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HomeMy WebLinkAbout2021-084 PO 20220066- Bills Glass & Windshields oriu C XX RECORDER Purchase Order ,m Fiscal Year 2022 Page: 1 of: 1 _ t B Cityof Ashland 'irr[ i '�' I ATN:Accounts Payable Purchase Ashland, OR 97520 Order# 20220066 T Phone: 541/552-2010 O Email: payable@ashland.or.us V BILL'S GLASS &WINDSHIELDS H C/O Facilities Maintenance Div E2407 SISKIYOU BLVD l 90 North Mountain Ave D ASHLAND, OR 97520 P Ashland, OR 97520 OR Email: SHERI@BILLSGLASS.COM Phone: 541/488-5358 T FaX: 541/552-2304 • [_35\[€� F€;a ��=[E�c\5'c; -1_ .. .._ -_ lli'I=1= �:_)=1s=€[=:_ - (541)488-2500 David Arnold 07/27/2021 114 FOB ASHLAND OR/NET301 Cit Accounts Pa able _=_t". —:'ji2 'aI=—7—:dt•1i:Glass Repair& Replacement 1 Glass repair and replacement 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 • • i - 47444° Date: 07/79/2071 Authorized Signature 11111tithr , $4,995.00 i ' FORM #3 CITY OF t A r q'll(;� :'9`()9' aPut'cliaG^ (_ .,.. Sl) ASHLAND REQUISITION Date of request: 4/29/2021 Required date for delivery: Vendor Name Bill's Glass Address,City,State,Zip 2407 Siskiyou Boulevard.Ashland,OR 97520 Contact Name&Telephone Number James Reeves 541-488-2500 Email address SOURCING METHOD ' ❑ Exempt from Competitive Bidding j 0 Emergency ❑ Reason for exemption: 0 Invitation to Bid 0 Form#13,Written findings and Authorization ❑.AMC 2.50 - Date approved by Council i ❑ 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 0 Request for Proposal Cooperative Procurement . Not exceeding$5,000 Date approved by Council: ❑ State of Oregon ® Direct Award _(Attach copy of council communication) Contract# ❑ VerbailWritten quote(s)or proposal(s) 0 Request for Qualifications(Public Works) ❑ State of Washington Dale approved by Council: Contract# (Attach copy of council communication) 0 Other government agency contract Intermediate Procurement 0 Sole Source Agency GOODS&SERVICES 0 Applicable Form(#5,6,7 or 8) - Contract# Greater than$5,000 and less than$100,000 0 Written quote or proposal attached Intergovernmental Agreement ❑ (3)Written quotes and solicitation attached ❑ Form#4,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 Agreement approved by Legal and approved/signed by O Direct appointment not to exceed$35,000 0 Written quote or proposal attached r, 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&<$75K Valid until: (Date) approval required.(Attach copy of council communication) Description of SERVICES Total Cost Glass repair and replacement for FY22 $4,995.00 Item# Quantity Unit Description of MATERIALS Unit Price Total Cost ❑ Per attached quotelproposal TOTAL COST Ap—e.2 $I Project Number ___ Account Numbef:%i-602400 'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. 1 IT Director in collaboration with departmen to-approve-al hardware and software purchases: IT Director Date Support-Yes/No By signing this requisition form,l codify the, he City's public cgn ratting requirements have been satisfied. / Employee: _ .,' \ / Department Head: n 3 0� �r I V,�coral to:r greater than$5,000) Department Manager/Supervisor: City Administrator: ( qE uarfoorgregt@r1y/29/2021 Funds appropriated for current fiscal year: YES/Nf7-4 4/'T)// O/ y Deputy Finance Director-(Equal to or greater than$5,000) Date Comments: Form#3-Requisition 7 • T BEISI 905384 April 27,2021 BUTLER'S GLASS SERVICE 319 E MCANDREWS RD MEDFORD,OR 97501 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: • i State: Oregon Workers'Compensation limits: Employer Liability Limits: Self Insurance Certification#: 1068 Statutory $5,000,000.00 Each Accident $5,000,008.00 Disease Coverage Limit by Client $5,000,000.00 Disease;:Each Employee Other Comments(place an"X"if applicable): n Named"Letter Holder": City of Ashland 20 E Main St Ashland,OR 97520 IT Other: Effective 1/112016 through 1/1/2022,Subject to 30 days notice of