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HomeMy WebLinkAbout2021-111 PO 20220114- Polaris Land Surveying LLC a_:; ,� , ,}, � � _ ;m Purchase Order � � ", .1 ,all Fiscal Year 2022 Page: 1 of: 1 B City of Ashland 40,1 :51' i gJf 5iy I ATTN: Accounts Payable L 20 E. Main Purchase 20220114 L Ashland, OR 97520 Order# T Phone: 541/552-2010 0 Email: payable@ashland.or.us • V H C/O Public Works Department E POLARIS LAND SURVEYING LLC I 51 Winburn Way N PO BOX 459 p Ashland, OR 97520 ASHLAND, OR 97520 Phone: 541/488-5347 R T Fax: 541/488-6006 _ 1701���1EfL g®si 3==_ �XI3e - ( 1 (541)414.822-�5�0�0099�- g�{ Scott Fleury 4J17 eric1= =`Y tJi111t21=tatirn C.�i�.SI1J_ L-'11 �. ��il�a_ " �` --eY__e§'_��!�sl e_ =-.._-_ - 08/23/2021 604 FOB ASHLANDIOR City Accounts Payable Mara IBM - On-call Surveying Services 1 On-call land surveying services 1.0 . $20,000.00 $20,000.00 FY 2022 Estimate$20,000.00 Project Account: *************** GL SUMMARY*************** 088100-604100 $20,000.00 Ii I I li By: Date. 8'. /ALU G� Authoriz ignature 0 =- —� 9 �R�-___--` - '-: ".m_._--_- $20,000.00 i • FORM #3 ,OI 0 ,7O1,( CITY OF ASHLAND A request for a Purchase Order REQUISITION 'pate of request: _ .,'0809/2021 '_ Vendor Name Polaris Land Surveying Address,City,State,Zip PO Box 459 Ashland,OR 97520 Contact Name Shawn Kampmann Telephone Number 541-482-5009 Email address shawn( polarissurvey.com SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: 0 Invitation to Bid (Copies on file) ❑ Form#13,Written findings and Authorization ❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached ❑ Written quote or proposal attached _(Attach copy of council communication) _(If council approval required,attach copy of CC) ❑ Small Procurement Cooperative Procurement Less than$5,000 0 Request for Proposal (Copies on file) ❑ State of Oregon Date approved by Council: ❑ Direct Award Contract# _(Attach copy of council communication) ❑ VerbalMritten quote(s)or proposal(s) ❑ State of Washington Intermediate Procurement ❑ Sole Source Contract# GOODS&SERVICES ❑ Applicable Form(#5,6,7 or 8) ! 0 Other government agency contract $5,000 to$100,000 0 Written quote or proposal attached , Agency ❑ (3)Written quotes and solicitation attached 0 Form#4, Personal Services$5K to$75K Contract# PERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement $5,000 to$75,000 ❑ Form#9,Request for Approval ❑ Agency 0 Less than$35,000,by direct appointment ElWritten quote or proposal attached Date original contract approved by Council: ❑ 3 Written proposals/written solicitation Date approved by Council: (Date) _ 0Form#4, Personal Services$5K to$75K Valid until: Date (Attach copy of council communication) Description of SERVICES Total Cost On call surveying as needed for FY22 $ 20;000:00T' Item# Quantity Unit Description of MATERIALS Unit Price Total Cost "TOTAL COST'' ❑ Per attached quote/proposal '$:''' Project Number _ - - Account Number 0 8 8 1 0 0.6 0 4 1 0 0 $_, 2 0,0 0 0 ,0 0 Project Number . - _ - Account Number • $_,_ Project Number -_ _ - Account Number I $_,- - -,- _ _•_ _ *Expenditure must be charged to the appropriate account numbers for the financials to accurately ri tlect the actual expenditures. IT Director in collaboration with department to approve all hardware and software purchases: IT Director Date Support-Yes/No By signing this requisition form,I certify that the City's public contracting requirements have been satisfied. �,, n /,I .3/24t//202-1 Employee:L�� Dana/. Q,l/1�,��1- L.�>l,)'y1,p.