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HomeMy WebLinkAbout2021-117 PO 20220121- All Mechanical Plumbing Solutions Inc. /gill � � � ;��__ Purchase Order l4' TY u a7 ��.5�,�t��fes,,:__.` /MI Fiscal Year 2022 Page: 1 of: 1 B Cityof Ashland _: "-�= ._. -_ — I ATN: Accounts Payable = � — - — � 20 E. Main Purchase 202201 '21 Ashland, OR 97520 Order# T Phone: 541/552-2010 0 Email: payable@ashland.or.us V H C/O Facilities Maintenance Div E ALL MECHANICAL PLUMBING SOLUTIONS, INC I 90 North Mountain Ave N 5555 N MEDFORD INDUSTRIAL ROAD p Ashland, OR 97520 O CENTRAL POINT, OR 97502 Phone: 541/488-5358 R T Fax: 541/552-2304 .�,.�...,��=9'_:,le a@IeZ:3=-6,�IsLst,._i?.[EI�E:`f�{?_ej�t�-%— =tet�}iz�..t����<oti-3��i§L='��- — _��—_ _ David Arnold e]E E181&01EIl�`�_=F=r4_ 09/01/2021 5382 City Accounts Payable On-call Plumbing Services 1 On-call plumbing services 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 r , ql-1 By: Date: Aut orize Signature $4,995.00 FORM #3 CITY OF A �� / ASHLAND REQUISITION Date of request: 8/5/2021 Required date for delivery: Vendor Name AMPS-All Mechanical Plumbing Solutions • Address,City,State,Zip PO Box 5468,Central Point.OR 97502 Contact Name&Telephone Number Joela Oetterer 541-734-3236 joelaa_oipefitter.biz Email address SOURCING METHOD ' ❑ Exempt from Competitive Bidding 0 Emergency ❑ Reason for exemption: 0 Invitation to Bid 0 Form#13,Written findings and Authorization ❑ AMC 2.50Date approved by Council: 0 Written quote or proposal attached ❑ Written quote or proposal attached (Attach copy of council communication) (If council approval required,attach copy of CC) ® Small Procurement 0 Request for Proposal . Cooperative Procurement Not exceeding$5,000 Date approved by Council: 0 State of Oregon ® Direct Award _(Attach copy of council communication) Contract# O Verbal/Written quote(s)or proposal(s) 0 Request for Qualifications(Public Works) 0 State of Washington Date 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 0 Form#4,Personal Services>$5K&<$75K Agency PERSONAL SERVICES 0 Special Procurement 0 Annual cost to City does not exceed$25,000. Greater than$5,000 and less than$75,000 0 Form#9,Request for Approval Agreement approved by Legal and approved/signed by ❑ Direct appointment not to exceed$35,000 0 Written quote or proposal attached City Administrator.AMC 2.50.070(4) ❑ (3)Written proposals/written solicitation Date approved by Council: 0 Annual cost to City exceeds$25,000,Council ❑ Form#4,Personal Services>$5K&<$75K Valid until: (Date) approval required.(Attach copy of council communication) Description of SERVICES Total Cost Plumbing services as needed for FY22 ..$.4,995:00 Item# Quantity Unit Description of MATERIALS Unit Price Total Cost ❑ Per attached quotelproposal TOTAL-,COST; Project Number -_ _ _ Account Number 088400-602400 'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director in collaboration with department to appr.,e all hardware and software purchases: IT Director Date Support-Yes/No By signing this requisition form,l cern at t•:City's pu.is con acing requirements have been satisfied. Employee: ��� Department Head: 7"&/1 .7/ / 2. . $"1/-32.,/ (Equal to or greater than$5,000) Department Manager/Supervisor: City Administrator: (Equal to or greater than$25,000) Funds appropriated for current fiscal year: YES /NO _ Deputy Finance Director-(Equal to or greater than$5,000) Date • Comments: • Form#3-Requisition • • • GOODS AND SERVICES AGREEMENT(LESS THAN$25,000) PROVIDER: AMPS—All Mechanical Plumbing Solutions,Inc. CITY OF PROVIDER'S 1 , 4 ASH LAND CONTACT: Joela Oetterer 20 East Main Street Ashland,Oregon 97520 ADDRESS: PO Box 5468 Telephone: 541/488-5587 Central Point, OR 97502 Fax: 541/488-6006 • PHONE: 541-734-3236 This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter,"City") and AMPS — All Mechanical Plumbing Solutions,Inc.,(a domestic/foreign business corporation).("hereinafter"Provider"),for plumbing services. . 1. PROVIDER'S OBLIGATIONS 1.1 Provide plumbing services 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." 