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HomeMy WebLinkAbout2021-028 PO 20210381- Cole, John Purchase Order lD' ? Fiscal Year 2021 Page: 1 of: 1 It ! `I liTll_i Ltd F W,l Ls_c a7i!E-ic T Ili I 2'1;1 1 !_'I F I Q CPIIA. � B City of Ashland I ATTN: Accounts Payable L 20 E. Main • Purchase 20210381 L Ashland, OR 97520 Order# T Phone: 541/552-2010 O Email: payable@ashland.or.us V H C/O Fire and Rescue Department E COLE, JOHN l 455 Siskiyou Blvd N 207 W 110TH ST#31 p Ashland, OR 97520 O NEW YORK, NY 10026 T Fax 541/482-2770 41541/44 2- 770 R 8 - O f : 1 } _]tl It ---_ T _ _ Chris Chambers ill�l f ({%i-(1� }�„[131f I _2_,06/25/2021 6194 - Cit Accounts Pa able Ce t- F-,-- —L-1 :-_I-1 - Video Production Work 1 Proposal for film with the Ashland Fire Department about the new 1.0 $8,000.00 $8,000.00 PODs Program Services Agreement(Less than $25,000) Completion date: May 31, 2021 Project Account: E-G00005-400 Project Account: E-G00015-999 ***************GL SUMMARY*************** 072900-604160 $5,000.00 072900-610355 $3 000.00 • • By:* 4 Date: _ Authorized Signature _ t }I •8 000.00 9 rk I FORM #3 i/ CITY OF if � i -AS H LAN IIS A request for a PLlrchas.. l rfri REQUISITION . y7ol Gf *? el request: 0611112021 `` required date for delivery: 0611612021: • Vendor Name johncole.co,Ile Address,City,State,Zip 207 W.110th St,Suite 31,New York,NY 10026 Contact Name&Telephone Number John Cole 541-282-4874 Email address john@johncole.co SOURCING METHOD 0 Emergency ❑ Exempt from Competitive Bidding 0 Invitation to Bid ❑ Reason for exemption: Date approved by Council: 0 Form#13,Written findings and Authorization ❑ AMC 2.50 _(Attach copy of council communication) 0 Written quote or proposal attached ❑ Written quote or proposal attached _(If council approval required,attach copy of CC) ❑ Small Procurement 0 Request for Proposal Cooperative Procurement Not exceeding$5,000 Date approved by Council: ❑ State of Oregon ❑ Direct Award . _(Attach copy of council communication) Contract# ❑ VerballWritten bid(s)or proposal(s) 0 Request for Qualifications(Public Works) 0 S ateraf of Washington Date approved by Council: (Attach copy of council communication) ❑ Other government agency contract IntermeSole Source Agency GOODS&SERVICES Procurement Sment 0 Applicable Form #5 6 7 or 8 Contract# GOODS& ❑ pp ( ) Greater than$5,000 and less than$100,000 ❑ Written quote or proposal attached Intergovernmental Agreement ❑ (3)Written bids&solicitation attached 0 Form#4,Personal Services$51(to$75K Agency PERSONAL SERVICES Date approved by Council: ❑ Annual cost to City does not exceed$25,000. Greater than$5,000 and less than$75,000 Valid until: (Date) Agreement approved by Legal and approved/signed by © City Administrator.AMC 2.50.070(4)Less than$35,000,by direct appointment 0 Special Procurement Annual cost to Cityexceeds$25,000, ❑ (3)Written proposals&solicitation attached 0 Form#9,Request for Approval required.(Attach copyofcouncil Councilcnication) ❑ Form#4,Personal Services$5K to$75K DatWritten e approved by Councote or il: attachedapproval Valid until: __„_ (Date) Description of SERVICES Total Cost $ 8.00@.00 . Item# Quantity Unit Description of MATERIALS Unit Price . Total Cost ;TOT�CL:COST 0 Per attached quotelpropo" 0 d q I ��'`r �r f .$8,000 Project Number d.0 0 0 0 5. a o o ,f/�f' Account Number 0 7 2 9 0 0.6 1 0 3 5 5 $3,000 3�'_ 072000. 604160 $5,000 Account Number 6 0 0 0 , 5.s o _ _ s o Account Number • 'Expenditure must be charged to the appropriate account numbers for fhe financials to accurately reflect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: IT Director Date Support-Yes/No By signing this requisition form,I certify that the City's public contracting requirements have been sat isfied. Employee:Chris Chambers,Pe " ;'";"."'""""` C ,y/t ,d /GlDd Department Head: ual to or greater than$5,000) City Ma'.ser: Department Manage (Eq rlSupervisor: . __ Eq ..to or gre•ter than$25,000) ����;% Funds appropriated for current fiscal year: SND Finan Director-(Equal to or grea errha 5,000) Date Comments: 2 Farm#3-Requisition Kariann Olson From: Chris Chambers Sent: Friday,June 11,2021 4:11 PM To: Kariann Olson Subject: Another one.... Attachments: Cole LLC Backup Do . df;Cole Contract 2021.pdf;Form#3-Requisition Cole Ilc.pdf Here's another one for video filming.The Proposal,W9, insurance, and Workers Comp form are all in the backup docs file. Chris Chambers/Wildfire Division Chief Ashland Fire&Rescue • 455 Siskiyou Boulevard Ashland,OR 97520 WILT Chris.Chambers(a)ashland.or.us Phone: 541-552-2066 TTY: 1-800-735-2900 Fax: 541-488-5318 This email is official business of the City of Ashland,and it is subject to Oregon public records law for disclosure and retention.If you have received this message in error,please notify me at 541-552-2066. • • • • • • • 1 , SERVICES AGREEMENT(LESS THAN$25,000) _ I PROVIDER: johncole.co,lle CITY OF PROVIDER'S CONTACT: John Cole ASHLANDEMAIL: 'ohn@'ohncole.co 20 East Main Street Ashland,Oregon 97520 • Telephone: 541/488-5587 ADDRESS: 207 W. 110t St, Suite 31,New York,NY 10026 Fax: 541/488-6006 PHONE: 541-282-4874 This Services Agreement (hereinafter "Agreement") isentered_into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and johncole.co, lie, a domestic sole proprietorship .("hereinafter"Provider"),for video production work. 1. PROVIDER'S OBLIGATIONS • ' 1.1 Provide video production services 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 th. :. ,i°001 to' 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. 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 • 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 employees. 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-axr-emerging -all—business eaferpti -- 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 Requirement: If the amount of this Agreement is$21,507:75 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. 2. CITY'S OBLIGATIONS 2.1 City shall payProvider the'sum of up to $8,000 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 one-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. 