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HomeMy WebLinkAbout2021-091 PO 20220067- American Industrial Door LLC Purchase Order • P.E.C PF. rift � � Fiscal Year 2022 Page: 1 of: 1 J -- __ . B City of Ashland _.;E�`;=3r: e =�9=e i'JrJ.LUMEN+ I ATTN: Accounts Payable20 E. Main Purchase L Ashland, OR 97520 Order# 20220067 T Phone: 541/552-2010 O Email: payable@ashland.or.us ✓ H C/O Facilities Maintenance Div E AMERICAN INDUSTRIAL DOOR, LLC I 90 North Mountain Ave N 6142 CRATER LAKE AVE p Ashland, OR 97520 O CENTRAL POINT, OR 97502 Phone: 541/488-5358 R T Fax: 541/552-2304 _I-f--41.111=-Aoh.1el_, =_=1_1a ==E:_ r I j=1:1 ='=)_ lair, E'=€°1_1=) F — —_ _"� I_I[-,==a_,?1_la[ _ _ 541 664-5555 David Arnold t=t(=s'a l=la=lec-_:IsleWAUzi=JaEq.*, E=iz= €=1[ Vit( 3=[slai=`eae=Et=--- gi:)zri1)a1-_-;a1-=14e1.-- 07/27/2021 07/27/2021 322 FOB ASHLAND OR Cit Accounts Pa able 74M Door Service& Repairs 1 Door service and repair 1.0 $4,995.00 $4,995.00 Goods and Services Agreement(Less than $25,000) Completion date: June 30, 2022 Project Account: ***************GL SUMMARY*************** 088400-602400 $4,995.00 • 07/29/2021 .4 By: Date: Authorized Signature $4,995.00 a ' FORM #3 CITY OF I A ' ASHLAND r'�t:j(:1�:4',:'t,Tor fl 1.ir'CirE:; ) rl;�,. , ,oL D fl 7 REQUISITION / Date of request: 5/4/2021 Required date for delivery: Vendor Name American Industrial Door.LLC Address,City,State,Zip 6142 Crater Lake Avenue.Central Point OR 97502 Contact Name&Telephone Number Troy Andrus/Gerald Hill 541-664-55551 Email address SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: 0 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) El 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# ❑ Verbal/Written 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 I Agency GOODS&SERVICES ❑ Applicable Form(#5,6,7 or 8) 1 Contract# Greater than$5,000 and less than$100,000 ❑ Written quote or proposal attached 1 Intergovernmental Agreement ❑ (3)Written quotes and solicitation attached ❑ Form#4,Personal Services>$5K&<$75K I 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 Cit Administrator.AMC 2.50.070(4) ❑ (3)Written proposals/written solicitation Date approved by Council: D 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 1 Total Cost Door service and repair for FY22 $4,995.00 Item# Quantity Unit Description of MATERIALS1 Unit Price Total Cost ❑ Per attached quote/proposal . TOTAL COST Project Number _ _ — Account NumbeL0240�-602400 *Expenditure must be charged to the appropriate account numbers for the financials to accurately ref!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 • y's pu ilk contracting requirements have been satisfied. Employee: 41161! Department Head: �i ��.� 13 232.41" `M : to ore eater than$5,000) Department Manager/Supervisor: City Administrator: 4e." 5y0(� (Equal to or greater tha� 2 9/2021 Funds appropriated for current fiscal year: YES /NO ( / Deputy Finance Director-(Equal to or greater than$5,000) Date Comments: Form 43-Requisition I GOODS AND SERVICES AGREEMENT(LESS THAN$25,000) PROVIDER: .American Industrial Door,LLC I CITY OF PROVIDER'S i ASH LAN D CONTACT: Troy Andrus I 20 East Main Street ADDRESS: 5022 Table Rock Road Ashland,Oregon 97520 OR 97502 Telephone: 541/488-5587 Central Point, Fax: 541/488-6006 PHONE: 1 541-664-5555 i This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of i Ashland, an Oregon municipal corporation (hereinafter "City'') and American Industrial Door, LLC, (a domestic/foreign business corporation)("hereinafter"Provider"),for service of overhead doors. 1. PROVIDER'S OBLIGATIONS 1.1 Provide service for overhead doors for FY22 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." I 1 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 1ia1?ility insurance including commercial general liability insurance with a combined single limit, or the equivalent, of not less than$2,000,000 (two million dollars)per occurrence for Bodily Injury and Property Damage. 1.2.1 The insurance required in this Article shall include the following coverages: • Comprehensive General or Commercial General Liability, including personal injury, contractual liability,and products/completed operations coverage; and • Automobile Liability. • Workers' Compensation 1.2.2 Each policy of such insurance shall be on an"occurrence" and not a"claims made"form,and shall: • Name as additional insured "the City of Ashland, Oregon, its officers, agents and employees" with respect to claims arising out of the provision of Work under this Agreement; . • Apply to each named and additional named insured as though a separate policy had been issued to each,provided that the policy limits shall not be increased thereby; • Apply as primary coverage for each additional named insured except to the extent that two or more such policies are intended to "layer" coverage and, taken together, they provide total coverage from the first dollar of liability; • Provider shall immediately notify the City fof any change in insurance coverage z • 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 American Industrial Door,LLC 1 1 J • 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 to providCompensation workes' oinpensation cove age for a1lwith of ORS 656.017,which requires subject its subject workers. 