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HomeMy WebLinkAbout2021-086 PO 20220069- Jahnke Heating & Air Purchase Order FrAl arf Fiscal Year 2022 Page: 1 of: 1 MitvolgERSANHIPIRINUMBRIMEME B City of Ashland I ATTN: Accounts Payable Purchase 20 E. Main Order# 20220069 Ashland, OR 97520 T Phone: 541/552-2010 O Email: payable@ashland.or.us ✓ H C/01Facilities Maintenance Div E JAHNKE HEATING &AIR I 90 North Mountain Ave N PO BOX 660 P Ashland, OR 97520 O TALENT, OR 97540 Phone: 541/488-5358 • R T Fax: 541/552-2304 - t _ -s ll —�i s- 1{i=z.6._�LLJe1-� = T1 Li � � `=t n::f`t_, =_- t. Ie �§€1EI=I--F3_IS 2 5�--�_� a aa -h —t-IE-I_i I31" �i°1==IeI=1—' _==�=1(1i`elf-=----- - _ I • David Arnold 7==-IL_k 07/27/2021 273 FOB ASHLAND OR Cit Accounts Pa able _- =_�=F'aNa s�i[si�FI_..Is r:`{_ — .,�E_--- �s�alt�} -esal3— a_re {e}€=lt _-_—__--___ _I - � �—_ alp{=-s G7.?l=}e�af_73 2_ HVAC Services - 1 HVAC Services 1.0 $4,995.00 $4,995.00 Goods and Services Agreement(Less than $@5,000) Completion date: June 30, 2022 Project Account: ***************GL SUMMARY*************** 088400 602400 $4,995.00 • • • �d Signature Date: 0729/202 F =y Aar,- $4,995.00 FORM #3 CITY OF ASHLAND ' REQUISITION Date of equest: , 7/12/21 Required date for delivery: Vendor Name • Jahnke Heating and Air Conditioning,Incl Address,City,State,Zip 112 South Pacific Highway,Talent,OR 97540 Contact Name&Telephone Number — Maureen Hunt 541-535-4470 maureen(6iahnkeheatingandair.com Email address 1 SOURCING METHOD I ❑ Exempt from Competitive Bidding I ❑ .Emergency ❑ Reason for exemption: ❑ Invitation to Bid ; ❑ Form#13,Written findings and Authorization ❑ AMC 2.50 Date approved by Council: i 0 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 j Cooperative Procurement Not exceeding$5,000 Date approved by Council: , ❑ State of Oregon ® Direct Award (Attach copy of council communication) 1 Contract# ❑ Verbal/Written quote(s)or proposal(s) El Request for Qualifications(Public Works)I 0 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 114,Personal Services>$5K&<$75K Agency PERSONAL SERVICES 0 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 I Agreement approved by Legal and approved/signed by ❑ Direct appointment not to exceed$35,000 ❑ Written quote or proposal attached I City Administrator.AMC 2.50.070(4) O (3)Written proposals/written solicitation Date approved by Council: — ! ❑ Annual cost to City exceeds$25,000,Council ❑ Form#4,Personal Services>$5K&<$75K Valid until: (Date) approval required.(Attach copy of council communication) Description of SERVICES I Total Cost HVAC Services for FY22 $4,995.00 Item# Quantity Unit Description of,MATERIALS1 Unit Price Total Cost 1 I ❑ Per attached quote/proposal i TOTAL COST j $ Project Number _ _ _ Account Number 088400-6024001 *Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. I k 1 IT Director in collaboration with department to approve hardware and software purchases: IT Director Date Support-Yes/No By signing this requisition form,I certify that the City's pu I c cont acting requirements have been satisfied. Employee: •!��I/i�/ Department Head: S � '�I132oz1 mor. eater than$5,000) Department Manager1Supervisor: City Administrator: 1 (Equal to or great"tJq<n ,MI. O 21 Funds appropriated for current fiscal year: YES/I-4X, 1 r l�. Deputy Finance Director-(Equar to or greaser than$5,000) Date Comments: Form#3-Reauisllon ' GOODS AND SERVICES AGREEMENT(LESS THAN$25,000) PROVIDER: Jahnke Heating and Air Conditioning,Inc. CITY OF PROVIDER'S ASH LAND CONTACT: Maureen Hunt 20 Bast Main Street Ashland,Oregon 97520 ADDRESS: 112 South Pacific Highway Telephone: 541/488-5587 Talent,OR 97540 Fax: 541/488-6006 PHONE: 541-535-4470 • •This Goods and Services Agreement(hereinafter"Agreement") Is ontered into by and between the City of Ashland,an Oregon municipal corporation(hereinafter"City")and Jahnke Heating and Air Conditioning,Inc., (a domestic/foreign business corporation)("hereinafter"Provider'),for HVAC services. 1. PROVIDER'S OBLIGATIONS 1.1 Provide HVAC services for FY22 as set forth in the"SUPPORTING DOCUMENTS"attached hereto and,by this reference,incorporated herein.Provider expressly acknowledges that time is ofthe 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 all received hereunder,apolicy or policies of liability insurance inoluding commercial general of Workp �' • liability insurance with a combined single limit,or the equivalent,of not less than$2,000,000(two million dollars)per occurrence for Bodily It jury and Properly Damage. 