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 All Work product or documents produced in furtherance of this Agreement belong to the City, and any • copyright, patent,trademark proprietary or any other protected intellectual property right shall vest in and is hereby assigned to the City. 3.5 This Agreement embodies the full and complete understanding of the parties respectingthe subject matter hereof. It supersedes all prior agreements,negotiations,and representations between the parties, whether written or oral. 3.6 This Agreement may be amended only by written instrument executed with the same formalities as this Agreement. • 3.7 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. 4. SUPPORTING DOCUMENTS 4.1 The following documents are, by this reference, expressly incorporated in this Agreement, and are • collectively\referred tb in this Agreement as the"SUPPORTING DOCUMENTS:" • • The Provider's complete written Proposal dated 05/14/2021. 4.2 This Agreement and the SUPPORTING DOCUMENTS shall be construed to be mutually• complimentary and supplementary wherever possible. In the event of a conflict which cannot be so resolved,the provisions of this Agreement itself shall control over any conflicting provisions in any of • the SUPPORTING DOCUMENTS. In the event of conflict between provisions of two of the SUPPORTINGDOCUMENTS,the several supporting documents shall be given precedence in the order listed in Subsection 4.1. . 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 May 31, 2021, 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: City of Ashland—Ashland Fire&Rescue Attn: Chris Chambers 455 Sisldyou Blvd Ashland,Oregon 97520 Phone: (541) 552-2218 With a copy to: City of Ashland—Legal Department 20 E.Main Street . • Ashland, OR 97520 Phone: (541)488-5350 • • If to Provider: - • Attn: John Cole LOCALLY: johncole.co,He Attn: John Cole • 207 W 110t St. 286 8th Street Suite#31 Ashland,OR 97520 New York,NY 10026 john@johncole.co john@j ohncole.co Phone: 541-282-4874 • Phone: 541-282-4874 • 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. • • • • • 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: johncole.co,He. (PROVIDER): 0 j By: By: Signature�tuSignature 4 a,F. • John Cole • Printed Name Printed Name /t/Iafterpr- Tom.., 0 Owner Title Title • S"/as/AI o57/pr &)6,2 • Date Date Purchase Order No. /(W-9 is to be submitted with this signed Agreement) • APP JD AS TSM — I Ash nd Asst.City Attorney Date 2 c-; Z" z • 'F .F .fir • • May 18, 2021 johncole.co, IIc 201 W. 110th St#31 New York NY 10026 PROPOSAL FOR FILM WITH THE ASHLAND FIRE DEPARTMENT ABOUT THE NEW PODs PROGRAM • We will have a conversation with the participating parties: 'Darren with the nature conservancy •Chris Chambers with AFD 'Chris Dunn •OR dept of forestry or forest service Once allof these participants share what they feel is important to be included in the film,we will create a script and a set of storyboards that puts the pieces together in a comprehensive, story driven arrangement. This script and storyboard set will go through a series of roughs and approvals, refining the plan and ending with a final illustrated script, approved and understood by all parties. In this phase, all elements of the mission and the production are.discussed and agreed upon. We will then arrange a day for shooting the participants to get their part of the script spoken in an agreed upon visual style and the audio components per the script. Secondarily,we will create the artistic visual components that becomes the bulk of the piece, demonstrating-and clarifying the intended mission of the film (an agreed upon variation of the youtube videos that we are using as the basis for this project). Again, these elements will be agreed upon in advance. • Followed by the post production process where we will put the pieces of art together with the interview elements creating a singular, 2-3 minute piece that illustrates the PODs concept in easy to understand visuals correlated with the audio gathered at the interviews. This included color correction and audio mixing. There will be a series of rough cuts created to ensure that we are on the same page with all the elements, including the incidental music, the-graphics of each organization included in this project and the credits given to all various participants needing to be credited. FINAL DELIVERY WILL BE.IN ALL APPLICABLE FORMATS FOR WEB AND TELEVISION BROADCAST. • CERTIFICATION OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE REQUIREMENTS Contractor is exempt from the requirement to obtain workers compensation insurance pursuant to ORS Chapter 656 for the following reason. Contractor is to initial the appropriate box as follows: SOLE PROPRIETOR (Initials) ■ Contractor is a sole proprietor,and • Contractor has no employees,and • Contractor will not hire employees or subcontractors to perform this contract. CORPORATION,FOR PROFIT (Initials) ■ Contractor's business is incorporated;and • All employees of the corporation are officers and directors and have a substantial ownership interest*in the corporation,and • All work will be performed by the officers and directors;Contractor will not hire other employees or subcontractors to perform this contract. CORPORATION-NONPROFIT (Initials) • Contractor's business is incorporated as a nonprofit corporation,and • Contractor has no employees;all work is performed by volunteers,.and • Contractor will not hire employees or subcontractors to perform this contract. PARTNERSHIP (Initials) • Contractor is a partnership,and • Contractor has no employees,and • • All work will be performed by the partners;Contractor will not hire employees or subcontractors to perform this contract,and • Contractor is not engaged in work performed in direct connection with the construction,alteration,repair, improvement,moving or demolition of an improvement to real property or appurtenances thereto.** InLIMITED LIABILITY COMPANY - (Initials) • Contractor is a limited liability company,and • Contractor has no employees,and • All work will be performed by the members;Contractor will not hire employees or subcontractors to perform this contract,and • If Contractor has more than one member,Contractor is not engaged in work performed in direct connection with the construction,alteration,repair,improvement,moving or demolition of an improvement to real property or appurtenances thereto.** 11 /2,0 2. (Signature of uthorized Signer) / (Date) • QL.