HomeMy WebLinkAbout2020-051 PO 20200408-Aquatic Ecosystem Sciences LLC Purchase Order
rift Fiscal Year 2020 Page: 1 of: 1
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B City of Ashland i� coit .*N* Ys"lav ka9101 tl LSi Fist
L ATTN:Accounts Payable20 E. Main Purchase
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Ashland, OR 97520 Order# 20200408
T Phone:541/552-2010
O Email: payable@ashland.or:us
V H CIO Water Treatment Plant •
EAQUATIC ECOSYSTEM SCIENCES LLC I 90 North Mountain Ave
295 EAST MAIN ST., SUITE 7 P Ashland, OR 97520
0 ASHLAND, OR 97520 Phone: 541/488-5345
R T Fax:541/552-2329
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04/28/2020 828 FOB ASHLAND OR/NET30 Cit Accounts Pa able
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Algae Treatment
1 Assist in Cyanobacteria identification. Interpretation of 1 $4,800.0000 $4,800.00
Cyanobacteria density.Consultation with City staff on algae
treatment and management of Reeder Reservoir.
Contract for Goods and Services Small Procurement Less than
$5,000
Completion date: 11/15/2020
Project Account:
***************GL SUMMARY
081900-604100 $4,80000
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Authorized Signature •.4 800.00
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FORM #3 CITY OF
ASHLAND
A request for a Purchase Order �� �0 .. _ _
REQUISITION ,% I '"b ate of request: 422-2020;'
Required date for delivery: .
Vendor Name AQUATIC ECOSYSTEM SCIENCES LLC
Address,City,State,Zip 295 EAST MAIN ST.SUITE 7 ASHLAND,OR.97520
Contact Name&Telephone Number JACOB KANN 541-482-1575
Email address jacob@aquatic-ecosciences.com
SOURCING METHOD
O Exempt from Competitive Bidding 1 ❑ Emergency
❑ Reason for exemption: 0 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:_ 0 State of Oregon
❑ Direct Award _(Attach copy of council communication) Contract#
® Verbal/Written quote(s)or proposal(s) 0 Request for Qualifications(Public Works) .❑ State of Washington
Date approved by Council_ Contract#_
_(Attach copy of council communication) 0 Other government agency contract
Intermediate Procurement 0 Sole Source Agency
GOODS&SERVICES 0 Applicable Form(#5,6,7 or 8) Contract#
Greater than$5,000 and less than$100,000 0 Written quote or proposal attached Intergovernmental Agreement
❑ (3)Written quotes and solicitation attached 0 Form#4,Personal Services>$5K&<$75K Agency
PERSONAL SERVICES 0 Special Procurement 0 Annual cost to City does not exceed$25,000.
Greater than$5,000 and less than$75,000 0 Form#9,Request for Approval Agreement approved by Legal and approved/signed by
❑ Direct appointment not to exceed$35,000 0 Written quote or proposal attached City Administrator.AMC 2.50.070(4)
❑ (3)Written proposals/written solicitation Date approved by Council:_ 0 Annual cost to City exceeds$25,000,Council
❑ Form#4,Personal Services>$5K&<$75K Valid until: (Date) approval required.(Attach copy of council communication)
Description of SERVICES Total Cost
ASSIST IN CYANOBACTERIA IDENTIFICATION.INTERPRETATION OF CYANOBACTERIA
DENSITY.CONSULTATION WITH CITY STAFF ON ALGAE TREATMENT AND MANAGEMENT
OF REEDER RESERVOIR. $4i80100 - _ . _ _, t_� : ,
Item # Quantity Unit .Description of MATERIALS Unit Price Total Cost
® Per attached quotelproposal TOTAL.COST•.