1.2.1 The insurance required in this Article shall include the following coverages: • Comprehensive General or Commercial General Liability, including personal injury, contractual liability,and products/completed operations coverage; and • Automobile Liability. • Workers'Compensation 1.2.2 Each policy of such insurance shall be on an"occurrence"and not a"claims made"form,and shall: • Name as additional insured "the City of Ashland, Oregon, its officers, agents and employees" with respect to claims arising lout 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 i'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 Page 1 of 6; Goods and Services Agreement between the City of Ashland and Jahnke Heating and Mr Conditioning,Inc. • • Be evidenced by a certificate or certificates oflsuch insurance approved by the City. c 1.3 Provider shall, at its own expense,maintain Worker's C ompensation Insurance i n coverage fore oeall with ORSS656.017,which requires subject employers to provId workers'ars compensation f its subject workers. mental or physical disability, sexual 1.4 Provider agrees that no person shall,on e grounds ri ids of r,ce,color,religion,creed,sex,marital status, familial status or domestic partnership, !discrimination performance of this orientation, gender identity or source of income, sufferdiscrimination in the p ents of federal and when employed ght by rah bilitati nider agrees tO comply with allstatutes,rules and regulations applicable Provider agrees � federal and state civil rights and.she minority-owned.business, woman- not to discriminate against a disadvantaged business enterprise, emerging Small ` owned business, a business that a SS Service-disabled awarding subs ntraot as requis or red by ORS 279A.110.usiness C, enterprise certified under ORS 200.0 competitive bidding or negotiation made by Provider for work to be 1.5 p all'solicitations either by each performed under a subcontract, including procurements' of materials or leases of equipment, potential subcontractor or supplier shall be notified by tbe!Providers of the Provider's obligations under 1 this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 1.6 Living Wage Requirements: If the amount of this Agreement is$22,002.43or-a orv,nPrwageras'is 4 required to comply with Chapter 3.12 of the Ashland Municipal Code by paying defined in that chapter, to all employees performing Work under this Agreement and to any e Subcontractor who performs 50%or more of the Work under this e�rient. Provider is also required areas where it will be seen by all j to post the notice attached hereto as"E,{hibit A"predominantly employees. portion of the Work be 1.7 Assignment: Provider shall not assign this Agreemen or subcontract any ttempted assignmentWokto or provided hereunder without the prior written consent! of the Cityapproval responsible for acts or omissions of any ass gns consent of nuc ors and of ail persons employed by thshall be void. Provider shall be em,and the the �' acts or omissions of any assigns or'subcontractors contractual relation between the bythe City of any assignment or subcontract shall not create any 1 assignee or subcontractor and the City. _J 7.7_0•2_1 2. CITY'S OBLIGATIONS : :. 2,1 City shall pay provider the sum as specified in the SUPPORTING l =taEmPosal}as-pd hereiPl DOCUMENTS. 2.2 In no event shall Provider's total of all compensation and reimbursement under this Agreement exceed the sum of$5,000.00,five thousand dollars without express,Written approval from the City official owledges whose signature appearssnh bs,authoritylow,or suth o order al's or,authorizeccessor ln additional Provider Work which wouldressly �caus bei ins that no maximum person be t authorization from the responsible official must maximum sum to be exceeded and that any Work delivered or expenses incurred 'without �I writing. Provider further acknowledges that any I authorization as provided herein is done at Providers own risk and as a volunteer without expectation of compensation or.reimbursement, ) page 2 of 6: Goods and Services Agreement between the City of Ashland and Jahnke Heating end Air Condt$onldg,Inc. 1 I . l specific11 amount of Work from 3. GENERAL PROVISIONS , any t 3.1 This is a nonexclusive Agreement. City is not obligated to procure procure similar types of goods and services from other providers in its sole i Provider and is free to t discretion. 