-..v.sIA j(A-1" `ei e. C0) (Authorized Signer's Title) • *NOTE: Under OAR436-50-050 a shareholder has a"substantial ownership"interest if the shareholder owns 10%of the corporation,or if less than 10%is owned,the shareholder has ownership that is at least equal to or greater than the average percentage of ownership of all shareholders. **NOTE: Under certain circumstances partnerships and limited liability companies can claim an exemption even when performing • construction work. The requirements for this exemption are complicated. Consult with City Attorney's Office before an exemption • request is accepted from a contractor who will perform construction.work. • • • • A 3 d CERTIFICATE OF LIABILITY INSURANCE DAIS(YYlDDlYYYY) 05/19/2021 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 pollcy(les)must have ADDITIONAL INSURED provisions or he endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER • COACT Theresa Handwork NAME: Taylor 8t Taylor Ltd. PHONE (212)490 8511 FAX (212)490-7238 fNC.No.Ex11: (NC,No): 271 Madison Avenue ADDRESS: thandwerk@taylodnsurence.com 6it1 Fioor INSURERS))AFFORDING COVERAGE NAIL S New York NY 10018-1001 INSIIRERA: Chubb Group INSURED INSURER B: Iohncoie.co,110 INSURER C: 288 61h sheat INSURER D: • INSURER E: Ashland • OR 97520 INSURER F: • COVERAGES CERTIFICATE NUMBER: 2021-2022 REVISION NUMBER: THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WiTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE.INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTOALLTHETERMS, EXCLUSIONS AND CONDiI1ONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILLIIRR TYPE OF INSURANCE IMOD MD WVPOLICY NUMBER POLICYEFF POLICY EXP UNITS (YY/001YYYY) (MYlDOlYYY1f) X COMMERCIAL GENERALIIABILITY EACH OCCURRENCE S 1,000,000 • DAME TOCLAIMS-MADE El OCCUR PR�ISES(Faoccurrence) $ED1,000,000 . MED SO(Airy one perm) $ 5.000 A _ SERD94723103 02/11/2021 02(11/2022 PERSONAL&ADV INJURY $ GENLAGGREGATE LIMWTAPPLIESPER: GENERALAGGREGATE $ 2,000,000 POLICY❑.17ECaT LOC PRODUCTS-COMP/OP AGO 3 2,000,000 I OTHER: AUTOMOBILELIABILIIY • COMBINED SINGLE LIMIT $ (Ea=Henn _ ANY AUTO BODILY INJURY(Per perron) $ OWNED SCHEDULE - BODILY INJURY(Pereoddeal) $ AUTOS ONLY _AUTOS HIRED NON-OWNED PROPERTY DAMAGE _ AUTOS ONLY _AUTOS ONLY (Per occident) _ UMBRELLA LIAR — OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE S DED I RETENTION$WORKERS COMPENSATION COMPENSATION I PPTEDATUTE I I RTM AND EMPLOYERS'LIABILITY Y I N ANY PROPRI:IORIPARFNERJEXECUTNE NfA EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? I ' • (I0wn1ory Ii NH) EL.DISEASE-EAEMPLOYEE $ If yes,deeadbe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Additional Rematka Sdudulo,may he.Heehed H more apace Ii inquired) The City of Ashland,Oregon,it's officers,agents and employees are included as Additional Insured on the General Liability Policy with respect to claims arising out of the negligence of the Named insured. CERTIFICATE HOLDER CANCELLATION • SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE WiTH THE POLICY PROVISIONS. 20 East Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 ®1986.2015 ACORD CORPORATION.All rights reserved: ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD _ I J City of Ashland 20 East Main Street Ashland OR 97520 BUSINESSOWNERS LIABILITY EXTENSION THIS ENDORSEMENT CHANGES THE POLICY. PLEASE,READ IT CAREFULLY. This endorsement modifies insurance provided under the following: BUSINESSOWERS COVERAGE FORM ' ' • TABLE OF CONTENTS • Page Supplementary Payments-Bail Bonds And Bonds To Appeal Judgments—No Sublimit 2 Medical Expenses—Three Years To Report Expenses 2 Non-Owned Watercraft Under 55 Feet 2 Non-Owned Aircraft 2 Damage To Property—Exception For Equipment Loaned Or Rented To Insured 2 Who Is An Insured—Subsidiaries Or Newly Acquired Or Formed Organizations 3 Who Is An Insured—Employees(Including For CPR and First Aid)And Volunteer Workers 3 Additional Insured-Lessor Of Leased Equipment 4 Additional Insured—Managers Or Lessors Of Premises • 4 Additional Insured-Vendors 5 Additional Insured—Other Persons Or Organizations Pursuant To Contract Or Agreement 6 Damage To Premises Rented To You—$1,000,000 7 Per Location General Aggregate Limit With Combined Total Aggregate Limit 8 Knowledge/Notice Of Occurrence 9 Bodily Injury, Including Resulting Mental Anguish 9 Coverage Territory,Limited Worldwide 10 Unintentional Failure To Disclose Hazards 10 Other Insurance, Including Primary Provision 10 Waiver Of Subrogation Required By Contract 12 This endorsement modifies the coverages provided under the Businessowners Coverage Form. Notwithstanding anything to the contrary, the provisions of the Businessowners Coverage Form apply,except as provided in this endorsement.The titles of the various paragraphs of this endorsement are inserted solely for convenience or reference and are not to be deemed in any way to limit or affect the provisions to which they relate. A. SUPPLEMENTARY PAYMENTS—BAIL BONDS AND BONDS TO APPEAL JUDGMENTS-NO SUBMIT In Section II-Liability, Paragraph A.Coverages, 1.f.Coverage Extension—Supplementary Payments,subparagraphs(1)(b)and(c)are replaced by the following: (b) The cost of bail bonds, but only for bond amounts within the available limit of insurance.We do not have to furnish these bonds. (c) The cost of bonds to appeal judgments or release attachments, but only for amounts within the available limit of insurance.We do not have to furnish these bonds. BOP-47675a(07/16) Includes copyrighted material of Insurance Services Office,Inc.,with its permission,2016. Page 1 of 11 B. MEDICAL EXPENSES—THREE YEARS TO REPORT EXPENSES In Section II—Liability, Paragraph A.Coverages,2. Medical Expenses,subparagraph a.