$4,800:00
Project Number _ _ _ Account Number 08.19.00.604100
*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: '-`' " �"�� Department Head: ZV-MK-tots
(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
Finance Director-(Equal to or greater than$5,000) Date
Comments:
Form#3-Requisition
, Contract for GOODS AND SERVICES Small Procurement Less than$5,000
C i TY o F INDEPENDENT CONTRACTOR: Aquatic Ecosystem Sciences LLC-
ASHLAND CONTACT: JACOB KANN
20 East Main Street ADDRESS:295 East Main St.Ashland,OR.97520
Ashland,:Oregon41/ 97520 TELEPHONE:541.482-1575 • FAX:866-742-8287
Telephone: 541/488-6002
Fax: 541/488-5311 - .-• EMAIL:jacobkann@aol.com
EFFECTIVE DATE:5-1-2020 COMPLETION DATE::11-15-2020'
TOTAL COMPENSATION:$4,800.00
GOODS AND SERVICES TO BE.PROVIDED:Assist in identifying and recording cyanobacteria sourced in Reeder Reservoir.Interpretation of
cyanobacteria density-and cyanobacteria potential for toxicity:Site visits'to determine'abatement viability and tithing.Consultation with City
water treatment staff on sonde data collection and reporting strategies in Reeder'Reservoir.
•
ADDITIONAL TERMS:
In the event of a conflict or discrepancy among the Contract Documents,this City,of Ashland Contract will be primary and take precedence,and any
exhibits or ancillary agreements having redundant or contrary provisions will be subordinate'to and interpreted in a manner that will not conflict with the
said'primary City of Ashland Contract. - ' ' - •
NOW THEREFORE,the CITY AND CONTRACTOR HEREBY AGREE as follows: '
1. All Costs by Contractor: Contractor shall,provide all goods as specified above and shall at its own risk and expense,perform any work
described above and,unless otherwise specified,furnish all labor,equipment and materials required for proper performance formance of such work. '
2. Qualified Work: Contractor has represented,and by entering inthis contract now represents,that any personnel assigned to the work required
under this contract are fullyqualified to perform the work to which they will be assigned in a skilled and worker-like manner arid,if required to be
registered,licensed or bonded by the State of Oregon,are so registered,licensed and bonded.Contractor must also maintain a current City
business license. ' _
3. Ownership of_Production:All documents,materials or items produced by Contractor pursuant to this contract shall be the property of City.
4. :Statutory Requirements:ORS 2798.220,2798.225,279B.230,279B2235,ORS Chapter 244 and ORS 670.600 are made part of this contract
.5. •Indemnification:Contractor agrees to defend,indemnify and save City,its officers,employees and agents harmless from those losses,expenses,
• or other damages resulting from injury to any person or damage to property arising out of or incident to the negligent performance of this'contract
by Contractor its employees,or agents. Contractor shall not be held responsible for any losses,expenses,or other damages,directly;solely,and
proximately caused by the negligence of City.
6. Termination: City's Convenience. This contract may be terrninated.at any time by the City.
7. Independent Contractor Status: Contractor is an independent Contractor and not an employee,of the City. Contractor shall have the complete
. responsibility for the performance of this contract.
8. Non-discrimination Certification:The undersigned certifies'that the undersigned Contractor has not discriminated against minority,women or '
emerging small businesses enterprises in obtaining any required subcontracts. Contractor further certifies that it'shall not discriminate in the award' '
•of such subcontracts,if any. '
9. Asbestos Abatement License:If required under 01k8 468A.710,Contractor or Subcontractor shall possess an asbestos abatement license.
10. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work.
• 11. Use of Recyclable Products:Contractor shall use recyclable products to the maximum extent economically feasible in the performance of the
contract work set forth in this document. '
. 12. Default. The Contractor shall be in default of this agreement if Contractor commits any material breach or default of any covenant,warranty,
•certification,or obligation it owes under the Contract. '
13. Insurance: Contractor shall at its own expense provide the following insurance: ' •
a a. Worker's Compensation insurance in compliance.with ORS 656.017,which requires subject employers to provide Oregon workers' . .
compensation coverage for all their subject workers. Worker's compensation insurance is required if work is performed by employees,
subcontractors;or volunteers. ' '
BY INITIALING THIS SENTENCE,CONTRACTOR CERTIFIES-UNDER PENH OF LAW THAT THE WORK REQUIRED BY THIS
CONTRACT SHALL BE PERFORMED SOLELY BY THE UNDERSIGNED:. ,
b. - General Liability insurance with a combined single limit;or the equivalent,of not less than$1,000,000 for each occurrence for Bodily Injury
and Property Damage. -
c. Automobile Liability insurance with a combined single limit,or the equivalent,of not less than$1,000,000 for each accident for Bodily
Injury and Property Damage,including coverage for owned,hired or non-owned vehicles,as applicable. .