1.4 Provider agrees that no person shall, on the grounds of rade, color,mental religion, creed, x,marital sability, sexual familial status or domestic partnership, national origin, age, physical 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 veteranwn uired by ORS 2an erging small 1 business enterprise certified under ORS 200.055,in awarding subcontractsa q 1.5 In all solicitations either by competitive bidding or negotiation made by Provider for work to be performed under a subcontract, including procurements! of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Providers of the Provider's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 1.6 Living Wage Requirements: If the amount of this Agreement is $22,002.43 or more, Provider is required to comply with Chapter 3.12 of the Ashland IYlunicipal Code by paying a living wage, as defined in that chapter, to all employees performing Work under this Agreement and to any Subcontractor who performs 50%or more of the Work under this Agreement. Provider is also required to post the notice attached hereto as "Exhibit A"predominantly in areas where it will be seen by all employees. 1.7 Assignment: Provider shall not assign this Agreement'or subcontract any portion of the Work to be provided hereunder without the prior written consent of the City. Any attempted assignment or subcontract without written consent of the City shall be vi id. Provider shall be fully responsible for the persons em,and the approval bytsi of any assigns or subcontractors and or subcontract shall ori lit 1 create any con contrloyed by actual elation between the by the City. of any assignment assignee or subcontractor and the City. 2. CITY'S OBLIGATIONS OBLIGATIONS .Zit.e.:14 - as specified _:.. . _ — 2.1 City shall pay Provider the sum " --- .ecified in the SUPPORTING DOCUMENTS. 2.2 In no event shall Provider's total of all compensation and reimbursement under this Agreement exceed the sum of$5,000.00,five thousand dollars without express,written approval from the City official whose signature appears below,or such official's successor in office. Provider expressly acknowledges _ that no other person has authority to order or authorize additional Work which would cause this maximum sum to be exceeded and that any authorization from the responsible official must be in writing. Provider further acknowledges that any Work delivered or expenses incurred without authorization as provided herein is done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement. Page 2 of 6: Goods and Services Agreement between the City of Ashland and American Industrial Door,LLC I - I 3. GENERAL PROVISIONS , on-exclusive Agreement. City is not obligated to procure any specific her providers ntfino k from 3.1 This is an of goods and services from Provider and is free to procure similar typesl i discretion. 1 3.2 Provider is an independent contractor and not an employee or agent of the City for any purpose. i 3.3 Provider is not entitled to,and expressly waives all claims to City benefits such as health and disability paid leave,and retirement. i ' insurance, 3,4 This Agreement embodies the full and complete ri notiations,and representations betweening of the parties respecting the the parties,subject ' matter hereof. It supersedes all prior agreements, g LIwhether written or oral. bytill ti written instrumint executed with the same formalities as this 3.5 This Agreement may be amended only 11, Agreement. ' 3.6 The following laws of the State of-Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220,279B.230 and 279B. 1.' 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 actionLct court under thisfor the district of Oregon. Each party 11 Agreement n any other venue,and expressly waives any and all rights to maintain expressly consents that, upon motion the thisotother cparoic f anyvencase may be dismissed or its venue transferred,as appropriate,so as to effectuate the City and its officers, employees and i Provider shall defend, save, hold harmless and inde ffy Cies damages, liabilities,crscosts,eand 3.8 • agents from and against any and all claims, suits, ofcor relating to the activities of Provider or its expenses of any nature resulting from, arising 1eeme- officers, employees,contractors,or agents under this Agr' nt. 3.9 Neither party to this Agreement shall holdother responsible r ges or delay in performance caused by acts of God, strikes,lockouts, accidents, or other eventsbeyond the control of the other or I the other's officers,employees or agents. ction to be unenforceable, 3.10 If any provision of this Agreement is found by obut such unenforceablerp ovision shall be deemed such provision shall not affect the other provisions, modified to the extent necessary to render it enforceable,preserving to the fullest extent permitted the intent of Provider'and the City set forth in this Agreement. 