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HomeMy WebLinkAbout2021-085 PO 20220068- Rogue Valley Backflow Service pipAl ITY R ; DER Purchase Order Fiscal Year 2022 Page: 1 of: 1 vim. rI 3xasesuAr IB City of Ashland " ATTN: Accounts Payable20 E. Main Purchase L Ashland, OR 97520 Order# 20220068 T Phone: 541/552-2010 O Email: payable@ashland.or.us V ROGUE VALLEY BACKFLOW SERVICE, MARK H C/O Facilities Maintenance Div E 90 North Mountain Ave D 11511 REI EN DR P Ashland, OR 97520 R ASHLAND, OR 97520 Phone: 541/488-5358 T Fax: 541/552-2304 €=( �=8161@[=g0i51g§lei.! _._4=1a efs1�= �i [fele :=E�=I>I=1L=1[ilalE Etleclel=l l�-------- =1114x=1,z 'a�5i=7'-1€L�= --_.541 482-9464 David Arnold 07/27/2021 633 FOB ASHLAND OR Cit Accounts Pa able Backflow Testing Services 1 Backflow testing services 1.0 $4,000.00 $4,000.00 Goods and Services Agreement(Less than $25,000) Completion date: June 30, 2022 Project Account: • ***************GL SUMMARY*************** 088400-602400 $4,000.00 • J • Date: 07/29/2021 : Authorized SignatureMaffiatai 7 , $4,000.00 • FORM #3 CITY OF A vot,,t.i{ ,-: r>u t,ct,50 ��� ASHLAND • REQUISITION `� Date of request: 7/9/2021 Required date for delivery: Vendor Name Rogue Valley Backflow Service Address,City,State,Zip - 10 Allen Lane.Talent,OR 97540 Contact Name&Telephone Number Erin Akers 541-482-9464 rvbackflowMgmail.com Email address SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: ❑ Invitation to Bid 0 Form#13,Written findings and Authorization ❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached ❑ Written quote or proposal attached (Attach copy of council communication) (If council approval required,attach copy of CC) ® Small Procurement ❑ Request for Proposal Cooperative Procurement Not exceeding$5,000 Date approved by Council: ( ❑ State of Oregon ® Direct Award _(Attach copy of council communication) Contract# ❑ VerbalfWritten quote(s)or proposal(s) ❑ Request for Qualifications(Public Works) ❑ State of Washington Date approved by Council: Contract# (Attach copy of council communication) ❑ Other government agency contract Intermediate Procurement ❑ Sole Source Agency GOODS&SERVICES ❑ Applicable Form(#5,6,7 or 8) Contract# Greater than$5,000 and less than$100,000 ❑ Written quote or proposal attached Intergovernmental Agreement ❑ (3)Written quotes and solicitation attached ❑ Form#4,Personal Services>$5K&475K Agency PERSONAL SERVICES ❑ Special Procurement ❑ Annual cost to City does not exceed$25,000. Greater than$5,000 and less than$75,000 ❑ Form#9,Request for Approval Agreement approved by Legal and approved/signed by ❑ Direct appointment not to exceed$35,000 ❑ Written quote or proposal attached City Administrator.AMC 2.50.070(4) ❑- (3)Written proposals/written solicitation Date approved by Council: ❑ Annual cost to City exceeds$25,000,Council ❑ Form#4,Personal Services>$5K&475K Valid until: (Date) approval required.(Attach copy of council communication) Description of SERVICES Total Cost Backflow Services for FY22 . $ 4,000.00 Item# Quantity Unit Description of MATERIALS : Unit Price Total Cost ❑ Per attached quote/proposal TOTAL COST Project Number • _ _ Account Number 088400-602400 {� *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 approve all hardware and software purchases: IT Director Date Support Yes/No By signing this requisition form,I certify that the►'tys rbli o t acting requirements have been satisfied. Employee: Department Head: '4113 Vo2- 411.1!,. .or greater than000) Department Manager/Supervisor: City Administrator: y(Equal to or greow/2 /2 O 2 1 f 3 Funds appropriated for current fiscal year: YES /NO Deputy Finance Director-(Equal to or greater than$5,000) Date Comments: Form#3-Requisition Rogue Valley Backflow Service Erin Akers LCB#15844 OH D#5438 10 Allen Ln Talent,OR 97540 (541)482-9464 e-mail: rvbackflow@gmail.com July 9, 2021 To: City of Ashland To whom it concerns, { The charge for a backflow assembly test is $27.50 per assembly. As a general rule we do not charge a repair labor fee for `typical' repairs when done at the time of testing. The cost of the average repair part is included with the invoice. The most common parts are valued at around $12.00-$50.00. In addition, service calls outside of the testing schedule will be charged at a rate of$40.00 flat or $50.00 per hour when time spent exceeds 1(one) hour. If, in testing and/or repair, the cost exceeds the usual, an authorizing representative of the city is contacted before incurring such expense for approval and direction to proceed. Please feel free to contact me with any questions or if further information is needed. Thanks, Erin Akers, Owner/Operator Rogue Valley Backflow Service GOODS AND SERVICES AGREEMENT(LESS THAN$25,000) PROVIDER: Rogue Valley Backflow Service - C I Ty o F PROVIDER'S ASH LAN D CONTACT: Erin Akers 20 East Main Street 10 S ADDRES : Allen Lane Ashland,Oregon 97520 Telephone: 541/488-5587 Talent,OR 97540 M • Fax: 541/488-6006 • PHONE: 541-482-9464 • dThis Go•ds and Services`Agreement (hereinafter"Agreement") is entered into by and between the City of t Ashland, an Oregon municipal corporation (hereinafter "City") and Rogue Valley Backflow Service (a domestic foreign business.corporation)("hereinafter"Provider"),for backflow services. il 1. PRO IDER'S OBLIGATIONS t: 1.1 'rovide backflow services for FY22 as set forth in the"SUPPORTING DOCUMENTS"attached hereto C :nd,by this reference,incorporated herein. Provider expressly acknowledges that time is of the essence u •f any completion date set forth in the SUPPORTING DOCUMENTS,and that no waiver or extension a •f such deadline may be authorized except in the same manner as herein provided for authority to [ •xceed the maximum compensation. The services defined and described in the "SUPPORTING 11 DOCUMENTS"shall hereinafter be collectively referred to as"Work." it 4 . 1.2 'rovider shall obtain and maintain during the term of this Agreement and until City's final acceptance n 'f all Work received hereunder,a policy or policies of liability insurance including commercial general iability insurance with a combined single limit, or the equivalent, of not less than$2,000,000(two 4 t Tian dollars)per occurrence for Bodily Injury and Property Damage. 