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HomeMy WebLinkAbout2021-142 PO 20220196- Polaris Land Surveying LLC pr4.11 Purchase Order Fiscal Year, 2022 Page: 1 of: 1 Pe:r -- 1L- �Ei-`e - a�RAL- B' City of Ashland ATfN: Accounts Payable Purchase L Ashland, OR 97520 Order# 2 022 0196 T Phone: 541/552-2010 0 Email: payable@ashland.or.us V H CIO 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 RT Fax: 541/488-6006 • = 3 $13 op IlI7 0[i ie}1 5 ,579`_tom (541)482-5009 Scott Fleury 11/29/2021 604 y J FOB ASHLAND OR City Accounts Payable �4 Site Survey 1 Limited property boundary and topographic site survey of the 1.0 $3,400.00 $3,400.00 Pioneer Hall &the Ashland Community Center Personal Services Agreement($25,000.00 or Less) Completion date: February 28, 2022 Project Account: *************** GL SUMMARY*************** 088400-604100 $3,400.00 • • Date: � � 4y: _ Authorzed ature Te p'I -S. _ —= 3 400.00 FORM #3 CITY OF A request fora Purchase o9 D © ( ASHLAND J. REQUISITION bate of request: 11/1612021-: 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 shawnRpolarissurvey.com SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ Emergency ❑ Reason for exemption: '❑ Invitation to Bid (Copies on file) 0 Form#13,Written findings and Authorization ❑ AMC 2.50 Date approved by Council:_ ❑ Written quote or proposal attached ❑ Written quote or proposal attached _(Attach copy of council communication) _(If council approval required,attach copy of CC) ❑ Small Procurement Cooperative Procurement Less than$5,000 0 Request for Proposal (Copies on file) 0 State of Oregon ❑ Direct Award Date approved by Council: Contract#_ 1=1 VerbalMritten quote(s)or proposal(s) —(Attach copy of council communication) ❑ State of Washington Intermediate Procurement ❑ Sole Source Contract# GOODS&SERVICES 0 Applicable Form(#5,6,7 or 8) ❑ Other government agency contract $5,000 to$100,000 0 Written quote or proposal attached Agency ❑ (3)Written quotes and solicitation attached ❑ Form#4, Personal Services$5K to$75K, Contract# PERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement $5,000 to$75,000 0 Form#9,Request for Approval ❑ Agency ❑ Less than$35,000,by direct appointment 0 Written quote or proposal attached Date original contract approved by Council: ❑ (3)Written proposals/written solicitation Date approved by Council: (Date) ❑ Form#4, Personal Services$5K to$75K Valid until: (Date) —(Attach copy of council communication) Description of SERVICES Total Cost Limited Property Boundary&Topographic Site Survey of the Pioneer Hall&the Ashland Community ;' 8,4,00,:f® Center v Item# Quantity Unit Description of MATERIALS Unit Price Total Cost TOTAL COST§,, 0 Per attached quotelproposal Project Number - - _ Account Number 0 8 8 4 0 0.0 0 4 1 0 0 3 4 0 0 0 0 Project Number -_ _ _ Account Number - $_,_ _ \,_ _ _. Project Number -_ — _ Account Number - $_,_ _ _,_ *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 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. • Employee:\ �� , D 1.�4,,�' 1 " _ Department Hee I. 11 23 2 V QVIYW 1'���1 '��� qu 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 PERSONAL SERVICESAGREEMENT ($25,000.00 or less) CONSULTANT: Polaris Land Surveying, LLC CITY OF �S H LAND 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@oolarissurvev.com This Personal Services Agreement(hereinafter"Agreement") 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 a Limited Property Boundary&Topographic Site Survey of the Pioneer Hall &the Ashland Community Center. 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 become 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 February 28,2022. 2. Scope of Work: Consultant will provide a Limited Property Boundary&Topographic Site Survey of the Pioneer Hall &the Ashland Community Center,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 wherein 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 so registered, licensed and bonded. Page 1 of 5: Personal Services Agreement with Polaris Land Surveying LLC 6. Compensation: City shall pay Consultant the sum of 53,400.00(three thousand four hundred 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$3,400.00(three thousand four hundred 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 Consultant'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 andis hereby assigned to the City. S. Statutory Requirements: The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220,279B.230 and 279B.235. 