14. Governing-Law;Jurisdiction;Venue: This contract shall be governed and construed in accordance with the laws of the State of Oregon
15. THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BETWEEN,THE PARTIES. NO WAIVER,CONSENT,
MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL BIND EITHER PARTY UNLESS IN WRITING AND SIGNED'BY BOTH
PARTIES. .. . '
16. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by reference.
'17. Consultant's compliance with Oregon Tax Law:
(1) Consultant represents and warrants to the City that 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 hot 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.
(2) Consultant represents and warrants that,for a period of no fewer than six(6)calendar years preceding the Effective Date of this Agreeme
faithfully complied with:
(i) All tax laws of the State of Oregon,including but not limited to ORS 305.620 and ORS Chapters 316;317,and'318;
(ii) Any tax provisions imposed by a political subdivision'of the State Of Oregon applicable to Consultant;and
(iii) Any rules,regulations,charter provisions,or Ordinances that implement or enforce any of theforegoingtax laws or provisions. .
Revised 10-28-14 • - 'Page 1 of 2
CONTRA TOR: CITY OF ASHLAND:
By: By:
t Signature Department=v1.3
ead
4sprint Reale Pr nt Name
Title Date
(W-9 is to be submitted with the signed contract.) Purchase Order No. JO#2-0 e 1 8
EXHIBIT A
CERTIFICATIONS/REPRESENTATIONS: Contractor,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 to
it and(b)Contractor 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. Contractor further represents and warrants to City that(a)it has the power and authority to.
enter into and perform the work,(b)the Contract,when executed and delivered,shall be a valid and binding
obligation of Contractor enforceable in accordance with its terms,(c)the work under the Contract shall be
performed in accordance with thehighestprofessional standards,and(d)Contractor is qualified,professionally
competent and duly licensed to perform the work: Contractor also certifies under penalty of perjury that its
business is not in violation of any Oregon tax laws,and it is a corporation authorized to act on behalf of the
entity designated aboveand authorized to do business in Oregon oris an independent Contractor as defined in
the contract documents,and has checked-four or mote of the following criteria:
3( (1)T carry out the labor or services at a location separate from my residence or is in-a specific
portion of my residence,>set aside as the location of the business.
XC (2)Commercial advertising or business cards or a trade association membership are purchased for
the business.
)C (3)Telephone listing is used for the business separate from the personal residence listing.
(4)Labor or services are performed only pursuant to written contracts.
>t (5)Labor or services are performed for two or more different persons within a periodof one year.
X (6)I assume fmancial responsibility for defective workmanship or for service not provided as
evidenced by the ownership of performance bonds,warranties,errors and omission insurance or
liability insurance relating to the labor or services to.be provided.
-t.41 :(4!)