cancellation. • Additionally,BBSI's self insured program is further supported by an excessworkers'compensation insurance policy with ACE American Insurance Co.. Copy of certificate is available upon request. For additional Information,please contact your local BBSI office at: MEDFORD (541)772-5469 2045 Cardinal Way Suite 100 Very truly yours, Medford,OR 97504 Gary Kramer President and Chief Executive Officer dpo:L0SI2 • I. ' • Be evidenced by a certificate or certificates ofsuch insurance approvedby the City. 1.3 Provider shall,at its own expense,maintainWorker's Compensation insurance in compliance with ORS 656.017,which requites subject employers to provide Workers'compensation coverage for all of its sObject workers. . . 1.4 Provider agrees that no person shall,CO the grounds of race,color,religion,creed,sex,marital status, familial status or domestic partnership, national origin, age, mental or physical disability, sexual orientation, gender identity or source of income, suffer discriinination in the performance of this • Agreenient when employed by Provider. Provider agrees to comply with all applicable requirements of 1 - : federal and state civil rights and rehabilitation statutes,rules and regulations Further,Provider agrees not to discriniinate against a disadvantaged business enterprise,minority-owned business, woman- owned business, a business that a service-disabled veteran owns or an emerging small business enterprise certified under ORS 200.055,in awarding subcontracts a.s required by ORS 279A.110. . , , 1.5 In all solicitations either by competitive bidding or negotiation made by Provider for work to be performed under a subcontract, including procurements Of materials or leases of equipment, each potential subcontractor or supplier shall benotifledby 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 112 of the Ashland Municipal Code by paying a living wage, as defined in that chapter, to all employees performing Work under_this-Agreement and to any Subcontractor who performs 50%or more of the Workunder 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 einployees. . _ - , 13 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 ofthe City shall be void. Provider shall be fully responsible fin-the acts or omissions of any assigns or subcommotors and of allpersons employed by them,and the approval by the City of any assignment or subcontract shall not create any contractual relation between the assignee or subcontractor and the City, : I . _ ! . — 2. CITY'S OBLIGATIONS , ... ,1-&- li 4=ei . . 2,1 City shall pay Provider the •1 .i , ., __`' , !7-7!-, ,-'-. ,: •!.- ,-•: ::.,- :. z*:; : -:-- '• ••• as -- specified in the SUPPORTING DOCUMENT& 22 In no event shall Provider's total of all compensation andreimbursement 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&lipids 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 1 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 reimbursernent . 1 • , I Page 2 01'6: Goods and Services Agreement betvign the City of Add*andBM's Glass ( t , , 1 t 1 1 . 1 , , . • I , , . , • • I • • 1 • • • . ... , • i GOODS AND SERVICP AViRliRIVIENT(LESS'PHAN$25,000) I 1 . . 1 I PROVIDER: Bill's Glass 1 1 ) c IT Y 0 f PROVIDER'S ASHLAND COIITACT: Jambilteeves 3 , 0 Batt Main Street Ashland,Ontott 97520 ADDRESS: 7A07 SiskiYou Boulevard Telephone: 511/4884587 'Mislaid,OR 9750 Pax: 541/4884006 1. ' 1 PROM: 541-488-5270 I I / . ., . . . .. • - 4 . This Goods and services Agreement(hereinafter"Agreement')is entered ho by and between the City of Ashland,an Oregon municipal corporation(hereinafter"City')and Rill's Glass,(a 6201°4k/foreign business i corporation)("hereinafter•-4Travider"),for glass repair andiesplacement. • 1 1. PROVIDER'S OBLIGATIONS 11 Provide glass repair and replacement for FY22 as set forth in the"SUPPORTING DOCUMENTS" attached hetet()and,by this