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HomeMy WebLinkAbout2020-053 PO 20200405- Bill's Glass & Windshields • • CITY RECORDER • Purchase Order ,a Fiscal Year 2020 Page: 1 of: 1 B City of Ashland ATTN:Accounts Payable '20 E. Main Purchase • 20200405 Ashland, OR 97520 Order# T Phone:541/552-2010 0 Email:payable@ashland.or.us • • V H C/O Facilities Maintenance Div E BILL'S GLASS&WINDSHIELDS i 90 North Mountain Ave N 2407 SISKIYOU BLVD p Ashland, OR 97520 D ASHLAND,OR 97520 Phone:541/488-5358 R T Fax: 541/552-2304 • - , • (541)488-2500 David Arnold Sll�(T,-4.04,�T IC1E 04/28/2020 114 FOB ASHLAND OR/NET30��.. City Accounts Pa able • (. ?r— �_ e re e c"i t of[Fri -74' t �w�.� �" '_- 1 r Nrror4i -: ,it?'41:1,pg ,« Glass Repair FY 21 1 Glass repair and replacement for FY 21 1 $4,995.0000 $4,995.00 Goods&Services Agreement Completion date: June 30, 2021 Project Account: GL SUMMARY*************** 082400-602400 $4,995.00 • • By: Date: V r Authorized Signature '•4 J95:00 • FO ° #3 CITY OF A request for 1 purchase , r ' 7—°o 1/4D ASHLAND REQUISITION Date of request: 4/21/2020 Required date for delivery: • Vendor Name Bill's Glass Address,City,State,Zip 2407 Siskiyou Boulevard,Ashland,OR 97520 Contact Name&Telephone Number James Reeves 541-488-2500 jamesebillsalass.com Email address SOURCING METHOD ❑ Exempt from Competitive Bidding ❑ 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: ❑ 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) 0 Other government agency contract Intermediate Procurement ❑ Sole Source Agency GOODS&SERVICES ❑•Applicable Form(#5,6,7 or 8) Contract# Greater than$5,000 and less than$100,000 ❑ 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 ❑ Annual cost to City does not exceed$25,000. Greater than$5,000 and less than$75,000 ❑ 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 Glass repair and replacement for FY21 $'4;995.0.0 Item# Quantity Unit Description of MATERIALS Unit Price Total Cost 0 Per attached quotelproposal 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 approve all hardware and software purchases: IT Director Date Support-Yes/No By signing this requisition form,I certify that the City's:''lid contracting requirements have been satisfied. Employee: �� —'/ Department Head: uG �s02tozb (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: Bill's Glass CITY OF PROVIDER'S -ASHLAND CONTACT: James Reeves 20 East Main Street Ashland,Oregon 97520 ADDRESS: 2407 Siskiyou Boulevard_ Telephone: 541/488-5587 Ashland,OR 97520 Fax: 541/488-6006 PHONE: 541-488-2500 This Goods.and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland,an Oregon municipal corporation(hereinafter"City")and Bill's Glass,a domestic business corporation ("hereinafter"Provider"),for glass repair and replacement. 1. PROVIDER'S OBLIGATIONS 1.1 Provide glass repair and replacement for FY21 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 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 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. 1.22 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 I' • Provider shall supply an endorsement naming the City, its officers,employees and agent's as additional insureds by the EffectiveDateof this.Agreement; and • Be evidenced bya certificate or certificates of such insurance approved by the City. Page 1 of 5: Agreement between the City of Ashland and Bill's Glass 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. 1A 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 businessenterprise 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 "Schedule of Labor Rates," 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 shall Provider's total of all compensation and reimbursement under this Agreement exceed the sum of$4,995 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 between the City of Ashland and Bill's Glass 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 Schedule of Labor Rates dated April 10,2020 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 orinequity,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 30,-2829; unless sooner terminated as provided-in Subsection 6.2. j Page 3 of 5: Agreement between the City of Ashland and Bill's Glass 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: Bill's Glass Attn:James Reeves 2407 Siskiyou Boulevard Ashland,OR 97520 541-488-2500 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 Bill's Glass 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 setforth 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: Bill's Glass(PROVIDER): By: ;1By: Signature igna Printed Name Printed Name Put Di/IA-a-8269,"e�✓l /LA , szr Title Title ✓ All WI. zo 12A/2'0 Date e M2 is to be submitted with this signed Agreement) Purchase Order No. g"--" ' " Page 5 of 5: Agreement between the City of Ashland and Bill's Glass 2407 SISKIYOU BLVD ASHLAND OR 97520 • 541-488-2500 • FAX-541-488-3270 • 1 L'S GLASSSERV1LCE a. Dated, 4/10/2020 City of Ashland Schedule of Labor Rates July 1, 2020 — June 30, 2021 Butler's Glass Service Inc. DBA Bill's Glass & Windshields. Cost per hour will be $65.00_ *per hour per man for work scheduled within the hours of 8:OOam-5:00 pm Monday t ugh Friday. Cost per hour will be $125.00 *per hour per man for work cmil that is performed outside of the above hours or days. *Additional men may be needed on some repairs due to size or safety-restrictions. This is the labor rate only, materials and equipment rental if needed are additional. After hours Boardups-$350.00 MINIMUM FOR LABOR AND MATERIALS- LABOR TO INCLUDE TRAVEL TIMES FROM MEDFORD New commercial construction projects are exempt from this pricing and will be bid on a per job basis. Sincerely, General Manager Page 1 of 1 ACCPREP® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 02/20/2020 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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Hart Insurance AgencyNAME: Kristi Dolmage PO Box 1240 Ang�o,Ext)c_ (541) 779-4232 (A1C,No):(541) 772-3963 E-MAIL Grants Pass OR 97528 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Insurance Company 10677 INSURED (541) 773-5881 INSURERB:Cincinnati Specialty Underwrit 13037 Butlers Glass Service Inc. dba Bill's Glass - Service INSURER C: 319 S McAndrews Road INSURERD: Medford OR 97501 INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 15150 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/DD/YYYY),(MM/DD/YYYY) • B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AMAGECLAIMS-MADE X OCCUR Y Y CSU0079916 02/19/2020 02/19/2021 pREMSESO(Ea occu RENTED $ MED EXP(Any one person) $ X Products & Completed PERSONAL&ADV INJURY $ GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY X PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: • $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANY AUTO •EBA0374731 02/19/2020 02/19/2021 BODILY INJURY(Per.person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ B X UMBRELLALIAB X OCCUR l CSU0086650 02/19/202002/19/2021 EACHOCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE - AGGREGATE $ 1,000,,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH AND EMPLOYERS'LIABILITY Y/N --_ STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $ OFFICER/M EM BER EXC LU DED7 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Certificate holder is listed as additional insured including waiver of subrogation where required by written contract per attached forma CSIA405 08/09 and CSGA4087 12/12 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. . the City of Ashland, Oregon, its officers, agents, and employees - - 90 North Mountain Avenue AUT/�HOR�I��ZEDREPRESEENNTAATIVE alae Ashland OR 97520 � I r/ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 AccPRE,® CERTIFICATE OF LIABILITY INSURANCE DATE(NIM/DD/YYYY) 02/20/2020 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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Hart Insurance Agency PHONE Kristi Do image - FAX PO Box 1240 (A/C.No.Extl: (541) 779-4232 (AIC,No):(541) 772-3963 E-MAIL ADDRESS: Grants Pass OR 97528 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Cincinnati Insurance Company 10677 INSURED (541) 773-5881 INSURERS: Butlers Glass Service Inc. dba Bill's Glass Service INSURERC: 319 E McAndrews Road INSURERD: Medford OR 97501 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:Cert ID 15147 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 WLIMITS LTRINSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 AMAGECLAIMS-MADE X OCCUR Y EPP0374731 02/19/2020 02/19/2021 PREMSESO(Eaoccu RENTED $ 500,000 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: Empl Benefits Liab $ 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) A X ANYAUTO EBA0374731 02/19/2020 02/19/2021 BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) A X UMBRELLA LIAB X OCCUR EPP0374731 02/19/2020 02/19/2021 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY .Y/N PER EERH ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) certificate holder is listed as additional insured per attached forms GA472 09/18, GA210 09/17 and AA288 01/16 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. the