3.2 Provider is an independent contractor and not an employee o1r agent of the City for any purpose. 33 Provider is not entitled to,and expressly waives all claims to City benefits such as health and disability •i insurance,paid leave,and retirement of the parties acting the subject is ! 3.4 This Agreement embodies.the full and tomenta negotiations,lete nndrepresentatlonsb tu►'eenthapart►es, matter hereof. It supersedes all prior agreements, eI whether written or oral. f :5 This Agreement may be amended only by written instrument executed with the same formalities as this 3 i Agreement. Agreement . 3.6 The following laws of the State of Oregon are hereby incorporated by reference into this gr ORS 2793.220,2793.230 and 2793.235. ent shall be governed by the laws ofthe State of Oregon without eris �g regard conflict of lawss I 3.7 Minci pis rinciples.Exclusive venue for litigation of any action arising Circa t Court ofthe State of Oregonfor Jacksonfederal courtforthe jurisdiction Oregon. Each P i Bement in any other venue, arty In which case xclusive venue shall be In ben dismissed or its venue z expressly waives any and all rights to maintain an action junderthis �e may +: expressly consents that,upon motion of the other party, any I transferred,as appropriate,so as to effectuate this choice of venue. . the City and its officers, employees and 3.8 Provider shall defend,save,hold harmless and indemaiiyl► ages, liabilities, costs, and i agents from and against any and all claims, suits, actions, losses, expenses of any nature resulting from,arising er this Agree u relating ati g to the activities of Provider or its officers,employees,contractors,or agents un i Bement shall hold the other responsible for damages or delay in performance 3.9 Neither party to this Agr ; caused by sots of God,strikes,lockouts,accidents,or'other events beyond the control of the other or the other's officers,employees oragents. rovision of this Agreement is found by a court of comp stent jurisd;coon to be unenforceable, I. 3.10 If any p provisions,but such unenforceable provision shallbe deemed ed such provision shall not affect the other p reserving tD the fullest extent p he ti modified to the extent necessary to render it enforceable,p intent of Provider and the City set forth inthis Agreement. F t! 3.11 Deliveries will be F.0.13 destination.Provider.shall pay all transportation and handling charges for the ______E — Goods.Provider is responsible and liable for loss oridarnage until final inspection and acceptance of t the Goods by the City. Provider remains liable for latent defects,fraud,and warranties. -i mayreject non-conforming Goods and require 3.12 The City may Inspect and test the Goods.The City ,as negotiated.If Provider does no c rerany them without chargereasonablertime,the City maem at a reduced =reject the Goods and cancel this g does not'cure any defects within a r 9 \ \ I Page 3 of 6: Goods end Services Agreement between the City of Ashland and Jahnke Ideating and Air Conditlonbm,Inc. _ i 1 i I f rights,Agreement in whole or in part.This paragraph does not affect or limit the City's gh ,including its rights under the Uniform Commercial Code,ORS Chapter 72(UCC). d 3.13 Provider represents and warrants comply om l with SUPPORTING DOods are new, current,CUMENTS and be free from warranted by the manufacturer.Delivered Goods will p Y • defects in labor,material and manufacture.Provider shall t lansfer all warranties to the City. t, I Agreement, and are i 4. SUPPORTING DOCUMENTS The following documents are, by this reference; expressly incorporated in this i. collectively referred to in this Agreement as the"SUPPORTING DOCUMENTS:" rII il • The Provider's hourly rate sheet. �` • The Provider's firm price bid(s)for each individual project. 1' 5.1 In the event Provider is in default of this Agr S. REMEDIES Bement,City may,at its option,pursueor any all of the remedies available to it under this Agreement and at law or In equity,including,butnot limitedto: 5.1.1 Termination of this Agreement scheduled 5.1.2 etall s monies Work that have bfor the Work een delit verer has ed inaddeegquately or defectively; completion dates or any 5.1.3 Initiation of an action or proceeding for damag , specific performance, or declaratory or I. 