1.2.1 The insurance required in this Article shall include the following coverages: Y • Comprehensive General or Commercial General Liability, including personal injury, contractual liability,and products/completed operations coverage; and • Automobile Liability. r • Workers'Compensation d • 1.2.2 Each policy of such insurance shall be on an"occurrence"and not a"claims made" form,and shall: ents and • Name as additional insured "the City, of Ashland, Oregon, its officers, agents employees" with respect to claims arising out of the provision of Work under this G Agreetriept; 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; 1 a ,, • Apply as primary coverage for each additional named insured except to the extent that l .E two or more such policies are intended to "layer" coverage and, taken together, they provide total coverage from the first dollar of liability; t • Provider shall immediately notify the.City of any change in insurance coverage F • Provider shall supply an endorsement naming the City,its officers,employees and agents as additional insureds by the Effective Date of this Agreement; and , Page 1 of 6: oods and Services Agreement between the City of Ashland and Rogue•Valley Backflow Service 1 • . . Th • - • . . . . • •. -,. . . •. . . - • • . ' . c ,„ • Be evidenced by a peril fidate ore ertindatet ofsuch insurance approved by the City. 1.3 .Provider shall, at its own expense,maintain.Wortter's Compensation insurance in compliance with ORS 6$6:011,vitiChre9nitessabject employers to.ii...iiiiiide workers'compensation coverage for all of - its subject workers, - 1.4 , rOvider agrees that no person shall,on the grounds of race,color,religion,creed•sex, marital status, Millet status or domestic partnership, national origin, age, mental .9r physical disability, sexual : .. rientatton, gender identity'or source of income, suffer discrimination in the performance of this 1 - greement when employed by Provider.:Provider agrees to comply with all applicable requirements of demi and state civil rights and rehabilitation statutes,rules and regulations Further,-Provider agrees • .- riot to discriminate against a disadvantaged business enterprise, minority-owned business, woman- . OWned.business, a business that'n service-disabled veteran owns or an emerging small business .., terpriae•Certified Wider ORS.200A55,in awarding siilnontracts as reqnired.by ORS 279A.110, 1.5 1 all solicitations either by competitive bidding or negotiation made. by Provider for work to be .• p formed under a subcontract, ineluding procurements' of materials or leases of equipment, each .. .. .... idotential subcontraCtor.br supplier Shalt be notified by the Providers of the Provider's obligations tinder - - . 1. .. t is Agreement and Title VI ofthe Civil Rights Act Of1904•and other federal nondiscritnination.laWs. . . .. ,'.-.1. 1.6 Vitl.g:Wage•Itegniiittnents: If the amount of this Agreement is $22,002:43 (4 more, Provider is r uired to comply With Chapter 3.12 a the Ashland Municipal Code by paying a living wage, as d fined. in. that chapter, .1:6 -all employees performing Work under this Agreement and to any • hcontraCtOr Who.peeforms,5(1%or More Of the Work!Ander this Agreement., Provider is also required postlbe notice attached hereto as"Exhibit Ai'predOrnintilitly in areas Where-it will be seen by all e:ployeeS, 1:7 ••SSIgnineut: Provider shall not assign this Agreement or subuontrOdi any portion of the Work to be . . . • - p o.vided hereunder without the prior Written consent Of the City. Any attempted assignment or a bcontract without written consent of the City shall be void.. Provider shall be fully responsible for the ... a tsoromission$of any assigns or.subnottlettetors and of all persons employed by them,and approval li;' the City of any assignment:iit subcontract shall not create any,contractual relation between the . , . .,. a'signee•or stibcontractor end the . . . 2 CU 'S OBLIGATIONSL--..e ---- -'-"---- . 2,1, ity.shallpay Provider the sum.., .;.,.- oi o, ,.'.•. • •.- •• i, i.o r ...•••!:. .....: t. . ! -t, - .• -. , - . . " .......' .' ....''''.0katIlintitlaiagat4141*-404054VOVIrra4,specified in:fl*SUPPORTING . •• —-- ... :„•1 - i ociii4N'T . • . 22 n no event shall Providees otel,9f all compensation and reirnbnisement-under this Agreement weed he:sum of$5,000 00,five thousand'dollaitwithout express,written approval from the City official So hoseeignatureuppears below,or such officlisys successor in office Provider eXprossly atknowledges ;,•-,.1-•;*:'' i hat no other person has authority to aider erauthorize additional Work which would:cause WS. rodmam sum to be exceeded end that any;authorization front the responsible:official.must be In• • .' -ling Provider father.acknoidedges that any Work delivered.or expenses incurred without ••••uthorikation as,provided herein is done at Provider's own risk end as a volunteer without expectation ;..-;::::•.:.i'i. 0 f:compensatiOn ot Teimbutseinett . . . .. page./at& 1 oods and Services Agreement between the City of Ashland andRogueValley Backflow Service . . . . • ,: . . • • . ,, .. . ..... .. •. , . .. . • .. . . ... ... •• . . ••• • • • . - - • . - • • ... . . ... , . .. . . . . . . , .. ... . • . :. • • i 4 3. GE I RAL PROVISIONS 3.1 This is anon-exclusive Agreement. City is typesnot of obligated oods and services from other providers in its f sole • Provider and is free to procure similar g discretion. I3.2 Provider is an independent contractor and not an employee or agent of the City for any purpose. , 3.3 i'rovider is not entitled to,and expressly waives all claims to City benefits such as health and disability 5 insurance,paid leave,and retirement 3.4 his Agreement ambo full complete edes all p ior agree rets,negotiatio negotiations,and representations between the parties, g of the parties respecting the subject atter hereof. It supers p i bather written or oral. eement ma be amended onlybywritten instrument executed with the same formalities as this 3.5 his Age Y greement. g i 3.6 1 he following laws of the State of Oregon are hereby.incorporated by reference into this Agreement: 'f. •RS 279B.220,279B.230 and 279B.235. ` unAgreement shall be in the 3.7 his Agreement shall be governed bythelaws ofaaction arising Oregon without regard a d to conflict of laws principles. Exclusive venue for litigation unless exclusive ircuit Court of the State of Oregon for in the federal dJackson istrict court for the districttorf Oregon. Bach party PI ral court, n which case exclusive venue shall be venue,and i. . :xpressly waives any and all rights to maintain an action under this segr a eben in any other its venueand t xpressly consents that, upon motion of the other party, y ransferred,as appropriate,so as to effectuate this choice of venue. res and 5 3.8 'rovider shall defend, save, hold harmless and indemnify the City and its officers,a liabilities, and fl 11 ;gents from and against any and fro claims,arising out�ofactions, or relating to thsses, e activities of Provider or its tk xpenses of any nature resulting t ' officers,employees,contractors,or agents under this Agreement. g delay performance n 3.9 either partyc to this AgreementocshklloUttss,accidentsthe ,orsothertble for events beyond the ont of of the other or � ,aused by acts of God,strikes,roc , 3 y he other's officers,employees or agents. . 