City of Ashland, Oregon, its officers, - agents, and employees 90 North Mountain Avenue AUTHORIZED REPRESENTATIVE Ashland OR 97520 I , ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Page 1 of 1 ' THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS ADDITIONAL INSURED - AUTOMATIC STATUS AND AUTOMATIC WAIVER OF SUBROGATION WHEN REQUIRED IN WRITTEN CONTRACT, AGREEMENT, PERMIT OR AUTHORIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Additional Insured - Owners, Lessees Or cluded in the "products-completed Contractors - Automatic Status For Other operations hazard", but only if: Parties When Required In Written Contract Or Agreement With You (1) The Coverage Part to which this endorsement is attached pro- 1. Section II - Who Is An Insured is vides coverage for"bodily injury" amended to include as an additional in- or "property damage" included • sured any person or organization you within the "products-completed have agreed in writing in a contract or operations hazard"; and agreement to add as an additional in- sured on this Coverage Part. Such per- (2) The written contract or written son(s) or organization(s) is an additional agreement requires you to pro- insured only with respect to liability for: vide additional insured coverage included within .the "products- a. "Bodily injury", "property damage" or completed operations hazard" "personal and advertising injury" for that person or organization. caused, in whole or in part, by the performance of your ongoing opera- If the written contract or written tions by you or on your behalf, under agreement requires you to provide that written contract or written additional insured coverage included agreement. Ongoing operations does within the "products-completed oper- not apply to "bodily injury"or"proper- ations hazard" for a specified length ty damage"occurring after: of time for that person or organiza- tion, the "bodily injury" or "property l (1) All work, including materials, damage" must occur prior to the ex- parts or equipment furnished in piration of that period of time in order connection with such work, on for this insurance to apply. the project (other than service, maintenance or repairs) to be if the written contract or written performed by or on behalf of the agreement requires you to provide additional insured(s) at the loca- additional insured coverage for a tion of the covered operations person or organization per only ISO has been completed; or additional insured endorsement form number CG 20 10, without specifying (2) That portion of"your work"out of an edition date, and without specifi- which the injury or damage aris- cally requiring additional insured es has been put to its intended coverage included within the "prod use by any person or organiza- ucts-completed operations hazard", tion other than another contrac- this Paragraph b. does not apply to for or subcontractor engaged in that person or organization. performing operations for a prin- cipal as a part of the same pro- 2. If the written contract or written agree- ject; and ment described in Paragraph 1. above specifically requires you to provide addi- b. "Bodily injury" or "property damage" tional insured coverage to that person or caused, in whole or in part, by "your organization: work" performed under that written contract or written agreement and in a. Arising out of your ongoing opera- tions or arising out of'your work"; or Includes copyrighted material of Insurance GA 472 09 18 Services Office. Inc.,with its permission. Page 1 of 3 b. By way of an edition of an ISO addi- 2. With respect to the insurance afforded to tional insured endorsement that in- the additional insureds described in Para- cludes arising out of your ongoing graph B.1., the following additional exclu- operations or arising out of "your sions apply: work"; This insurance does not apply to: then the phrase caused, in whole or in part, by in Paragraph A,1.a. and/or Para- a. "Bodily injury", "property damage" or graph A.1.b. above, whichever applies, is "personal and advertising injury" aris- replaced by the phrase arising out of. ing out of operations performed for the federal government, state or mu- 3. With respect to the insurance afforded to nicipality;or the additional insureds described in Para- graph A.1., the following additional exclu- b. "Bodily injury" or "property damage" sion applies: included within the "products- completed operations hazard." This insurance does not apply to "bodily injury", "property damage" or "personal C. The insurance afforded to additional insureds and advertising injury" arising out of the described in Paragraphs A.and B.: rendering of, or the failure to render, any 1. Only applies to the extent permitted by professional architectural, engineering or law;and surveying services, including: a. The preparing, approving or failing to 2. Will not be broader than that which you repare approve, shop are required by the written contract, writ- prepares,oroapprove, e,remaps,a, surveys, ten agreement, written permit or written , field orders, change orders or draw- authorization to provide for such addition- ings and specifications; or al insured; and b. Supervisory, 3. Does not apply to any person, organiza- b. inspection, architectural tion, state, governmental agency or sub- or engineering activities. division or political subdivision specifically This exclusion applies even if the claims named as an additional insured for the against any insured allege negligence or same project in the schedule of an en- other wrongdoing in the supervision, hir- dorsement added to this Coverage Part. ing, employment,training or monitoring of D. With respect to the insurance afforded to the others by that insured, if the "occurrence" additional insureds described in Paragraphs which caused the "bodily injury" or"prop- A.and B.,the following is added to Section III erty damage", or the offense which -Limits Of Insurance: caused the"personal and advertising inju- ry", involved the rendering of, or the fail- The most we will pay on behalf of the addi- ure to render, any professional architec- tional insured is the amount of insurance: tural, engineering or surveying services. 1. Required by the written contract, written 4. This Paragraph A. does not apply to addi- agreement, written permit or written au- tional insureds described in Paragraph B. thorization described in Paragraphs A. B. Additional insured-State Or Governmental and B. or Agency Or Subdivision Or Political Subdi- 2. Available under the applicable Limits of vision - Automatic Status When Required Insurance shown in the Declarations; In Written Permits Or Authorizations whichever is less. 1. Section II - Who Is An Insured is amended to include as an additional in- This endorsement shall not increase the appli- sured any state or governmental agency cable Limits of Insurance shown in the Decla- or subdivision or political subdivision you rations. have agreed in writing in a contract, E. Section IV - Commercial General Liability agreement, permit or authorization to add Conditions is amended to add the following: as an additional insured on this Coverage Part. Such state or governmental agency Automatic Additional Insured Provision or subdivision or political subdivision is an additional insured only with respect to op- This insurance applies only if the "bodily inju- erations performed by you or on your be- ry" or "property damage" occurs, or the "per- half for which the state or governmental sonal and advertising injury" offense is corn- agency or subdivision or political subdivi- miffed: sion issued, in writing, a contract, agree- 1. During the policy period;and ment, permit or authorization. Includes copyrighted material of Insurance GA 472 0918 Services Office, Inc.,with its permission. Page 2 of 3 2. Subsequent to your execution of the writ- As used in this endorsement, wrap-up insur- ten contract or written agreement, or the ance means any insurance provided by a con- issuance of a written permit or written au- solidated(wrap-up) insurance program. thorization, described in Paragraphs A. and B. Primary And Noncontributory Insurance When Required By Written Contract, F. Except when G.below applies,the following is Agreement, Permit.Or Authorization added to Section IV - Commercial General Liability Conditions, 5. Other Insurance, Except when wrap-up insurance applies to the and supersedes any provision to the contrary: claim or "suit" on behalf)of the additional in- sured, this insurance is primary to and will not When Other Additional Insured Coverage seek contribution from any other insurance Applies On An Excess Basis available to the additional insured described in This insurance is primary to other insurance Paragraphs A.and B.provided that: available to the additional insured described in 1. The additional insured is a Named In- Paragraphs A.and B.except: sured under such other insurance;and 1. As otherwise provided in Section. IV - 2. You have agreed in writing in a contract, Commercial General Liability Condi- agreement, permit or authorization de- tions, 5. Other Insurance, b. Excess