(b)is replaced by the following: (b) The expenses are incurred and reported to us within three years of the date of the accident; and C. NON-OWNED WATERCRAFT UNDER 55 FEET In Section 11-Liability, Paragraph B.Exclusions,subparagraph(2)of Exclusion 1.g.Aircraft,Auto Or Watercraft is replaced by the following: This exclusion does not apply to: (2) A watercraft you.do not own that is: (a) Less than 55 feet long;and (b) Not being used to carry persons or property for a charge; D. NON-OWNED AIRCRAFT In Section II-Liability, Paragraph B.Exclusions,the following exception is added to Exclusion 1.g. Aircraft,Auto or Watercraft in Section 11—Liability: This exclusion does not apply to an aircraft you do not own provided: 1. The pilot in command holds a currently effective certificate, issued by the duly constituted authority of the United States of America or Canada,designating that person as a commercial or airline transport pilot; 2. It is rented with a trained,paid crew;and 3. It does not transport persons or cargo for a charge. • E. DAMAGE TO PROPERTY-EXCEPTION FOR EQUIPMENT LOANED OR RENTED TO THE INSURED In Section II-Liability, Paragraph B. Exclusions,the following exception is added to Exclusion 1.k. Damage To Property: Paragraphs(3)and (4)of this exclusion do not apply to"property damage"to equipment rented or loaned to the insured, provided such equipment is not being used to perform any operations at a construction job site. F. WHO IS AN INSURED-SUBSIDIARIES OR NEWLY ACQUIRED OR FORMED ORGANIZATIONS In Section II-Liability, Paragraph C.Who is an Insured is amended to include the following: If there is no other insurance available, each of the following is also a Named Insured: 1. A subsidiary organization of the first Named Insured shown in the Declarations of which,at the • beginning of the policy period and at the time of loss,the first Named Insured controls,either directly or indirectly, more than 50 percent of the interests entitled to vote generally in the election of the' governing body of such organization;or BOP-47675a(07/16) Includes copyrighted material of Insurance Services Office,Inc.,with its permission,2016. Page 2 of 11 • 2. A subsidiary organization of the first Named Insured shown in the Declarations that the first Named . Insured acquires or forms during the policy period, if at the time of loss the first Named Insured controls,either directly or indirectly, more than 50 percent of the interests entitled to vote generally in the election of the governing body of such organization. G. WHO IS AN INSURED-EMPLOYEES(INCLUDING CPR AND FIRST AID)AND VOLUNTEER WORKERS In Section II-Liability, Paragraph C.Who is an Insured,Paragraph 2.a. is replaced by the following: 2. Each of the following is also an insured: a. Your"employees"but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, no"employee"is an insured for: (1) "Bodily injury"or"personaland advertising injury": (a) To you,to any of your directors,managers, members,"executive officers"or partners • (whether or not an"employee")or to any co-"employee"while such injured person is either in the course of his or her employment or while performing duties related to the conduct of your business;. (b) To the brother,child, parent, sister or spouse of such injured person as a consequence of any injury described in Paragraph(a)above;or • (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of any injury described in Paragraph(a)or(b)above. • With respect to"bodily injury"only,the limitations described in Paragraph 2.a.(1)above do not apply to you or to your directors,managers,members,"executive officers", partners or supervisors as insureds.The limitations also do not apply to your"employees" as insureds,with respect to such damages caused by cardiopulmonary resuscitation or first aid services administered by such an"employee". (2) "Property damage"to any property owned,occupied or used by you or by any of your directors,managers,members,"executive officers"or partners(whether or not an "employee")or by any of your"employees".This limitation does not apply to"property damage"to premises while rented to you or temporarily occupied by you with the permission of the owner. b. Your"volunteer workers", but only while acting within the scope of their activities for you and at your direction. • H. ADDITIONAL INSUREDS In Section II-Liability, Paragraph C.Who is an Insured,the following is added: 2. Each of the following is also an insured: LESSOR OF LEASED EQUIPMENT • • BOP-47675a(07/16) Includes copyrighted material of Insurance Services Office,Inc.,with its permission,2016. Page 3 of 11 • e. Any person or organization from whom you lease equipment, but only with respect to liability for • "bodily injury","property damage"or"personal and advertising injury"caused, in whole or in part, by your maintenance,operation or use of equipment leased to you by such person or organization and only if you are required by a contract or agreement to provide them with such insurance as is afforded by this policy. However,the insurance afforded to such additional insured: • (1) Only applies to the extent permitted by law; and (2) Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. With respect to the insurance afforded to these additional insureds,this insurance does not apply to any"occurrence"which takes place after the equipment lease expires. MANAGERS OR LESSORS OF PREMISES f. Any person or organization from whom you lease premises, but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and only if you are required by a contract or agreement to provide them with such insurance as is afforded by this policy. However,the insurance afforded to such additional insured: (1) Only applies to the extent permitted by law;and (2) Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. With respect to the Insurance afforded to these additional insureds,the following additional exclusions apply: This insurance does not apply to: (1) Any"occurrence"that takes place after you cease to be a tenant in such premises. (2)Structural alterations, new construction or demolition operations performed by or for such additional insureds. VENDORS g. Any person or organization who is a vendor of"your products", but only with respect to"bodily injury"or"property damage"arising out of"your products"which are distributed or sold in the regular course of the vendor's business. However. (1) The insurance afforded to such vendor only applies to the extent permitted by law;and (2) If coverage provided to the vendor is required by a contract or agreement,the insurance afforded to such vendor will not be broader than that which you are required by the contractor agreement to provide for such vendor. BOP-47675a(07/16) Includes copyrighted material of Insurance Services Office,Inc.,with its permission,2016. Page 4 of 11 • , With respect to the insurance afforded to these vendors,the following additional