Inference,ineOrperatedlierein. Provider expressly adolewledges.that time is of the essence of any completion date set forth in the SUPPORTING DOCUMANTS,and that no waiver or extension of such deadline may be authorized except in the same manner ai UMW.provided • for authority to exceed the maximum coMpansation. The services defined anddescribed in the "SUI'PORTINGOOCIWTS'shall hereinafter be-colleaftykly referred-Se as"Wine 1.2 Provider shall obtain and maintain during the term of thisAgreenh: ant and until City's final acceptance dell Work received herconoler,a policy 4:tr pOlides of liabilitty instavice Winding commercial general liability insurance with a combined single limit,or the mivalent,of not less than$2;000,000(two million dollats)Porocaltrence for Hodily ROOM PropetIty Damage. . 12.1 The insurance requtOrt bytbis Atticie that Olollukt toe followina dOvetliter • Comprehensive General or Commercial General Liability, Including personal injury, contractual liability,and piodnoldomnpleted operations coverage; and. . i bi bil t A • uomoeLiality. 1 1 • Workene Compensation 1 13 11,2 Each policy of such insurance ahallibe on an"Occurrence"and nota"claims made"form,nail shall: 1 1 • Xante as additional insured "the City of Ashland, Oregon, its officers, agents:and ( 3 etnployees" with respect to claims arising Out of the provision of Work under this , Agreemettt; 1 1 • Apply to each tiameriOnd additional Maned insured as thoagh).a separate policy bad been .: issued to each,provided tbai the policy litnits,Stall not be increased thereby; 1 - • • • • Apply as primary bovetcgofori each additional named.insured except to the extent that two or More such policies ate intended to"lay ' coverage arid, taken togethet,they provide total coverage from the flat dollar Of liability; 1 4, Provider shall iromediatolY notify the City of any change in insurance coverage • Provider shall,supply an endorsement naming the City,Its office*employees and agents as additional ksgeds by the Effective Date of tide Agreentent; and . 1. Page i 46:Goods and SAMOS Agrefialeat beltrecn duo aty°floating and Burs dat44 I . , I , . 1 1 ' , • .I ' . 1 ; . ' , .. ) . i 3. GENERAL PROVISIONS • I 3.1 This is anoikoiclusive Agreement City is not obligatedto procure any*eine amount of Work from Provider and is free to procure similar type of goods and services from other providers in its sole , discretion. .., . , . 32 PrOvider is all independint cont0Corancl not an employee Or agent of the City for any purpose. 3.3. Provider is net entitled to,and expressly-woiVes all claims te.CRy benefits such os health and disability in-infante,paid leave,and retina:dent 5.4 This Agreement embodies the Rill and cOmplite widen***ofthe parties respeCting the subject matter hereof It supersedes all prior agreements,negOtiatiOna,awl repiesentatiOnstetwoenthe parties, whether Written Or oral. 3.5 This Agreenient oiy be amended only by writteninalrem.ett eesecuted with-the Same formalities as this Agreement ( I , 3.6 The following laws of the State of Oregon are hereby incorporated by reference into We Agreement ORS 27915.220,279B40 sod 279B235. . • 3.7 This AgteeMent shall be.governed by the Ws of*Stine of Oregon:v*1mM regard to conflitt Ohms 1 : principles. Exclusive Two for litigation-of toky action easing under this Agreement shall born the Circuit Court'Atha State of Oregonfoi JacksOnCounlywiless exchtstve jurisdiction-is infederal court, in WhiOli case eicclusive venue shill be lathe federal district OWE for the district of Oregon. Bachparty ennOsel$NeehtOs any and all‘ighte to OlaiAtain an action nit*this Agreement in any other venue and \ l• expressly consents that upon motion of the other partY, any case Way be disniisSed or its venue ,trandetred,ai appropriate,so as to effectuate t this choice Of venu , 3.8 Provider, hall defend, save,hold bonniest;and indemnify the City and its officer,employees and agents from and against any and all claims, silks, actions,lines, damages; tabilitin, costs, and expenses of any natiiruteaul6ng front,arisitig mit of,or relating to Vie nelleities"of Provider Or its ofriCerS,employ contractors,or agents Wider this Aietinem. 