In- scribed in Paragraph A. or B.that thisin- surance;or • surance would be primary and would not 2. For any other valid and collectible incur- seek contribution from any other insur- ance available to the additional insured as ante available to the additional insured. an additional insured by attachment of an As used in this endorsement, wrap-up insur- endorsement to another insurance policy ance means any insurance provided by a con- that is written on an excess basis. In such solidated(wrap-up)insurance program. case,this insurance is also excess. H. Section IV - Commercial General Liability G. The following is added to Section IV - Com- Conditions, 9. Transfer Of Rights Of Re- mercial General Liability Conditions, 5. covery Against Others To Us is amended by Other Insurance, and supersedes any provi- the addition of the following: sion to the contrary: We waive any right of recovery we may have Primary Insurance When Required By Writ- .against any additional insured under this en- ten Contract, Agreement, Permit Or Au- dorsement against whom you have agreed to thorization waive such right of recovery in a written insurance applies to con- tract, written agreement, written permit or writ- Exceptx owhen wrap-upoof the additional nol thein- ten authorization because of payments we sured,clthis insurance behalfis primaryoto any other make for injury or damage arising out of your insurance available to the additional insured ongoing operations or 'your work done under a written contract, written agreement, written described in Paragraphs A. and B. provided that: permit or written authorization. However, our rights may only be waived prior to the "occur- 1. The additional insured is a Named In- rence" giving rise to the injury or damage for sured under such other insurance;and which we make payment under this Coverage Part.The insured must do nothing after a loss 2. You have agreed in writing in a contract, to impair our rights.At our request,the insured agreement, permit or authorization de- will bring "suit" or transfer those rights to us scribed in Paragraph A. or B.that this in- and help us enforce those rights. surance would be primary to any other in- surance available to the additional in- sured. • Includes copyrighted material of Insurance GA 472 0918 Services Office, Inc.,with its permission. Page 3 of 3 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. CincIPiustio BUSINESS AUTO XC+® (EXPANDED COVERAGE PLUS) ENDORSEMENT This endorsement modifies insurance provided by the following: BUSINESS AUTO COVERAGE FORM With respect to the coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by this endorsement. A Blanket Waiver of Subrogation This provision does not apply unless the valid SECTION IV - BUSINESS AUTO CONDI- written contract has been: TIONS, A. Loss Conditions, S. Transfer of 1. Executed prior to the accident causing Rights of Recovery Against Others to Us is "bodily injury"or"property damage";and amended by the addition of the following: We waive any right of recoveryhave 2. Is still in force at the time of the"accident" we may causing °bodilyinjury" or "property darn- against any person or organization because of age". payments we make for "bodily injury" or "property damage"arising out of the operation D. Employee Hired Auto of a covered °auto" when you have assumed liability for such "bodily injury" or "property 1. Changes M Liability Coverage damage" under an "insured contract", provid- The following is added to the section It- ed the"bodily injury"or"property damage"oc- Liability Coverage, A. Coverage, 1. curs subsequent to the execution or the "in- Who is an Insured: sured contract". B. Noncontributory Insurance An "employee" of yours is an °insured" while operating an auto hired or rented SECTION IV - BUSINESS AUTO CONDI- under a contract or agreement in that TIONS, B. General Conditions, 5. Other In- while e performingperf " nwith your t ermostoe surance c.is replaced by the following: while tofyoubusiness.duties related to the conduct of your business. c. Regardless of the provisions of Par- 2. Changes In General Conditions graph a. above, this Coverage Form's Liability Coverage is primary SECTION IV • BUSINESS AUTO CON- and we will not seek contribution DITiONS, B. General Conditions, 5. from any other insurance for any Oa- Other Insurance is amended by repiac- biiity assumed under an °insured Ing Paragraph S.b.with the following: contract" that requires liability to be assumed on a primary noncontributo- b. For Hired Auto Physical Damage ry basis. Coverage the following are deemed to be covered"autos°you own: C. Additional insured by Contract SECTION I! - LIABILITY COVERAGE, A. (1) Any covered °auto" you lease. hire, rent or borrow;and Coverage, I. Who is an Insured is amended to include as an Insured any person or organi- (2) Any covered "auto" hired or zation with which you have agreed in a valid rented by your"employee"under written contract to provide insurance as is af- a contract in that individual "em- forded by this policy. ployee's" name, with your per- mission, while performing duties This provision is limited to the scope of the related to the conduct of your valid written contract. business, includes copyrighted material of ISO AA 288 01 16 Properties, Inc.,with its permission. Page 1 of 4 • However, any "auto" that is teased, a. Is effective on the date of acquisition hired, rented or borrowed with a driver or formation, and is afforded for 180 is not a covered"auto". days after such date: E. Audio. Visual and Data Electronic Equip- b. Does'not apply to "bodily injury" or ment 'property damage' resulting from an SECTION III - PHYSICAL DAMAGE COV "accident" #hat occurred before you ERAGE, C. Limit of insurance is amended acquired or farmed fire organization; by adding the following: c. Does not apply to any newly acquired 4. The most we will pay for all "loss" to au- or formed organization that Is a joint dio, visual or data electronic equipment venture or partnership:and and any accessories used with this d. Does not apply to an insured under equipment as a result of any one "acci- any other automobile liability policy, dent"is the lesser of or would be an insured under such a • a. The actual cash value of the dam- policy but for the termination of such aged or stolen property as of the time policy or the exhaustion of such poll- of the"accident"; cy's limits of Insurance. b. The cost of repairing or replacing the 3. Any of your employees" while using a damaged or stolen property with oth- covered auto In your business or your er property of like kind and quality;or hire personalrborrow that"auto".you do not own. hire or "auto". G $2,500. G. Liability Coverage Extensions - Supple- Provided the equipment,at the time of the mentary Payments-Higher Limits "loss"ls: SECTION If - LIABILITY COVERAGE, A. a. Permanently installed in or upon the Coverage, 2.Coverage Extensions,a.Sup- covered"auto"In a housing.opening plementary Payments is amended by: or other location that is not normally 1. Replacing the $2,000. Limit of Insurance used by the "auto" manufacturer for for bail bonds with$4,000 in(2);and the installation of such equipment; b Removable from a permanently in- 2. Replacing the$250 Limit of insurance for stalled housing unit as described In reasonable expenses with$500 in(4). Paragraph 2.a.above;or H. Amended Fellow Employee Exclusion c. An integral part of such equipment. SECTION II. LIABILITY COVERAGE, B.Ex- clusions.5. Fellow Employee is modified as follows: SECTION iI - LIABILITY COVERAGE, A. Exclusion 5.Fellow Employee Is deleted. Coverage, 1.Who is an Insured is amended by adding the following: I. Hired Auto-Physical Damage The following are"insureds": If hired"autos"are covered"autos"for Liability 1. Any subsidiary which is a legally Incorpo- Coverage, then Comprehensive and Collision • td entity r which you a financial Physical Damage Coverages as provided un- r teresttit morthan 50%own the voting der SECTION iII - PHYSICAL DAMAGE ex- stock on the effective date of this cover- COVERAGE of this Coverage subjectub Part arehage form. tended to 'autos"you hire, to the fol- lowing: However, the insurance afforded by this 1, The most we will pay for "loss" to any provision does not apply to any subsidiary hired"auto" is$50,000 or the actual cash that is an "Insured" under any other au- value or cost to repair or replace, which- tomobile liability policy, or would be an ever is the least,minus a deductible. insured under such policy but for termi- nation of such policy or the exhaustion of 2. The deductible will be equal to the largest such policy's limits of insurance. deductible applicable to any owned"auto" 2. Any organization that is newly acquired or for that coverage,or$1.000,whichever Is formed by you and over which you main- tain less. majority ownership. The insurance 3. Hired Auto - Physical Damage coverage f provided by this provision: , Is excess over any other collectible insur- ance. { 1. Includes copyrighted material of ISO s AA 288 01 16 ' Properties, Inc.,with its permission. Page 2 of 4 4. Subject to the above limit,deductible,and