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HomeMy WebLinkAbout2020-044 PO 20200390- Cutting Edge Restoration Purchase Order Via Fiscal Year 2020 Page: 1 of: 1 B City of Ashland — --^ ATTN:Accounts PayableL 20 E. Main Purchase Ashland, OR 97520 Order#. 20200390 T Phone: 541/552-2010 O Email: payable@ashland.or.us • ✓ H CIO Public Works Department E CUTTING EDGE RESTORATION I 51 Winburn Way N 267 OAK CREST WAY • p Ashland, OR 97520 O MEDFORD, OR 97501 PhoFax: 488 -600647 R (541 776-8507 Paula Brown _ (= -IETl_I_=f :al l 4 1- T.11-1„77 73-g5;3DI =�1?PID 11=i��- 1 � ,7_-- I let�l lel)r;1- 04/13/2020 111111 ::: FOB ASHLAND O R/NET30 V City Accounts Payable &`-7:41-- r -E� 'fiTi Cleaning Calle Guanajuato V 1 Annual cleaning of Calle Guanajuato recycling structure 1 $2,886.0000 $2,886.00 Goods and Services-Agreement'(Less than$25,000) V Completion date: 05/ /2020 Project Account: ***************GL SUMMARY*************** 082400 704100 $2,886.00 • • I B Date: Authorized Signature > ,, lY '.2 886.00 FORM #3 CITY OF • A requestr Purchase Orr -- 4,--0o -/ D ASH LAN D REQUISITION Date of request: - o4io7/202 Vendor Name Cutting Edge Restoration Address,City,State,Zip 804 W. 12th Street Medford, OR 97501 Contact Name David Geigle - Telephone Number 541-326-6131 Email address heavensdoor7icloud.com SOURCING METHOD • ❑ Exempt from Competitive Bidding 0 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 ❑ Request for Proposal (Copies on file) 0 State of Oregon Date approved by Council: ❑� Direct Award _(Attach copy of council communication) • Contract# 0VerbalMritten quote(s)or proposal(s) 0 State of Washington Intermediate Procurement ❑ Sole Source Contract# GOODS&SERVICES 0 Applicable Form(#5,6,7 or 8) 0 Other government agency contract $5,000 to$100,000 0 Written quote or proposal attached Agency ❑ (3)Written quotes and solicitation attached 0 Form#4, Personal Services$5K to$75K Contract# ' PERSONAL SERVICES ❑ Special Procurement Intergovernmental Agreement $5,000 to$75,000 -- 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 Annual cleaning of Calle Guanajuato recycling structure $2;886:00; V - Item# Quantity Unit Description of MATERIALS Unit.Price Total Cost • - I TOTAL:.COST 0 Per attached quotelproposal Project Number Account Number 0 8 2 4 0 0.7 0 4 1 0 0 $ 2 8 8 6 o o V 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: V , • IT Director Date Support-Yes/No By signing this quisition form,I certify that th C' 's public contracting requirements have been satisfied. V t� !i4/�zd ap Employee: Department Head: (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: Cutting Edge Restoration CITY O,F PROVIDER'S CONTACT: David Geigle AS H LAN D 20 East Main Street ADDRESS: 804 W. 12*Street Ashland,Oregon 97520 Medford,OR 97501 Telephone: 541/488-5587 PHONE: 541-326-6131 Fax: 541/488-6006 This Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation(hereinafter "City") and Cutting Edge Restoration, (an assumed business name) ("hereinafter"Provider"),for Annual cleaning of Calle Guanajuatorecycling structure. 1. PROVIDER'S OBLIGATIONS 1.1 Provide annual cleaning of Calle Guanajuato recycling structure 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,a policy 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 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 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 • Be evidenced by a certificate or certificates of such insurance approved by the City. Page 1 of 6: Agreement between the City of Ashland and Cutting Edge Restoration . T A') ..g:Hfirl()>Tf -.4 J :e..e.J>i(?(.1A fi(ri:;10 • ! 1, (?)fli '461 Lif f.'h41.) 