1.2 Provider shall obtain and maintain during the term of this Agreement and until City's final acceptance of all Work received hereunder,apolicy or policies of liability 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 Iiability,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 of any change in insurance coverage • Provider shall supply an endorsement naming,the City,its officers,employees and agents as additional insureds by the Effective Date of this Agreement; and Page 1 of 6: Goods and Services Agreement between the City of Ashland and AMPS—All Mechanical Plumbing Solutions,Inc. I • • • 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 Compensation insurance in compliance with ORS 656.017,which requires subject employers to provide workers'compensation coverage for all of its subject workers. 1.4 Provider 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 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 veteran owns or an emerging small business enterprise certified under ORS 200.055,in awarding subcontracts as required by ORS 279A.110. 1.5 In all solicitations either by competitive bidding or negotiation made by Provider for work to be perforined 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 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. 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 void. Provider shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all persons 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, 2. CITY'S OBLIGATIONS , `,Gr a- z,� 2,1 City shall pay Provider the s ei _ -., 44- -- - . specified 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 Bill's Glass • 3. GENERAL PROVISIONS 3.1 This is a non-exclusive Agreement. City is not obligated to procure any specific amount of Work from Provider and is free to procure similar types of goods and services from other providers in its sole discretion. ( I 3.2 Provider is an independent contractor and not an employee or agent of the City for any purpose. 3.3 Provider is not entitled to,and expressly waives all claims to City benefits such as health and disability insurance,paid leave, and retirement. 3.4 This Agreement embodies the full and complete understanding of the parties respecting the subject matter hereof. It supersedes all prior agreements,negotiations,and representations between the parties, whether written or oral. 3.5 This Agreement may be amended only by written instrument executed with the same formalities as this 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.235. 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 district court for the district of Oregon. Each party expressly waives any and all rights to maintain an action under this Agreement in any other venue,and expressly consents that, upon motion of the other party, any case may be dismissed or its venue transferred,as appropriate,so as to effectuate this choice of venue. 3.8 Provider shall defend, save, hold harmless and indemnify,the City and its officers, employees and agents from and against any and all claims, suits, actions, losses, damages, liabilities, costs, and expenses of any nature resulting from, arising out of', or relating to the activities of Provider or its officers,employees,contractors, or agents under this Agreement. 3.9 Neither party to this Agreement shall hold the other responsible for damages or delay in performance caused by acts of God, strikes, lockouts, accidents, or other events beyond the control of the other or the other's officers, employees or agents. 3.10 If any provision of this Agreement is found by a court of competent jurisdiction to be unenforceable, such provision shall not affect the other provisions,but such unenforceable provision shall be deemed 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 and handling charges for the Goods. Provider is responsible and liable for loss or damage until final inspection and acceptance of the Goods_by the City. Provider remains liable for latent defects,fraud,and warranties. - G 3.12 The City may inspect and test the Goods. The City may reject non-conforming Goods and require Provider to correct them without charge or deliver them at a reduced price,as negotiated.If Provider does not cure any defects within a reasonable time, the City may reject the Goods and cancel this • Page 3 of 6: Goods and Services Agreement between the City of Ashland and AMPS—All Mechanical Plumbing Solutions,Inc. 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 and warrants that the Goods are new, current, and fully warranted by the manufacturer. Delivered Goods will comply with SUPPORTING DOCUMENTS and be free from 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 or 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 anyWork 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. 