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. 4 ex eases related to termination of this Agreement i 5.2 In no event shall City be liable to Provider for any p or for anticipated profits.If previous amounts paid to Provider exceed the amount due,Provider-shall ii pay immediately any excess to City upon written demand provided. I 6. TERM AND TERMINATION 6.1 Term as set ford►below P This Agreement shall be effective from the date of execution on behalf of the City ¢ (the`Effective Date").and shall continue in hill force and effect until June 30,2022,unless sooner e E terminated as provided in Subsection 6.2. , lb , 6.2 Termination Itual k 6.2.1 The City and Provider may terminate thisAgreement by mutua n greemterminatentatny t is Agreement e. 6.2.2 The City may,upon not less than thirty(3tl)days'prior in its sole discretion. g for any reason deemed appropriate Agreement,with;cause,by not less than fourteen(14)days'prior 6.2.3 Either party may terminate cause thiscured r. written notice if theecause is nottcwithin 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 under this Agreement,such notice shall be given in Whenever notice is required or permitted to be gv 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,I return receipt requested,postage prepaid,to the i address set forth below: If to the City: Page 4 of 6: Goods and Services Agreement between the City of Ashland and Jahnke Heating and Mr Conditioning,Inc. I I I I II City of Ashland Faollities Maintenance Department Attn: David Arnold 20 B.Main Street Ashland,Oregon 97520 Phone:(541)552-2292 I With a copy to: , City of Ashland—Legal Department 20 B.Main Street • Ashland,OR 97520 Phone:(541)488-5350 If to Provider: Jahnke Heating and Air Conditioning,Ina. i Attn:Maureen Hunt • `ii 541-535-4470 L r 8. WAIVER OF BREACH to the other's breach of any provision, term, t One or more waivers or failures to object by either party subsequent condition,or covenant ftlr�amin this e Agreement shall not be construed as a waiver of any breach,whether or n e 9. PROVIDER'S COMPLIANCE WITH TAX LAWS 1 L 9.1 Provider represents and warrants to the City►that: anyextensions hereof;comply throughout the term of this Agreement including 9.1.1 Provider shall, i with: (l) All tax laws of the State of Oregon,including but not limited to ORS 305.620 and ORS chapters 316,317,and 318; political subdivision of the State of Oregon applicable -,i, Ci) Any tax provisions imposed by a to Provider,and (ill) 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 compiled-vdth: C) All tax laws of the State of Oregon,including but not limited to ORS 305.620 and ORS 2 chapters 316,317,and 318; linable u Any tax provisions imposed by a political subdivision of the State of Oregon app 1 � C� to Provider;and Iement or enforce any of I b (iii) Any rules,regulations,charter provisions.or ordinances that Imp E the foregoing tax laws or provisions. I l with the tax laws of the State of Oregon and all applicable tax laws of any 9.2 Propolitical s bdiv siure o oft y t subdivision the State of Oregon shall constitute a material breach of this Agreement. Further,any violation of Provider's warranty,bas of this forth in n this Article shall entitle the constitute ity toa terminate breachial of this Agreement. Any material iAgreement and to seek damages and any other relief available under this Agreement,at law,or in this tY. Page 5 of 6: Goods and Services Agreement between the City of Ashland and Jahnke Heating and Air Conditioning,Inc. i f 1 I I • II i IN WITNESS WHEREOF the parties have caused this Agreement to be signed in their respective names by their duly authorized representatives es of the dates set forth below. Jahnke Heating and Air Conditioning,Inc. CITY OF ASHLAND: Jahnke , , By: 1��J �-(V sy Signature Sco''r FuEt32 (Y1(j,A�yt/'e e.1r1 M u.,r1f �` Printed NameI Printed Name a Title OCTI Title 11'12or-1 Date _ I . 