03Poif;twui) '..415,,t)let 11,'suifLA 1() 01-fc't ;,.i ) 1.I '44 ?T.!: :)t:11 ....2 .,34-..J1a-f it ,;;;(1..1 fy; Ji 25.f.T2 i tf fl. S.130(Pi:/:i;(0 2 `,:)ff •;;.)11.1. 1R:11(P.i;?.." 'LP!! 7,,101101.)kii 1,1;.0)r, "/;.)iki 6.4..°;:, ‘i0 jiti14 ir; :LS; Afiklial ;1)08iiOT.11.; • 9d I ) .50 1.f.i. .r.;! 1 :Sf4fc$5/1)) e.12i504.1 r•I.J12`)A *..gs. ,A)Ti.id&if. 11'1iji ',TAT!'" '11:h".Y.1.11,e1;i ,..,,ritsr 2IC:0211, P.,4r; c:10: !.01 104:: 2Jri;;0`., 'PV..1.,01"0"Cr rk,20.,111; iy2T.1120 c1Cfl1bb11 Lfu 2)21f•ifyij •IriqqA. 151!)?'17 V:"..).P.IN (2)',1! -072f.1 7f.;)hvj fg. Z:;41 .1%)CW.4`0111).,1=.:; <`) •IeH.J .1::j.4id°) e:tW *Of 'Ai -.E9bi."019 , 1).0.1 .°K;IIrip:: f( 1,jt.L.yi•:t+bi.,15 1,1i.'.12.q.2.4;',.;.-3 ..1211.22).; yJi') r• 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 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. 1.6 Living Wage Requirements: If the amount of this Agreement is $21,507.75 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. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider the sum of$2,886.00 as provided herein as full compensation for the Work as 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$2,886.00 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 as provided herein is done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement 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. 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'il'..,,iiii.gito :41 (.4 J:i. f.„..:111 ..:•,.;it.),0d.,,.,rt) .10‘,,,1f1;,....,,q:::;./., ,..L,:ji -1,;.:.(4, ',1ti;1 ii.),,,;/II a.,;.rj i:ttsc4ift-",,:.67;,A, ,I.0%. b1113 „11,;..vlf.Elii.C.;t:f4'.4'f11.)ra4:112 i.::'-.4'',•ii;I:.41',V'' ;i :i;r:::i1.7iff It;150,;;SiT olk,":0 s.'il_:: rijzcily,i 1-A.11'.)131,1 1 'n:Ii/ii )i}:,;.. tTh:..d. ,f i:, ,f".it'3•::,11; w.J.) .',..F:T; !firlf;.! "' ") %)L 1“)...1•4 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 infederal 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. 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 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 complete written Estimate dated 3/31/20. Page 3 of 6: Agreement between the City of Ashland and Cutting Edge Restoration pe/; t'`„0,110:"',f; • fld +.4.VS:V;t1 !'.31 tf P.:tik.1 1...)C)(.;1 f15?:);1.';1,::1.2:,f0.":- s `q.Pi 1.• q),cW,it* 141., 1;if;:p.3i1.0! Fo;,./;.4'1,r_iC "..-VW efl!"'CF: : I140 DOCJ*1./ 9:-:/1 1. -3• 5 i.0,0/ (MI kyte,„? V :,) Q9f ti;irf,.,( oPlf:qi L17.:Vrx 11).!r,i,f;rWiT": frtr,r,f;) ,12f ie:r! ,1'1'4 Jesus ,5 1.;,;,• :3s: "pc; 11:0•1°). gCfl O‘A/f,;:" e.crorl;' 1P,-; (- t I: F.:111(i v.; 151,:lf,!! ;,11Y31 rf'14711U5?( ).1:J jc;/. 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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 May 31, 2020, 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 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—Public Works Department Attn: Kaylea Kathol 20 E.Main Street Ashland,Oregon 97520 Phone: (541)488-5587 With a copy to: City of Ashland—Legal Department 20 E.Main Street Ashland,OR 97520 Phone: (541)488-5350 If to Provider: Cutting Edge Restoration Page 4 of 6: Agreement between the City of Ashland and Cutting Edge Restoration . . . . 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(..r..r... ...y.i7f.p., , .;:,--,L,-,, ,, .igi:•, ..e,7..ii. !-1-5:01-fl. ..Fi.iffr. ,,,Wi.r. ir"..qi.r;1 ,.,..'i;.1Lre..41 'W il^...,r3,1?.:,,,,•.,:' .!:!f0 -P( )_ 15;- . :;.--Jr). t-v.•Jcc.H.,:i_Al a.;i1oVi „Itri. --- iii15311L-1\14) ',:jr) ioillr;:;4 '4"6)1. :OtA :( O . );...e,,V.2 ' P / .• . .41.ii7 fAs..S'i Si ;Silk ,lit',:siall1.1T;(1 .:',•%,:i.'',1 --- ;1 /'. /-;s$II:;.;° rfilibt .• 0.',r. Of7 i'r:•:',. AO ...hir ;3 i•e. i4 ) f.:,--,4J.,q,d,.!..:)..ii .