Contractor (Date)
•
Revised 10-28-14 Page 2 of 2
ACORDn CERTIFICATE OF LIABILITY INSURANCE oai22i o
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Paul W Volz Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
g cy HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
450 Siskiyou Blvd Ste 5 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Ashland OR 97520
541-482-8463 INSURERS AFFORDING COVERAGE NAIC#
INSURED AQUATIC ECOSYSTEM SCIENCES LLC • INSURER A FARMERS INSURANCE EXCxANGE
JACOB KANN INSURER B: CNA
295E MAIN ST SUITE 7 INSURER C:
ASHLAND, OR 97520 INSURER D:
!PH 541-482-1575 FR 541-552-1024 INSURER E:
COVERAGES
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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
/NSR ADM - POLICY EFFECTIVE POLICY EXPIRATION
LTR tNSRD TYPE OF INSURANCE POLICY NUMBER DATEIMM/DD/YY1 -DATE(MM/DD/YY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000
REN TED
X COMMERCIAL GENERAL LIABILITY PREM SESO(Ea occurence) $ 75,000
CLAIMS MADE I X I OCCUR MED EXP(Any one person) $ 5,000
A X 03512-04-19 11-17-19 11-17-20 PERSONAL&ADV INJURY $ 2,000,000
GENERAL AGGREGATE $ 4,000,000
GEM.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000
I POLICY I—IjE a I1 LOC •
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
_ ANYAUTO (Ea accident) $
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person) $
HIRED AUTOS BODILY INJURY
NON-OWNED AUTOS (Per accident)
• PROPERTY DAMAGE
(Peraccident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANYAUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ __
-I OCCUR CLAIMS MADE AGGREGATE $
_ $
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATIONAND TORY LIMITS OER
EMPLOYERS'LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT
OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $
Byes dIATI sunder
SPE/IAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $
OTHER -
B PROFESSIONAL EEH27-619-95-50 11-15-19 11-15-20 $1,000,000 PER CLAIM
LIABILITY $1,000,000 PER YEAR
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Additional Insured Endorsement applies
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Ashland DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
51 Wlnburn Way NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
Ashland, OR 97520 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIN ON TH SURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESE TAT
I -
ACORD25(2001108) ACORD CORPORATION 1988
Aquatic Ecosystem Sciences LLC
www.aquatic-ecosciences.Com JACOB KANN, PH.D.
AQUATIC ECOLOGIST
295 East main St.Suite 7
Ashland,OR 97520
rfr ti Voice:541-482-1575
l° - ' Fax:541-552-1024
i 1-""9�f^ Email:jacob@aquatic-ecosciences.com
April 18,2020
Greg Hunter-Water Treatment Plant Supervisor
City of Ashland Water Division
90 N.Mountain Ave.
Ashland, Oregon, 97520
RE: 2020 Consulting for Reeder Reservoir (5/1/2020 to 11/15/2020)
Dear Greg,
As per your email here is a quote to provide consulting services for Reeder Reservoir water quality and algal
blooms. The below estimate of Services to be performed for the City of Ashland includes consultation
regarding cyanobacteria blooms, algal toxins, and taste and odor issues in Reeder Reservoir. Specific items
may include but are not limited to:
• Assist in identifying and recording cyanobacteria sourced in Reeder Reservoir.
• Interpretation and determination of cyanobacteria density and potential for toxicity.
• Assist in sample preparation for toxin analysis.
• Site visits to determine abatement viability and timing.
• Consultation with City water treatment staff on sonde data collection,interpretation and reporting
strategies.
Billing Rate is$135/hr.
Quote: =$4,800.00
Please let me know if you have any questions. Thank you.
Sincerely,
Jacob Kann,Ph.D.,President
Aquatic Ecosystem Sciences LLC
GEICO GEICO CASUALTY COMPANY
Washington DC VERIFICATION OF COVERAGE
(SEE BELOW UNDER CAUTIONARY NOTE)
MAILING ADDRESS Policy Number: 4286119542
JACOB KANN AND NINA M GALLWEY Effective Date: 11-01-19
374 IDAHO ST Expiration Date: 05-01-20
ASHLAND OR 97520-3034 Registered State: OREGON
To whom it may concern:
This letter is to verify that we have issued coverage under the above policy number for the dates indicated in the
effective and expiration date fields for the vehicle listed.This should serve as proof that the below mentioned vehicle
meets or exceeds the financial responsibility requirement for your state.
This verification of coverage does not amend, extend or alter the coverage afforded by this policy.
Vehicle Year: 2010
Make: SUBARU
Model: OUTBACK
VIN: 4S4BRBCC8A3376828
COVERAGES LIMITS DEDUCTIBLES
Bodily Injury Liability
Each Person/Each Occurrence $100,000/$300,000
Property Damage Liability $100,000
Medical Payments $5,000
Personal Injury Protection Non-Ded
Uninsured Motorists Bodily Injury
Each Person/Each Occurrence $100,000/$300,000
Uninsured Motorists-Property Damage $20,000
Comprehensive $250 Ded
Collision $250 Ded
Emergency Road Service Full
Rental Reimbursement $45 Per Day/$1,350 Max
Lienholder Additional Insured Interested Party
Additional Information:
Issued 04/22/2020
If you have any additional questions, please call 1-800-841-3000.