3.11 Deliveries will be F.O.B destination.Provider shall pay all transportation arid handling charges for the Goods. Provider is responsible and liable for loss r damage defects,untilffinal and inspetioantien and acceptance of for the Goods by the City. Provider remains liable 1 # Goods and require 3.12 Phe City to cy inspect thanwi test charge or deliver City them at a reduced price,as negotiated.If Provider Provider correct them does not cure any defects within a reasonable time,'the City may reject the Goods and cancel this I Page 3 of 6: Goods and Services Agreement between the City of Ashland aI d American Industrial Door,LLC 1 I • • Agreement in whole or in part, This paragraph does not affect or limit the City's rights, including its • rights under the Uniform Commercial Code,ORS Chapter 72(UCC). 3.13 Provider represents ider re resents and warrants that the Goods are new, current, and fully warranted by the manufacturer. Delivered Goods will comply with SUPPORTING DOCUMENTS and be free o defects in labor,material and manufacture.Provider shall transfer all warranties to the City. 4. SUPPORTING DOCUMENTS The following documents are, by this reference, expressly incorporated in this Agreement, and are collectively referred to in this Agreement as the"SUPPORTING DOCUMENTS:" • The Provider's hourly rate sheet. • The Provider's firm price bid(s)for each individual project. 5. REMEDIES 5.1 In the event Provider is in default of this Agreement, City may, at its option,pursue any or all of the remedies available to it under this Agreement and at law i r 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. G. TERM AND TERMINATION 6.1 Term This Agreement shall be effective from the date of execution on behalf of the City as set forth below (the "Effective Date") and shall continue in full force and effect until June 30, 2022, unless sooner terminated as provided in Subsection 6.2. 6.2 Termination 6.2.1 The City and Provider may terminate this Agreement by mutual agreement at any time. 6.2.2 The City may,upon not less than thirty(30)days'prior written notice,terminate this Agreement for any reason deemed appropriate in its sole discretion. 6.2.3 Either party may terminate this Agreement,with cause,by not less than fourteen(14)days'prior written notice if the cause is not cured within that fourteen(14) day period after written notice. Such termination is in addition to'and not in lieu of any other remedy at law or equity. • 7. NOTICE Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery,by sending via a reputable commercial overnight courier, or by mailing using registered or certified United States mail,return receipt requested,postage prepaid, to the address set forth below: If to the City: Page 4 of 6: Goods and Services Agreement between the City Of Ashland and American Industrial Door,LLC • • City of Ashland Facilities Maintenance Department Attn: David Arnold 20 E.Main Street Ashland,Oregon 97520 Phone: (541)552-2292 With a copy to: City of Ashland—Legal Department 20 E.Main Street Ashland,OR 97520 Phone: (541)488-5350 If to Provider: American Industrial Door,LLC Attn:Troy Andrus 541-664-5555 .1 8. WAIVER OF BREACH E One or more waivers or failures to object by either party to the other's breach of any provision, term, condition, or covenant contained in this Agreement shall not be construed as a waiver of any subsequent breach,whether or not of the same nature. 9. PROVIDER'S COMPLIANCE WITH TAX LAWS 9.1 Provider represents and warrants to the City that: 9.1.1 Provider shall,throughout the term of this Agreement,including any extensions hereof, comply with: (i) All tax laws of the State of Oregon,including but not limited to ORS 305.620 and ORS chapters 316,317,and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider; and (iii) Any rules,regulations,charter provisions,or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.1.2 Provider,for a period of no fewer than six(6)calendar years preceding the Effective Date of this Agreement, has faithfully complied with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316,317,and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider; and (iii) Any rules,regulations,charter provisions,or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.2 Provider's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Provider's warranty, as set forth in this Article 9,shall constitute a material breach of this Agreement. Any material breach of this Agreement shall entitle the City to terminate this Agreement and to seek damages and any other relief available under this Agreement,at law,or in equity. Page 5 of 6: Goods and Services Agreement between the City of Ashland and American Industrial Door,LLC 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: American Industrial Door,LLC(PROVIDER): By: By: ` , Signature �Tt' FLEVD. Gerald Hill Printed Nam, Printed Name (JOraa—AL taO S Ote r.0 Operations Manager Title . — Title 7-1 i31212-1 4/30/2021 Date Date (W-9 is to be submitted with this signed Agreement) Purchase Order No. 6 7 t � Page 6 of 6: Goods and Services Agreement between the City of Ashland and American Industrial Door,LLC �MEg�ChN BUY/IMBR/Cq .. .f '. .' 