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 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 hot 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 AMPS—All Mechanical Plumbing Solutions,Inc. • 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: - AMPS—All Mechanical Plumbing Solutions,Inc. Attn:Joela Oetterer 541-734-3236 8. WAIVER OF BREACH +. 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 z 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 AMPS—All Mechanical Plumbing Solutions,Inc. 3 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: AMPS—All Mechanical Plumbing Solutions,Inc.' BY; Arc rc (PROVIDE ): Signature By• Q� 'gnature /t/tocr•I's e-N Printed Name Kim Janakes 11(r-C Ic rh �� 1.4 it / � Printed Name (^J Title ^o/( President 9-- / Title I Date 6/14/2021 • Date • (W-9,is to be submitted with this signed Agreement) Purchase Order No. (02_ / • • { i 1- • Page 6 of 6: Goods and Services Agreement between the City of Ashland and AMPS—All Mechanical Plumbing Solutions,Inc. • is AMPS ,l ASHLAND MEDFORD PLUMBING, INC. ALL MECHANICAL PLUMBING SOLUTIONS, INC. PO Box 5468;Central Point, OR 97502 • Phone:541-734-3236 • Fax:541-732-0092 OR CCB 229008 City of Ashland Contract Fiscal Year 2021/2022 Rate Sheet July 1,2021-June 30,2022• May 11,2021 Billing on a Time and Material Basis—to be paid within 30 days of billing. Plumbing Service Regular Rates Mon-Fri 8am—5 pm Regular Labor Rates(Plus Materials) PER HOUR' 1 Plumber $110 2 Man team $190 Camera Lines $350 Jetting Lines $300 Drain Calls $250 Combo of Camera/Jetting/Drain Calls On case by case basis Mileage Rates N/A inside City of Ashland Leak Detection Subcontracted+20% After Hours Rates $185 an hour(2 hour min) Holidav/Weekend Rates $220 and hour(2 hour min) Excavation Service Rates Mon-Fri 8am-5pm MACHINE WITH OPERATOR PER HOUR Ex Lg Excavator $120 Mini Excavator $100 Dump Truck $95 Skid Steer $100 Back Hoe $100 Bull Dozer $100 Roller $100 . 1 LABOR PER HOUR Foreman $110 Labor Class 1 $95 Labor Class 2 $85 ROCK PER TON Y.."Rock $12.65 4"Shale/Rock $11.50 Specializing in PI Lire,mechanical,Hydropics,Radiant, Geothermal and Full Service Excavation AMPS AMPS ASHLAND MEDFORD PLUMBING, INC. ALL MECHANICAL PLUMBING SOLUTIONS, INC. PO Box 5468; Central Point,OR 97502 • Phone:541-734-3236 • Fax: 541-732-0092 OR CCB 229008 Exclusions: Permits and fees, sewer and water fees, Geo-Engineer's Soil Report & Inspection Fees, piping is PEX unless otherwise stated, landscaping, erosion control, saw cutting and concrete removal, concrete work, excavation of plumbing trenches, any roof patching, fire caulking, any work on existing plumbing in other areas, sleeving set by others, water meter, site security, electrical and controls, site and civil work, sewer, spoils left on site, storm and foundation piping or drains, fire sprinklers, irrigation, sheetrock work, patch work, painting and framing, items not identified on plans, unforeseen damages subsequent to plumbing installation to drywall, paint,flooring,woodwork, siding etc., dumpsters, crane,forklift, saw cutting and concrete removal, concrete pour back, items not identified on plans, responsibility for damage to installed materials. We are not responsible for existing plumbing that we connect to. We do not warranty any owner provided piping, parts, material, fixtures and/or trim. No surveying is included—All surveying required for grid line installation is the responsibility of the general contractor. No footings shall be installed before rough in plumbing. All installed footings that are damaged due to the underground plumbing shall be the responsibility of the general contractor. Escalator Clause: Due to the recent fluctuation in commodity pricing and availability AMPS can only, hold this price for 5 business days. Material pricing may increase without a notification within that time. Please note that due to COVID19 and Natural Disasters lead times for acquiring product and materials can be out as far as 20 weeks, if not more. AMPS priority is to provide our customers quality work in a timely manner. Rock&Soil Clause: Plumbing trench excavation due to hard rock requiring a class 120 track hoe excavator with jackhammer attachment will be an additional cost. Hard rock can be removed at a cost plus basis. No hard rock will be removed before written authorization to proceed from owner or an authorized