1' , g 1 Date W-9 is to be submitted with this signed Agreement) t ;-e ,1- e 4 7 Purchase Order No. C I I I I I 1 I 1 1 I • 1 Page 6 of 6; Goods end Services Agreement between the City of Ashland and Jahnke Heating and Air Condi doling,Inc. 1 ( 1 HEATING &AIR CONDITIONING INC. IttillardlbStop A7►onc Eppaerfr-sa0 TRAM July 9,2021 City of Ashland . ATTN:Dave Arnold,Facilities Maintenance :•t 90 N Mountain Ashland,OR 97520 . Rate Sheet 1 i Diagnostic Charge(Service Dept)$79.00I i Overtime Diagnostic Charge (After hours Service Dept)$150.00 Yearly equipment maintenance$105 per unit(filters are available!for additional charge) Filter Change only$79(filters are available for additional charge) Duct Inspection$85 Duct repair$85 per hour Time&Materials jobs are based on$85 per hour plus materials ti **We use a flat-rate base on a computer-generated pricing(Service Titan Pricebook) For any specific jobs,parts or installations we can provide a written proposal which requires authorized signatures before any work can begin. E Thank you for your business, Sincerely, •--..-1,..1__Tho...A.j,_,Q..I.4 j \.), .... ,),i Jahnke Heating&Air Conditioning i •li . P.O. Box 660 • Talent, OR 97540 • (541)535-4470 • (541) 779-8496• (541)479-3600 0 • ACORDDATE(MM CERTIFICATE OF LIABILITY INSURANCE 05/11/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I I IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If j SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this I certificate does not confer rights to the certificate holder In lieu of such endorsement(s). I PRODUCER CONTACT FEDERATED MUTUAL INSURANCE COMPANY NAME; CLIENT CONTACT CENTER PHONE HOME OFFICE:P.O.BOX 328 (A1C,No.Ext):886.333-4949 FAX No):507-446r4664 CMIATONNA,MN 55060 ADDRess:CLI ENTCONTACTCENTER(aFEDINS.COM INSURER(S)AFFORDING COVERAGE NAIC II INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 356-839-9 INSURER B: JAHNKE HEATING&AIR CONDITIONING INC INSURER C: PO BOX 660 TALENT,OR 97540-0660 INSURER D: INSURER El INSURER F: COVERAGES CERTIFICATE NUMBER:95 I REVISION NUMBER:0 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT1 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. I I ILTD TYPE OF INSURANCE MGR DL POLICY NUMBER API IDCMYv`�/Y1 I ASOMLIMITS X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $1,000,000 11 (Es $100,000 CLAIMS•MADE n OCCUR PREMISE R PREMISES EE RENTED cel MED EXP(My one person) EXCLUDED A Y N 9089608 04/08/2021 04/08/2022 PERSONALS ADV INJURY $1,000,000 OE1'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY n jECT n LOC PRODUCTS•COMPIOP A00 $2,000,000 OTHER: AUTOMOBILE LIABILITY I (Ee BINE%SINGLE UMIT $1,000,000 X ANY AUTO I BODILY INJURY(Per person) —A OWNED AUTOS ONLY AUTO ULED Y N 9089608 04/08/2021 04/08/2022 BODILY INJURY(Per eeddent HIRED AUTOS ONLY NON-OWNED AUTOS ONLY IPPer ROPaeddenERTY DAMAGE _ — X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $1,000,000 . A EXCESS UAB CLAIMS•MADE N N 9089609 04/08/2021 i 04/08/2022 AGGREGATE $1,000,000 DED I !RETENTION WORKERS COMPENSATION PER STATUTE 0TH. AND EMPLOYERS'LIABILITY /N i ANY PROPRIETORIPARY TNERIEXECUTIVE Ir EA-EACH ACCIDENT OFFICERIMEMBER EXCLUDED? I N I A (Mandatory in NH) E.L DISEASE-EA EMPLOYEE II yes,describe under E.L DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below • 1 . DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remerts Schedule,may be elledmd II more apace Is required) SEE ATTACHED PAGE I I CERTIFICATE HOLDER CANCELLATION i 366-839-9 95 0 CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE s 20 E MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND,OR 97520-1814 ACCORDANCE WITH THE POLICY PROVISIONS. 3'. AUTHORIZED REPRESENTATIVE fi ii I O 1986-2015 ACORD CORPORATION.All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD I } II1 I I } I AGENCY CUSTOMER ID: 366-839-0 LOC#: ACCORD ADDITIONAL REMARKS SCHEDULE Page 1 o1 1 AOENCY NAMED INSURED FEDERATED MUTUAL INSURANCE COMPANY JAHNKE HEATING&AIR CONDITIONING INC POIJCY NUMBER PO BOX 660 SEE CERTIFICATE#95.0 TALENT,OR 97540-0660 CARRIER RAID CODE SEE CERTIFICATE#95.0 EFFECTIVE DATE:SEE CERTIFICATE#95.0 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE ADDITIONAL INSURED ALSO INCLUDES THE CITY OF ASHLAND, OREGON, ITS OFFICERS, AGENTS AND EMPLOYEES THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT ENDORSEMENT FOR BUSINESS AUTO LIABILITY. INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. ACORD 101(2008/01) ®2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo areregisteredmarks of ACORD COMMERCIAL GENERAL LIABILITY POLICY NUMBER: Policy# ISSUE DATE: 4/1212019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART • SCHEDULE Name of Additional Insured Person(s)or Organization(s): City of Ashland 20 East Main Street Ashland OR 97520 Section II—Who Is An Insured Is amended to include as an additional Insured the person(s)or organization(s) shown in the Schedule,but only with respect to liability for"bodily injury","property damage", "personal injury"or "advertising injury"caused,in whole or in part,by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations;or I j B. In connection with your premises owned by or rented to you. • I ' CG D4 11 04 08 ®2005 The Travelers Companies,Inc. Page 1 of 1 includes the copyrighted material of Insurance Services Office,Inc.with Its permission. 