•::,;,...b,..Ti :,:lnimc....:;bilk:hol.,.W. t"...,,,,, ...:ci:73--)fi; cl.i,,,f.)FLrfqj --I:, t-•,,,,," Attn: David Geigle 804 W. 12th Street Medford,OR 97501 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 this4Article 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. Page 5 of 6: Agreement between the City of Ashland and Cutting Edge Restoration • 2.0 4-0P ;11:,°,4.iii; • '•‘• I() '.;•1 1,Y ';`••rifl 1.1Y 'CC)) iCJ 1 f..t J: (!i• 'if; W:1:0 4.$(it •ri.P ;:nr./61 Y,t,t1 4 i'i)(1 ••,C.1 ;:.:f!':7';?;.;(fig /id. !!`i, °,`• I.) -•• f (Iiir • ;1•A1 i)06°.:;r1 •I• `,14•:;i ...V Ek'11; i; Ci &.•.PiL11. LA )10 f)r.i1 ICi ;146 1:qji ii 1 rf.k :Cr:, • U. 1 1c \ I. 1(1.''':"=)!T•M li; :•••L •":1,r;1• ;•!(*)",ri s,!",•117, ,•;i! .7.,•-• P,O? 11'; tty,ii7j ;„ 4'; 1,,%,41=','A ‘Jej ft,t 1—`;Tri 7-1HW glIfik .) CITY OF ASHLAND: CUTT ` GE RES TION(PROVIDER): By: lg,‘'' By: Signature Signature b, -1/41 c:› Printed Name Printed Name pbx r_12_P--3Z Title Title (ffl 470a4 219 7c„ l Date Date MA is to be submitted with this signed Agreement) Purchase Order No. Page 6 of 6: Agreement between the City of Ashland and Cutting Edge Restoration Estimate Recycle Bin Center, 03/31/2020 Cutting Edge Restoration CCB Lic#194900 David Geigle (541)326-6131 Kaylea Kathol, Project.Manager City of Ashland - Public Works/Engineering 51 Winburn Way,Ashland OR 97520 C:(541)331-114410: (541) 552-2419 Scope of Work: I hereby propose to furnish all the materials and perform the labor necessary for the completion of the following: (1) Complete pressure washing of the interior of the Recycle Bin Storage area,top to bottom (2) Includes the entrance doors to the grease recycle area (3) Includes the recycle storage bins Note: Removal of grease from grease barrels before pressure washing would be recommended. Also it would be helpful to have all recycle bins outside of the Recycle Bin Storage area before pressure washing. Grease catching drain bags for around the drain areas to be provided by the City of Ashland. Cutting Edge Restoration is not responsible for any contamination resulting from pressure washing services. Estimated time for completion is one to two days.All the above work will be preformed in a timely and substantial workmanlike manner for the sum of: Time, Labor and Materials: $2,886.00 Due on Completion: $2,886.00 Respectfully Submitted, David igle, Cutting Edge Restoration "Wfc � C UTTI-1 OP ID:GW ,4�oRv- CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYY1r) 04/06/2020 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(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER . 541-899-9535 ACT George Wheeler The Insurance Center,Inc. reef En):541-899.9535 I FA ,No): 541-899-9532240 West•Cu Street POBox6 ILS Jacksonville,OR 97530 George Wheeler INSURERS)AFFORDING COVERAGE 'NAIC# INSURER A:Developers Surety&Indemnity INSURED INSURER B:Scottsdale Insurance Company Cuthng Edge Restoration David Dein-Geigle INSURER C: •PO Box 782 Jacksonville,OR 87530 INSURER D: , INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP ISD MO POLICY NUMBER IMM/D1)/YYYY1 IMMIDOIYYYW LIMITS A X COMMERCIAL GENERAL UABIUTY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR y BIS00014725-08 01/28/2020 01/28/2021 PRFI dII$Es Ea rrDenC� $ 300,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREG LIMIT APPLIES PER: GENERAL AGGREGATE _$ 2,000,000 POLICY I I j [ I LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY CO MaccsleDDD)SINGLE LIMIT $ ANY AUTO — OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS ONLY _AUTOS yy Ep BODILY INJURY(Per accident) $ AUTOS ONLY _ O ONLY (PRerradentDGE $ ! $ B UMBRELLA UAB OCCUR EACH OCCURRENCE $ 1,000,000 X EXCESS UAB CLAIMS-MADE XBS0118048 10/21/2019 