3.10 f any provision of this Agreement is found by a court of competent jurisdiction to be unenforceable, •uch provision shall not affect the other provisions,but such unenforceable o the fullestvion shall be deemed the 1 r : odified.to the extent necessary to render it enforceable,preserving 1 t tent of Provider and the City set forth in this Agreement. c _l ` 3.11 .1►eliveries will be g.O.B destination.Provider small pay all transportation and handling charges for the ( oods. Provider is responsible and liable for loss or damage until final inspection and acceptance of by City.Goods the Cit . Provider remains liable for latent defects,fraud,and warranties. reject nos-conforming Goods and require 3.12 he City may inspect and test the Goods. The City may rounder to re ant them without ca reasonable time,liver m at a City reduced price, ect the negotiated. G ods and cancel this , goes not cure any defects within a r 1 Page 3 or 6: oods end Services Agreement between the City of Ashland and Rogue Valley Backflow Service 1 i t 1 • greement in whole or in part.This paragraph does not affect or limit the City's rights,including its ights under the Uniform Commercial Code,ORS Chapter 72(UGC). 3.13 rovider represents and warrants that the Goods SUPPORTING DOCUMENTS and be free from anufacturer. Delivered Goods will comply •efects in labor,material and manufacture.Provider shall transfer all warranties to the City. k 4. SUP'ORTING DOCUMENTS :t The (allowing documents are, by this reference, expressly incorporated in this Agreement, and are colle•tively 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. r g 5. REM DIESpursue anyor all of the ?. 5.1 n the event Provider is in default of this Agreement,City_may, at its option, emedies available to it under this Agreement and at law or in equity,including,but not limited to: .1,1 Termination of this Agreement; t .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; 6 •.1.3 Initiation of an action or proceeding for damages, specific performance, or declaratory or 1, injunctive relief; a .1.4 These remedies are cumulative to the extent ntithe remedies mediesia a nortin any ist ert, and d City may t pursue any remedy or remedies singly, lated to ination of this ment 5.2 n no event pate City isbe Iflprevious e io us amountser paid to Provideany expenses r exceed theramount due,Provider shall o r for anticipated profits. prev nonwritten demand provided. pay immediately any excess to City p t 4, 6. TE' . AND TERMINATION t 6.1 erm his Agreement shall be effective Rom u irafull force and effectuhdl June 30,2022,set rtless sooner forth below ithe"Effective Date") and shall con ti rminated as provided in Subsection 6.2. H 6.2 ermination :.2.1 The City and Provider may terminate this Agreeent by`mu agreementualen t sme. Agt'eement ..2.2.The City may,upon not less than thirty(30)days'prior t for any reason deemed appropriate in its sole discretion, riot II .23 Either party may terminate this AgTeement,'with cause,by not less than fourteen(14)days'p 1 written notice if the cause is not cured within that fourteen(14) day period after written notice. i Such termination is in addition to and not in lieu of any other remedy at law or equity. 7. NOTI Eregiment, such notice shall be given in 4 When ver notice is required or permitted to be given under this Ag. i writin to the other party by personal delivery,by sending via a reputable commercial overnight aourie,tor r 1 by ma ling using registered or certified United States mail,return receipt requested,postage p p addres•set forth below: 1I'to the City: 1 Page 4 of& oods and Services Agreement between the City of Ashland and Rogue Valley Backflow Service I 1 City of Ashland i Facilities Maintenance Department ttn: David Arnold r 0 E.Main Streetj 'shland,Oregon 97520 1 1 l'hone:(541)552-2292 I. •ith a copy to: i' ity of Ashland—Legal Department 0 E.Main Street E, .shland,OR 97520 'hone:(541)_488-5350 I to Provider: ' , 'ague Valley Backflow Service 5 71 ttn:Erin Akers 41-482-9464 4 ii 8. WA ER OF BREACH J by revision, term, One r more waivers or failures to object either partyto the other's breach of any p' i condi'on, or covenant contained in this Agreement shall not be construed as a waiver of any subsequent w breac' whether or not of the same nature. i 9. PRO v IDER'S COMPLIANCE WITH TAX LAWS v. 9.1 °rovider represents and warrants to the City that: r '.1.1 Provider shall,throughout the term of this Agreement,including any extensions hereof,comply 7� ith: 4 (i) All tax laws of the State of Oregon,including but not limited to ORS 305.620 and OR S chapters 316,317,and 318; a political subdivision of the State of Oregon applicable t (ii) Any tax provisions imposed by p ;f to Provider;and (iii) Any rules,regulations,charter provisions,or ordinances that implement or enforce any of the foregoing tax laws or provisions. t• i' '',1.2 Provider,for a period of no fewer than six(6)calendar years preceding the Effective Date o 11t ORS f this greement, has faithfully complied with: ( ? ii (i) All tax laws of the State of Oregon,including but not limited to ORS 305.620 an 1chapters 316,317,and 318; licatile (ii) Any tax provisions imposed by a political subdivision of the State of Oregon app 1 to Provider;and g (iii) Any rules,regulations,charter provisions,or,ordinances that implement or enforce any o f - the foregoing tax laws or provisions. , with the tax laws of the State of Oregon and all applicable tax laws of any Bement. , pi 4 9,2 ovical s bd vi to comply f 1jurtier, subdivision of Provider's warranty,as set forth in this Article 9,shall constitutela material hr,athsA r beach of this Agreement. Any material breach of this Agreement shall entitle the City to terminate F tl is Agreement and to seek damages and any other relief available under this Agreement,at law,or in e ity. Page S or 6: oods and Services Agreement between the City of Ashland and Rogue Valley Backflow Service i ( • • WITNESS WHEREOF the parties have:eAuset! this Agreement tobe signed in their respective natues by heir.d14.0.thiotiied represetititiVe#as:Of 0:6,040 set fOtth below. C OF ASHLAND Rogue••Valley.04400.1v Servke(PROV*R) • i :,,„:7•34u;Z' qvArlakmAr- -• - • • Signature ......... .