exclusions apply: (1) This insurance afforded the vendor does not apply to: - (a) "Bodily injury"or"property damage"for which the vendor Is obligated to pay damages by reason of the assumption of liability in a contract or agreement.This exclusion does not apply to the liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; • (c) Any physical or chemical change in the product made intentionally by the vendor; (d) Repackaging,except when unpacked solely for the purpose of inspection,demonstration, testing or the substitution of parts under instructions from the manufacturer,and then repackaged in the original container; (e) Any failure to,make such inspections,adjustments,tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation,servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; • (g) Products which,after distribution or sale by you, have been labeled or relabeled or used as a container,part or ingredient of any other thing or substance by or for the vendor;or • (h) "Bodily injury"or"property damage"arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However,this exclusion does not apply to: (i) The exceptions contained in Subparagraph(d)or(f);or • (ii) Such inspections,adjustments,tests or servicing as the vendor has agreed to make • or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization from whom you have acquired such products,or any ingredient, part or container entering into,accompanying or containing such products. • With respect to the insurance afforded to these vendors,the following is added to Paragraph D. Liability And Medical Expenses Limits Of Insurance: If coverage provided by the vendor is required by a contract or agreement,the most we will pay on behalf of the vendor is the amount of insurance: (1) Required by the contract or agreement;or (2) Available under the applicable Limits Of Insurance shown in the Declarations; BOP-47675a(07/16) Includes copyrighted material of Insurance Services Office,Inc.,with its permission,2016. Page 5 of 11 whichever is less. J This shall not increase the applicable Limits Of Insurance shown in the Declarations. • OTHER PERSONS OR ORGANIZATIONS PURSUANT TO CONTRACT OR AGREEMENT h. Any persons or organizations that you are required.by a contract or agreement to provide with such insurance as is afforded by this policy. However,such a person or organization is an insured only: (1) To the extent such contract or agreement requires the additional insured to be afforded status as an insured;and (2) For activities that did not occur,in whole or in part,,before the execution of the contract or agreement. , No person or organization is an insured under this provision: (1) That is more specifically identified under any other provision of Paragraph C.Who Is An Insured(regardless of any limitation applicable thereto). (2) With respect to any assumption of liability in a contract or agreement.This limitation does not apply to the liability for damages the additional insured would have in the absence of the contract or agreement. However,the insurance afforded to such persons or organizations: (1) Only applies to the extent permitted by law;and (2) Will not be broader than that which you are required by the contract(or agreement to provide for such additional insured. The following is added at the end of Paragraph C.Who Is An Insured: No person or organization is an insured with respect to the conduct of any current or past partnership,joint venture or limited liability company that is not shown as a Named Insured in the Declarations. However, no person or organization is an insured with respect to the: a. Ownership, maintenance or use of any assets;or b. Conduct of any person or organization whose assets, business or organization; any Named Insured acquires, either directly or indirectly,for any: (1) "Bodily injury"or"property damage"that occurred;or (2) "Personal and advertising injury"arising out of an offense first committed; in whole or in part, before such acquisition is executed. With respect to the insurance afforded to the persons or organizations described in Paragraphs e.,f.,.and h.above,the following is added to Paragraph D.Liability And Medical Expenses Limits Of Insurance: BOP-47675a(07/16) Includes copyrighted material of Insurance Services Office,Inc.,with its permission,2016. Page 6 of 11 • The most we will pay on behalf of such person or organization Is the amount of insurance: (1) Required by the contract or agreement; or (2) Available under the applicable Limits Of Insurance shown in the Declarations; whichever is less. This shall not increase the applicable Limits Of Insurance shown in the Declarations. 1. DAMAGE TO PREMISES RENTED TO YOU—$1,000,000 In Section H-Liability, Paragraph D.Liability and Medical Expenses Limits of Insurance, Paragraphs 3.and 4.are deleted and replaced with the following: 3. Subject to the Liability And Medical Expenses Limits Of Insurance,the most we will pay under Business Liability Coverage for damages because of"property damage"to any one premises while rented to you or while temporarily occupied by you with permission of the owner is$1,000,000. 4. Aggregate Limits The most we will pay for: a. All"bodily Injury"and"property damage"that is included in the-"products-completed operations hazard"Is twice the Liability and Medical Expenses limit. • b. All: (1) "Bodily injury"and"property damage"except damages because of"bodily injury"or"property damage"included in the"products-completed operations hazard"; (2) Plus medical expenses; (3) Plus all"personal and advertising injury"caused by offenses committed; is twice the Liability and Medical Expenses Limit. The Limits of Insurance of Section II—Liability apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period • shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case,the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. J. PER LOCATION GENERAL AGGREGATE LIMIT WITH COMBINED TOTAL AGGREGATE LIMIT In Section II-Liability, Paragraph D.Liability and Medical Expenses Limits of Insurance,the following is added: .