1 3.9 .Neither party to this Agreement shall hold*other responsible for damages or delay in perfOrinante I caused hY acts of God,*Das,lockouts,accidents,or other events beyond the control of the other or I \ . the other's DMus,eniPleYees OK eget*. i 3.10 If any provtaion of this Agreement is found by a cottit Of comp atentlinisdliticik tce be up.enforceablb, such StiViSp3.Own not effect tie otherproilsionS,big Oat unenforceable provision shall be deeined . modified to the extent necessary to rend4 it obt061i,roaming to•the-fullest entent Perniitted the intaiit of Provider and the City tet.forth inOtis Agre,ement. 331 Deliveries Will beP,O.B destination.Provider shall.pay ell trauspnation andlitoulling charged for the t Goods:Provider is responsible andliable for los or damage until final inspection and oceptano-of the deeds:by the City. Provider renitiins Rae for latent defectsAntd,tinivitrianties. 1I 11.2 The City may inspect and test the goods.The Qty they=Pet nOn'eonformteg OS*lind require PrOvider to correct them without charge or deliver them at ureduced•price„as negotiated.If Provider does not One aoy defeets within a reaSentible;time,the' CitY ttittY rOjeet the God&'tehl eeneel,thie ••- 1 Plio3 bt&Goads end Seivieee/*cement betweenthe Cit 0f*idellaencl-Bit's Oats 1 I t. • : r•-• I I - ., t Agreement in whole or in part.This paragraph does not affect or limit the City's rights,including its • rights undex the Uniform.Commerad Code,'ORS Chapter 72 MCC). I , 3.13 Provider represents and warrants that the;Goods are new, current and My warranted by the manufacturer.Delivered Goods will comply with SUPPORTING DOCUMENTS and be free from• defects in laber,material and manufacture.Provider shall transfer all warranties to the City. 4. SUPPORTING DOCUMENTS ( The following documents are, by tins reference, expressly incorporated in this Agreement and are collectively referred to in-this Agreement as the"SUPPORTING-DOCUMENTS:" is 1 . 6 The Provider's hourly rate sheet. • The Provider's firm price bid(s)for each individual project. , 1 5. REMEDIES 5.1 In the event Provider is in default of this Agreement City may,at its option,pursue any or all of the remedies available to it under this Agreement and at law or in equity,including,but not limited to: 1 • SA.1 Termination of this Agreement; I I 11 5.12 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; ' 5.13 Initiation of an action or proceeding for damages, specific performance, or declaratory or ncfive relict 1 5.14 These remedies are cumulative to the extent the remedies are not inconsistent and City may t , .. I ' pursue any remedy or remedies singly,collectively,successively&pi any order Whatsoever. 52 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 r i, • pay immediately any excess to City upon written demandfprovided. 6. TERM AND TERMINATION ' 6.1 Term This Agreement shall be effective from the date of execution on behalf of the City as set forth below (the"Effective Date")and shall continue in full force and effect until June 30,2022,unless sooner terminated as provided in.Subsection 6.2. ' . , 6.2 Termination 6.2.1 The City and Provider may ternanate this Agreement by mind agreement at any time. 622 The City may,upon not less than thnty' (30)days'prior written notice,terminate this Agreement for any reason deemed.fiPProlniate in its sele(dis eratien• - 62.3 Either party May terminate thin Agreement,with cause,by not less titan fourteen(14)days'prior written notice if the cause is not cured within that{fourteen(14)day period after written liotiee. Such ternunano n is in addition to awl net in lieu of any oilier reln_edy atlaw or equity. 