• :•. -• •: ttiotr—VcOuiple tr; g.Y„-e.vx Printed Name Printed Name 6- • • vo vel - -V1 • 41Title TitteDate ' • k:3:1.764 • • • . 1 .. . Date to:bie-submitte4 with iiii8.0gotd.Agtdgment) • kir:chi% Order.No: - • r !: • • • •• Pape Apr 6: OtoitS and Services Agreetuerftletweerrlilediyof Ashland and:Rogue.Valley Backflow Service . . _. •• • • 1 ® DATE(MMIDDIYYYY) A 9 o CERTIFICATE OF LIABILITY INSURANCE 07/06/2021 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). PRODUCER CNAME:ONTACT Rachel Petetit Focus1 Insurance Group,Inc PHONEFAX 720 E Jackson St (Arc.No.Ext): 541472-3120 (arc,No):541-772-7900 Medford,OR 97504 aooalEss: rachel@focuslins.com License#: NPN: 16192192&CA INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Attune Insurance INSURED ROGUE VALLEY BACKFLOW SERVICE LLC INSURER B: Ohio Security Insurance Company 24082 DBA ROGUE VALLEY BACKFLOW SERVICE INSURER C: 10 Allen Ln INSURER 0: Talent,OR 97540 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 00015497-615025 REVISION NUMBER: 17 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. /NSR ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE /NSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYY) A X COMMERCIAL GENERAL LIABILITY Y BTIS00001HIBP-24091-02 08/2812020 08/28/2021 EACH OCCURRENCE $ 1,000,000 DAETED CLAIMS-MADE X OCCUR PREM SES(EGE TOa occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONALSADVINJURY s Included GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY Ira LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY BAS58217718 12/14/2020 12/14/2021 (EeeBcldeDno INGLELIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED AUTOS ONLY X ogles) BODILY INJURY(Per accident) $ XHIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ OED RETENTION S $ WORKERS COMPENSATION PERTUTE OTH_ AND EMPLOYERS'LIABILITY YIN ER ANY PROPRIETOR/PARTNER/EXECUTIVE l l N r A E.L.EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L DISEASE-EA EMPLOYEE$ I(yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Certificate holder is named as additional insured in regards to the general liability per the attached endorsement SM 04 04 01 18 li CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Ashland THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Fleet Services/Facilities Maintenance ACCORDANCE WITH THE POLICY PROVISIONS. 90 North Mountain Avenue Ashland, OR 97520 ALITHORIZEDREPRESENTA VE it- I _. (RPI) ©1 -2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by RP1 on July 06,2021 at 08:53AM BUSINESSOWNERS SM 04 04 01 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS ENHANCEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM The provisions of the Businessowners Coverage Form apply except as otherwise provided in this endorsement. All numbers and letters used to designate paragraphs in this endorsement are specific to this endorsement only. The following is a summary of increased limits of insurance and additional coverage provided by this endorsement. For complete details on specific coverage, refer to the appropriate provisions in this endorsement. Unless otherwise noted, if similar coverage is provided in this endorsement and is also provided in another coverage form or coverage endorsement attached to this policy, the.coverage provided by this endorsement will apply first. Similar coverage provided elsewhere in the policy will apply after the limit in this endorsement has been exhausted. Unless otherwise stated in this Endorsement, the Coverage provided in this Endorsement is subject to the Deductible shown in the Businessowners Coverage Form Declarations, or$500, whichever is less. However, if Flood, Earthquake, Earthquake Sprinkler Leakage, Windstorm or Hail, Hurricane and/or Difference in Conditions Coverage is provided, the deductible shown in the specific coverage declarations applies. The titles and descriptions in the Coverage Schedule below are intended solely for ease of reference and do not in any way limit, expand or otherwise affect the provisions of this endorsement. BUSINESSOWNERS SCHEDULE OF COVERAGE CHANGES COVERAGE LIMIT OF INSURANCE PAGE Building Glass Included in Building Limit. Coverage, page 4 Property Limitations- Furs,fur garments and garments trimmed in fur Coverage, page 4 Theft -$5,000. Jewelry,watches,jewels, pearls, precious and semi-precious stones,gold,silver,bullion- $5,000. Patterns, dies,molds and forms-$10,000 Fire Department Service Up to$25,000 unless a higher limit is shown in Coverage, page 4 Charge the Declarations. Civil Authority: Actual loss of Business Income due to civil Coverage, page 4 Business Income action that prevents access to business area for six consecutive weeks;or when the coverage ends. Coverage begins 48 hours after the time of the first action. Necessary Extra Coverage for necessary extra expense begins Expense immediately after the time of the first action that prohibits access and ends six consecutive weeks after the date of that action;or when coverage for Business Income ends. • SM 04 04 01 18 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 9 with its permission.©2018 Blackboard U.S. Holdings, Inc.All Rights Reserved. May not be copied without permission. COVERAGE LIMIT OF INSURANCE PAGE Money Orders and $10,000 Coverage, page 4 "Counterfeit Money" Forgery Or Alteration $10,000,unless a higher Limit Of Insurance is Coverage, page 4 shown in the Declarations. Business Income From $10,000 Coverage, page 4 Dependent Properties Fire Extinguisher $25,000 Coverage, page 4 Systems Recharge Expense Electronic Data $25,000 Aggregate per Policy Year unless higher Coverage,page 5 Limit of Insurance is shown in the Declarations. Fire/Theft Reward Lesser of$10,000; or the dollar amount of the Coverage, page 5 covered fire or theft loss. (This coverage is not applicable in New York) • Water Back-up and $15,000 on an aggregate annual limit basis, Coverage, page 5 Sump Overflow regardless of the number of locations or losses. • Fine Arts Coverage $10,000 for any one loss at each described Coverage, page 5 premises. Newly Acquired Or Buildings:$300,000 at each building; • Coverage, page 6 Constructed Property p y Building Personal Property:$250,000 at each building. Personal Property Off- $15,000 Coverage, page 6 Premises Outdoor Property $10,000 unless a higher limit for Outdoor Coverage, page 6 Property is shown in the Declarations, but not more than$2,500 for any one tree,shrub or plant. Personal Effects $10,000 at each Described Premises. Coverage, page 6 Valuable Papers and $25,000 in any one occurrence at the described Coverage, page 6 Records premises, unless a higher Limit Of Insurance is shown in the Declarations, $5,000 for a loss not at the described premises. Accounts Receivable $25,000 in any one occurrence at the described Coverage, page 6 premises, unless a higher Limit Of Insurance is shown in the Declarations. $5,000 for a loss not at the described premises. S ' Appurtenant Structures $50,000 for loss or damage in any one Coverage, page 6 occurrence for any combination of loss Or damage to Building and Business Personal Property. Outdoor Signs $25,000 in any one occurrence unless a higher Coverage, page 6 and 7 Limit of Insurance for Outdoor Signs is shown in the Declarations. SM 04 04 01 18 Includes copyrighted material of Insurance Services Office, Inc. Page 2 of 9 with its permission.