•• BOP-47675a(07/16) Includes copyrighted material of Insurance Services Office,Inc.,with its permission,2016. Page 7 of 11 t Subject to the Combined Total Aggregate Limit shown in the Declarations,for the sum of all damages that the insured becomes legally obligated to pay for all "bodily injury"and"property damage"caused • by "occurrences" under Paragraph A.1. Business Liability, and for all medical expenses caused by accidents under Paragraph A.2. Medical Expenses, which can be attributed only to a single "location": a. A separate Location General Aggregate Limit will apply to each "location", and that limit is equal to the Other than Products/Completed Operations Aggregate Limit shown in the Declarations. b. The separate Location General Aggregate Limit is the most we will pay for the sum of all damages for "bodily injury" or "property damage" under Paragraph A.1. Business Liability, except in connection with "bodily Injury" or "property damage" included in the "products- completed operations hazard", and for medical expenses under Paragraph A.2. Medical Expenses, regardless of the number of: (1) Insureds; (2) Claims made or"suits"brought;or (3) Persons or organizations making claims or bringing,"suits". • c. Any payments made under Paragraph A.1. or under Paragraph A.2. Medical Expenses shall reduce the separate Location General Aggregate Limit for that"location".Such payments shall not reduce the Other Than Products/Completed Operations Aggregate Limit shown in the Declarations nor shall they reduce the separate Location General Aggregate. Limit for any other"location". d. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the Other Than Products/Completed Operations Aggregate Limit shown in the Declarations,such limits will be subject to the applicable separate Location General Aggregate Limit. 2. Subject to the Combined Total Aggregate Limit shown in the Declarations,for the sum of all damages that the Insured becomes legally obligated to pay for all "bodily injury" or"property damage" caused by occurrences under Paragraph A.1. Business Liability and for all medical expenses caused by accidents under Paragraph A.2.,which cannot be attributed only to operations at a single"location". • a. Any payments made under Paragraph A.1. Business Liability for damages or under Paragraph A.2. for medical expenses shall reduce the amount available under the Other Than Products/Completed Operations Aggregate Limit or the Products/Completed Operations Aggregate Limit,whichever is applicable;and b. Such payments shall not reduce the separate Location General Aggregate Limit applicable to a single"location". 3. Subject to the separate Location General Aggregate Limit and all other applicable limits, the Combined Total Aggregate Limit shown in the Declarations is the most we will pay for the combined sum of amounts described above,regardless of the number of"locations". 4. Any payments we make for"bodily injury"or"property damage" included in the"products-completed operations hazard" will reduce the Products-Completed Operations Aggregate Limit regardless of the number of "locations", and not reduce the Other Than Products/Completed Operations Aggregate Limit nor the separate Location General Aggregate Limit applicable to a single"location." 5. As used in this endorsement, "location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. 6. The provisions of Paragraph D. Liability and Medical Expenses Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. BOP-47675a(07/16) Includes copyrighted material of Insurance Services Office,Inc.,with its permission,2016. Page 8 of 11 K. KNOWLEDGE/NOTICE OF OCCURRENCE In Section II-Liability, Paragraph E.Liability and Medical Expenses General Conditions,2. Duties In the Event Of Occurrence,Offense,Claim or Suit is amended to include the following: e. Knowledge of an"occurrence"or offense by an agent or"employee"of the insured will not constitute - knowledgeby the insured,unless an"executive officer(whether or not an"employee")of any insured or an"executive officer's"designee knows about such"occurrence"or offense. Failure of an agent or"employee"of the insured,other than an"executive officer"(whether or not an"employee") of any insured or an"executive officer's"designee,to notify us of an"occurrence"or offense that such person knows about will not affect the insurance afforded to you. f. If a claim or loss does not reasonably appear to involve this insurance, but it later develops into a claim or loss to which this insurance applies,the failure to report it to us will not violate this condition, provided the insured gives us immediate notice as soon as the insured is aware that this insurance may apply to such loss or claim. • L BODILY INJURY,INCLUDING RESULTING MENTAL ANGUISH •In Section II-Liability, Paragraph F. Liability and Medical Expenses Definitions, paragraph 3.is deleted and replaced with the following: 3. "Bodily injury"means physical: a. Injury; b. Sickness;or c. Disease; • sustained by a person, including resulting death,humiliation, mental anguish,mental injury or shock at any time. All such loss shall be deemed to occur at the time of the physical injury,sickness or disease. M. COVERAGE TERRITORY, LIMITED WORLDWIDE In Section II-Liability, Paragraph F.Liability and Medical Expenses Definitions, paragraph 4. is deleted and replaced by the following: 4.. "Coverage territory"means all parts of the world. However,"coverage territory"does not include any: • a. "Bodily injury"or"property damage"that takes place or any offense committed outside of the United • States of America(including its possessions and territories),Canada and Puerto Rico,unless the• insured's responsibility to pay damages is determined by a"suit"on the merits that is brought in the • United States of America(including its possessions and territories),Canada or Puerto Rico;or b. Injury or damage in connection with any"suit"brought outside the.United States of America(including • its possessions and territories),Canada and Puerto Rico. BOP-47675a(07/16) Includes copyrighted material of Insurance Services Office,Inc.,with its permission,2016. Page 9 of 11 • N. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS In Section HI—Common Policy Conditions, Paragraph C.Concealment, Misrepresentation or Fraud is amended to include the following additional paragraph: Unintentional failure of an"employee"of the insured to disclose a hazard or other material information will not violate this condition, unless an"executive officer"(whether or not an"employee")of any insured knows about such hazard or other material information. • O. OTHER INSURANCE,INCLUDING PRIMARY PROVISION In Section III—Common Policy Conditions, Paragraph H.Other Insurance,subparagraphs 2.and 3. are replaced by the following: H. Other Insurance If other valid and collectible insurance is available to the insured for a loss we cover under this Insurance, our obligations are limited as follows: 1. Primary Insurance This insurance is primary except when Paragraph 2 below applies. If this insurance is primary,our obligations are not affected unless any of the other insurance is also primary.Then,we'will share with all that other insurance by the method described in Paragraph 3 below. 2.- Excess Insurance a. This insurance is excess over: (1) Any of the other insurance,whether primary,excess, contingent or on any other basis: (a)That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (b)That is insurance that applies to"property damage"to premises rented to you or temporarily occupied by you with permission of the owner;or (c)If the loss arises out of aircraft,"autos"or watercraft to the extent not subject to Exclusion g.of Section II.B. Exclusions, 1.Applicable to Business Liability Coverage; or (2) Any other primary insurance available to you covering liability for damages arising out of the premises or operations for which you have been added as an additional insured. b. When this insurance is excess,we will have no duty to defend the insured against any"suit"if any other insurer has a duty to defend the insured against that"suit." If no other insurer defends,we will undertake to do so,but we will be entitled to the insured's rights against all those other insurers. c. When this insurance is excess over other insurance,we will pay only our share of the amount of the loss, if any,that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; BOP-47675a(07/16) Includes copyrighted material of Insurance Services Office,Inc.,with its permission,2016.Page 10 of 11 • (2) The total of all deductible and self-insured amounts under all that other insurance. d. We will share the remaining loss,if any,with any other insurance that is not described in this Excess Insurance provision and was not brought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. 3. Method of Sharing • If all of the other insurance permits contribution by equal shares,we will follow this method also. Under this approach,each Insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains,whichever comes first. If any of the other insurance does not permit contribution by equal shares,we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. P. WAIVER OF SUBROGATION REQUIRED BY CONTRACT • In Section Ili—Common Policy Conditions, Paragraph K.Transfer of Rights of Recovery Against Others To Us,subparagraph 2.is replaced by the following: 2. Applicable to Businessowners Liability Coverage: We will waive the rights of recovery we would otherwise have had against another person or organization, for loss to which this insurance applies,provided the insured has waived their rights of recovery against such person or organization in a contract or agreement that is executed before such loss. To the extent that the insured's rights to recover all or part of any payment made under this Coverage Part have not been waived,those rights are transferred to us.The insured must do nothing after loss to impair them.At our request,the insured will bring"suit"or transfer those rights to us and help us enforce them.This paragraph does not apply to Medical Expenses Coverage. All other terms and conditions of the policy remain unchanged. • • • BOP-47675a(07/16) Includes copyrighted material of Insurance Services Office,Inc.,with its permission,2016.Page 11 of 11 r CALIFORNIA CASUALTY GENERAL CALIFORNIA CASUALTY GENERAL INSURANCE COMPANY OF OREGON INSURANCE COMPANY OF OREGON P.O. BOX 39700 P.O. BOX 39700 COLORADO SPRINGS CO 80949-9700 COLORADO SPRINGS CO 80949-9700 • OREGON OREGON EVIDENCE OF MOTOR VEHICLE LIABILITY INSURANCE EVIDENCE OF MOTOR VEHICLE LIABILITY INSURANCE NAIC4 35955 NAIC// 35955 ' INSURED: COLE, JOHN AND MARY ELLEN INSURED: COLE, JOHN AND MARY ELLEN 286 8TH ST 286 8TH ST ASHLAND OR 97520 ASHLAND OR 97520 -, EFFECTIVE DATE EXPIRATION DATE POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE POLICY NUMBER 04/24/21 04/24/22 1013996669 04/24/21 04/24/22 1013996669 '"' "" YEAR MAKE/MODEL VIN YEAR MAKE/MODEL VIN 99 PLYMO GRAND VOYAG 2P4GP44G9XR124630 99 PLYMO GRAND VOYAG 2P4GP44G9XR124630 FOR CLAIMS OR CUSTOMER SERVICE: 1-800-841-4736 FOR CLAIMS ORCUSTOMERSERVICE: 1-800-841-4736 ' UP-1600(0099) UP-1609(0699) r I CALIFORNIA CASUALTY GENERAL CALIFORNIA CASUALTY GENERAL INSURANCE COMPANY OF OREGON INSURANCE COMPANY OF OREGON P.O. BOX 39700 '' P.O. BOX 39780 COLORADO SPRINGS CO 00949-9700 COLORADO SPRINGS CO 80949-9700 OREGON OREGON EVIDENCE OF MOTOR VEHICLE LIABILITY INSURANCE EVIDENCE OF MOTOR VEHICLE LIABILITY INSURANCE NAIL#35955 NAIc// 35955 INSURED: COLE JOHN AND MARY ELLEN INSURED: COLE JOHN AND MARY ELLEN 286 8TH ST 286 8TH ST ASHLAND ' OR 97520 ASHLAND OR 97520 EFFECTIVE DATE EXPIRATION DATE POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE POLICY NUMBER 04/24/21 04/24/22 101 3996669 04/24/21 04/24/22 101 3996669 YEAR MAKE/MODEL VIN YEAR MAKE/MODEL VIN 17 HONDA RIDGELINE B 5FPYK3F89HB032039 17 HONDA RIDGELINE B 5FPYK3F89HB032039 FOR CLAIMS OR CUSTOMER SERVICE: 1-800-841-4736 FOR CLAIMS OR CUSTOMER SERVICE: 1-8 00-841-4736 rUP-160093/99) U11600(96119) , CALIFORNIA CASUALTY GENERAL CALIFORNIA CASUALTY GENERAL INSURANCE COMPANY OF OREGON INSURANCE COMPANY OF OREGON P.O. BOX 39700 P.O. BOX 39700 COLORADO SPRINGS CO 80949-9700 COLORADO SPRINGS CO 80949-9700 OREGON OREGON EVIDENCE OF MOTOR VEHICLE LIABILITY INSURANCE EVIDENCE OF MOTOR VEHICLE LIABILITY INSURANCE • NAIC// 35955 NAION 35955 INSURED: COLE( JOHN AND MARY ELLEN INSURED: COLE JOHN AND MARY ELLEN 286 8TH ST 286 8TH ST ASHLAND OR 97520 ASHLAND OR 97520 EFFECTIVE DATE EXPIRATION DATE POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE POLICY NUMBER 04/24/21 04/24/22 101 3996669 04/24/21 04/24/22 101 3996669 YEAR MAKE/MODEL VIN YEAR MAKE/MODEL VIN 17 DODGE GRD-CARAVAN 2C4RDGCG7HR651527 17 DODGE GRD-CARAVAN 2C4RDGCG7HR651527 FOR CLAIMS OR CUSTOMER