7. NOTICE t 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 iiia a reputable commercial overnight courier,or . _... by mailing using registered or certified United gtares mall,return receipt requested,postage PrePmd,to the . address set forth below: , HU the City: , 1 Page 4 of 6:'Goods and Services Agreement between the City of Addend and itilits Glass . I 1 1 1 1 ; ; 1 , . . . ; 1 . ; ... , • I , : City of Ashland 1 Faclilles blaintenance Deparineent : , , Attn! David Arnold 20E.Main Street ; Asbland,Oregon 97520 Phone:(541)552-2292. , With a copy to: ! City ofAshland—Legal Department 20 E.Main Street Ashland,OR 97520 Phone:(541)488,5150 i I ,- 1 If to Provider: ' )3111's Glass Athi:James Reeves 541-488-3270 Se WAIVER OF ROAM ; One or more waivers or failures to object by either party to the other's breach of any provision, tom , condition,or covenant contented in this Agreement shall not be construed as a waiver of any subsequent breach,whether or not ofthe sanie nature. • 9. PROVIDER'S ally1PLTANCE MTH TAX LAWS 9.1 ProVidecrapictients end warrants to the CifY iliat: 9.1,1 Provide;shall,throughout the terni of this Agreement,including any extensions hercot comply wI . (1) All tax laws elite State of Oregon,including but not liciited to ORS 305.620 and ORS , chards 316,317,and 318; 1 (ii) Any tax provisions imposed by a po liticid.subdivision of the State of Oregon applicable to Provider;crwl (iii) Any rules,regultrlionikr.harterprelisions or ordinances that implement or cafe=any of . .t.15.9 foregoing ta;x imvs or provis:ions. 9.1.2 Provider,for a pisriodcifno feWer than six(6)calendar:yeain preceding the Effective Date of this Agreetnent, has filtlifolly complledwith; I (i) All tax laws of the State of Oregon,including but not limitedin ORS 305.620 and ORS chapters 316,3171 and.318; I (h) Any tax provisions imposed by apolitical subdivision of the State of Oregon applicable to PrOvider;and , 1 (iii) Anyridea,regulations,chatterprovisions,or ordinances that implement or enforce any of the foregoing tax laws cir provisions. 9.2 Provider's failure to 00201Y with the tax kin 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. I Further,any violation of Provider's wataiity,as set fortnin this Article 9,shall constitute a material breach of this Agreement. Any material*each oilbia Agreement shall entitle time City to terminate this Agreement and to seek damages and any other relief available under this Agreement at law,or in Maty. , I ; , , I Pap 5 af6:chods and Services Agreement betweenthe City ofAstAarviandBM'selass . , . I • 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: Bill's Glass(PROVIDER: By: i By: Ialik / Signature it1ke.,S '0 .1 ear Matsu/ _ Printed Name Printed Name Title Title II024 Date! 2-1 Date 1 CE-2 is to 13e submitted with tbis signed Agreement) Purchase Order No. 1 • Page 6 of 6: Goods and Services Agreement between the City&Ashland and Bill's Gash • • 319 E.McAndrews Rd. • MEDFORD OR 97501 541-773-5881 • FAX-541-773-5881 • - , S ASS.SERVICE . April 26, 2021 City of Ashland Schedule of LabRates July 1, 2021- June 30, 2022 Butler's Glass Service Inc. DBA Bill's Glass & Windshields. Cost per hour will be $65.00 *per man for work scheduled within the hours of 8:OOam-5:00 pm Monday through Friday. Cost per hour will be $125.00 I *per man for work that is performed outside of the above hours or days. *Additional men may be needed on some repairs due to size or safety restrictions. This is the labor rate only, materials and equipment rental if heeded are additional. After-hours Boardups $350.00 minimum for labor and materials-labor to include travel times from Medford. New commercial construction projects are exempt from this pricing and will be bid on a per job basis. Sincerely, General Manager • • • ,,,^"1 ACRO® CERTIFICATE OF