CAUTIONARY NOTE:THE CURRENT COVERAGES,LIMITS,AND DEDUCTIBLES MAY DIFFER FROM THE COVERAGES,LIMITS AND DEDUCTIBLES IN EFFECT AT
OTHER TIMES DURING THE POLICY PERIOD.THIS VERIFICATION OF COVERAGE REFLECTS THE COVERAGES,LIMITS,AND DEDUCTIBLES AS OF THE ISSUED
DATE OF THIS DOCUMENT WHICH IS SHOWN UNDER"ADDITIONAL INFORMATION"OR IF AN ISSUED DATE IS NOT SHOWN,THE DATE OF THIS FACSIMILE OR
EMAIL.
U33 12-17
•
GEICO GEICO CASUALTY COMPANY
Washington DC VERIFICATION OF COVERAGE
(SEE BELOW UNDER CAUTIONARY NOTE)
MAILING ADDRESS Policy Number: 4286119542
JACOB KANN AND NINA M GALLWEY Effective Date: 11-01-19
374 IDAHO ST Expiration Date: 05-01-20
ASHLAND OR 97520-3034 Registered State: OREGON
To whom it may concern:
This letter is to verify that we have issued coverage under the above policy number for the dates indicated in the
effective and expiration date fields for the vehicle listed. This should serve as proof that the below mentioned vehicle
meets or exceeds the financial responsibility requirement for your state.
This verification of coverage does not amend, extend or alter the coverage afforded by this policy.
Vehicle Year: 1992
Make: ISUZU
Model: TROOPER S
VIN: JACDH58V5N7907797
COVERAGES LIMITS DEDUCTIBLES
Bodily Injury Liability
Each Person/Each Occurrence $100,000/$300,000
Property Damage Liability $100,000
Medical Payments $5,000
Personal Injury Protection Non-Ded
Uninsured Motorists Bodily Injury
Each Person/Each Occurrence $100,000/$300,000
Uninsured Motorists-Property Damage $20,000
Comprehensive $500 Ded
Emergency Road Service Full
Lienholder Additional Insured Interested Party
Additional Information:
Issued 04/22/2020
If you have any additional questions, please call 1-800-841-3000.
CAUTIONARY NOTE:THE CURRENT COVERAGES,LIMITS,AND DEDUCTIBLES MAY DIFFER FROM THE COVERAGES,LIMITS AND DEDUCTIBLES IN EFFECT AT
OTHER TIMES DURING THE POLICY PERIOD.THIS VERIFICATION OF COVERAGE REFLECTS THE COVERAGES,LIMITS,AND DEDUCTIBLES AS OF THE ISSUED
DATE OF THIS DOCUMENT WHICH IS SHOWN UNDER"ADDITIONAL INFORMATION"OR IF AN ISSUED DATE IS NOT SHOWN,THE DATE OF THIS FACSIMILE OR
EMAIL.
U33 12-17
GEICO.
GEICO Casualty Company
14111 Danielson Street
Poway, CA 92064-6886
April 22,2020
JACOB KANN
374 IDAHO ST
ASHLAND OR 97520-3034
Policy Number:4286119542
Company: GEICO Casualty Company
To Whom It May Concern:
This letter is to verify that the following individual(s)are listed as drivers and/or named insureds for the above
referenced policy as of April 22, 2020:
Jacob Kann
Please contact us if we may be of further assistance.
Sincerely,
GEICO Customer Service
•
POCDRV(12-15)
GEICO CASUALTY COMPANY
GEICO
Washington DC VERIFICATION OF COVERAGE
(SEE BELOW UNDER CAUTIONARY NOTE)
MAILING ADDRESS Policy Number: 4286119542
JACOB KANN AND NINA M GALLWEY Effective Date: 05-01-20
374 IDAHO ST Expiration Date: 11-01-20
ASHLAND OR 97520-3034 Registered State: OREGON
To whom it may concern:
This letter is to verify that we have issued coverage under the above policy number for the dates indicated in the
effective and expiration date fields for the vehicle listed.This should serve as proof that the below mentioned vehicle
meets or exceeds the financial responsibility requirement for your state.
This verification of coverage does not amend, extend or alter the coverage afforded by this policy.
Vehicle Year: 2010
Make: SUBARU
Model: OUTBACK
VIN: 4S4BRBCC8A3376828
COVERAGES LIMITS DEDUCTIBLES
Bodily Injury Liability
Each Person/Each Occurrence $100,000/$300,000
Property Damage Liability $100,000
Medical Payments $5,000
Personal Injury Protection Non-Ded
Uninsured Motorists Bodily Injury
Each Person/Each Occurrence $100,000/$300,000
Uninsured Motorists-Property Damage $20,000
Comprehensive $250 Ded
Collision $250 Ded
Emergency Road Service Full
Rental Reimbursement $45 Per Day/$1,350 Max
Lienholder Additional Insured Interested Party
Additional Information:
Issued 04/22/2020
If you have any additional questions, please call 1-800-841-3000.
CAUTIONARY NOTE:THE CURRENT COVERAGES,LIMITS,AND DEDUCTIBLES MAY DIFFER FROM THE COVERAGES,LIMITS AND DEDUCTIBLES IN EFFECT AT
OTHER TIMES DURING THE POLICY PERIOD.THIS VERIFICATION OF COVERAGE REFLECTS THE COVERAGES,LIMITS,AND DEDUCTIBLES AS OF THE ISSUED
DATE OF THIS DOCUMENT WHICH IS SHOWN UNDER"ADDITIONAL INFORMATION"OR IF AN ISSUED DATE IS NOT SHOWN,THE DATE OF THIS FACSIMILE OR
EMAIL.
U33 12-17
GEICO GEICO CASUALTY COMPANY
Washington DC VERIFICATION OF COVERAGE
(SEE BELOW UNDER CAUTIONARY NOTE)
MAILING ADDRESS Policy Number: 4286119542
JACOB KANN AND NINA M GALLWEY Effective Date: 05-01-20
374 IDAHO ST Expiration Date: 11-01-20
ASHLAND OR 97520-3034 Registered State: OREGON
To whom it may concern:
This letter is to verify that we have issued coverage under the above policy number for the dates indicated in the
effective and expiration date fields for the vehicle listed. This should serve as proof that the below mentioned vehicle
meets or exceeds the financial responsibility requirement for your state.
This verification of coverage does not amend, extend or alter the coverage afforded by this policy.
Vehicle Year: 1992
Make: ISUZU
Model: TROOPER S
VIN: JACDH58V5N7907797
COVERAGES LIMITS DEDUCTIBLES
Bodily Injury Liability
Each Person/Each Occurrence $100,000/$300,000
Property Damage Liability $100,000
Medical Payments $5,000
Personal Injury Protection Non-Ded
Uninsured Motorists Bodily Injury
Each Person/Each Occurrence $100,000/$300,000
Uninsured Motorists-Property Damage $20,000
Comprehensive $500 Ded
Emergency Road Service Full
Lienholder Additional Insured Interested Party
Additional Information:
Issued 04/22/2020
If you have any additional questions, please call 1-800-841-3000.
CAUTIONARY NOTE:THE CURRENT COVERAGES,LIMITS,AND DEDUCTIBLES MAY DIFFER FROM THE COVERAGES,LIMITS AND DEDUCTIBLES IN EFFECT AT
OTHER TIMES DURING THE POLICY PERIOD.THIS VERIFICATION OF COVERAGE REFLECTS THE COVERAGES,LIMITS,AND DEDUCTIBLES AS OF THE ISSUED
DATE OF THIS DOCUMENT WHICH IS SHOWN UNDER"ADDITIONAL INFORMATION"OR IF AN ISSUED DATE IS NOT SHOWN,THE DATE OF THIS FACSIMILE OR
EMAIL.
U33 12-17