re presentative. Soil Exclusion/Notes: Due to the uncertainty of subgrade conditions prior to complete excavation, AMPS will make every effort to provide an accurate recommendation for depth and stability of subgrade. However, it is the sole responsibility of the owner or the general contractor to approve subgrade before any structural material is placed.AMPS can provide a soils engineer if desired at an additional cost. The soils engineer will made a professional recommendation to aid in subgrade determination if the owner or general contractor desires. Hazardous Materials Disclaimer: AMPS will be held harmless in the discovery and manipulation of any and all hazardous materials, It is the job owner's responsibility to meet all requirements in handling such materials at no cost to AMPS. AMPS will go on standby time or redirect work until such • situation is resolved. Owner will be responsible for all cost involved, including wages and equipment rental. AMPS will not lose work time due to delays generated by such discoveries. All materials are guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements are contingent upon strikes, accidents or delays beyond our control. Owner to carry fire,tornado,flood and other necessary insurance. Our workers are fully covered by Workman's Compensation Insurance. A late payment service charge of 2%per month will be charged on accounts 30 days past due from data of billing. The service charge is an annual percentage rate of 24%. Minimum service charge is$100.00,plus the reasonable cost of collection,including but not limited to attorney and legal fees. I agree that my liability for the charges is not waived and I agree to be held personally liable for such charges. Authorized Signature Jon JakakcS Date W1ay 11, 2021 Acceptance of Proposal/Contract—The above price,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments will be made 20%Down and Final Payment Upon Completion. Signature Date of Acceptance Specializing ha P1 Ling,Mechanical,lljdro»ics,Radiant, Geothermal 1 Frill Service P.rcavation. 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 modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s)or Organization(s): City of Ashland 20 East Main Street Ashland OR 97520 Section II—Who Is An Insured is amended to include as an additional insured the person(s)or organization(s) shown in the Schedule, but only with respect to liability for"bodily injury", "property damage", "personal injury"or "advertising injury"caused, in whole or in part,by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations;or 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 I Sandy L. Orr 14/12/2019 4,21,06 PM (PDT) I Page 2 of 3 • COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM The following is added to Paragraph c. in A.1., Who between you and that person or organization, that is Is An Insured, of SECTION II—COVERED AUTOS signed by you before the "bodily injury" or "property , LIABILITY COVERAGE in the BUSINESS AUTO damage"occurs and that is in effect during.the policy COVERAGE FORM and Paragraph e.in A.1.,Who Is period, to name as an additional Insured for Covered An Insured, of SECTION II — COVERED AUTOS Autos Liability Coverage, but only for damages to LIABILITY COVERAGE in the MOTOR CARRIER which this insurance applies and only to the extent of COVERAGE FORM, whichever Coverage Form Is that person's or organization's liability for the conduct part of your policy: of another"insured". This Includes any person or organization who you are required under a written contract or agreement • j CA T4 37 02 16 s'2018 The Travelers Indemnity Company.All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office,Inc.with its permission. 48120859 1 10/19 SAMPLE CERTIFICATE 1 Sandy L. Orr 1 4/12/2019 4:21,06 PM (PDT] 1 Page 3 of 3 A CERTIFICATE OF LIABILITY INSURANCE DATEo5/20DD>2 s/zor1o21 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(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). PRODUCER NAME CT CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE:P.O.BOX 328 (A/C.No,Ext):888-333-4949 IA/.No):507-446-4664 OWATONNA,MN 55060 E.ADDRESS:CLIENTCONTACTCENTERCTFEDINS.COM INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:FEDERATED RESERVE INSURANCE COMPANY 16024 INSURED 185-255-7 INSURER B; ALL MECHANICAL PLUMBING SOLUTIONS INC. INSURER C: PO BOX 5468 CENTRAL POINT,OR 97502-0060 INSURER D: INSURER D INSURER