10/21/2020 AGGREGATE 3 1,000,000 DED RETENTIONS '- WORKERS COMPENSATION PER 0TH- AND EMPLOYERS'LIABILITY YIN STATUTE ER OFFIANYPROPRIETOR/PARTNER/EXECUTIVEEEMR LDEN f A E.L.EACH ACCIDENT $ (Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101.Additional Ramada Schedule,may be attached N more space Is required) City of Ashland,it's elected officials,officers&employees named additional insured.endorsement attached CERTIFICATE HOLDER CANCELLATION CITYASH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland ACCORDANCE(WITH THE POLICY PROVISIONS. Attn:Tami DeMille-Campos 20 East Main St. AUTHORIZED REPRESENTATIVE ' Ashland,OR 97520 George Wheeler �- I 1 ACORD 25(2016/03) ©1988-2015 "ORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ID 00 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization Is an additional insured only with respect to liability for"bodily injury", "property damage"or°personal and advertising injury`caused by and to the extent of your negligence in the performance of your ongoing operations for the additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds,the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage"or°personal and advertising injury arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports',surveys,field orders,change orders or drawings and specifications;or b. Supervisory,inspection,architectural or engineering activities. 2. "Bodily injury"or"property damage"occurring after a. All work, including materials, parts or equipment furnished in connection with such work, on the project(other than service,maintenance or repairs)to be performed by or on behalf of the additional insured(s)at the location of the covered operations has been completed;or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project 3. "Bodily injury","property damage"or"personal and advertising injury"involving or related to or in connection with any additional insured or any location covered by a scheduled or blanket additional Insured endorsement that is a part of the policy. C. Primary and Non-contributory Insurance-We will consider this insurance to be primary and non- contributory to other Insurance issued directly to additional insured person(s) or organization(s) to which this endorsement applies if each such additional Insured Is a named insured in such other Insurance and a written contract between you and such person(s) or organization(s) specifically requires that we consider this insurance to be primary and non-contributory.. D. Waiver of Subrogation—We waive any right of recovery we may have against the additional insured person(s) or organization(s) to which this endorsement applies if each such additional insured is a named insured in such other insurance and a written contract between you and such person(s) or organization(s) specifically requires that we waive subrogation of payments we make for injury or damage arising out of"your work" done under a contract with such person(s) or organization(s) to which this endorsement applies. 10 00 37 04 13 Page 1of1 The Insurance Center PROGRE /YE' PO BOX 6 AUTO JACKSONVILLE,OR 97530 NAIC Company Code:42994 Policy Number: 913970283 Underwritten by: Progressive Classic Insurance Co Policyholders: David Geigle Jodi Geogle Page 1 of 1 April 6,2020 The Insurance Center 1-888-699-9535 Contact your agent for personalized service. Customer Service 1400-876-5581 Verification of Insurance for 24 hours a day,7 days a week David Geigle and Jodi Geogle This verification of insurance is not an insurance policy and does not amend,extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement,term or condition of any contract or other document with respect to