K. Transportation Expense-Higher Limits excess provisions we will provide cover- age equal to the broadest coverage appli- SECTION III PHYSICAL DAMAGE COV- cable to any covered °auto"you own In- ERAGE, A. Coverage, 4. Coverage Exten- sured under this policy. sions is amended by replacing $20 per day Coverage includes loss of use of that hired au- with $50 per day, and $600 maximum with $1, Transpor- to, provided it results from an "accident" formaximum In Extension a.which you are legally liable and as a result of1on Expenses. which a monetary loss is sustained by the L. Airbag Coverage leasing or rental concern. The most we will SECTION III - PHYSICAL DAMAGE COV- pay for any one"accident"is$3.000. ERAGE, B. Exclusions, 3.a. Is amended by If a limit for Hired Auto - Physical Damage is adding the following: shown in the Schedule, then that limit replac- es, and is not added to,the$50,000 limit indi- However, the mechanical and electrical cated above, breakdown porton of this exclusion does not apply to the accidental discharge of an airbag. .1. Rental Reimbursement This coverage for airbags is excess over any SECTION III - PHYSICAL DAMAGE is other collectible insurance or warranty. amended by adding the following: M. Loan or Lease Gap Coverage • 1. We will pay for rental reimbursement ex- 1. SECTION IiI - PHYSICAL DAMAGE penses incurred by you for the rental of COVERAGE, C. Limit of insurance is an"auto"because of a loss"to a covered deleted in its entirety and replaced by the "auto'. Payment applies in addition to the following, but only for private.passenger , otherwise applicable amount of each coy- type"autos"with an original loan or lease, erage you have on a covered 'auto". No and only in the event of a "total loss' to deductible applies to this coverage. such a private passenger type"auto": 2. We will pay only for those expenses in- a. The most we will pay for"loss"in any curred during the policy period beginning one"accident"Is the greater of: 24 hours after the "loss" and ending, re- (1) The amount due under the terms gardiess of the policy's expiration, with of the lease or loan to which the lesser of the following number of days: your covered private passenger type'auto°is subject,but will not a, The number of days reasonably re- include; quired to repair the covered "auto". If "loss"is caused by theft,this number (a) Overdue lease or loan pay- of days is added to the number of mems; days It takes to locate the covered (b) Financial penalties imposed "auto"and return it to you:or under the lease due to high b. 30 days mileage, excessive use or abnormal wear and tear, 3. Our payment is limited to the lesser of the _ not following amounts: (c) funded by the lesSritsor; re - a. Necessary and actual expenses in- curred; or (d) Costs for extended warran- ties, Credit Life Insurance, b. $50 per day. Health. Accident or Disabil- 4. This coverage does not apply while there ity insurance purchased with the loan or lease;and are spare or reserve "autos" available to you for your operations. (e) Carry-over balances from 5. We will pay under this coverage only that previous loans or teases,or amount of your rental reimbursement ex- (2) Actual cash value of the stolen penses which is not already provided for or damaged property. under SECTION III - PHYSICAL DAM- b. An adjustment for depreciation and ' AGE COVERAGE, A. Coverage. 4. physical condition will be made in de- Coverage Extensions. termining actual cash value at the time of loss". i Includes copyrighted material of ISO { AA 288 01 16 Properties, Inc.,with its permission. Page 3 of 4 I ` I fi 2. SECTION V- DEFINITIONS Is amended P. Unintentional Failure to Disclose Hazards by adding the following, but only for the purposes of this Loan or Lease Gap SECTION IV - BUSINESS)AUTO CONDI- Coverage: TIONS, B. General Conditions, 2. Conceal- 'Total loss° means a loss" In which the amended by adding the following:ntation or Fraud Is cost of repairs plus the salvage value ex- ceeds the actual cash value. However. if you unintentionally fail to disclose anhazards existinondate o N. Glass Repair-Waiver of Deductible this Coverage Form, he we twill enfot ctive deny cover- SECTION III - PHYSICAL DAMAGE COV age under this Coverage Form because of ERAGE,D. Deductible is amended by adding such failure. the following: Q. Mental Anguish Resulting from Bodily fnju- No deductible applies to glass damage If the glass is repaired In a manner acceptable io us SECTION V•DERNITIONS, C."Bodily[Nu- rather than replaced. ry" is deleted in its entirety and replaced by O. Duties in the Event of an Accident, Claim, the following: Suit or Loss•Amended "Bodily injury'means bodily injury,sickness or SECTION iV - BUSINESS AUTO CONDi- disease sustained by a person,including men- TIONS,A.Loss Conditions,2. Duties in the tai sgutha and death sustained by the same Event of.Accident,Claim,Suit or Loss,a.is persoon that results from such bodily isjuryt amended by adding the following: sickness or disease. "Bodily injury" does not • include mental anguish or death that does not This condition applies only when the "acct- result from bodily injury, sickness or disease. dent"or"loss"is known to: R. Coverage for Certain Operations in Con. 1. You.If you are an individual: healon with Railroads 2. A partner,If you are a partnership: With respect to the use of a covered "auto" in 3. An executive officer or insurance manag• operations for or affecting a railroad: er.if you are a corporation:or 1. Section V-Definitions.H. Insured con- tract".1.c.is amended to read: 4. A member or manager, if you are a lim- ited liability company. c. An easement or license agreement; 2. Section V-Definitions,H. Insured con- tract",2.a.Is deleted. Includes copyrighted material of ISO AA 288 01 16 Properties; inc..with its permission. Page 4 of 4 . i • THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL GENERAL LIABILITY BROADENED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Endorsement-Table of Contents: PQyeraae: Beans on Pegg; 1. Employee Benefit Liability Coverage..............................._.. 2. Unintentional Failure To Disclose Hazards '9 9 3. Damage To Premises Rented To You.... 4. Supplementary Payments ._................. ................. ............. 0 1 5.. Medical Payments 10 10 6. 180 Day Coverage For Newly Formed Or Acquired Organizations................ 7. Waiver Of Subrogation..... _• 101 �11 8. Automatic Additional Insured-Specified Relationships: .......................................11 • Managers Or Lessors Of Premises; • Lessor Of Leased Equipment; • Vendors; • State Or Governmental Agency Or Subdivision Or Political Subdivision-Permits Or Authorizations Relating To Premises;and • Mortgagee,Assignee Or Receiver 9. Property Damage To Borrowed Equipment........._.... 14 10. Employees As Insureds-Specified Health Care Services And Good Samaritan Services 15 11. Broadened Notice Of Occurrence..................._.........._.............. 15 12. Nonowned Aittraft .." 14. Boodily Injury Redefined 15 Expected Or Intended Injury Redefined.................... 15 15, Former Employees ._..............................................15 As Insureds. 15 15 B. Limits Of Insurance: The Commercial General Liability Limits of Insurance apply to the insurance provided by this endorse- ment,except as provided below: 1. Employee.Benefit Liability Coverage Each Employee Limit: $1.000,000 Aggregate Limit: $3,000.000 Deductible Amount: $ 1,000 3. Damage To Premises Rented To You The lesser of: a. The Each Occurrence Limit shown in the Declarations;or b. $500,000 unless otherwise stated$ 4. Supplementary Payments a. Sail Bonds: $2,500 b. Loss Of Earnings:$ 500 Includes copyrighted material of Insurance GA 210 0917 Services Office,Inc,with its permission. Page 1 of 15 S. Medical Payments Medical Expense Limit:$10,000 9. Property Damage To Borrowed Equipment Each Occurrence Limit $10,000 Deductible Amount: $ 250 • • Includes copyrighted matefiai of Insurance GA2100917 Services Office,Inc.,with its permission. Page 2 01 15 C. Coverages 2) Occurred prior to the 1. Employee Benefit Liability Coverage "first effective date" of a. The following is added to Section 1- this endorsement pro- Coverages: vided: Employee Benefit Liability Cover- a) You did not have age knowledge of a claim or"suit'on or (1) insuring Agreement before the "first ef- fective date"of this (a) We will pay those sums that endorsement. the Insured becomes legally obligated to pay as damag- You will be es caused by any act, error deemed to have or omission of the insured, knowledge of a or of any other person for claim or "suit" whose acts the insured is when any "author- legally liable, to which this ized representa- insurance applies. We will live"; have the light and duty to i) Reports all, or defend the Insured against any part,of the any "suit" seeking those act, error or damages. However, we will omission to us have no duty to defend anyr other against any "suit" seeking insu er; damages to which this In- surance does not apply.We ii) Receives a may, at our discretion, in- written or ver- vestigate any report of an bal demand or