48128059 110/19"AMP1,M CE921920MS I Sandy L. Orr 14/12/2019 4,21,06 PM (PUT) 18890 2 01 3 5 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following is added to Paragraph c.in A.1.,Who between you and that person or organization,that is Is An Insured,of SECTION II-COVERED AUTOS signed byi you before the"bodily injury" or"property LIABIUTY COVERAGE in the BUSINESS AUTO damage"occurs and that is In effect during the policy COVERAGE FORM and Paragraph e.In A.1.,Who is period,to name as an additional Insured for Covered An Insured, of SECTION II — COVERED AUTOS Autos Liability Coverage, but only for damages to LIABILITY COVERAGE In the MOTOR CARRIER which this;insurance applies and only to the extent of COVERAGE FORM, whichever Coverage Form Is that person's or organization's liability for the conduct part of your policy: of another"insured". This includes any person or organization who you are required under a written contract or agreement • 4 ' CA T4 37 02 16 a 2016 mo Travelere Indemnity Company.Alt rights reserved. Page 1 of 1 Includes copyrighted materiel of tneurence Services Office,Inc,with its permission. 40326859 1 I6/I9 SAMPLE CERTIFICATE I sandy L. Orr 1 4/32/2039 4,21106 FM (MMT) 1 a09"3 of 3 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT ENDORSEMENT This endorsement modifies insurance provided under the following: I I BUSINESS AUTO COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. WHO IS AN INSURED for"bodily injury"and "property damage" liability is amended to include: Any person or organization other than a joint venture, for which you have agreed by written contract to procure bodily injury or property damage "auto" liability insurance arising out of operation of a covered "auto"with your permission. However,this additional insurance does not apply to: (1) The owner or anyone else from whom you hire or borrow a covered "auto". This exception does not apply if the covered "auto"is a"trailer"connected to a covered "auto"you own. (2) Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household. (3) Someone using a covered "auto" while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that busin Iss is yours. (4) Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees", while moving property to or from a covered "auto". (5) A partner (if you are a partnership), or a member (i you are a limited liability company) for a covered "auto"owned by him or her or a member of his or her household. B. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached. In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any insured, or to procure insurance. C. The limits of insurance applicable to such insurance shall be the lesser of the limits required by the agreement between the parties, or the limits provided by this policy. D. Additional exclusions. The insurance afforded to any person or organization as an insured under this endorsement does not apply: 1. To"loss"which occurs prior to the date of your contract with such person or organization; 2. To "loss" arising out of the sole negligence of any person or organization that would not be an insured except for this endorsement. 3. To "loss" for any leased or rented "auto" when the lessor or his or her agent takes possession of the leased or rented "auto"or the policy period ends,whichever occurs first. Includes copyrighted material of Insurance Services Office, Inc.with its permission. CA-F-127(03-03) Policy Number: 9089608 Transaction Effective Date:04-08-2021 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract Condition and supersedes any provision to the or agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the This insurance isprimary to and will not seek additional insured. contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and © Insurance Services Office, Inc.,,2018 Page 1 of 1 CG 20 01 12 19 Policy Number: 9089608 Transaction Effective Date:04-08-2021 COMMERCIAL GENERAL LIABILITY CG 20 33 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or additional