04-08-2021 COMMERCIAL GENERAL LIABILITY CG.20 33 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or additional insureds, the following additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to: organization have agreed in writing in a contract 1. "Bodily injury", "property damage" or or agreement that such person or organization be "personal and advertising injury" arising out added as an additional insured on your policy. of the rendering of, or the failure to render, Such person or organization is an additional insured only with respect to liability for "bodily any professional architectural, engineering or injury", "property damage" or "personal and surveying services, including: advertising injury" caused, in whole or in part, by: a. The .preparing, approving, or failing to 1. Your acts or omissions; or prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, 2. The acts or omissions of those acting on your change orders or drawings and behalf; specifications; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. However, the insurance afforded to such This exclusion applies even if the claims additional insured: against any insured allege negligence or other 1. Only applies to the extent permitted by law; wrongdoing in the supervision, hiring, and employment, training or monitoring of others 2. Will not be broader than that which you are by that insured, if the "occurrence" which required by the contract or agreement to caused the "bodily injury" or "property provide for such additional insured. damage", or the offense which caused the A person's or organization's status as an "personal and advertising injury", involved the additional insured under this endorsement ends rendering of or the failure to render any when your operations for that additional insured professional architectural, engineering or are completed. surveying services. j C © Insurance Services Office, Inc., 2018 Page 1 of 2 CG 20 33 12 19 Policy Number: 9089608 Transaction Effective Date:04-08-2021 2. "Bodily injury" or "property damage" C. With respect to the insurance afforded to these occurring after: additional insureds, the following is added to a. All work, including materials, parts or Section III -Limits Of Insurance: equipment furnished in connection with The most we will pay on behalf of the additional such work, on the project (other than insured is the amount of insurance: service, maintenance or repairs) to be 1. Required by the contract or agreement you performed by or on behalf of the additional have entered into with the additional insured; insured(s) at the location of the covered or operations has been completed; or 2. Available under the applicable limits of b. That portion of "your work" out of which insurance; the injury or damage arises has been put whichever is less. to its intended use by any person or organization other than another contractor This endorsement shall not increase the or subcontractor engaged in performing applicable limits of insurance. operations for a principal as a part of the same project. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 33 12 19 Policy Number: 9089608 Transaction Effective Date:04-08-2021 • COMMERCIAL GENERAL LIABILITY POLICY NUMBER: Policy# ISSUE DATE: 4/12/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s)or Organization(s): City of Ashland 20'East Main Street Ashland OR 97520 Section II—Who Is An insured Is amended to include as an additional Insured the person(s)or organizations) shown in the Schedule,but only with respect to liability for"bodily injury","property damage", "personal Injury"or "advertising injury"caused,in whole or in part,by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations;or B. In connection with your premises owned by or rented to you. CG D4 11 04 08 02008 The Travelers Companies,Inc, Page 1 of 1 Includes the copyrighted material of Insurance Services Office,Inc.with Its permission. 48128859 1 18/19 SAMPLE CEET1PICATE 1 Sandy L. Orr 1 4/13/2019 4,21106 PH (PDT) 1 Page 2 OL 3 4 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following Is added to Paragraph c.in A.1., Who between you and that person or organization,that is Is An Insured, of SECTION II—COVERED AUTOS signed by you before the"bodily Injury" or"property LIABILITY COVERAGE in the BUSINESS AUTO damage"occurs and that Is In effect during the policy COVERAGE FORM and Paragraph e.In A.1.,Who Is period,to name as an additional Insured for Covered An Insured, of SECTION II — COVERED AUTOS Autos Liability Coverage, but only for damages to LIABILITY COVERAGE In the MOTOR CARRIER which this insurance applies and only to the extent of COVERAGE FORM, whichever Coverage Form is that person's or organization's liability for the conduct part of your policy: of another"Insured". This includes any person or organization who you are required under a written contract or agreement CA T4 37 02113 02018 The Travelers Indemnity Company.AU rights reserved. Page 1 of I Inctudsa copyrighted material of Insurance Services orgne,Inc.with Its permission. 40128059 118/18 SAMPLE CERTIPICATE 1 Sandy L. Orr 14/12/2019 4,21105 PM (POTJ 1 PAge 3 08 3 v BEISI 912215 May 11, 2021 JAHNKE HEATING &AIR CONDITION 7675 4TH ST WHITE CITY, OR 97503-6648 Re: Barrett Business Services, Inc. ("BBSI") Letter of Self-Insurance for Workers' Compensation Coverage As the named addressee of this Letter, your company's required workers' compensation coverage is provided through BBSI's state approved Self-Insured Workers' Compensation Plan by way of your co-employment contract with BBSI. Additional information is as follows: State: Oregon Workers'Compensation Limits: Employer Liability Limits: Self Insurance Certification #: 1068 Statutory $5,000,000.00 Each Accident $5,000,000.00 Disease Coverage Limit by Client $5,000,000.00 Disease; Each Employee Other Comments(place an"X"if applicable): X Named"Letter Holder": City of Ashland 90 North Mountain Avenue Ashland, OR 97520 X Other: Effective 5/1/2020 through 4/30/2022. Subject to 30 days notice of cancellation. Additionally, BBSI's self-insured program is further supported by an excess workers'compensation insurance policy with ACE American Insurance Co.. Copy of certificate is available upon request. For additional information, please contact your local BBSI office at: MEDFORD (541)772-5469 2045 Cardinal Way Suite 100 Very truly yours, Medford, OR 97504 Gary Kramer President and Chief Executive Officer doc:LOSI-2