F: COVERAGES CERTIFICATE NUMBER:20 . REVISION NUMBER:I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED MOVE 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. IL R TYPE OF INSURANCE IINNSR SWy p POLICY NUMBER (MM10D YVY) (MA) MOM) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 DAMAGE Too RENTED CLAIMS-MADE $100,000 OCCUR PREMISES(Ea aeourrencel MED EXP(Any one person) EXCLUDED A Y N 9850895 11/15/2020 11/15/2021 PERSONAL ADV INJURY $1,000,000 GE/':AGGREGATE LIMIT APPLIES PER: GENERALAOGREOATE $2,000,000 X POLICY 1-1721: ❑ PRODUCTS•COMP/OP AGO $2,000,000 LOC OTHER: AUTOMOBILE LIABILITY lEe COMBINED0 SINGLE UNIT $1,000,000 eodden X ANY AUTO BODILY INJURY(Par person) —A OWNED AUTOS ONLY _AUTOSU E0 Y N 9850895 11/15/2020 11/15/2021 BODILY INJURY(Per sadden/ HIRED AUTOS ONLY NON•OWNED AUTOS ONLY IPerecleTROPERTY DAMAGE ( X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $2,000,000 A EXCESSIJAB CLAIMS-MADE N N 9850898 11/15/2020 11/15/2021 AGGREGATE $2,000,000 DED I 'RETENTION WORKERS COMPENSATIONPER STATUTE ER AND EMPLOYERS'LIABILITY Y I h ANY PROPRIETORIPARTNERIEXECUTIVE EL EACH ACCIDENT OFFICERIMEMBER EXCLUDED? N I A (Mandatory In NH) E.L DISEASE-EA EMPLOYEE II yes,describe under E.L DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,AddIaonel Remarks Schedule,may be attached II more space Is required) THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT ENDORSEMENT FOR BUSINESS AUTO LIABILITY. CERTIFICATE HOLDER CANCELLATION 185-255-7 20 1 CITY OF ASHLAND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 E MAIN ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ASHLAND,OR 97520-1814 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2018(03) 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 business 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: 9850895 Transaction Effective Date:11-15-2020 COMMERCIAL GENERAL LIABILITY CG 20 33 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II - Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or additional insureds, the following additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to: organization have agreed in writing in a contract 1. "Bodilyinjury", "property damage" or j ry , g or agreement that such person or organization be { added as an additional insured on your policy. "personal and advertising injury" arising 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 4 1. Your acts or omissions; or prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, 2. The acts or omissions of those acting on your change orders or drawings and behalf; specifications; or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. However, the insurance afforded to such additional insured: This exclusion applies even if the claims 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: 9850895 Transaction Effective Date:11-15-2020 • 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 most we will pay on behalf of the additional such work, on the project (other than insured is the amount of insurance: service, maintenance or repairs) to be 1. Required by the contract or agreement you performed by or on behalf of the additional have entered into with the additional insured; insured(s) at the location of the covered or operations has been completed;or of "your2. Available under the applicable limits of b. That portion work" out of which insurance; the injury or damage arises has been put whichever is less. to its intended use by any person or 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: 9850895 Transaction Effective Date:11-15-2020 BBSI 911415 • June 14,2021 ALL MECHANICAL PLUMBING SOLUTIONS INC 5555 N MEDFORD INDUSTRIAL ROAD CENTRAL POINT, OR 97502-0894 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): i ! X Named"Letter Holder": City of Ashland 20 East Main St Ashland, OR 97520 X Other: This letter of self-insurance for workers'compensation replaces Acord form 25. Contract effective 12/2/19, renewal date 12/1/21. Subject to 30days' notice of cancellation. Additionally, BBSI's self-insured program is further supported by an excess workers'compensation insurance policy with ACE American Insurance Co.. Copy of certificate is available upon request. For additional information, please contact your local BBSI office at: MEDFORD (541)772-5469 2045 Cardinal Way Suite 100 Very truly yours, Medford, OR 97504 Gary Kramer President and Chief Executive Officer doe:Lose-2