LIABILITY INSURANCE DATE(M • o4/z7/2o2x •• 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)mast have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION 15 WAIVED,subject(o 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 tCONTACT I Hart Insurance Agency NAME: Rristi Doltaage PO Box. 1240 - PHONE (541) 779-4232 ttg: FAX (541)..772-3963 I Grants Pass OR 97528 E-MAIL kdolmage@hartinsurance.com j 1 INSURER(S)AFFORDING COVERAGE NAM/I j INSURER A:Cincinnati Specialty Underwrit13037 , INSURED (541) 773-5881 Butlers Glass Service Inc INSURER BtCincinnati Insurance Company . 10677 Bills Glass & Win shields INSURER C: 319 E McAndrews Road INSURER D: Medford OR 97501 INSURERE: INSURER F: ..I COVERAGES CERTIFICATE NUMBER:cert In: 18983.. REVISION NUMBER: 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. OMRASDL SUER POUCyy EFF Pamir EXP TRTYPE OF INSURANCE INSD WMI VD . . POLICYNUMBER IMDDIYYYI� POLICY (MWODIYYYYI LIMITS i A X COMMERCIAL GENERALLIABILITY EACH OCCURRENCE S. 1,000,000 DAMAGE TO RENTED • mAims-MADE X OCCUR Y Y c300079916 02/19/202102/19/2022 pREMISEB(Ed opdorn?nca) $ i . ' MED.EXP(M y one petsan) .5 . X Products &Completed I PERSONAL&ADV INJURY_s i GEN'LAGGREOATEUMITAPPLIES PER: GENERALAGGREOATE .. 2 9 poucY[TIC I EEC n LOC I PRODUCTS-COMPlt)PAGG S 2,000,000 j OTHER: 1 $ AUTOMOBILE LIABILITY COMBINEDSINGLEUMIT tFaacddent( $ 1,000,000 I. B •x ANY AUTO Y 55AA0374731 02/19/202102/19/2022 BOOILYINJURY(Perperson) 5 I OWNED. —SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per ecddent) 5 HIRED NON-OWNED AUTOS ONLY AUTOS ONLY (Pei acdd DAMAGE s $ A X UMBRELLALIAB X OCCUR CSU0086650 02/19/202102/19/2022 EACHOCCURREN EE $ 1,000,000 EXCESS UAB CLAIMS MME AGGREGATE $ 1,000,000 DED RETENTIONS WORKERS COMPENSATION • PER DTH, $ • AND EMPLOYERS'LIABWTY YIN STATUTE I ER ANYPROPRIETORJPARTNEFUEXECUT VE n E.L.EACH ACCIDENT $ . OFFICERlMEMBEREXCLUDED? N/A (Mandatory In NH) E.L.DISEASE.EA EMPLOYEE $ i Ifiyyes,desalbe under DESCRIPlONOFOPERATIONSbeIoW _ ELDISEASE-,POUCYUMIT $ I S. DESCR(P.TION OF OPERATIONS/.LOCATIONS I VEHICLES(ACORD 101.Addhionei Rerina,Ia Schedule, oy b meattached Ilmore space Is required) ' Certificate holder is listed as'additional insured including waiver of subrogation where required by written contract per attached forms CSTA405 08/09 and CSGA4087 12/12 I CERTIFICATE HOLDER • CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED.BEFORE • • THE EXPIRATION. DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Ashland ACCORDANCEINITH THE POLICY PROVISIONS. I 20 East Main'Street AUTHORIZEDREPREBENTATWE • Ashland OR 97520 ©1988,2015 ACORD CORPORATION. All rights reserved. ' ACORD 25(2016103) The ACORD name and logo are registered marks Of ACORD Page 1 of 1, '`,t Rte® • CERTIFICATE OF LIABILITY INSURANCE bATE(MWDERTYYY) 021• THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON I OLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR'ALTER THE COVERAGE HAFFORDED BYTTHE HOLDER. ES 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(tes)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 andorsernent(s). PRODUCER CONTACT Hart Insurance Agency NAME: Rriati Doimage PO Box 1240 PAHOONNo,Exi): (591) 779-9232 Fqt MAIL (AIC,No);(541) 772=3963 Grants Pass OR 97528 ADOREss. kdolmage®hartinsurance.loom • INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:Cincinnati Insurance Company 10677 Butlers Glass service Inc (541) 773-5881 INSURERS: Bills Glass 6 Windshields INSURER C: • 319 E McAndrews Road INSURER O: Medford OR 97501 INSURERS: INSURER F: . COVERAGES CERTIFICATE NUMBER:cern ID 18889 • REVISION NUMBER: 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. INSR TYPE OF INSURANCE ADOL SUER INSO wvo POLICY NUMBER POIJCYEFF POLICY WOD/TY(P A X COMMERCIAL OENERALLIABIuTY IMMIDDIYYYY),(MhVDDryYYY) L1MIT9 ICLAIMS-MADE n OCCUR Y Y HP20374731EACH OCCURRENCE 02/19/212102/19/2022 DAMAGE TORENTED