9. Living Wage Requirements: If the amount of this Agreement 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, indemnify,save, and hold City, its officers, employees, and agents harmless from any and all losses, claims, actions,costs,expenses,judgments,or other damages resulting from injury to any person (including injury resulting in death),or damage (including loss or destruction)to property, of whatsoever nature 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 be held 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 terminated 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 Page 2 of 5: Personal Services Agreement.with 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 it's 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 tinie 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 or subcontract 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,or obligation 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 assign rights 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' Compensationinsurance in compliance with ORS 656.017,which requires subject employers to provide Oregon Workers' Compensation coverage for its subject workers, unless such 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. This is to cover any damages caused by error, omission or negligent acts related to the Work to be provided under this Agreement. c. 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, 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 with Polaris Land Surveying LLC 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. Consultant 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,qr 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 rights to maintain an action under this Agreement in any other venue. Page 4 of 5: Personal Services Agreement with Polaris Land Surveying LLC 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. THERE'ARE 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: �r /� By: ..._; /1/1"----kiwt-erytAA•u--- 411W Signature Printed Name 1 Printed Name NSW—- LOCe• 0200- IAA Title Title I I 12: 12.1 Nh ..4.e-i. 235 2o2J Date Date (W-9 is to be submitted with this signed Agreement) Purchase Order No. /q6 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 WAG E below must comply with City of Ashland laws regulating pa mentofa living wase. $15.96;per'hour, effective June 30, 2021. The Living Wageis adjusted annually every Ir June '301by the Consumer Price Index. Employees must be paid a portion of business of their 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 assistance for the project or the employee. > For all hours worked under a business from the City of service contract between their Ashland in excess of > 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: 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 of I EXHIBIT B . EXHIBIT C CERTIFICATIONS/REPRESENTATIONS: Consultant,;by and through its authorized representative, under penalty of perjury,certifies that(a)the number shown on the attached W-9 form is its correct taxpayer ID(or is waiting for the number to be issued toit 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. Consultant 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. 7( (I)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 .3 the business. Jam' (2)Commercial advertising or business cards ora trade association membership are purchased for the business. (3)Telephone listing isused for the business separate from the personal residence listing. (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. (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 AI d v'e.01 2.3 224 Date Page I of I ..EXIIIBIT C , 0 IL- , F' / LAND SURVEYING , LLC !._.. . =' -..... . ..; ,•..,jy,. 1 .:isawu ws:u,::=*&.s:;u,Me:,�ks.,°,}a4:=�.ht=r 9+�:.... ,.::�+i: '#4"ew#�' .y�,5+rtn3:,r.Yt o.��w�'aafi<2�'s .,ir :-.'�[ 7t 11- November 7November 1,2021 City of Ashland Public Works Dept. 10 Winburn Way Ashland,Oregon 97520 Attn: Scott Fleury, Public Works Director Re: Limited Boundary&Topographic Site Survey 59 Winburn Way,Ashland,Oregon _ Assessor's Map No.39 1E 09 BC,Tax Lot 2500 Scott, Per a request from Mark Kamrath of CEC Engineering,Inc.,the following is a proposal for surveying services to perform a Limited Property Boundary&Topographic Site Survey of the Pioneer Hall&the Ashland Community Center located at 59 Winburn Way in Ashland, per the scope of services outlined below: SCOPE OF SERVICES: • Research of deeds,,easements,surveys and utilities for the above described property and adjoiners,based on a title report tobe furnished by owner. ♦ Field survey to re-establish project survey control network previously utilized by this office and to map existing site and street improvements to include pavement,cubs,sidewalks,walkways,buildings,utilities,retaining walls, fencelines,drainageways,slopes,grades and trees over 6"diameter and other general topographic features. ♦ - Office calculations and analysis of'field survey data to determine property boundaries and preparation of the topographic site plan mapping at one half foot contour intervals.Deliverables to include mapping in electronic AutoCAD .dwg format as well as on printed media to a standard engineering scale. • Optional (if requested),to prepare and file.