act, error or omission and claim for dam- settle any claim or"suit"that ages because may result. But: of the act, er- 1) The amount we will pay ror or omis- for damages is limited sion;and as described in Section b) There is no other Ill - Limits Of Insur- applicable insur- ance;and anoe. 2) Our right and duty to (2) Exclusions defend ends when we have used up the appli- This insurance does not apply to: cable limit of insurance (a) Bodily Injury, Property in the payment of judg- ments or settlements. Damage Or Personal And Advertising Injury No other obligation or Habil- "Bodily injury", "property ity to pay sums or perform damage" or "personal and acts or services is covered advertising injury". unless explicitly provided for under Supplementary (b) Dishonest, Fraudulent, Payments. Criminal Or Malicious Act (b) This insurance applies to Damages arising out of any damages only if the act, er- intentional, dishonest, ror or omission,is negligent- fraudulent, criminal or ma6- ly committed in the "admin- cious act, error or omission, istration" of your "employee committed by any insured, benefit program";and including the willful or redc- 1) Occurs during the policy less violation of any statute, period;or i F Includes copyrighted material of Insurance GA 210 0917 Services Office, Inc.,with its permission. Page 3015 (c) Failure To Perfom)A Con- effort and cooperation of the tract insured, from the applicable Damages arising out of fail- funds accrued or other col- ure of performance of con- lecdbte insurance. tract by any Ensurer. (I) Taxes,Fines Or Penalties (d) Insufficiency Of Funds Taxes,fines or penalties,In- cluding those imposed un- Damages of funds to der the Interne/ Revenue meet any obligations under Code or any similar state or any plan Included in the local law. "employee benefit program". (j), Employment-Related Prac- (e) Inadequacy Of Perfor- tices mance Of invest- Any liability arising out of ment/Advice :Given With any: Respect To Participation Any claim based upon: (1) Refusel to employ; (2) Termination of employ. 1) Failure of any invest- ment; ment to pertorm; 2) Errors in providingin (3) Coercion, demotion, - evaluation, reassign- formation on past per- ment, discipline, defa- formance of investment mation, harassment, vehicles;or humiliation, employ- 3) discrimina- Advice given to any tion or other person with respect to mart-related ns;or es, that person's decision to acts or omissions;or participate or not to par- (4). Consequential liability tidpate in any plan in- as a result of(1).(2)or eluded in the"employee (3)above. benefit program". This - exclusion applies Workers Compensation . whether the insured may be And Similar Laws held liable as an employer Any claim arising out of your or in any other capacity and failure to comply with the to any obligation to share mandatory provisions of any damages with or repay workers' compensation, un- someone else who must pay employment compensation damages because of the in- insurance, social security or )ury' disability benefits law or any (3) Supplementary Payments similar law. ERISA Section 1 - Coverages, Sup- (g) plementary Payments -Cover- Damages for which any in- ages A And B also apply to this Cured is liable because of li- Coverage, ability Imposed on a fidud- b. Who is An Insured ary by the Employee Re- tirement Income Security As respects Employee Benefit Lia- Act of 1974, as now or bility Coverage.Section Ii-Who is hereafter amended, or by An Insured is replaced by the follow- any similar federal, state or ing: i local laws. i (1) if you are designated in the Dec- (h) Available Benefits larations as:: Any daim for benefits to the (a) An individual, you and your I extent that such benefits are spouse are Insureds.but on- available, with reasonable ly with respect to the con- Includes copyrighted material of insurance GA 210 0917 Services Office, Inc.,with its permission. Page 4 of 15 7 duct of a business of which liability company,and over which you are the sole owner. you maintain ownership or major A ity interest, will qualifyas a (b) partnership or joint ven- Named Insured if no othr similar ture, you are an insured, insurance applies to that argent- Your members, your part- zation.However,coverage under ners, and their spouses are this provision: also insureds but only with respect to the conduct of (a) Is afforded only until the your business. 180th day after you acquire (c) A limited liabitltjr compahy, or form the organization or you are an insured. Your the end of the policy period, members are also insureds, whichever is earlier;and but only with respect to the (b) Does not apply to any act, conduct of your business. error or omission that was Your managers are in- committed before you ac- sureds,but only with respect quired or formed the organi- to their duties as your man- zation. agers. c. Limits Of Insurance (d) An organization other than a •. partnership,joint venture or As respects Employee Benefit Lia- ' . limited liability company,you bility Coverage, Section Ili "Limits are an insured,Your"mew- Of insurance is replaced by the fol- time officers" and directors lowing; are insureds, but only with respect to duties as (1) The Limits of Insurance shown in their your officers or duties s, Section B.Limits Of insurance, Your stockholders are also 1. Employee Benefit Liability insureds, but only with re- Coverage and the rules below fix spect to their liability as the most we wilt pay regardless stockholders. of the number of: (e) A trust, you are an insured. (a) Insureds; Your trustees are also in- (b) Claims made or "suits" sureds,but only with respect brought; to their duties as trustees. (c) Persons or organizations (2) Each of the following is also an making claims or bringing insured: "suits"; (a) Each of your "employees" (d) Acts,errors or omissions;or who is or was authorized to administer your "employee (e) Benefits induded in your benefit program"; 'employee benefit program". (b) Any persons, organizations (2) The Aggregate Limit shown in or"employees"having prop- Section B.Limits Of insurance, er temporary authorization 1. Employee Benefit Liability to administer your "employ- Coverage of this endorsement is ee benefit program" if you the most we will pay for all dam- die, but only until your legal ages because of acts, errors or representative is appointed; omissions negligently committed or in the "administration" of your "employee benefit program" (c) Your legal representative if you die, but only with re- (3) Subject to the limit described in spect to duties as such.That (2) above, the Each Employee representative will have all Limit shown in Section B. Limits your rights and duties under Of Insurance, 1. Employee this Coverage Part. Benefit Liability Coverage of this endorsement is the most we (3) Any organization you newly ac- - will pay for all damages sus- quire or form, other than a part- tamed by any one "employee", nership, joint venture or limited including damages sustained by Includes copyrighted material of Insurance GA 210 00 17 Services Office, inc.,with its permission. Page S of 15 ' F I such "employee's" dependents (d) We may pay any part or all and beneficiaries,as a result of: of the Deductible Amount to (a) An act,error or omission;or effect settlement of any claim or"suit"and,upon no- b) A series of related ads, er- tification of the action taken, rors or omissions, regard- you shall promptly reim- less of the amount of time burse us for such part of the that lapses between such Deductible Amount as we acts, errors or omissions; have paid. negligently committed in the d. Additional Conditions "administration"of your"employ- As respects Employee Benefit Lia- ee benefit program". loll'rty Coverage, Section IV-Com- However, the amount paid under mercial General Liability Condi- this endorsement shall not ex- tions is amended as fotows: reed, and will be sutlect to the (1) item 2. Duties In The Event Of limits and restrictions that apply Occurrence,Offense,Claim Or to the payment of benefits in any Suit is replaced by the following: plan included in the "employee benefit program." 2. Duties In The Event Of An (4) Deductible Amount Act,Error Or Omission,Or Claim Or Suit (a) Our obligation to pay dam- a. You must see to it that ages on behalf of the ln- we are notified as soon sured applies only to the as practicable of an act, amount of damages in ex error or omission which cess of the Deductible may result in a claim. Amount stated In the Deda- To the extent possible, rations as applicable to notice should include: Each Employee. The limits of insurance shall not be re- (1) What the act, error duced by the amount of this or omission was deductible. and when it oc- (b) The Deductible Amount curved;and stated in the Declarations (2) The names and applies to all damages sus- addresses of any- tamed by any one "employ- one who may suf- ee", including such"employ- fer damages as a ea's"dependents and bene- result of the act, frdaries, because of all acts, error or omission. errors or omissions to which this insurance applies. b. if a claim is made or • "suit"is brought against (c) The terms of this insurance, any insured,you must: including those with respect to: (1) Immediately record the specifics of the 1) Our right and duty to claim or "suit" and defend the insured the date received; against any "suits" and seeking those damag- es;and (2) Notify us as soon as practicable. 