6E � �" ::: A IERICAN INDUSTRIAL DOORLLC INDUSTRIAL DOOR LLC ....ter. to.“ .. .. � , .. .. .. ... April 27, 2021 City of Ashland Attn: Dave Arnold 90 N. Mountain Ashland, OR 97520 RE: Service Estimates Dave, American Industrial door LLC, specializes in sales and serviced for both commercial and resident overhead doors. We are family owned and have been in business in the Rogue Valley since 1983. Below are our rates: Repairs during business hours (M-F 7:30 am-5 pm) $125 per hour for one tech, $185 per hour for 2 man team. Plus parts. Preventative Maintenance Scheduled -during'Ibusiness hours (M-F 7:30 am-5 pm) $115 per hour for one tech, $175 per hour for 2 man team. Plus parts. PM programs can be set up on a time interval you decide (semi or annual). We are available 24 hours. Emergency after hours and weekend work is $300 for call out plus our normal hourly rate. Let me know if you have any questions and thanks again for your interest in our service. - 1 • Sincerely, )b/.(zid s/ • Gerald Hill Operation Manager • American Industrial Door LLC 541-664-5555 CCB 56160 j . ;. 6142 Crater Lakevenue;: PHONE '(541)664 5555 Central Point,Oregon 9752 FAX (54i)669 5556 ;License OR 561:60 CA 857109 WEB sffE http//Www americandaorilc coal . i 904863 BBSI May 02, 2021 AMERICAN INDUSTRIAL DOOR LLC 5022 TABLE ROCK RD CENTRAL POINT, OR 97502-9413 Re: Barrett Business Services, Inc. ("BBSI") Letter of Self-Insurance for Workers'Compensation Coverage As the named addressee of this Letter, your company's required workers' compensation coverage is provided through BBSI's state approved Self-Insured Workers' Compensation Plan by way of your co-employment contract with BBSI. Additional information is as follows: State: Oregon Workers'Compensation Limits: Employer Liability Limits: Self Insurance Certification #: 1068 Statutory $5,000,000.00 Each Accident $5,000,000.00 Disease Coverage Limit by Client $5,000,000.00 Disease; Each Employee Other Comments(place an"X"if applicable): X Named "Letter Holder": City of Ashland 20 Ashland St Ashland, OR 97520 �I I X Other: This letter of self-insurance for workers' compensation replaces Acord form 25. Contract effective 6/22/15, renewed through 6/1/22. 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 3512 Excel Drive Suite 107 Very truly yours, Medford, OR 97504 I I Gary Kramer President and Chief Executive Officer doe:LOSI-2 i I • '4✓°® CERTIFICATE OF LIABILITY INSURANCE �'� ' D7/D9�2, 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. 1 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)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). PRODUCERCONTACT FEDERATED MUTUAL INSURANCE COMPANY PHONAME CLIENT CONTACT CENTER HOME OFFICE:P.O.BOX 328 (A/C,No, Ertl:88$333-4949 FAX C. No:507-446-4664 OWATONNA,MN 55060 aooeEss:CLIENTCONTACTCENTER(a1FEDINS.COM INSURER(S)AFFORDING COVERAGE - NAIC# INSURER AI FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 391-637-6 INSURER B: j AMERICAN INDUSTRIAL DOOR,LLC INSURER C: 6142 CRATER LAKE AVE CENTRAL POINT,OR 97502-9414 INSURER D: INSURER E: INSURER F: I COVERAGES CERTIFICATE NUMBER:177 REVISION NUMBER:1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED ITO 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.; BIER TYPE OF INSURANCE !Ns WVD POLICY NUMBER POLICY EFFYY POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE ri OCCUR PRAE aES(Ee oncanrenwl $100,000 MED EXP(Any one person) EXCLUDED A Y N 9841842 07/06/2021 07/05/2022 PERSONAL a ADV INJURY $1,000,000 CEN'L AGCR GATE LIMB APPLIES PER: GENERAL AGGREGATE $2,000,000 X POIJCYtrim: LOCPRODUCTS-COMP/OP AGO $2,000,009 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,600,000 IEa amldend X ANY AUTO BODILY INJURY(Per person) OWNED AUTOS ONLY SCHEDULED A _ _AUTOS Y N 9841842 07/06/2021 07/06/2022 BODILY INJURY(Per accident) HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY (Per eeciden X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $5,000,000 A EXCESS UAB CLAIMS-MADE N N 9841843 07/06/2021 07/06/2022 AGGREGATE $5,000,000 DED I I RETENTION WORKERS COMPENSATION PER STATUTE OTH- ER AND EMPLOYERS'LIABILITY IN -- - ANY PROPRIETORIPARTNER/EXECUTIVE YID E.L EACH ACCIDENT OFFICER/MEMBER EXCLUDED? I I N/A (Mandatory in NH) E.L DISEASE-EA EMPLOYEE It yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be ettedled IT more apace Is required) SEE ATTACHED PAGE 1 CERTIFICATE HOLDER CANCELLATIONi 391-637-6 177 1 CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PUBLIC WORKS ENGINEERING DEPT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 E MAIN ST ACCORDANCE WITH THE POLICY PROVISIONS. ASHLAND,OR 97520-1814 AUTHORIZED REPRESENTATIVE ZW 0 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 391-637-6 LOC IA I AC D® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED FEDERATED MUTUAL INSURANCE COMPANY AMERICAN INDUSTRIAL DOOR.LLC POLICY NUMBER 6142 CRATER LAKE AVE SEE CERTIFICATE#177.1 CENTRAL POINT,OR 97502-9414 CARRIER NAIC CODE SEE CERTIFICATE#177.1 EFFECTIVE DATE:SEE CERTIFICATE 11 177.1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, I FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE ADDITIONAL INSURED ALSO INCLUDES: THE CITY OF ASHLAND, OR AND ITS ELECTED OFFICIALS, OFFICERS 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 A WRITTEN 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. FOR REASONS OTHER THAN NON-PAYMENT OF PREMIUM,30 DAYS NOTICE WILL BE PROVIDED TO THE CERTIFICATE HOLDER IN THE EVENT THAT THE ISSUING COMPANY CANCELS THE POLICY BEFORE THE EXPIRATION DATE OF THE POLICY. ACORD 101(2008101) O 2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. A. WHO IS AN INSURED for"bodily injury"and "property damage" liability is amended to include: Any person or organization other than a joint venture, for which you have agreed by written contract to procure bodily injury or property damage "auto" liability insurance arising out of operation of a covered "auto"with your permission. However,this additional insurance does not apply to: (1) The owner or anyone else from whom you hire or borrow a covered "auto". This exception does not apply if the covered "auto" is a "trailer" connected to a covered "auto"you own. (2) Your "employee" if the covered "auto" is owned by that "employee" or a member of his or her household. (3) Someone using a covered "auto" while he or she is working in a business of selling, servicing, repairing, parking or storing "autos" unless that businless is yours. (4) Anyone other than your "employees", partners (if you are a partnership), members (if you are a limited liability company), or a lessee or borrower or any of their "employees", while moving property to or from a covered "auto". (5) A partner (if you are a partnership), or a member (if you are a limited liability company) for a covered "auto"owned by him or her or a member of his or her household. B. The coverage extended to any additional insured by this endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached. 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: Transaction Effective Date: COMMERCIAL GENERAL LIABILITY CG 20 33 12 19 i THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or additional insureds, the following additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to: organization have agreed in writing in a contract 1. "Bodily or agreement that such person or organization be injury", "property damage" or 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"caused, in whole or in part, by: a. The preparing, approving, or failing to 1. Your acts or omissions; or prepare or approve, maps, shop drawings, onyour opinions, reports, surveys, field orders, 2. The acts or omissions of those acting change orders or drawings and behalf; specifications; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. However, the insurance afforded to such This exclusion applies even if the claims additional insured: against any insured allege negligence or other 1. Only applies to the extent permitted by law; wrongdoing in the supervision, hiring, and employment, training or monitoring of others 2. Will not be broader than that which you are by that insured, if the "occurrence" which required by the contract or agreement to caused the "bodily injury" or "property provide for such additional insured. damage", or the offense which caused the A person's or organization's status as an "personal and advertising injury", involved the additional insured under this endorsement ends rendering of or the failure to render any when your operations for that additional insured professional architectural, engineering or are completed. surveying services. © Insurance Services Office, Inc., 2018 Page 1 of 2 CG 20 33 12 19 Policy Number: Transaction Effective Date: 2. "Bodily injury" or "property damage" C. With respect to the insurance afforded to these occurring after: additional insureds, the following is added to a. All work, including materials, parts or Section III -Limits Of Insurance: equipment furnished in connection with The rpost 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. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 33 12 19 Policy Number: Transaction Effective Date: