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HomeMy WebLinkAbout2020-041 PO 20200385- National Firefighter Corp. Purchase Order Fiscal Year 2020 Page: 1 of: 1 B City of Ashland ATTN;Accounts Payable L 20 E. Main Purchase 20200385 Ashland, OR 97520 Order# L T Phone:541/552-2010 O Email:payable@ashland.or.us V H CIO Facilities Maintenance Div E NATIONAL FIRE FIGHTER CORP I 90 North Mountain Ave • N 3100 N PACIFIC H1NY p Ashland, OR 97520 O MEDFORD, OR 97501 _ Phone: 541/488-5358 R T Fax:541/552-2304 541 344-1438 • , David Arnold 11111111111111S Pa able S..Tf•A:%! _ Fire Extinguisher Inspection 1 Fire extinguisher inspection and service 1 $4,991.0000 $4,991.00 Goods&Services Agreement Completion date: June 30,2020 Project Account: ***************GL SUMMARY*************** 082400-602400 $4,991.00 • • v By. 3944�1� Date: LI R. aco-0 Authorized Signature _�� _,—� = $4 991.00 FORM #3 CITY OF o �o o ASH LAN D rcy, REQUISITION Date of request: 3/5/2020 Required date for delivery: Vendor Name - National Fire Fighter Corp. Address,City,State,Zip 3100 North Pacific Highway,Medford,OR 97501 Contact Name&Telephone Number Mike Webb 541-779-0167 mikew@nationalfirefighter.com Email address • SOURCING METHOD ❑ Exempt from Competitive Bidding 0 Emergency_ ❑ Reason for exemption: ❑ Invitation to Bid 0 Form#13,Written findings and Authorization ❑ AMC 2.50 Date approved by Council: ❑ Written quote or proposal attached ❑ Written quote or proposal attached (Attach copy of council communication) „�(If council approval required,attach copy of CC) ® Small Procurement 0 Request for Proposal Cooperative Procurement Not exceeding$5,000 - Date approved by Council: ❑ State of Oregon ® Direct Award _(Attach copy of council communication) Contract# ❑ 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) ❑ Other government agency contract Intermediate Procurement 0 Sole Source Agency GOODS&SERVICES 0 Applicable Form(#5,6,7 or 8) Contract# Greater than$5,000 and less than$100,000 0 Written quote or proposal attached Intergovernmental Agreement ❑ (3)Written quotes and solicitation attached ❑ Form#4,Personal Services>$5K&<$75K Agency PERSONAL SERVICES 0 Special Procurement 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 ❑ Written quote or proposal attached City Administrator.AMC 2.50.070(4) ❑ (3)Written proposals/written solicitation Date approved by Council: ❑ Annual cost to City exceeds-$25,000,Council ❑ Form#4,Personal Services>$5K&<$75K Valid until: (Date) approval required.(Attach copy of council communication) Description of SERVICES Total Cost. Fire extinguisher inspection and service K4,991.00 Item# Quantity Unit Description of•MATERIALS Unit Price Total Cost ❑ Per attached quoteiproposai r;;, TOTAL COST . - $ Project Number _ Account Number 082400-602400 • '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.ve all hardware and software purchases: IT Director Date Support-Yes/No By signing this requisition form I •rtify that the City's ubl' contracting requirements have been satisfied. Employee: Department Head: z7M44 7.0 roc, (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 &SERVICES AGREEMENT PROVIDER: National Fire Fighter Corp. CITY 0 F PROVIDER'S ASH LAN D CONTACT: Mike Webb 20 East Main Street Ashland,Oregon 97520 ADDRESS: 3100 North Pacific Highway Telephone: 541/488-5587 Medford, OR 97501 Fax: 541/488-6006 PHONE: 541-779-0167 This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and National Fire Fighter Corp, a domestic business corporation("hereinafter"Provider"), for fire extinguisher inspection and service. 1. PROVIDER'S.OBLIGATIONS 1.1 Provide fire extinguisher inspection and service for FY20 as set forth in the "SUPPORTING DOCUMENTS" attached. hereto;,ands; 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 authoriaed,except in the same manner as herein provided for authority to exceed the maximum compensation. The goods and 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, a policy or policies of liability insurance including commercial general liability insurancewith.a combined single limit, or the equivalent, of not less than $2,000,000 (two million dollars)per occurrence for Bodily Injury and Property Damage. 1.2.1 The insurance required in this Article shall include the following coverages: • Comprehensive General or Commercial General Liability, including personal injury, contractual liability, and products/completed operations coverage; and •.. Automobile.Liability. • 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 fitstdollar 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 • Be evidenced by a certificate or certificates of such insurance approved by the City. Page 1 of 5: Agreement between the City of Ashland and National Fire Fighter Corp. 1.3 All subject employers working under this Agreement are either employers that will comply with ORS 656.017 or employers that are exempt under ORS 656.126. 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 performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Providers of the Provider's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider for its Work at the hourly rates and,charges as set forth in Exhibit"X", entitled "Picking Ticket"which is attached hereto and incorporated herein by this reference,as full compensation for Provider's performance of all Work under this Agreement. 2.2 In no event shallProvider's total'Of all compensation and reimbursement under this Agreement exceed the sum of$4,991.00 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. 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. 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. Page 2 of 5:'Agreement lbetivadn the City of Ashland and National Fire Fighter Corp. • 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. 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 complete written Rate Sheet dated 10/29/2019. 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 any Work that have been delivered inadequately or defectively; 5.1.3 Initiation of an action or proceeding for damages, specific performance, or declaratory or injunctive relief; 5.1.4 These remedies are cumulative to the extent the remedies are not inconsistent,and City may pursue any remedy or remedies singly, collectively, successively or in any order whatsoever. 5.2 In no event shall City be liable to Provider for any expenses related to termination of this Agreement or for anticipated profits. If previous amounts paid to Provider exceed the amount due, Provider shall pay immediately any excess to City upon written demand provided. 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 3Q, 2020, unless sooner terminated as provided in Subsection 6.2. Page 3 of 5: Agreement between the City of Ashland and National Fire Fighter Corp. 6.2 Termination 6.2.1 The City and Provider may terminate this Agreement by mutual agreement at any time. 6.2.2 The City may, upon not less than thirty (30) days' prior written notice, terminate this Agreement for any reason deemed appropriate in its sole discretion. 6.2.3 Either party may terminate this Agreement, with cause, by not less than fourteen (14) days' prior written notice if the cause is not cured within that fourteen (14) day period after written notice. Such termination is in addition to and not in lieu of any other remedy at law or equity. 7. NOTICE Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery, by sending via a reputable commercial overnight courier, or by mailing using registered or certified United States mail, return receipt requested, postage prepaid, to the address set forth below: If to the City: City of Ashland—Facilities Maintenance Department Attn: David Arnold 90 North Mountain Avenue 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: National Fire Fighter Corp. Attn: Mike Webb 3100 North Pacific Highway Medford, OR 97501 541-779-0167 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. Page 4 of 5: Agreement between the City of Ashland and National Fire Fighter Corp. • 9.1.2 Provider, for a period of no fewer than six(6) calendar years preceding the Effective Date of this Agreement, has faithfully complied with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider; and (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.2 Provider's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Provider's warranty, as set forth in this Article 9, shall constitute a material breach of this Agreement. Any material breach of this Agreement shall entitle the City to terminate this Agreement and to seek damages and any other relief available under this Agreement,at law,or in equity. 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: National Fire ighter Corp (PROOVIIDER): By: B . Signature `i Signature � (f_ r,� L Sf�W ) MjClc el �,^, OJ Printed Name / Printed Name �1�✓ -/2.t�1a2 /Q /+," ei/ Scae5 ,(S.ckr1.4C-P_ Title Title Date Date (W-9 is to be submitted with this signed Agreement) Purchase Order No. Page 5 of 5: Agreement between the City of Ashland and National Fire Fighter Corp. • � , ,, ORDER CONFIRMATION IndustrialIndustrialIndustrial50ux ''l 'p ".,�`"}"501/ Iff EUGENE WELDERS SUPPLY GO.DBA NATIONAL FIRE FIGHTER WILDLAND CORP. tionaI Aim gh ir INDUSTRIAL SOURCE,NATIONAL FIRE FIGHTER CORP. PO BOX 21107 • �/ cum PO BOX 2330 EUGENE,OR 97402 EUGENE,OR 97402 Thank you for placing your order! Your order is our top priority. • Order Summary Customer Number: M1072 P/O Number: EXT SVC QUOTE. Order Number: 02284175, Payment Method: On account Shipping information: 01-01-2020 CITY OF ASHLAND- VEHICLE MAINT 20 E MAIN ST Fire Extinguisher Service Quote • ASHLAND OR 97520 Shipping Method: _ SALESMAN • Ordered items J Item Description Quantity Quantity UOM Price Extended Price Ordered Shipped EXS SC FIRE PROTECTION SERVICE CALL 1 1 EA $47.95 $47.95 6YR AMX5 6YR AMEREX SERVICE/REFILL 29 29 EACH $30.55 $885.95 6YR AM,X10A 6YR AMEREX SERVICE/REFILL ALUM. 14 14 EA $48.95 $685.30 6YR HTAMX11 6YR HALOTRON SERVICE/REFILL 10 10 EA $75.00 $750.00 TF AMX2.5 HYDRO AMEREX DC 2.5# 1 1 EA $26.50 $26.50 TF AMX5 HYDRO AMEREX DC 5# 16 16 EA $40.55 $648.80 TF CO2 10 HYDRO 10# CO2 EXTINGUISHER 1 1 EA $70.00 $70.00 EXS 1YR 1YR INSPECTION EXTINGUISHER 270 270 EA $6.95 $1876.50 I Subtotal: $4991.00 Tax: $o.00 Del Charge: $o.00 Freight: $0.00 Other: $o.00 Grand Total: $4991.00 • TE A��O® CERTIFICATE OF LIABILITY INSURANCE DA 7/22/2019DIY 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). CONT PRODUCER NAMEACT Angela Sangl Ward Insurance Agency Inc. PHONE FAX PO Box 10167 _(AIC,No,Ext):541-687-1117 (A/C,No):541-342-8.280 Eugene OR 97440 ADDRESS: angela@wardinsurance.net - INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Indemnity Insurance Company of NA 43575 INSURED LAINCOM-01 INSURER B:Ace American Insurance Company 22667 Eugene Welder's �Supply Co. dba Industrrialal Source INSURER C:Commerce and Industry Insurance Company 19410 dba National Fire Fighter Wildland Corp. INSURER D:Associated Industries Insurance Company Inc 23140 1574 W 6th Ave INSURER E: Eugene OR 97402 INSURER F: COVERAGES CERTIFICATE NUMBER:1240395221 a REVISION NUMBER: _ THIS IS TO CERTIFY THAT THE POLICIES OF-INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y Y D37720136 5/31/2019 5/31/2020 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $10,000 • PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 • POLICY PRO- JECT • LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ _ .B AUTOMOBILE LIABILITY Y Y H08518713 5/31/2019 5/31/2020 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ C X UMBRELLA LIAB X OCCUR Y EBU 021369864 5/31/2019 5/31/2020 EACH OCCURRENCE $10,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $10,000,000 DED RETENTION$ $ WORKERS COMPENSATION. - - PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? ' (Mandatory In NH) E.L_._DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ D GENERAL LIABILITY FOR Y Y AES105332702 5/31/2019 5/31/2020 Gen Agg/Occ: . $2M/$1M NATIONAL FIRE FIGHTER CORP Prod.CO/Pers.&Adv. $2M/$1 M MED.EXPENSE:$0 Dmg To Rented Prem.: $100,000 • DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Certificate holder and all entities required by written contract are included as additional insureds on a primary and non-contributory basis with waiver of subrogation as respects to the general liability and auto liability as required by written contract per attached endorsements. Umbrella follows form.All coverages are subject to policy limits,terms,conditions and exclusions. 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: Evidence of Insurance AUTHORIZEDF PRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: D37720136 Eugene Welder's Supply Co, DBA Industrial Source ADDITIONAL INSURED-WHERE REQURED UNDER CONTRACT OR AGREEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This\endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Section II-Who is an Insured, 1.,is amended to add as an additional insured: (f) Any person or organization to whom you become obligated to indude as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to , that person or organization, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" arising out of your operations or premises owned by or rented by you. However, the insurance provided will_not exceed the lessor: 1. The coverage and/or limits of this policy,or 2. The coverage and/or limits required by said contract or agreement - I Authorized Agent / - LD-16422 (04/04) Reprinted with permission of Insurance Services Office Page 1 of 1 • POLICY NUMBER: D37720136 Eugene Welder's Supply Co, DBA Industrial Source NON-CONTRIBUTORY ENDORSEMENT FOR ADDITIONAL INSUREDS THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY COVERAGE Schedule Organization Additional Insured Endorsement (If no information is filled in, the schedule shall read: 'All persons or entities added as additional insureds through an endorsement with the term "Additional Insured in the title") For organizations that are listed In the Schedule above that are also an Additional Insured under an endorsement attached to this policy,the following is added to Section IV.4.a: If other insurance is available to an insured we cover under any of the endorsements listed or described above (the "Additional Insured") for a bss we cover under ttisp±y, this insurance will appy to such bss on a primary basis and we will not seek contribution from the other insurance available to the Additional Insured. - • Authorized Agent • LD-20287(06/06) Page 1 of 1 POLICY NUMBER: D37720136 COMMERCIAL GENERAL LIABILITY Eugene Welder's Supply Co, DBA Industrial Source CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: as required by written contract or agreement Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: - • We waive any right of recovery we may have against the person or organization shown in the Schedule • above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. - l CG 24 04 05 09 ©Insurance Services Office, Inc., 2008 Page 1 of 1 0 l ® DATE(MM/DD/YYYY) AccoRD CERTIFICATE OF LIABILITY INSURANCE 1/10/2020 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 certificatedoes not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER - CONTACT KPD Insurance, Inc. PHONE FAX PO Box 784 (AIC.No.Ext):541-741-0550 (A/C,No):541-741-1674 Springfield OR 97477 •ADDRESS: wc-certs@kpdinsurance.com. INSURERS)AFFORDING COVERAGE NAIC# • INSURERA:SAIF Corp 36196 INSURED EUGEWELO2W INSURER B: Eugene