SERVICE: 1-800-841-4736 FOR CLAIMS OR CUSTOMER SERVICE: 1-800-841-4736 IIP-1600L0099} UP-16001011/99). These are your vehicle insurance identification cards as required by state law. Please keep one copy of this card in the described motor vehicle along with your vehicle registration card. One copy of this card is for registration purposes, if required in your state;otherwise please keep in your wallet. Please verify that the Vehicle Identification Number (VIN) on your vehicle matches the VIN on both your identification card and your registration. If the number on your identification card is incorrect, please call our Customer Service Department to have the identification card reissued with the correct VIN. If the VIN on the registration is incorrect contact your local Department of Motor Vehicles to have the registration corrected. UP-1268 (08/99) • If your car needs to be repaired after an accident,you will receive fast and dependable service at a Guaranteed Repair Network shop. Ask a claims representative for more information! - PL-335B(08/99) California Casualty For questions on your policy or to report a loss, call 1-800-841-4736.This document can be Home Office: Portland,OR viewed at calcas.com/My-Account. Coverage provided by: CALIFORNIA CASUALTY GENERAL INSURANCE COMPANY OF OREGON Named Insured(s): COLE,JOHN AND MARY ELLEN Policy Number: 101 3996669 Outline of Coverage for the 2017 DODGE GRD-CARAVAN Vehicle ID Number: 2C4RDGCG7HR651527 Class:880420 Other Than Collision Symbol: Collision Symbol: Limit: $35,000 Bl/PD Liability Symbol: N/A PIP/MP Liability Symbol: N/A Coverage is provided where a premium is shown. See your Policy Contract for coverage details. Coverage Limits Deductible Premium _Bodily Injury Liability $100,0001$300,000 Each Person/Each Accident $ 146.00 Property Damage Liability $100,000 Each Accident $ 111.00 • Personal Injury Protection $ 83.00 Medical Expenses $15,000 _ Income Loss - $3,000 Per Month Essential Services $30 Per Day • . Funeral Expenses $5,000 Child Care Expenses Applies $25 Per Day/$750 Maximum Medical Expense Deductible Not Applicable $0 $ .00 Uninsured Motorists $100,000/300,000 Each Person/Each Accident $ 45.00 Property Damage Uninsured Motorists $20,000 Each Accident $ 6.00 Other Than Collision Actual Cash Value Subject to Deductible $250 $ 119.00 Collision Actual Cash Value Subject to Deductible $250 $ 358.00 Transportation Expense Optional Limits Apply $50 Per Day/$1,500 Maximum $ 31.00 Total Vehicle Premium: $ 899.00 The following discounted factors have been applied to this vehicle: Safe Driving Discount Applies, Platinum Level,Multi-Car Discount, Anti-Lock Brake Discount, Persistency(Loyalty) Rating, Package Discount and Affinity Group Member UP-1176(01/19) INSURED COPY • 03/22/21 Page:3 of 4 • California Casualty For.questions on your policy or to report a loss, call 1-800-841-4736.This document can be Home Office: Portland,OR viewed at calcas.com/My-Account. Coverage provided by: CALIFORNIA CASUALTY GENERAL INSURANCE COMPANY OF OREGON Named Insured(s): COLE,JOHN AND MARY ELLEN Policy Number: 101 3996669 Outline of Coverage for the 2017 HONDA RIDGELINE B Vehicle ID Number: 5FPYK3F89HB032039 Class:880420 Other Than Collision Symbol: 37 Collision Symbol: 32 Limit: BI/PD Liability Symbol: 290 PIP/MP Liability Symbol: 480 Coverage is provided where a premium is shown. See your Policy Contract for coverage details. Coverage Limits Deductible Premium Bodily Injury Liability $100,000/$300,000 Each Person/Each Accident $ 133.00 Property Damage Liability $100,000 Each Accident $ 102.00 Personal Injury Protection $ 47.00 Medical Expenses $15,000 Income Loss $3,000 Per Month Essential Services $30 Per Day Funeral Expenses $5,000 Child Care Expenses Applies $25 Per Day/$750 Maximum Medical Expense.Deductible Not Applicable $0 $ .00 Uninsured Motorists $100,000/300,000 Each Person/Each Accident $ 45.00 Property Damage Uninsured Motorists $20,000 Each Accident $ 6.00 Other Than Collision Actual Cash Value Subject to Deductible $250 $ 114.00 Collision Actual Cash Value Subject to Deductible $250 $ 311.00 Transportation Expense Optional Limits Apply $50 Per Day/$1,500 Maximum $ 31.00 Total Vehicle Premium: $ 789.00 The following discounted factors have been applied to this vehicle: Safe Driving Discount Applies,Platinum Level, Multi-Car Discount, Anti-Lock Brake Discount, Persistency(Loyalty) Rating, Package Discount, Passive Restraint Discount and Affinity Group Member UP-1176(01/19) INSURED COPY 03/22/21 Page:2 of 4 California Casualty For questions on your policy or to report a loss, call 1-800-841-4736.This document can be Home Office: Portland,on viewed at calcas.com/My-Account. Coverage provided by: CALIFORNIA CASUALTY GENERAL INSURANCE COMPANY OF OREGON AUTOMOBILE POLICY DECLARATIONS Your policy is billed by E-Z Pay.Billing RENEWAL information will be mailed separately. NAMED INSURED(S): POLICY NUMBER: POLICY PERIOD: COLE,JOHN AND MARY ELLEN 101 3996669 Effective 04/24/21 Expiration 04/24/22 286 8TH ST 12:01 A.M. Standard Time at the ASHLAND OR 97520 Named Insured's address of record Outline of Coverage for the 1999 PLYMO GRAND VOYAG Vehicle ID.Number: 2P4GP44G9XR124630 Class:88N120 Other Than Collision Symbol: Collision Symbol: • Limit: $70,000 BI/PD Liability Symbol: N/A PIP/MP Liability Symbol: N/A Coverage is provided where a premium is shown. See your Policy Contract for coverage details. Coverage Limits Deductible Premium • Bodily Injury.Liability $100,000/$300,000 Each Person/Each Accident $ 128.00 Property Damage Liability $100,000 Each Accident $ 98.00 Personal Injury Protection $ 55.00 Medical Expenses $15,000 Income Loss $3,000 Per Month Essential Services $30 Per Day Funeral Expenses $5,000 Child Care Expenses Applies $25 Per Day/$750 Maximum Medical Expense Deductible Not Applicable $0 $ .00 Uninsured Motorists $100,000/300,000 Each Person/Each Accident $ 41.00 Property Damage Uninsured Motorists $20,000 Each Accident $ 6.00 Total Vehicle Premium: $ 328.00 The following discounted factors have been applied to this vehicle: Safe Driving Discount Applies,Platinum Level, Multi-Car Discount,Anti-Lock Brake Discount, Persistency(Loyalty) Rating, Passive Restraint Discount and Affinity Group Member r UP-1176(01/19) INSURED COPY 03/22/21 Page:1 of 4