2) Your duties,and the du- ties of any other in- You must see to it that volved insured, in the we receive written no- event of an act,error or tioe of the claim or"suit' • omission,or daim: as soon as practicable. apply irrespective of the ap- c. You and any other in- plication of the Deductible volved insured must: Amount. Includes copyrighted material of insurance GA 210 09 17 Services Office,Inc.,with its permission. Page 6 of 15 i F (1) Immediately send b. Method Of Sharing us copies of any demands, notices, If all of the other insur- summonses or le- ance permits contribu- gal papers re- tion by equal shares, calved in connec- we will follow this meth- tion with the daim od also. Under this ap- or"suit"; proach each insurer contributes equal (2) Authorize us to ob- amounts until it has tain records and paid its applicable limit other information; of insurance or none of (3) Cooperate with us the loss remains, in the investigation whichever comes first. or settlement of the If any of the other in- claim or defense suranoe does not permit against the "suit"; contribution by equal and shares, we will'contrib- (4) Assist us,upon our uta by limits. Under this request, in the en- method, each insurer's a of any share is based on the right against any ratio of its applicable person or organi- limit of insurance to the nation which may total applicable limits of be liable to the in- insurance of all insur- sured because of ems• an act, error or e. No Coverage omission to which this insurance may This insurance shall not also apply. cover any loss for.which the insured is entitled to d. No insured will, except recovery under any at that insureds own other insurance in force cost, voluntarily make a previous to the effective payment, assume any date of this Coverage obligation, or incur any Part. expense without our consent. e. Additional Definitions (2) Item 5. Other Insurance is re- As respects Employee Benefit Lie- placed by the following: billy Coverage, Section V Defini- tions is amendedas follows: 5. Other Insurance If other valid and collectible added:The following definitions are added: insurance is available to the insured for a loss we cover 1. "Administration"means: under this Coverage Part, a. Providing information to our obligations are limited as "employees", including follows: their dependents and a. Primary Insurance beneficiaries, with re- This insurance is rima- spect to eligibility for or ry except when c.below "employeecope of benefit programs applies.If this insurance _ is primary, our oblige- b. Interpreting the "em- lions are not affected playas benefit pro- unless any of the other grams"; , insurance is also prima c. Handling records in ry. Then, we will share connection with the with all that other incur- "employee benefit pro- ance by the method de- scribed in b.below. grams";or includes copyrighted material of Insurance GA 210 0917 Services Office, Ina,with its permission. Page 7 of 15 d. Effecting, continuing or ees" who are eligible terminating any "em- under the plan for such ployee's"participation in benefits; any benefit included in the "employee benefit c. Unemployment insur- program". ance, social security benefits, workers' corn- However, "administration" pensation and disability does not include: benefits;and a. Handling payroll deduc- d. Vacation plans, Includ- lions; or ing buy and sell pro- b. The failure to effect or grams; leave of ab- maintain any insurancesence programs,induct- or adequate limits of ing mil and matern e; coverage of Insurance, family, and civil leave; including but not limited tuition assistance plans; to unemployment insur- transportat su and • ance, social security health club subsidies. benefits, workers' corn- 4. "First effective date"means pensation and disability the date upon which cover- benefits. age was first effected in a 2. "Cafeteria plans" means series of uninterrupted re- plans authorized by appiica- newels of insurance cover- ble law to allow"employees" age. to elect to pay for certain (2) The following definitions are de- benefits with pre-tax dollars. leted .in their entirety and re- placed3. 'Employee benefit pro- grams" by the following: means a program .. 8. "Employee"means a person providing some of all of the actively employed, formerly following benefits to "em- employed, on leave of ab- ployees", whether provided sence or disabled,or retired. through a"cafeteria plan"or "Employee" includes a otherwise: 'leased worker"."Employee" a. Group life insurance does not include a "tempo- group accident or health rary worked' insurance;dental,vision 21. "Suit"means a dvil proceed- and hearing plans; and ing in which money damag- flexible spending ac- es because of an ad, error counts;provided that no or omission to which this in- one otherthan an"em- surance applies are alleged. ployee" may subscribe "Suit"includes: to such benefits and such benefits are made a. An arbitration proceed- generally available to ing in which such dam- those "employees"who ages are claimed and to satisfy the plan's eligibil- which the insured must ity requirements: submit or does submit with our consent; b. Profit sharing plans, employee savings b. Any other alternative plans, employee stock diispute resolution pro • - ownership plans, pen- ceeding In which such sion plans and stock damages are claimed subscription plans, pro- and to which the in- vided that no one other cured submits with our than an "employee" consent;or may subscribe to such c. An appeal of a civil pro- benefits and such bene- ceeding. fits are made generally available to all "employ- Includes copyrighted material of Insurance GA 210 0917 Services Office,Inc.,with its permission. Page B of 45 i 2. Unintentional Failure To Disclose Haz- 2) Rust or other cor- anis rosion, decay, de- Section IV-Commercial General Liabfl- terioration, hidden. ity Conditions, 7. Representations is or latent defect or amended by the addition of the following: pro pquality in property that caus- Based on our dependence upon your rep- es it to damage or resentations as to existing hazards, if un- destroy Itself; intentionally you should fag to disdose an such hazards at the inception date of your 3) Smog; policy, we will not reject coverage under 4) Mechanical break- this Coverage Part based solely on such down, including Farfara' rupture or bursting 3. Damage To Premises Rented To You caused by centrif- ugal force; a. The last Paragraph of 2.Exclusions under Section 1-Coverage A-Bod» Settling, sacking, ity Injury And Property Darnege Li- shrinking or ex- ability Is replaced by the following: pension; Exclusions C,through q,do not apply by Nesting or infests- to "property damage" by fire, explo- tion, or discharge sion, lightning, smoke or soot to or release of waste premises while rented to you or tern- products or seore- porarily occupied by you with permis- tions, by insects, sion of the owner, for which the birds, rodents or amount we will pay is limited to the other animals;or Damage To Premises Rented To 7) Presence, growth, You Limit as described in Section III proliferation, -Limits Of Insurance. spread or any ac- b. The insurance provided under Sec- fluffy of fungus, in- tion I -Coverage A-Bodily Injury chiding mold or And Property Damage Liability all- mildew, and any plies to"property damage"arising out mycotoxins, of water damage to premises that are spores, scents or both rented to and occupied by you, byproducts pro- duced or released (1) As respects Water Damage Le- by fungi. gal Liability,as provided in Para- graph 3.b.above: (b) "Property damage" caused directly or indirectly by any The exclusions under Section 1- of the following: Coverage A-Bodily Injury And (i) Earthquake, volcanic Property rty Damage Liability, 2. eruption, landslide or Exclusions, other than I. War any other earth move- and the Nuclear Energy Liabil- ity Exclusion(Broad Form),are merit; deleted and file following are (ii) Water that backs up or added: overflows or is other- This insurance does not apply to: wise discharged from a sewer, drain, sump, (a) "Property damage": sump pump or related equipment; (i) Assumed in any con- tractor agreement;or (iii) Water under the ground (ii) Caused by or resulting surface pressing on, or flowingfroany of the follow- or seeping � through: ing: 1) Wear and tear; 1) Foundations,walls, floors or paved surfaces; I I Includes copyrighted material of Insurance GA 210 0917 Services Office, Inc.,with its permission. Page 9 of 15 2) Basements, you with permission of whether paved or the owner; not;or b. In the case of damage 3) Doors, windows or by fire, explosion, light- other openings. ning, smoke or soot, (c) "Property damage" caused while rented to you;or by or resulting from water c. In the case of damage that leaks or flows from by water, while rented plumbing, heating,air condi- to