*Map of Survey with the office of the Jackson County Surveyor to conform with Oregon Revised Statutes (O.R.S.)209250. FEES: Fees will be paid on an Hourly Basis according to the attached hourly rate schedule enclosed as Exhibit A,valid until December 31,2021.The estimated cost to perform the P. 0. Dox 459. Aohland, Oregon 97520 u Phone: (541) 482-5009 ar fax: (5:41)..4_86-0797 MoGllc: (541;) 601-3000 H www.polarloourvey.com Scott Fleury Survey Proposal Page 2 • professional surveying services as outlined in the Scope:of Services above is as follows: A range between Twenty Eight Hundred and Thirty Four Hundred Dollars. ($2,800.00-$3,400.00) Polaris Land Surveying LLC will endeavor to keep the actual cost of the work as low as may be consistent with the purpose of the project and with proper workmanship and materials. All additional work that is outside the scopeiof services as described shall also be paid for at the hourly rate schedule enclosed as iExhibit A. Any fees required by City of Ashland,Jackson County,title companies,or other quasi-governmental agencies are not included in the surveying costs outlined above and shall be the responsibility of the owner. As compensation for services rendered,an invoice will be sent on the first day of each month,or at the conclusion of the project,showing the hours and rates of the various classifications of personnel working on the project. Payment of the invoice amount must be made within 15 days of the invoice date. Late payments may be subject to a service charge of 1.5%per month of the unpaid balance,at the discretion of Polaris Land Surveying LLC. This letter is written as a Surveying Proposal and Agreement.An acceptance line is provided for your signature if you wish to engage us to perform the aforementioned 5eMceS. Please return one signed copy for our files. In the event suit or action is instituted to enforce this agreement or any terms hereof, or in the event of an appeal from suit,action or proceeding,the prevailing party shall be entitled to such sums as the court may adjudge reasonable as attorney's fees in such suit,action or appeal. Please don't hesitate to call if you have any questions. Yours truly, Shawn Kampmann Professional Land Surveyor 9:\surveys\Temp\Scott Fleury-59 Winburn Way Ashland survey proposal.docx AUTHORIZATION Approved By. _ Date r. 0. Sox 459. Ashland, Oregon 97520 x Phone: (541) 452-5009 R Fax: (541) 458.0797 Mob11e: (541!) 601-3000 n www.polarlsourvey.com 1- A iq if L. A14r, UgVgYING ,, L. L. 0 =-4 EXHIBIT"A" POLARIS LAND SURVEYING LLC EEE_S_CHEIOULE (EFFECTIVE JANUARY 1,2021) PRINCIPAL LAND SURVEYOR $140.001 hour PROFESSIONAL LAND SURVEYOR $120.001 hour . SENIOR SURVEY TECHNICIAN .$ 90.001 hour SURVEY TECHNICIAN $ 80.001 hour DRAFTING TECHNICIAN .$ 80.001 hour SURVEY FIELD CREW(STANDARD) $160.001 hour SURVEY FIELD CREW(w/(91'S) .$ 180.001hour DOCUMENT PROCESSING. $ 60.001 hour MILEAGE(out of town projects) $ 0.575/mile OUT-OF-POCKET EXPENSES ACTUAL COST P. O. Box 459. Aohland, Oregon 97520 Ph,aae: (541) 4,52-5009 n FOX: (547) 4,98-0797 (541,) 601-3000 w. www.polorloourvey.com , 4Co CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD)YYYY) • 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 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 ondorsemont(s). PRODUCER CONTACT Ryan Schorovsky SfafeFarm Jon Snowden Insurance Agency,Inc. :\ PHONE (541)482-2461 FAX (541)482 4957 1A1c.Nq,ExU Art cam°): CD 420 Bridge St . E-M Essc ryari•schorovsky,szmr@statefarm.com CSOa ' INSURER(S)AFFORDING COVERAGE NAIC n Ashland OR 97520INSURERA: State Farm Fire and Casualty Company 25143 INSURED INSURER e: State Farm Mutual Automobile Insurance Company 25178 Polaris Land Surveying,LLC INSURER C: PO Box 459 INSURER D: • .. , INSURER E: Ashland OR 97520. . INSURER F: . 