� Department Head: /" - (Equal or greater than$5,000) Department Manager/Supervisor: CityAdministrat fir: _ ._ (Equal to or greater than$25,000)• Funds appropriated for current fiscal year: YES / NO /tseme:q —2 f —Z.,/ Deputy Fin ce Director (Equal to or greater than$5,000) Date Comments: Form#3-Requisition ^ I 1 PERSONAL SERVICES AGREEMENT ($25,000.00 or less) CONSULTANT Polaris Land Surveying, LLC CITY OF AS H LAN D ADDRESS: PO Box 459 20 East Main Street Ashland,OR 97520 Ashland,Oregon 97520 Telephone: 541/488-5587 TELEPHONE: 541-482-5009 Fax: 541/488-6006 EMAIL: shawn@polarissurvey.com This Personal Services Agreement(hereinafter"Agreement's) is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and Polaris Land Surveying LLC, a domestic limited liability corporation("hereinafter"Consultant"),for on call surveying as needed. NOW THEREFORE, in consideration of the mutual covenants contained herein,the City and Consultant hereby agree as follows: 1. Effective Date.and Duration: This Agreement shall becomfe effective on the date of execution on behalf of the City,as set forth below(the"Effective Date"),and unless sooner terminated as specifically provided herein,shall terminate upon the City's affirmative acceptance of Consultant's Work as complete and Consultant's acceptance of the City's final payment therefore, but not later than June 30, 2023. ' 2. Scope of Work: Consultant will provideon call surveying as.needed,as more fully set forth in the Consultant's Rate sheet effective January 1,2021,which is attached hereto as"Exhibit A"and incorporated herein by this reference. Consultant's services are collectively referred to herein as the "Work." 3. Supporting Documents/Conflicting Provisions: This Agreement and any exhibits or other'supporting documents shall be construed to be mutually complementary and supplementary wherever possible. In the event of a conflict which cannot be so resolved,the provisions of this Agreement itself shall control over any conflicting provisions in any Of the exhibits or supporting documents. 4. All Costs Borne by Consultant: Consultant shall,at its own risk,perform the Work described above and, unless otherwise specified in this Agreement,furnish all labor,equipment,and materials required for the.proper performance of such Work. 5. Qualified Work: Consultant has represented,and by entering into this Agreement now represents,that all personnel assigned to the Work to be performed under this Agreement are fully qualified to perform the service to which they will be assigned in a skilled and worker like manner and,if required to be registered, licensed or bonded by the State of.Oregon,are sojregistered,licensed and bonded. • Page 1 of 5: Personal Services Agreement with;Polaris Land Surveying LLC I ! • • 6. Compensation: City shall pay Consultant the sum of$20,000.00(twenty thousand dollars) as full compensation for Consultant's performance of all Work under this Agreement. In no event shall Consultant's total of all compensation and reimbursement under this Agreement exceed:the sum of- 520,000.00(twenty thousand dollars)Without the express,written approval from the City official whose signature appears below,or such official's successor in office. Payments shall be made within thirty (30)days of the date of receipt by the City of Consultnt's invoice. Should this Agreement be terminated prior to completion of all Work,payments will be made for any phase of the Work completed and accepted as of the date of termination: 7. Ownership of Work/Documents: All Work,work product; or other documents produced in furtherance of this Agreement belong to the.City,and any copyright,patent,trademark proprietary or any other protected intellectual property right shall vest in and is hereby assigned to the City. 8. Statutory Requirements: The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 2793.220,279B.230 and 2793.235. 9. Living Wage Requirements: If the amount of this Agreeml nt is$22,002.43 or more,Consultant is required to comply with Chapter 3.12 of the Ashland Municipal Code by paying-a living wage,as defined in that chapter,to all employees performing Work under this Agreement and to any Subcontractor who performs 50%or more of the Work under this Agreement. Consultant is also required to post the notice attached hereto as"Exhibit B"predominantly in areas where it will be seen by all employees. 10. Indemnification: Consultant hereby agrees to defend, inde I nify,save, and hold City, its officers, employees,and agents hannless from any and all losses,claims,actions, costs,expenses,judgments,or other damages resultingfrom injury to any person (including injury resulting in death),or damage (including loss or destruction)to property,of whatsoever natfure arising out of or incident to the performance of this Agreement by Consultant(including but not limited to,Consultant's employees, agents,and others designated by Consultant to perform Work or services attendant to this Agreement). However,Consultant shall not beheld responsible for any losses,expenses,claims,subrogations, actions,costs,judgments,or other damages,caused solely by the negligence of City. 11. Termination: a. Mutual Consent. This Agreement may be tenninatedi at any time by the mutual consent of both parties. b. City's Convenience. This Agreement may be terminated by City at any time upon not less than thirty(30)days' prior written notice delivered by certified mail or in person. c. For Cause. City may terminate or modify this Agreement, in whole or in part,effective upon delivery of written notice to Consultant,or at such later date as may be established by City under. any of the following conditions: i. If City funding from federal,state,county or other sources is not obtained and continued at levels sufficient to allow for the purchase of the indicated quantity of services; ii. If federal or state regulations or guidelines are modified,changed,or interpreted in such.a way that the.services are no longer.allowable or appropriate for purchase under this Agreement or are no longer eligible for the funding proposed for payments authorized by this Agreement;or f Page 2 of 5: Personal Services Agreement vrich Polaris Land Surveying LLC - • • • iii: If any license or certificate required by law or regulation to be held by Consultant to provide the services required by this Agreement is for any reason denied, revoked,suspended,or not renewed. d. for Default or Breach. i. Either City or Consultant may terminate this Agreement in the event of a breach of the Agreement by the other. Prior to such termination the party seeking termination shall give to the other party written notice of the breach and its intent to terminate. If the party committing the breach has not entirely cured the breach within fifteen(15)days of the date of the notice, or within such other period as the partY giving the notice may authorize in writing, then the Agreement may be terminated at any tine thereafter by a written notice of termination by the party giving notice. ii. Time is of the essence for Consultant's performance of each and every obligation and duty under this Agreement. City,by written notice to Consultant of default or breach,may at any time terminate the whole or any part of this Agreement if Consultant fails to provide the Work called for by this Agreement within the time specified herein or within any extension thereof. iii. The rights and remedies of City provided in this subsection(d)are not exclusive and are in addition to any other rights and remedies provided by law or under this Agreement. 12. Independent Contractor Status: Consultant is an independent contractor and not an employee of the City for any purpose. 13. Assignment: Consultant shall not assign this Agreement orlsubcontract any portion of the Work without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be void. 14. Default. The Consultant shall be in default of this Agreement if Consultant: commits any material breach or default of any covenant,warranty,certification,orlobligation under the Agreement; institutes an action for relief in bankruptcy or has instituted against it an action for insolvency;makes a general assignment for the benefit of creditors;or ceases doing business.on a regular basis of the type identified in its obligations under the Agreement;or attempts to assignjrights in,or delegate duties under,this Agreement. 15. Insurance. Consultant shall,at its own expense, maintain the following insurance: a. Workers' Compensation. Consultant shall obtain and maintain Workers' Compensation insurance in compliance.with ORS 656.017,which requires subject employers to provide Oregon Workers' Compensation coverage for its subject workers, unless suc_h employers are exempt under ORS • 656.126. If exempt under ORS 656.126,Consultant shall certify such exemption to the City. b. Professional Liability insurance with a combined single limit, or the equivalent,of not less than $2,000,000(two million dollars)per occurrence. Thisisto cover any damages caused by error, omission or negligent acts related to the Work to be provided under this Agreement. c. General Liability insurance witha combined single limit,or the equivalent,of not less than $2,000,000(two million dollars)'per occurrence for Bodily Injury, Death,and Property Damage. d. Automobile Liability insurance with a combined single limit,or the equivalent,of not less than $1,000,000(one million dollars)for each accident for Bodily Injury and ProPerty Damage, including coverage for owned,hired or non-owned vehicles,as applicable. . • Page 3 of 5: Personal Services Agreement%vith Polaris Land Surveying LLC . • ' I e. Notice of cancellation or change. There shall be no cancellation,material change,reduction of limits or intent not to renew the insurance coverage(s)without thirty(30)days' prior written notice from the Consultant or its insurer(s)to the City. f. Additional Insured/Certificates of Insurance. Consultanti!shall name the City of Ashland,Oregon, and its elected officials,officers and employees as Additional Insureds on any insurance policies, excluding Professional Liability and Workers' Compensation,required herein,but only with respect to Consultant's services to be provided under this Agreement.The consultant's insurance is primary and non-contributory.As evidence of the insurance coverages required by this Agreement, the Consultant shall furnish acceptable insurance certificates and endorsements prior to commencing the Work under this Agreement. . 16. Nondiscrimination: Consultant agrees that no person shall,on the grounds of race,color,religion, creed,sex,marital status, familial status or domestic partnership,national origin,age, mental or physical disability,sexual orientation,gender identity or source of income,suffer discrimination in the performance of any Work under this Agreement when employed by Consultant. Consultant agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes,rules and regulations. Further,Consultant agrees not to discriminate 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 as required by ORS 279A.110. 17. Consultant's Compliance With Tax Laws: 17.1 Consultant represents and warrants to the City that: 17.1.1 Consultant 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 Consultant;and (iii) Any rules, regulations,charter provisions,or ordinances that implement or enforce any of the foregoing tax laws or provisions. 17.1.2 Consultant, 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 Consultant;and (iii) Any rules, regulations,charter provisions,or ordinances that implement or enforce any of the foregoing tax laws or provisions. 18. Governing Law;Jurisdiction: This Agreement shall be governed and construed in accordance with the laws of the State of Oregon without regard to.conflict of laws principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is in federal court, in which case exclusive venue shall be in the federal district court for the district of Oregon. Each party expressly waives any and all rightsito maintain an action under this Agreement in any other.vent e Page 4 of 5: Personal Services Agreement with Polaris Land Surveying LLC 1 I 19. Amendments. This Agreement may be amended only by written instrument executed by both parties with the same formalities as this Agreement. 20. THIS AGREEMENT AND THE ATTACHED EXHIBITS CONSTITUTE THE ENTIRE - UNDERSTANDING BETWEEN THE PARTIES.,THEREARE NO UNDERSTANDINGS, AGREEMENTS,OR REPRESENTATIONS,EITHER ORAL OR WRITTEN,NOT SPECIFIED HEREIN REGARDING THIS AGREEMENT. CONSULTANT, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE,HEREBY ACKNOWLEDGES THAT HE/SHE HAS READ THIS AGREEMENT, UNDERSTANDS IT,AND AGREES TO BE BOUND BY ITS TERMS AND CONDITIONS. 21. Certification. Consultant shall execute the certification attached hereto as"Exhibit C"and incorporated herein by this reference. 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: POLARIS LAND SURVEYING,LLC(CONSULTANT): By: By: c.% SU ""— 't'4",./ 1 Signature salr FLEUQ.se 3101 IAAh [Ai'rlr rite A hh Printed Name( Printed Name Qurbui. tll:2t5._ Ell eec_mL_ J' A n..c 5 e (� Title Title 451MI267, / qs— lbt 2,02../ate Date (W-9 is to be submitted with this signed Agreement) � v Purchase Order No. Page 5 of 5: Personal Services Agreement with Polaris Land Surveying LLC EXHIBIT B CITY OF ASHLAND, OREGON City of Ashland . LIVING ALL employers described WAGE below must comply with City of Ashland laws regulating •a ment of a livin. wa.e. $15.96 per hour, effective June 30,:2021. The Living Wage is adjusted annually every June 30 by the y;the Consumer Price Index. Employees must be paid a portion of business oftheic 401K and IRS eligible living wage: employer,if the employer has cafeteria plans(including ten or more employees,and childcare)benefits to the has received financial amount of wages received by For all hours worked under a assistance for the project or the employee. business from the City of service contract between their Ashland in excess of I S- Note: For temporary and employer and the City of $22,310.46. part-time employees,the Ashland if the contract Living Wage does not apply exceeds$22,310.46 or more. ➢ If their employer is the City of to the first 1040 hours worked Ashland,including the Parks in any calendar year. For For all hours worked in a and Recreation Department. more details,please see month if the employee spends Ashland Municipal Code 50%or more of the ➢ In calculating the living wage, Section 3.12.020. employee's time in that month employers may add the,value working on a project or of health care,retirement, For additional information: t Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator, City Hall,20 East Main Street,Ashland,OR 97520,or visit the City's website at www.ashland:or.us. Notice to Employers: This notice must be posted predominantly in areas where it can be seen by all employees. CITY OF ASHLAND Page 1 di EXHIBIT ' I ' I I EXHIBIT C • CERTIFICATIONS/REPRESENTATIONS: Consultant,lby and through its authorized representative, under penalty of perjury,certifies that(a)thei number shown on the attached W-9 form is its correct taxpayer ID(or is waiting for the number to be issued to it and(b)Consultant is not subject to backup withholding because: (i)it is exempt from backup withholding,or(ii) it has not been notified by the Internal Revenue Service(IRS)(that it'is subject to backup • withholding as a result of a failure to report all interest or dividends,or(iii) the IRS has notified it that it is no longer subject to backup withholding. Consulant:further represents and warrants to City that: (a) it has the power and authority to enter into this Agreement and perform the Work,(b)the Agreement,when executed and delivered,shall be a valid and binding obligation of Consultant enforceable in accordance with its terms,(c)the work under the Agreement shall be performed in accordance with the highest professional standards,and(d)Consultant is qualified,professionally competent,and duly licensed(if applicable)to perform the Work. Consultant also certifies under penalty of.perjury that its'business is not in violation of any Oregon tax laws, it is an independent contractor as defined in the Agreement, it is authorized to do business in the State of Oregon,and Consultant has checked four or more of the following criteria that apply to its business. I LV (1)Consultant carries out the work or services ata location separate from a private residence or is in a specific portion of a private residence,set aside as the location of the business. t� (2)Commercial advertising or business cards or a trade association membership are ✓ purchased for the business. (3)Telephone listing is used for the business •separate from the personal residence listing. 1 (4) Labor or services are performed only pursuant to written contracts. (/ (5) Labor or services are performed for two or more different persons within a period , ' of one year. 1/ (6)Consultant assumes financial responsibility for defective workmanship or for service.not provided as evidenced by the ownership of performance bonds, warranties,errors and omission(professional liability)insurance or liability insurance • relating to the Work or services to be provided. Consultant's signature A-v5 vsrt /6 , 7.v2( Date • Page I of I EXHIBIT C v . .1 LAND 5 URVEYING , LLC K K EXHIBIT"A" POLARIS LAND SURVEYING LLC fEE�5_CHEDULE (EFFECTIVE JANUARY 1,2021) PRINCIPAL LAND SURVEYOR $140.001 hour PROFESSIONAL LAND SURVEYOR $120.001 hour SENIOR SURVEY TECHNICIAN ....$90.00/hour SURVEY TECHNICIAN $ 80.00/hour DRAFTING TECHNICIAN $ 80.00/hour SURVEY FIELD CREW(STANDARD) $160.00/hour SURVEY FIELD CREW(w/GPS) ....$ 180.00/hour DOCUMENT PROCESSING.. $ 60.00/hour MILEAGE(out of town projects) $ 0.545/mile OUT-OF-POCKET EXPENSES . ACTUAL COST P. 0. Sox 459, Aohfand. Oregon_?,,7520._ w_ Phone: (5}41) 4_82.5_009 a Pax: (541) 488-0797 . Mobile: (541J 601-3000—rr www.polar195urvcy.COM ,acoRD® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) �� 08/16/2021 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 ORI ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT_CBETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. 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,cortain 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 Ryan Schorovsky • StateFarm Jon Snowden Insurance Agency.Inc. PHONE E><1)• (541)482-2461 FAX (541)482-4957 O 420 Bridge St EMAIL an.schorovsk .szmr statefamt.com 0'0;1, Mt SS: ryy I INSURER(S)AFFORDING COVERAGE NAIL S Ashland OR 97520 INSURER A: State Farm Fire and Casualty Company 25143 INSURED INSURER B State Farm Mutual Automobile Insurance Company 25178 Polaris Land Surveying,LLC INSURER C: PO Box 459 INSURER D: INSURER E: Ashland OR 97520 INSURERF: • COVERAGES CERTIFICATE NUMBER: 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. I TR TYPE OF INSURANCE ADDLiSUBR POLICYIEFF POLICY EXP LIMITS IPisrtl W Vn POLICY NUMBER (MMIDD/YYYY) IMMIODIYYYY) X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE s 1,000,000 7 CLAIMS-MADE X OCCUR PR_PREMISES Ea rib RENTED S 300.0011 1 MED EXP(Any one person) S:5,000 L — Y 97-CQ-H089-5 05/07/2021 05/07/2022 PERSONAL 8 ADV INJURY S �GENt.AGGREGATELIMITAPPLIESPER: I GENERAL AGGREGATE S 2,000,000 X POLICY JECT OTHER: LOC PRODUCTS•COMP/OP AGG S 1 S AUTOMOBILE UABIUTY Y L23 4521-D30-37H 04/30/2021 10/30/2021 E(Enar ED SINGLE LIMIT s 1,000,000 a Bddem) ANY AUTO I BODILY INJURY(Per person) S 090 4953-B09-37F • 08/09/2021 02/09/2022 B ` OWNEDSCHEDULED I BODILY INJURY(Per Occident) S AUTOS ONLY X AUTOS HIRED NON-OWNED I PROPERTY DAMAGE s . AUTOS ONLY AUTOS ONLY (Per accident) S UMBRELLA LIAB OCCUR ' EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I RETENTIONS ' S WORKERS COMPENSATION PEROTH- AND EMPLOYERS'LIABILITY I STATUTE RR . ANY PROPRIETORIPARTNERIEXECUTIVE Y IaN N 1 A 97-CM-M475-1 05/05/2021 05/05/2022 E.L EACH ACCIDENT S 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) I E.L DISEASE-EA EMPLOYEE S 500,000 • If yes•describe under DESCRIPTION OF OPERATIONS below I E.L DISEASE•POLICY LIMIT S 500.000 DESCRIPTION OF OPERATIONS f LOCATIONS f VEHICLES(ACORD 101,Additional Remarks Schedule,may bo attached If more space Is required) Land Surveying On-call services The City of Ashland,its elected officials&employees are included as additional insureds. Coverage is primary and non-contributory. I 1 CERTIFICATE HOLDER CANCELLATION •SHOULD ANY OF.THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE 'DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS. CITY OF ASHLAND OREGON AND ITS ELECTED I : OFFICIALS,OFFICERS&EMPLOYEES AUTHCRQEDjREPRESsEN7ATNE 20 E MAIN ST Completed by an authorized State Farm representative.If signature l ASHLAND OR 97520 is required,please contact a State Farm agent. . . ©1988-2016 ACORD CORPORATION. All rights-reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1001486 132849.13 04+22.2020 it 1 Ac ® DATE(MMmDmYY) 1...—..------- ..' CERTIFICATE OF LIABILITY INSURANCE 08/17/2021 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 N BELOW. THIS CERTIFICATE ETWE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETHE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must hate ADDITIONAL INSURED provisions or be endorsed: If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain po'icies 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 LeZette Brewton NAME: Assurance Risk Managers.Inc. PHONE (303)454-9562 FAX (303)454-9564 (SIC,No,Ert}: (AIC.No): 10651 East Bethany Drive AUURLss: lezette.brewton@arm•i.com Suite 300 1 1 INSURER(S)AFFORDING COVERAGE NAIL I Aurora CO 80014-2688Hanover Insurance Company 22292 INSURERA: P Y INSURED INSURER B: Polaris Land Surveying,LLC. INSURER C: • P O BOX 459 INSURER D: INSURER E: I Ashland OR 97520.0016 INSURERF: I COVERAGES CERTIFICATE NUMBER: 21-22 E&O 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 ADDL SUER POLICY:EFF POLICY EXP LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER (MMIDDIYYYY) (MM11000IYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S GE TO RENTED _ dM CLAIMSDE n OCCUR PREM SES(Ea occurrence) $ MED EXP(Any ono person) S PERSONAL&ADV INJURY , 5 GEM.AGGREGATE LIMITAPPLIESPER: GENERAL AGGREGATE S . POLICY❑JEC n LOC PRODUCTS-COMP/OP AGG 5 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Baacciden- 0 ANY AUTO BODILY INJURY(Per person) S — OWNED SCHEDULED BODILY INJURY(Per occidonI) 5 AUTOS ONLY _ AUTOS HIRED NON-OWNED PROPERTY DAMAGE- 5 AUTOS ONLY _ AUTOS ONLY /Per aec ileni S -UMBRELLA UAB OCCUR EACH OCCURRENCE 5 EXCESS LIAB CLAIMS-MADE AGGREGATE S DEO I I RETENTION S S • WORKERS COMPENSATION AND EMPLOYERS'LIABIUTY Y IN IPER T ME ERH ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA EL EACH ACCIDENT 5 OFFICERIMEMBER EXCLUDEO7 (Mandatory In NH) EL DISEASE-.EA EMPLOYEE S 0 yes,describe under DESCRIPTION OF OPERATIONS below I EL DISEASE-POLICY LIMIT . S EACH CLAIM 1,000,000 PROFESSIONAL LIABILITY 1 A CLAIMS MADE POLICY LH4 A349055 08 0612812021 06/28/2022 aggregate 2,000,000 1 • DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks SGhoduto,may bo attached if More space is required) PSA(S25,000 or less) j I I 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 Oregon&its Elected Officials&Employees ACCORDANCE WITH THE POLICY PROVISIONS. 20EMain St I . AUTHORIZED REPRESENTATIVE'�, � . � 2 V L' �- Ashland OR 97520 I 1`' I�' I I 01988.2015 ACORD CORPORATION. All rights reserved. ' ACORD 25(2016/03) -The ACORD name and logo are registered marks of ACORD I I 4 . CMP-4604.1 Page 9 or 1 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY, 1 � - ADDITIONAL INSURED--OWNERS,LESSEES,OR CONTRACTORS(Scheduled) This endorsement modifies Insurance provided under the following: BUSINESSOWNERS COVERAGE FORM • SCHEDULE Policy Number; 97-CQ-H089-5 • Named Insured: f j POLARIS LAND SURVEYING LLC PO Box 459 1 Ashland OR 97520-0016 Name And Address Of Additional Insured Person Or Organization: CITY OF ASHLAND OREGON AND ITS ELECTED OFFICIALS,OFFICERS&EMPLOYEES 20 E Main St Ashland OR 97520-1814 I • 1. SECTION II—WHO IS AN INSURED of SECTION II—LIABILITY Is amended to Include, as an additional Insured,any person or organization shown In the Schedule,but only; a. Ongoing Operations With respect to liability for"bodily Injury", "property damage", or"personal and advertising injury" caused by your ongoing operations for that additional insured and only to the extent that such "bodlly injury", "property damage"or"personal and advertising Injury is caused by your negligence or the negligence of those performing operations on your behalf;or b. Products-Completed Operations To the extent that the liability for"bodily injury"or"property damage"Is causedby"your work"performed for Thal additional insured and Included In the"products-completed operations hazard". 2. Any Insurance provided to the additional insured shall only apply with respect to a claim made or a"suit"brought for damages for which you are provided coverage. 3. Primary Insurance. The insurance afforded the additional Insured shall be primary insurance. Any Insurance carried by the additional Insured shall be noncontributory with respect to coverage provided by you. All other policy provisions apply. • CMN-4804.1 755042 03•20.2010 II 1 • 1