and occupied by you. tioning, fire protection sys- tems, or other equipment, (2) The most we will pay is limited as caused by or resulting from described in Section B. Limits freezing, unless: Of insurance, 3. Damage To Premises Rented To You of this (i) You did your best to endorsement. maintain heat in the building or stnicture;or 4. Supplementary Payments (II) You drained the equip- Under Section 1 -Supplementary Pay- ment and shut off the ments-Coverages A And B: water supply if the heat a. Paragraph 2. is replaced by the fol- was not maintained. lowing: (d) "Property damage"to: Up to the limit shown in Section B. () Plumbing, heating, air Limits Of Insurance,4.a.Bail Bonds conditioning,fire protec- of this endorsement for cost of bail tion systems, or other bonds required because of accidents equipment or appliance or traffic law violations arising out of es;or the use of any vehicle to which the Bodily Injury Liability Coverage ap- (i) The interior of any plies.We do not have to furnish these building or structure, or bonds. to personal property in the building or structure, b. Paragraph 4. is replaced by the fol- caused by or resulting lowing: from rain,snow,sleet or All reasonable expenses incurred by ice, whether driven by the insured at our request to assist us wind or not. q in the investigation or defense of the c. Limit Of Insurance claim or"suit",including actual loss of earnings up to the limit shown in Sec- With respect to the insurance afford- tion B. Limits Of Insurance, 4.b. ed in Paragraphs 3.a.and 3.b.above, Loss Of Earnings of this endorsement the Damage To Premises Rented per day because of time off from To You Limit as shown in the Deck- work. rations is amended as follows: 5. Medical Payments (1) Paragraph 6. of Section III - Limits Of Insurance is replaced The Medical Expense Limit of Any One • by the following: Person as stated in the Declarations is amended to the limit shown in Section B. 6. Subject to Paragraph 5. Limits Of Insurance, 5. Medical Pay- ` above, the Damage To ments of this endorsement. I Premises Rented To You Limit Is the most we will pay 6. 180 Day Coverage For Newly Formed under Coverage A-Bodily Or Acquired Organizations Injury And Property Dam- Section II - Who Is An insured is • age Liability for damages amended as follows: • because of "property dam • - age"to any one premises: Subparagraph a. of Paragraph 3. is re- placeda. While rented to you, or by the following: • temporarily occupied by a. Insurance under this provision is af- forded only until the 180th day after Includes copyrighted material of Insurance GA 210 0917 Services Office,Inc.,with its permission. Page 10 of 15' •i 1 you acquire or form the organization use of that part of the prem. or the end of the policy period, ises leased to you, subject whichever is earlier; to the following additional 7. Waiver Of Subrogation exclusions: Section IV-Commercial General Liabli- This insurance does not ap- plyity Conditions,9.Transfer Of Rights Of to: Recovery Against Others To Us is (t) Any occurrence"which amended by the addition of the following: takes place after you We waive any right of recovery we may cease to be a tenant in have against any person or organization that premises; against whom you have agreed to waive (i) Structural alterations, such right of recovery in a written contract new construction .or or agreement because of payments we demolition operations make for injury or damage arising out of performed by or on be- your ongoing operations or "your work" half of such additional done under a written contract or agree- insured. ment with that person or organization and • included in the"products-completed oper- (b) Lessor Of Leased Equip- ations hazard': However, our rights may Ment only be waived prior to the 'baurrence" • giving rise to the injury or damage for Any person or organization which we make payment under this Cov- from whom you lease erage Part. The insured must do nothing equipment when you and after a loss to impair our rights.At our re- such person(s) or organize- quest,the insured will bring"suit'or trans- tion(s)have agreed per paf fer those rights to us and help us enforce �rePh 8 a.(1) of this en- those rights. dorsement to provide insur- anoe. Such person(s) or or- 8. Automatic Additional Insured - Sped- ganization(s) are insureds fled Relationships only with respect to liability for "bodily Injury, "property a. The following is added to Section 9- damage" or "personal and Who b An Insured: advertising injury"caused,In (1) Any person(s) or organization(s) whole or In part, by your described in Paragraph 8.a,(2)of maintenance, operation or this endorsement(hereinafter re- use of equipment leased to ferred to as additional insured) you by such person(s)or or- whom you are required to add as organa tian(s). A person's or an additional insured under this organization's status as an Coverage Part by reason of a additional insured under this written contract, written, agree- endorsement ends when mens, written permit or written their contract or agreement authorization, with you for such leased equipment ends. However, (2) Only the following persons or or- this insurance does not ap- ganizations are additional in- ply to any "occurrence" sureds under this endorsement, which takes place after the and insurance coverage provided equipment lease expires. to such additional insureds is km- (c) Vendors ited as provided herein: (a) Managers Or Lessors Of Any person or organization Premises (referred to below as ven- i dor) with whom you have The manager or lessor of a agreed per Paragraph premises leased to you with 8.a.(1) of this endorsement whom you have agreed per to provide insurance,but on- Paragraph 8.a.(1)of this en- ly with respect to 'bodily in- dorsement to provide insur- jury" or 'property damage" ance, but only with respect arising out of your products" to liability arising out of the which are distributed or sold • ownership, maintenance or in the regular course of the i Includes copyrighted material of Insurance GA 210 0917 Services Office,inc.,with its permission. Page 11 of 15 vendor's business, subject or repair opera- to the following additional tions, except such exclusions: operations per- @ The insurance afforded formed at the ven- the vendor does not dors premises in apply to: connection h sale of the prowitductthe; 1) "Bodily Injury" or "property damage" 7) Products which,af- for which the ven- ter distribution or dor is obligated to sale by you, have pay damages by been labeled or re- reason of the as- labeled or used as sumption of liability a container, part or in a contract or ingredient of any agreement. This other thing or sub- exclusion does not stance by or for the apply to liability for vendor;or damages that the 8) "Bodily injury" or vendor would have "property damage" in the absence of arising out of the the contract or sole negligence of agreement; the vendor for its 2) Any egress war- own acts or omis- ranty unauthorized sions or those of by you; its employees or anyone else acting 3) Any physical or on its behalf. How- chemical change in ever,this exclusion the product made does not apply to: intentionally by the a) The weep- vendor; tions contained 4) Repackaging, ex- in Paragraphs rept when un- (c) (1) 4) or 6) Packed solely for of this en- the purpose of in- dorsement;or spection, demon- b) Such inspec- stration, testing, or tions, aci)ust the substitution of parts under in- menta,tests or structions from the the vend as manufacturer, and the vendor has then repackaged in agreed to the original con- make or nor- tainer; mally under- takes to make 6) Any failure to make in the usual such Inspections, course of adjustments, tests business, in or servicing as the tbn with the has agreed with the distri- to make or normal- button or sale ly undertakes to of the prod- make in the usual acts. course of busi- (ii) This insurance does not ness,in connection apply to any insured with the distribution or sale of the Person or organization: products; 1) From whom you 6) Demonstration, In- have acquired stallation, servicing such products, or any ingredient,part Includes copyrighted material of Insurance GA 210 0917 Services Office, Inc.,with its permission. Pa0e 12 of 15 or container,enter- (e) Mortgagee, Assignee Or ing into, accornpa- Receiver Hying or containing such products;or Any person or organization with whom you have agreed 2) When liability in- par Paragraph 8.a.(1) of this eluded within the endorsement to provide in- "products- surance, but only with re- completed opera- spect to their liability as tions hazard" has mortgagee,assignee, or re- been excluded un- ceiver and arising out of the der this Coverage ownership, maintenance, or Partwith respect to use of the premises by you. such products. However, this insurance (d) State Or Governmental does not apply to structural Agency Or Subdivision Or alterations, new eo eratins Political Subdivision and demolition opperations Or Authorizations performedfor that per- PermitsRelating To Premises soonnoorr organization. Any state or governmental (3) The insurance afforded to addi- agency or subdivision or po- tionsl insureds described in Par- iiiital subdivision with which agraph $.a,(1) of this endorse- you have agreed per Para- menta graph 8.a.