©2018 Blackboard U.S. Holdings, Inc.All Rights Reserved. May not be copied without permission. COVERAGE LIMIT OF INSURANCE PAGE Money and Securities $10,000 Inside the Premises for"money"and Coverage, Page 7 "securities';$10,000 Outside the Premises for "money"and"securities"while anywhere else. Employee Dishonesty $10,000 unless a higher Limit of Insurance is Coverage, page 7 shown in the Declarations. Property Definition- Paragraph a.(1)(a)Is replaced as follows:(a)48 Coverage, page 7 "Period of restoration" hours after the time of direct physical loss or damage for Business Income Coverage; Section II-1. Business $1,000 for the cost of bail bonds required Coverage, page 7 Liability-f. Coverage because of accidents or traffic law violations;the Extension cost of appeal bonds or bonds to release Supplementary attachments, but only within limits of insurance; Payments reasonable expenses incurred to assist in the investigation of the claim,including loss of earnings up to$500 per day for time away from work. Contractual Liability for Deletes the contractual liability exclusion for Exclusion revision, page 7 Personal Injury personal injury coverage. Broad Form Additional Automatically includes Additional Insureds when Coverage, page 8 and 9 Insured required by contract. Waiver Of Transfer Of Waives right of recovery we may have against Coverage,page 9 Rights Against Us entity because of payments made if there is a contract,executed prior to the loss requiring such waiver. SECTION II-EXCLUSIONS Asbestos "Bodily injury',"property damage"or"personal Exclusion language, page 7 and 8 and advertising injury"arising out of exposure or threat of exposure to asbestos in any form. Nuclear Hazard Nuclear reaction or radiation or radioactive Exclusion language, page 8 contamination however caused. Fungi or Bacteria "Bodily injury","property damage"or"personal Exclusion language, page 8 and advertising injury"from any actual,alleged or threatened contact,of any kind with"fungi"or bacteria within a building or structure including its contents,regardless of any other cause, event, material or product contributed concurrently... SM 04 04 01 18 Includes copyrighted material of Insurance Services Office, Inc. Page 3 of 9 with its permission.©2018 Blackboard U.S. Holdings, Inc.All Rights Reserved. May not be copied without permission. I. SECTION I—PROPERTY is amended as follows: A. Building Glass Coverage The following Building Glass Coverage is added to Section A. Coverage, 1.Covered Property: We will pay for direct physical loss of or damage to all glass that is part of a building or structure at the described premises owned by you. The amount we will pay for'this additional coverage is included in the applicable Building Limit as set forth in Section C. Limits of Insurance of the policy. This coverage is in addition to Glass Expenses coverage provided under Paragraph n., Additional Coverages. B. Loss or Damage by Theft The following change is made to item c.in Section A. Coverage,4.Limitations For loss or damage by theft, the applicable limits shown below apply, unless a higher Limit of Insurance is shown in the Declarations: (1) $5,000 for furs,fur garments and garments trimmed with fur. (2) $5,000 for jewelry, watches, watch movements, jewels, pearls, precious and semiprecious stones, bullion, gold, silver, platinum and other precious alloys or metals. (3) $10,000 for patterns, dies, molds and forms. C. Enhancements to Existing Additional Coverages The following changes are made to Section A.Coverage, 5.Additional Coverages: 1. Fire Department Service Charge Paragraph c. Fire Department Service Charge is amended to provide that we will pay up to a limit of $25,000, and that no deductible applies to this Additional Coverage. 2. Civil Authority Paragraph i. Civil Authority is amended to provide that the beginning and end of such coverage will be: a. Civil Authority Coverage for Business Income will begin 48 hours after the time of the first action of civil authority that prohibits access to the described'premises and will apply for a period of six consecutive weeks from the date on which such coverage began. b. Civil Authority Coverage for Extra Expense will begin immediately after the time of the first action of civil authority that prohibits access to the described premises and will apply for a period of six consecutive weeks from the date on which such coverage began; or when your Civil Authority Coverage for Business Income ends,whichever is later. 3. Money Orders and "Counterfeit Money" Paragraph j. Money Orders and "Counterfeit Money" is amended to provide that the most we will pay for any loss under this Additional Coverage is$10,000. 4. Forgery Or Alteration Paragraph k. Forgery Or Alteration, Subparagraph (4) is amended to provide that the most we will pay for any loss, including legal expenses, under this Additional Coverage is$10,000, unless a higher Limit Of Insurance is shown in the Declarations. 5. Business Income From Dependent Properties Paragraph m. Business Income From Dependent Properties, Subparagraph (1) only is amended to provide that the most we will pay under this Additional Coverage is$10,000 unless a higher Limit of Insurance is shown in the Declarations. 6. Extinguisher Systems Recharge Expense Paragraph o. Fire Extinguisher Systems Recharge Expense is amended to provide that: a. The maximum distance from the described premises within which we will pay for the cost of recharging or replacing, whichever is less, your fire extinguishers and fire extinguishing systems(including hydrostatic testing if needed) if they are discharged is increased to 1,000 feet; and • b. The most we will pay under this Additional Coverage is$25,000 in any one occurrence. SM 04 04 01 18 Includes copyrighted material of Insurance Services Office, Inc. Page 4 of 9 with its permission.