PREMISES(Ea oeartence) S$ 1'500000;000000 500000,,000000 MED EXP(Any one person) $ 10,000 • GEM AGGREGATE LIMIT APPLIES PER: PERSONAL d ADV INJURY. S 1'000,000 X I POLICY I lei LOC I GENERAL AGGREGATE II $ 2,000,000 PRODUCTS S 2,000,000. OTHER: AUTOMOBILELIABRJTY $ A X ANYAUTO ' COMBINED SINGLE LIMIT (Ea accldanU $ 1,000,000 OWNED SCHEDULED 02/19/2021 02/19/2022 BODILY INJURY(Perperson) 5 AUTOS ONLY BODILY INJURY(Par accident) 5 NON-OWNED HIRED NON-OWNED —AUTOS ONLY _ AUTOS ONLY PROPERTY DAMAGE $ (Per accident) A x UMBRELLA LIAR S $ OCCUR EPP0374731 02/19/2021 02/19/2022 EACH OCCURRENCE S 1,000,000 EXCESS L M CLAIMS-MADE DED I IRETENTIONS AGGREGATE $ 1,000,000 WORKERS COMPENSATION S. AND EMPLOYERS'LIABILITY PER . ANYPROPRIETORJPARTNERMXECUTIVE YIN I3TA C I OFFICER/6fEMDEREXCLUDE07 NIA EL EACH ACCIDENT .$ (Mandatory In NH) DE ndetor;incite OF OPERATIONS below EL DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT $ S $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Add/Renal Remarks Schedule,may by attached If more ace Is certificate holder is listed as additional insured per.attached forms GA472 09/18 a6 210 09/17 and • AA288 01/16 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City Of Ashland ACCORDANCE WITH THE POLICY PROVISIONS. I 20 Eabt Main Street AUTHORIZEDREPRESENTATFE g Ashland OR 97520 4Wel' ��IeI e • ACORD 25 2018/03 ©1988.2015 ACORD CORPORATION. All rights reserved. • ( ) The ACORD name and logo are registered marlin of ACORD Page 1 of 1 • COMMERCIAL GENERAL LIABILITY POLICY NUMBER: Policy# ISSUE DATE: 4/12/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modes 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 B. In connection with your premises owned by or rented to you. CG D4 11 04 08 ©2008 The Travelers Companies;Inc. Page 1 of 1 Includes the copyrighted material of Insurance Services Office,Inc.with its permission. 48128859 118/19 SAMPLE CERTIFICATE 1 Sandy L. Ors 1 4/12/2019 4:21:06 PM (PDT) 1 Page 2 0£ 3 AC ® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 07/13/2021 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 CONTACT NAME: Hart Insurance Agency PHONE Kristi Dolmage FAX PO Box 1240 (A/C.No.Ext): (541) 779-4232 (A/C,NoL:(541) 772-3963 E-MAIL Grants Pass OR 97528 ADDRESS: kdolmage®hartinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Specialty Underwrit 13037 INSURED (541) 773-5881 msuRERB:Cincinnati Insurance Company 10677 Butlers Glass Service Inc Bills Glass & Windshields INSURER C: 319 E McAndrews Road INSURERD: Medford OR 97501 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 18883 REVISION NUMBER: 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. INSR TYPE OF INSURANCE ANW y Sy Bp POLICY NUMBER I'WPOLICY EFF POLICY EXP (MM/DDIY ) (MMIDD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 - AMAGECLAIMS-MADE X OCCUR Y Y CSU0079916 02/19/2021 02/19/2022 PREMSESO(Eaoccu RENTED $ MED EXP(Any one person) $ X Products & Completed PERSONAL&ADV INJURY $ GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICYX PRO- LOC PRODUCTS-COMP/OPAGG $ 2,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 B X ANY AUTO EBA0374731 02/19/202102/19/2022 BODILYINJURY(Perperson) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) _ A X UMBRELLALIAB X OCCUR CSU0086650 02/19/202102/19/2022 EACH OCCURRENCE $ 1,000,000 EXCESS UAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below • E.L.DISEASE-POLICY LIMIT $ $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate holder is listed as additional insured including waiver of subrogation where required by written contract per attached forms CSIA405 08/09 and CSGA4087 12/12 CERTIFICATE HOLDER CANCELLATION SHOULD ANYI OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Ashland Public Works 90 North Mountain Avenue AUTHORIZED REPRESENTATIVEEN2 Ashland OR 97520 0 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1