Welders Supply Co.dba:Industrial Source dba:National Fire Fighter INSURER C: dba: National Fire Fighter Wildland Corp INSURER D: PO Box 2330 • INSURER E: Eugene OR 97402 INSURER F: COVERAGES CERTIFICATE NUMBER:847977137 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES`DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD, POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) . COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE $ CLAIMS-MADE OCCUR PREM SESO(Ea occu RENTED $ MED EXP(Any one person) $ • PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO LOC PRODUCTS-COMP/OP AGG $ PRO- JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) -_ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ • • $ A WORKERS COMPENSATION " 783031 1/1/2020 1/1/2021 XX AND EMPLOYERS'LIABILITY STATUTE EV - AND /N ANYPROPRIETOR/PARTNERIEXECUTIVE N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1.,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 • DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Evidence of Workers Compensation Insurance for the State of Oregon • RE:All Operations • • 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. Sample Certificate AUTHORIZED REPRESENTATIVE Aitt4644.4. • ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD � J • POLICY NUMBER:037720136 Eugene Welder's Supply Co, DBA Industrial Source NON-CONTRIBUTORY ENDORSEMENT FOR ADDITIONAL INSUREDS THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY COVERAGE Schedule Organization - Additional Insured Endorsement (If no information is filled in, the schedule shall read: "All persons or entities added as additional insureds through an endorsement with the term "Additional Insured in the title) For organizations that are listed In the Schedule above that are also an Additional Insured under an endorsement attached to this policy,the following is added to'Section N.4.a: If other insurance is available to an insured we cover under any of the endorsements listed or described above (the "Additional Insured") for a bss we cover under this potty, this insurance will appy to such bss on a primary basis and we will not seek contribution from the other insurance available to the Additional Insured. • • • • Authorized Agent LD-20287 (06/06) Page 1 of 1 r , COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT DA-48170 (06/17) I Highlights-Please refer to form for exact wording and coverage Number Enhancement 1 Extended Cancellation 60 Days 2A Broad Form Named Insured You control 50%of voting stock; Newly Acquried up to 180 Days, 2B Employees As Inureds 2C Lessors As Insureds 2D Persons or Organizations As Insureds Under a Written Contract Any person or Organization with respect to operation, maitenance or use of covered "auto" under written "insured contract",written agreement, or written permit issued to you by a governmental or public authority., 3 Fellow Employee Coverage 4 Physical Damage-Additional Temporary Transporationa Expense $50 per day for temporary transporation expense/$1,000 Maximum 5 Auto Loan/Lease Gap Expenses that your or any of your"employees" are legally obligated to pay because of written contractor agreement entered into for 6 Rental Agency Expense use of rental vehicle in the conduct of your business: 7 Extra Expense-Broadend Coy. Recovery expense of returning a stolen covered "auto" 8 Airbag Coverage 9 Audio,Visual And Data Electronic Equipment-Broadened Coverage $2;000 for"loss" in any one "accident" 10 Glass Repair-Waiver of Deductible No deductible applies to glass damage if the glass is repaired rather than replaced. 11 Two or More Deductibles 12 Amended Duties in the Event of Accident,Claim,Suit or Loss Knowledge of Accident 13 Waiver of Subrogation Transfer of Rights of Recovery Against Others to US 14 Unintentional Failure to Disclose Hazards 15 Autos Rented by Employees 16 Hired Auto-Coverage Territory - 17 Resultant Mental Anguish Coverage "Bodily injury" includes mental anguish POLICY NUMBER: D37720136 COMMERCIAL GENERAL LIABILITY Eugene Welder's Supply Co, DBA Industrial Source CG 24 04 05 09 L WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: as required by written contract or agreement Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 ©Insurance Services Office, Inc., 2008, Page 1 of 1 0 POLICY NUMBER: 037720136 Eugene Welder's Supply Co, DBA Industrial Source ADDITIONAL INSURED-WHERE REQURED UNDER CONTRACT OR AGREEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Section II-Who is an Insured, 1.,is amended to add as an additional insured: (f) Any person or organization to whom you become obligated to indude as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization, but only with respect to liability for "bodiy injury", "property damage" or "personal and advertising injury" arising out of your operations or premises owned by or rented by you. However,the insurance provided will not exceed the lessor: 1. The coverage and/or limits of this policy,or 2 The coverage and/or limits required by said contract or agreement • • • • Authorized Agent • LD-16422 (04/04) Reprinted with permission of Insurance Services Office Page 1 of 1