©2018 Blackboard U.S. Holdings, Inc.All Rights Reserved. May not be copied without permission. ( 7. Electronic Data Paragraph p. Electronic Data, Subparagraph (3) only is amended to provide that the most we will pay under this Additional Coverage- Electronic Data, for all loss or damage sustained in any one policy year, regardless of the number of occurrences of loss or damage or the number of premises, locations or computer systems involved is $25,000, unless a higher Limit of Insurance is shown in the Declarations. This increased limit remains subject to the requirement that if loss payment on the first occurrence does not exhaust this amount, then the balance is available for subsequent loss or damage sustained in, but not after, that policy year. With respect to an occurrence which begins in one policy year and continues or results in additional loss or damage in a subsequent policy year(s), all loss or damage is deemed to be sustained in the policy year in which the occurrence began. D. New Additional Coverages: The following coverages are added to Section A.Coverage, 5.Additional Coverages 1. Fire/Theft Reward (This coverage is not applicable in New York) a. We will pay for a reward for information leading to a felony conviction in connection with an occurrence that results in a fire or theft loss covered this policy up to the lesser of$10,000 or the dollar amount of the covered fire or theft loss. b. This limit for this reward applies regardless of the 'number of persons providing that information. For the purposes of this Additional Coverage, an occurrence means a single act or series of acts caused by one or more persons resulting in a covered fire or theft loss. This reward is not available to any person responsible in any way for the fire or theft loss or to the Named Insured. No deductible applies to this Additional Coverage. 2. Water Back-up and Sump Overflow We will pay for direct physical loss or damage to Covered Property covered under SECTION (- PROPERTY caused by or resulting from: a. Water or waterborne material which backs up through or overflows or is otherwise discharged from a sewer or drain; or, b. Water or waterborne material which overflows or is otherwise discharged from a sump, sump pump or related equipment, even if the overflow or discharge results from mechanical breakdown of a sump pump or its related equipment. However, we will not pay the cost of repairing or replacing a sump pump or its related equipment in the event of mechanical breakdown. The most we will pay for the coverage provided under this Additional Coverage is $15,000 on an annual aggregate limit, regardless of the number of locations or losses. If a Water Back-up and Sump Overflow scheduled endorsement is added to the policy this coverage will not apply. 3. Fine Art Coverage a. We will pay for direct loss or damage to Fine Art whether owned by you or others, and in your care, custody or control. • b. Fine Art includes, but is not limited to, antiques,, paintings, etchings, drawings, tapestries, sculptures and fragile property such as porcelains, china and marble. c. The most we will pay for loss in any one occurrence under this Additional Coverage is $10,000 at each described premises. Our payment for loss or damage to personal property of others will only be for the account of the owner of the property. The amount payable under this Additional Coverage is additional insurance over the insurance available for Business Personal Property. d. The value of Fine Art will be the least of the following amounts: (1) The actual cash value of that property; (2) The cost of reasonably restoring that property to its condition immediately before the loss; or, (3) The cost of replacing that property with substantially identical property. e. In the event of loss, the value of property will be determined as of the time of loss. SM 04 04 01 18 Includes copyrighted material of Insurance Services Office, Inc. Page 5 of 9 with its permission.©2018 Blackboard U.S. Holdings, Inc.All Rights Reserved. May not be copied without permission. E. Enhancements to Existing Coverage Extensions The following changes are made to Section A. Coverage, 6.Coverage Extensions: 1. Newly Acquired Or Constructed Property Paragraph a. Newly Acquired Or Constructed Property,is amended to provide that: a. The most we will pay for loss or damage to Buildings under Subparagraph (1) of this Coverage Extension is$300,000 at each building. b. The most we will pay for loss or damage to Business Personal Property under Subparagraph(2) of this Coverage Extension is$250,000 at each building. c. The expiration date in Subparagraph(3)(b) is increased from 30 days to 60 days. 2. Personal Property Off-Premises Paragraph b.Personal Property Off-Premises is amended to provide that the most we will pay for loss or damage under this Coverage Extension is$15,000. 3. Outdoor Property Paragraph c. Outdoor Property is amended to provide that the most we will pay for loss or damage under this Coverage Extension is $10,000 unless a higher limit for Outdoor Property is shown in the Declarations,but not more than$2,500 for any one tree,shrub or plant. 4. Personal Effects Paragraph d. Personal Effects is amended to provide that the most we will pay for loss or damage under this Coverage Extension is$10,000 at each described,premises. 5. Valuable Papers And Records Paragraph e. Valuable Papers and Records, Subparagraph (3) only, is amended to provide that the most we will pay under this Coverage Extension for loss or damage to"valuable papers and records" in any one occurrence at the described premises is $25,000, unless a higher Limit of Insurance for "valuable papers and records" is shown in the Declarations. For"valuable papers and records" not at the described premises,the most we will pay is$5,000. 