insureds, the following additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to: organization have agreed in writing in a contract 1. Bodil y injury", g"property dama e" or or agreement that such person or organization be added as an additional insured on your policy. personal and advertising injuryarising out { Such person or organization is an additional of the rendering of, or the failure to render, insured only with respect to liability for "bodily any professional architectural, engineering or injury", "property damage" or "personal and surveying services, including: ! advertising injury" a. The preparing, approving, or failing to caused, in whole or in part, by: 1. Your acts or omissions;or prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, 2. The acts or omissions of those acting on your change orders or drawings and behalf; specifications; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. However, the insurance afforded to such This exclusion applies even if the claims additional insured: against any insured allege negligence or other 1. Only applies to the extent permitted by law; wrongdoing in the supervision, hiring, and employment, training or monitoring of others 2. Will not be broader than that which you are bye that insured, if the "occurrence" which required by the contract or agreement to caused the "bodily injury" or "property provide for such additional insured. damage", or the offense which caused the A person's or organization's status as an "personal and advertising injury", involved the additional insured under this endorsement ends rendering of or the failure to render any when your operations for that additional insured professional architectural, engineering or surveying services. are completed. © Insurance Services Office, Inc.; 2018 Page 1 of 2 CG 20 33 12 19 Policy Number: 9089608 Transaction Effective Date:04-08-2021 2. "Bodily injuryor "property damage" C. With respect to the insurance afforded to these occurring after: additional insureds, the following is added to a. All work, including materials, parts or Section III -Limits Of Insurance: equipment furnished in connection with The most we will pay on behalf of the additional such work, on the project (other than insured is the amount of insurance: service, maintenance or repairs) to be 1. Required by the contract or agreement you performed by or on behalf of the additional have entered into with the additional insured; insured(s) at the location of the covered or operations has been completed; or 2. Available under the applicable limits of b. That portion of "your work" out of which insurance; the injury or damage arises has been put to its intended use by any person or whichever is less. organization other than another contractor This endorsement shall not increase the or subcontractor engaged in performing applicable limits of insurance. operations for a principal as a part of the same project. 11 it Page 2 of 2 © Insurance Services Office, Inc!, 2018 CG 20 33 12 19 Policy Number: 9089608 Transaction Effective Date:04-08-2021 912215 B135 I May 11, 2021 JAHNKE HEATING &AIR CONDITION 7675 4TH ST WHITE CITY, OR 97503-6648 Re: Barrett Business Services, Inc. ("BBSI") Letter of Self-Insurance for Workers' Compensation Coverage As the named addressee of this Letter, your company's required workers'compensation coverage is provided through BBSI's state approved Self-Insured Workers' Compensation Plan by way of your co-employment contract with BBSI. Additional information is as follows: State: Oregon Workers'Compensation Limits: Employer,Liability Limits: Self Insurance Certification#: 1068 Statutory $5,000,090.00 Each Accident $5,000,000.00 Disease Coverage Limit by Client $5,000,000.00 Disease;Each Employee Other Comments(place an"X"if applicable): •X Named"Letter Holder": City of Ashland 90 North Mountain Avenue Ashland, OR 97520 I � I I. X Other: Effective 5/1/2020 through 4/30/2022. Subject to 30 days',notice of cancellation. Additionally, BBSI's self-insured program is further supported by an excess workers'compensation insurance policy with ACE American Insurance Co.. Copy of certificate is available upon request. For additional information, please contact your local BBSI office at: MEDFORD (541)772-5469 2045 Cardinal Way Suite 100 Very truly yours, Medford, OR 97504 P � Gary Kramer President and Chief Executive Officer I doe:LOSI-2