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. . MISR - ADDLISUBR POLICY EFF -POUCY EXP LTR TYPE OF INSURANCE INgn I W1rD POLICY NUMBER . WM/OD/YYYYI IMM/DolrivY)_ LIMITS . X COMMERCIAL GENERAL UABIUTY • EACH OCCURRENCE $ 1.000,000 CLAIMS-MADE I X I OCCUR PsoER dlRENTED occurrence) $ 300.000 YY ' MED EXP(Anyone"person) $ 5.000 L • • Y 97-CQ-H089-5 05/07/2021 05/07/2022 PERSONAL ItADVINJURY • $ GEN-T.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 XI POLICY PROCT LOC PRODUCTS-COMP/OP AGG S JE OTHER: S AUTOMOBILE LIABILITY . Y L23 4521-D30-37H 04/30/2021 10130/2021 (Ea' EDSINGLELIMIT s 1,000.000 CO BINE q ANY AUTO BODILY INJURY(Per person) $ oANEo SCHEDULED 090 4953-B09-37F 08/09/2021 02/09/2022 B AUTOS ONLY X AUTOS ' , BODILY INJURY(Per occident) S HIRED NON-OWNED . . - PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY „ Per accident • S UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ - EXCESS LIAB CLAIMS.MADE AGGREGATE S DED RETENTIONS - S WORKERS COMPENSATIONI AND EMPLOYERS•LIABILITY STATUTE _SRH ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N EL EACH ACCIDENT S 500.000 OFFICERIMEMBER EXCLUDED? n N)A 97-CM-M475-1 05/05/2021 05/05/2022 (Mandatory In NH) . , E.L DISEASE-EA EMPLOYEE S 500,000 I yes,descnbo under 500,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,AddlUonal Remarks Schedule,may be attached It 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. • 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 POLICY PROVISIONS: CITY OF ASHLAND OREGON AND ITS ELECTED • I OFFICIALS,OFFICERS&EMPLOYEES auTHOR1zEo REPRESENTATIVE • 20 E MAIN ST Completed by an authorized State Farm representative.If signature ASHLAND OR 97520 is required,please contact a State Farm agent. . • ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD i1001486 132849.13 04-22-2020 Ac D® CERTIFICATE OF LIABILITY INSURANCE D'TE("MIDO/Yr'"' ki...----"" 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 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 NAMECONTACT LeZette Brewton : Assurance Risk Managers,Inc. PHDNE (303)454-9562 FAX (AIC.No): (303)454-9564 (A1C.No,Ed): 10651 East Bethany Drive iEMAILADDRESS: Iezette.brewton®arm i.com Suite 300 INSURER(S)AFFORDING COVERAGE ' NAIC C Aurora CO 80014-2688 INSURER A: Hanover Insurance Company 22292 INSURED INSURER B: , • Polaris Land Surveying,LLC. INSURER C: , POBox459 INSURER D: INSURERE: , • Ashland OR 97520-0016 INSURERF: : , . COVERAGES CERTIFICATE NUMBER: 21-22 E&O 1 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 SUBR POLICY EFF POLICY EXP LTR, TYPE OF INSURANCE INSD WVD POLICY NUMBER • (MMIDDIYYYY) (M61/DDIYYYY) UMITS COMMERCIAL GENERAL UABILITY EACH OCCURRENCE occurrence) S • DAMAGE TO RENTED CLAU,IS-h1ADE OCCUR PREMISES{Ea occurrence) S MED EXP(Any ono parson) $ PERSONAL B ADV INJURY S GENT.AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE - S POLICY n T n LOC7 PRODUCTS-COMP/OP AGG S OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s (Ea accident) - ANY AUTO BODILY INJURY(Par person) S OWNED SCHEDULED BODILY INJURY(Par accident) S _ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY jPer accident) S UMBRELLA UAB OCCUR - EACH OCCURRENCE _ S ^- EXCESS LIAB CLAIMS-MAGE AGGREGATE S - OED I RETENTION S U S WORKERS COMPENSATION PER I ERH- AND EMPLOYERS'UABIUTY Y IN ANYPROPRIETORIPARTNERIEXECUTIVE ❑ NrA EL.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory In NH) EL.DISEASE-EA EMPLOYEE S II yes.descnbo under U DESCRIPTION OF OPERATIONS below EL DISEASE-POUCY UMIT S PROFESSIONAL LIABILITY EACH CLAIM 1,000,000 A CLAIMS MADE POLICY LH4 A349055 08 06/28/2021 06/28/2022 aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may bo attached If more space ix required) PSA($25,000 or less) 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. 20 E Main St AUTHORIZED REPRESENTATIVE //����....�� Ashland OR 97520 (,t�� I () • ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo ire registered marks of ACORD r • I • • • CMP-4604.1 Pogo 1 of 1 I THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. • f 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: POLARIS LAND SURVEYING LLC • PO Box 459 Ashland OR 97520.0016 Nail1e And Address Of Additional Insured Person Or Organization: CITY OF ASHLAND OREGON AND ITS ELECTED OFFICIALS,OFFICERS&EMPLOYEES 20 E Main St Ashland OR 97520.1014 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"bodily 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 caused by"your work"performed for Ihal 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 iclaim 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. • CMP-4604.1 165042 03-20-2010 • • • • i 1