6. Accounts Receivable Paragraph f. Accounts Receivable, Subparagraph (2) only, is amended to provide that the most we will pay under this Coverage Extension for loss or damage in any one occurrence at the described premises is $25,000, unless a higher Limit of Insurance for accounts receivable is shown in the Declarations. For accounts receivable not at the described premises,the most we will pay is$5,000. F. Coverage Extension-Appurtenant Structures The following coverage is added to Section A.Coverage,6.Coverage Extensions: Appurtenant Structures (1) When there is a Building Limit of Insurance shown in the Declarations, you may extend the insurance provided by this policy for the described premises to apply to direct physical loss or damage caused by or resulting from a Covered Cause of Loss to Incidental Appurtenant Structures within 1,000 feet of the described premises. (2) When there is a Business Personal Property Limit of Insurance shown in the Declarations at the described premises, you may extend the insurance provided by this policy to apply to direct physical loss or damage caused by or resulting from a Covered Cause of Loss to Business Personal Property within Incidental Appurtenant Structures within 1,000 feet of the described premises. (3) Incidental Appurtenant Structures include storage buildings, carports, garages and similar structures which have not been specifically described in the Declarations.The most we will pay for loss or damage under this Coverage Extension in any one occurrence for any combination of loss or damage to Building and Business Personal Property is$50,000. G. Limits of Insurance—Outdoor Signs The following change is made to Section C.Limits of Insurance: Paragraph 2. is amended to provide that the most we will pay for loss or damage to outdoor signs,whether or not the sign is attached to a building, is$25,000 per sign in any one occurrence. fj SM 04 04 01 18 Includes copyrighted material of Insurance Services Office, Inc. Page 6 of 9 with its permission.©2018 Blackboard U.S. Holdings, Inc.All Rights Reserved. May not be copied without permission. H. Enhancements To Optional Coverages The following changes are made to Section G. Optional Coverages: 1. Outdoor Signs Paragraph d. of 1.Outdoor Signs is amended to provide that the most we will pay for loss or damage in any one occurrence is $5,000, unless a higher Limit of Insurance for Outdoor Signs is shown in the Declarations. 2. Money and Securities Paragraph c.(1) and c.(2) of 2. Money and Securities is amended to provide that the most we will pay for loss or damage in any one occurrence is$10,000, unless a higher Limit of Insurance is shown in the Declarations. 3. Employee Dishonesty Paragraph c. of 3. Employee Dishonesty is amended to provide that most we will pay for loss or damage in any one occurrence is$10,000, unless a higher Limit of Insurance for Employee Dishonesty is shown in the Declarations. I. Property Definitions Section H. Property Definitions, Subparagraph a.(1)(a) of Definition 9."Period of restoration"is deleted and replaced with by the following: (a) 48 hours after the time of direct physical loss or damage for Business Income Coverage; or H. SECTION II—LIABILITY is amended as follows: A. The following change is made to A.Coverages: Paragraph (1), sections (b), (c) and (d) of Subparagraph f. Coverage Extension-Supplementary Payments of Paragraph 1. Business Liability,are deleted and replaced by the following: (b) Up to$1,000 for the cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which Business Liability Coverage for"bodily injury"applies.We do not have to furnish these bonds. (c) The cost of appeal bonds or bonds to release attachments, but only for bond amounts within our Limit of Insurance.We do not have to furnish these bonds. (d) All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or"suit", including actual loss of earnings up to $500 per day because of time off from work. B. The following changes are made to B. Exclusions, Paragraph 1. Applicable To Business Liability Coverage: 1. Contractual Liability for Personal Injury Subparagraph (4) of Exclusion p. Personal and Advertising Injury is replaced by the following: (4) Arising out of an offense defined in Subparagraph f. (use of another's advertising idea in your "advertisement") or g. (infringing upon another's copyright, trade dress or slogan in your "advertisement") of Section F. Liability And Medical Expenses Definitions, Definition 14., "Personal and advertising injury", for which the insured has assumed liability in a contract or agreement. This exclusion does not apply to liability for damages that the insured would have in the absence of the contract or agreement. 2. The following exclusions are added: a. Asbestos (1) "Bodily injury", "property damage" or"personal and advertising injury" arising out of any actual or alleged exposure to asbestos or asbestos containing materials, including the mere presence of asbestos in any form. (2) Any damages,judgments, settlements, loss costs or expenses that: (a) May be awarded or incurred by reason of any.claim or"suit" alleging actual or threatened injury or damage of any nature or kind to persons or property which would not have occurred in whole or in part but for the presence of asbestos; SM 04 04 01 18 Includes copyrighted material of Insurance Services Office, Inc. Page 7 of 9 with its permission.©2018 Blackboard U.S.Holdings, Inc.All Rights Reserved. May not be copied without permission. (b) Arise out of any request, demand, order or statutory or regulatory requirement that any insured or others test for, monitor, cleanup, remove, encapsulate, contain,treat, detoxify or neutralize or in any way respond to or assess the effects of an asbestos presence; or (c) Arise out of any claim or"suit"for damages because of testing for, monitoring, cleaning up, removing, encapsulating, containing, treating, detoxifying or neutralizing or in any way responding to or assessing the effects of an asbestos presence. b. Nuclear Hazard Bodily injury", "property damage" or "personal and advertising injury" arising out of any nuclear reaction or radiation or radioactive contamination, however caused. But if nuclear reaction or radiation, or radioactive contamination, results in fire, we will pay for "bodily injury" or "property damage"caused by the fire. c. Fungi or Bacteria (1) "Bodily injury", "property damage" or"personal and advertising injury" arising out of the actual, alleged or threatened inhalation of, ingestion of or presence of any"fungi" or bacteria within a building or structure, including its contents, regardless of whether any other cause, event, material or product contributed concurrently or in any way or sequence to such injury or damage. (2) Any loss, cost or expenses arising out of the abating, testing for, monitoring, cleaning up, removing, containing, treating, detoxifying, neutralizing, remediating or disposing of , or in any way responding to, or assessing the effects of, "fungi" or bacteria, by any insured or by any other person or entity. C. Broad Form Additional Insured The following is added to C.Who Is An Insured: 1. Each of the following is also an insured: Any person or organization with whom you have agreed in a written contract, written agreement or written permit that such person or organization be added as an additional insured on your policy under SECTION II - LIABILITY. Such person or organization is an additional insured only with respect to liability for"bodily injury"or"property damage"caused by an"occurrence"first taking place after the effective date of the contract, agreement or permit, and caused in whole or in part, by: a. Your ongoing operations performed for that person or organization, "your product," or premises owned or used by you; however this provision does not include any architects, engineers, or surveyors with respect to any injury or damage arising out of the rendering or failure to render any professional services by or for you, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys,field orders, change orders or drawings and specifications; or (2) Supervisory, inspection,architectural or engineering activities. b. Your maintenance, operation or use of equipment, other than aircraft, "auto"or watercraft, rented or leased to you by such person or organization. A person or organization's status as an additional insured under this endorsement ends when their written contract or written agreement with you for such rented leased equipment ends. With'respect to the insurance afforded to these additional insureds, this insurance does not apply to any"occurrence"which takes place after the rental agreement or equipment lease expires. c. "Bodily injury" or"property damage"arising out of"your products"which are distributed or sold in the regular course of that person's or organization's business, however the insurance afforded that person or organization does not apply to: • ( (1) "Bodily injury" or"property damage"for which that person or organization is obligated to pay damages by reason of the assumption of liability' in a contract or agreement; however this exclusion does not apply to liability for damages that person or organization would have in the absence of the contract or agreement; (2) Any express warranty unauthorized by you; (3) Any physical or chemical change in the product made intentionally by that person or organization; SM 04 04 01 18 Includes copyrighted material of Insurance Services Office, Inc. Page 8 of 9 with its permission.©2018 Blackboard U.S. Holdings, Inc.All Rights Reserved. May not be copied without permission. 5 (4) Repackaging, unless 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; (5) Any failure to make such inspections, adjustments, tests or servicing as that person or organization has agreed to make or normally undertakes to make in the usual course of business in connection with the sale of the product; or (6) Products which, after distribution or sale by you, have been labeled or re-labeled or used as a container, part of ingredient of any other thing or substance by or for that person or organization; however this insurance does not apply to any insured person or organization, from who you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. The coverage afforded to an additional insured under this Paragraph 3. is subject to the following: a. The Limits of Insurance provided will be the lesser of: (1) The Limits of Insurance shown in the Declarations;or (2) The Limits of Insurance you are required to provide under the written contract, written agreement or written permit. b. This coverage will be excess with respect to the person or organization included as an additional insured by its provisions; any other insurance that person or organization has will be primary with respect to this insurance, unless this coverage is required to be primary and not contributory in the written contract, written agreement or written permit. c. This coverage does not apply unless the written contract or written agreement has been executed (executed means signed by the named insured and additional insured) or written permit issued prior to"occurrence"giving rise to the"bodily injury"or"property damage". D. Waiver of Transfer of Rights Against Others To Us The following is added to Paragraph K. Transfer Of Rights Of Recovery Against Others To Us in SECTION III—COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization because of payments we make under SECTION II — LIABILITY for injury or damage arising out of your ongoing operations or "your work" done under a contract with a person or organization and included in the "products- completed operations hazard", provided the contract is effective prior to the "occurrence" giving rise to the injury or damage. All other terms and conditions of the policy remain unchanged. SM 04 04 01 18 Includes copyrighted material of Insurance Services Office, Inc. Page 9 of 9 with its permission.©2018 Blackboard U.S. Holdings, Inc.All Rights Reserved. May not be copied without permission. • www.saif.com salk:.. Oregon Workers' Compensation Certificate of Insurance Certificate holder: CITY OF ASHLAND,CITY SHOPS 90 NORTH MOUNTAIN AVENUE ASHLAND,OR 97520 The policy of insurance listed below has been issued to the insured named below for the policy period indicated.The insurance afforded by this policy is subject to all the terms,exclusions and conditions of such policy;this policy is subject to change or cancellation at any time. Insured Producer/contact Rogue Valley Backflow Service LLC United Insurance Agencies Rogue Valley Backflow Service United Insurance Agencies 10 Allen Ln 541.242.6464 workerscomp@uiaoregon.com Talent,Or 97540-9739 Issued 08/12/2020 Limits of liability. Policy 875425 Bodily Injury by Accident $500,000 each accident Period 09/01/2020 to 09/01/2021 Bodily Injury by Disease $500,000 each employee Body Injury by Disease $500,000 policy limit Description of operations/locations/special items All operations Important This certificate is issued as a matter of information only and confers no rights to the certificate holder.This certificate does not amend,extend or alter the coverage afforded by the policies above.This certificate does not constitute a contract between the issuing insurer,authorized representative or producer and the II certificate holder. Authorized representative Kerry Barnett President and CEO i ti it 400 High Street SE Salem,OR 97312 P:800.285.8525 F:503.584.9812 F Pollcy_OLCA CertificateOflnsurance