which this verification of insurance may be issued or may pertain,the insurance afforded by the policies described herein is subject to all the terms,exclusions and conditions of the policies. Please accept this letter as verification of insurance for this policy. Policy and driver information Policy number: 913970283 Policy state: Oregon Policy period: Mar 18,2020-Sep 18,2020 There was no lapse in coverage during this policy period. Effective date: Mar 18,2020 Drivers: David Geigle Insured Driver Jodi Geogle Insured Driver Address: PO Box 782 Jacksonville,OR 97530 Vehicle information Vehide: 2005 Ford F150 Vehicle identification number: 1FTRF14505KC62095 Coverage information Bodily Injury Liability: $100,000 each person/$300,000 each accident Property Damage Liability: $100,000 each accident Collision: Deductible: $500 deductible Comprehensive: Deductible: $100 deductible Personal Injury Protection: $15,000 Form vol(07/13) 4 CERTIFICATION OF EXEMPTION FROM • " WORKERS' COMPENSATION INSURANCE REQUIREMENTS Contractor is exempt from the requirement to obtain workers compensation insurance under ORS 4a1;•r 656 for the following reason.Contractor is to initial th'e appropriate box as follows: :o1 SOLE PROPRIETOR (Initials) • Contractor is a sole proprietor,and • Contractor has no employees,and • Contractor will not hire employees or subcontractors to perforin this contract. CORPORATION—FOR PROFIT (Initials) ■ Contractor's business is incorporated;and • All employees of the corporation are officers and directors and have a substantial ownership interest*in the corporation,and • All work will be performed by the officers and directors;Contractor will not hire other employees or subcontractors to perform this contract. CORPORATION-NONPROFIT (Initials) ■ Contractor's business is incorporated as a nonprofit corporation,and • Contractor has no employees;all work is performed by volunteers,and • Contractor will not hire employees or subcontractors to perforin this contract. PARTNERSHIP j (Initials) ■ Contractor is a partnership,and • Contractor has no employees,and • All work will be performed by the partners;Contractor will not hire employees or subcontractors to perform this contract,and • Contractor is not engaged in work performed in direct connection with the construction,alteration,repair, improvement,moving or demolition of an improvement to real property or appurtenances thereto.** LIMITED LIABILITY COMPANY (Initials) • Contractor is a limited liability company,and ■ Contractor has no employees,and • All work will be performed by the members;Contractor will not hire employees or subcontractors to perform this contract,and • If Contractor has more than one member,Contractor is not engaged in work performed in direct connection with the vi I traction,alteration,repair,improvement,moving or demolition of an improvementto real property or 42 purtenances thereto.** 64/0 i /2_02.,c,. (Signature of Autho" igner) 1 (Date) (41- 1dji\J e—P--- Ci)( E4521-2--- . (Signer'sTitle V l *NOTE: Under OAR436-50-050 a shareholder has a"substantial ownership"interest if the shareholder owns 10%of the corporation,or if less than 10%is owned,the shareholder has ownership that is at least equal to or greater than the average percentage of ownership of all shareholders. , ,g • "uq,e,f r :1 j,1' • •,, 2. +:1 " e;•`,"• rri; ,,,Y14•P•C; . . -• 1c :1. gt; e• .1.0,./V. (": T.11r • - ; ;t,,•, • , 1 • '1., — • — " 1 4`..t.,if. r 14) lif4 (11:7YfiFi';f1 C.',1A1C:C".cr?i; q!: !it %it; "4“ !.; 10( sabl:dr -; . : 4,- ii-'CCif • 11,4:f ,,-• .^1! ;,, op:.; ;!1' c• — 11. 2 )•,...;,:2,!Tri •.' • Of::: . ; g.' "i"?,foo 74:141,..1r.33 "Ot ' :11,"4,'!.:E.; 1,,4i: I F tL I'41i