(1) of this en- (a) Only applies to the extent dorsement to provide incur- permitted by law;and ance, subject to the follow- ing additional provision: (b) Will not be broader than that which you are required by This insurance applies only , the written contract, written with respect to the following agreement, written permit or hazards for which the state written authorization to pro- or governmental agency or vide for such additional in- subdivision or political sub- cured;and division has issued a permit or authorization in connec- (c) Does not apply to any per- tion with premises you own, son, organization, vendor, rent or control and to which state, governmental agency this insurance applies: or subdivision or political subdivision, specifically (i) The existence, mainte- named as an additional In- nance, repair, construe- stied under any other provi- lion,erection or removal sion of, or endorsement of advertising signs, added to, this Coverage awnings, canopies, cal- Part, provided such other tar entrances, coal provision or endorsement holes, driveways, man- covers the injury or damage holes, marquees, hoist for which this insurance ap- away openings, side- plies. walk vaults, street ban- ners or decorations and b. With respect to the insurance afford- similar exposures;or ed to the additional insureds de- sorbed In Paragraph 8.a.(1) of this (ii) The construction, erec- endorsement, the following is added tion or removal of sieve- to Section Ill-Limits Of insurance: tors;or The most we will pay on behalf of the (iii) The ownership, mainte- additional insured is the amount of in- • nance or use of any el- suranoe: evators covered by this insurance. (1) Required by the written contract, written agreement,written permit or written authorization described Includes copyrighted material of insurance GA 210 0917 Services Office, Inc.,with its permission. Page 13 of 15 in Paragraph 8.a.(1) of this en- lion I -Coverage A -Bodily Injury dorsement; or And Property.Damage Liability: (2) Available under the applicable Paragraphs (3) and (4)of this exclu- Limits of Insurance shown in the Sion do not apply to tools or equip- Declarations; ment loaned to you,provided they are whichever is less. not being used to perform operations at the time of loss. This endorsement shall not increase b. With respect to the insurance provid- the applicable Limits of insurance ed by this section of the endorse- shown in the Declarations. ment, the following additional provi- c. Section N - Commercial General sions apply: Liabiiiityr Conditions is amended to (1) The Limits of Insurance shown in • include the following: the Declarations are replaced by Automatic Additional Insured Pro- the limits designated in Section vision B. Limits Of Insurance, 9. onlyIf the Property Damage To Borrowed • This insurance appliesEquipment of this endorsement "bodily injury' or "property damage" with respect to coverage provid- • occurs,or the"personal and advertis- ed by this endorsement. These • ing injury'offense is committed: limits are indusive of and not in (t) During the policy period;and addition to the limits being re- placed. The Limits of Insurance (2) Subsequent to your execution of shown in Section B. Limits Of the written contract or written insurance,9.Property Damage agreement,or the issuance of a To Borrowed Equipment of this written permit or written authori- endorsement fix the most we will zation, described in Paragraph pay in any one "occurrence"re- 8.a.(1). gardless of the number of: d. Section IV - Commercial General (a) insureds; Liability Conditions is amended as (b) Claims made or "suits" follows: brought;or Condition 5. Other Insurance is (c) Persons or organizations amended to include: making claims or bringing Primary And Noncontributory In- 'suits". surance (2) Deductible Clause This insurance is primary to and will (a) Our obligation to pay dam- not seek contribution from any other ages on your behalf applies insurance available to an additional only to the amount of dam- insured per Paragraph 8.a.(1) of this ages for each "occurrence" endorsement provided that: which are in excess of the (1) The additional insured is a Deductible Amount stated in Named Insured under such other Section B. Limits Of lnsur- insurance;and ance, 9. Property Damage To Borrowed Equipment of (2) You have agreed in writing in a this endorsement.The limits contract, agreement, permit or of insurance will not be re- authorization described in 8.a.(2) duced by the application of of this endorsement that this in- such Deductible Amount surance would be primary and would not seek contribution from (b) Section IV - Commercial any other Insurance available to General Liability Condi- the additional insured. tions, 2. Duties In The Event Of Occurrence, Of- 9. Property Damage To Borrowed Equip- fense, Claim Or Suit, ap- • ment plies to each claim or "suit" a. The folbwing is added to Exclusion irrespective of the amount. 2.j.Damage To Property under Sec- Includes copyrighted material of Insurance GA 210 0917 Services Office, Inc,with its permission. Page 14 of 15 f (c) We may pay any part or all 12. Nonowned Aircraft of the deductible amount to effect settlement of any The following is added to Exclusion 2.g. claim or'suit"and, upon no- Aircraft,Auto Or Watercraft under Sec- tification of the action taken, tion I -Coverage A-Bodily Injury And you shall promptly ream- Property Damage Liability: burse us for such part of the This exdusion does not applyto an air- deductible amount as has craft you do not own,provided that been paid by us. a. The pilot in command holds a current 10. Employees As Insureds - Specified Health Care Services And Good Samar- effective certificate,e, issued by a duly itan Services constituted authority of the United States of America or Canada, desig- Paragraph 2.a.(1Xd) under Section II - Hatingthat person as a commerdal or Who Is An hsured does not apply to: airline transport pilot a. Your "employees" who provide pm- b. The aircraft is rented with a trained, fessional health care services on your paid crew;and behalf as a duly licensed nurse, c,. The aircraft does not transport per- emergency medical technician or sons or cargo for a charge. paramedic in the jurisdiction where an "occurrence"or offense to which this 13. Bodily Injury Redefined Insurance applies takes place;or Section V-Definitions,4,"Bodily injury' b. Your"employees"or"vdunteer work- is replaced by the following: ers", other than an employed or vol- unteer doctor, providing first aid or 4. "Bodily injury'means bodily harm or good samaritan services during their injury, sickness, disease, disability, work hours for you will be deemed to humiliation, shock, fright, mental an- be acting within the scope of their guish or mental injury,including care, employment by you or performing du- toss of services or death resulting ties related to the conduct of your from any of these at any time. business. 14. Expected Or Intended Injury Redefined 11. Broadened Notice Of Occurrence The last sentence of Exclusion 2,a. Ex- Paragraph a. of Condition 2. Duties in pected Or Intended Injury under Sec- The Event Of Occurrence, Offense, tion I -Coverage A-Bodily Injury And Claim Or Suit under Section IV- Com- Property Damage Liability Is replaced by mercial General Liability Conditions is the following: replaced by the following: This exclusion does not apply to `bodily a. You must see to it that we are notified irrjury"or"property damage"resulting from as soon as practicable of an "occur- the use of reasonable force to protect per- rence"or an offense which may result sons or property. in a claim.To the extent possible,.no- 15. Former Employees As Insureds tice should include: (1) How, when and where the "otr The following Is added to Paragraph 2. curenee"or offense took place; under Section it-Who Is An Insured: (2) The names and addresses of 2 Each of the following is also an in- any Injured persons and wit- eared. nesses;and Any of your former "employees", di- rectors, managers, members, .part- (3) The nature and location of any ners or"executive officers", including injury or damage arising out of but not limited to retired, disabled or the"occurrence"or offense, those on leave of absence, but only This requirement applies only when for acts within the scope of their em- the "occurrence" or offense is known ployment by you or for duties related to an"authorized representative". to the conduct of your business. Includes copyrighted material of Insurance GA 210 0917 Services Office, Ina,with its permission. Page 15 of 15 COMMERCIAL GENERAL LIABILITY CSGA 4087 12 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US PER CONTRACT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following Is added to Paragraph 8.Transfer of Rights of Recovery Against Others to Us of SECTION ' IV-CONDITIONS: If you have agreed,in a written contract or agreement,to provide a waiver of any right of recovery against a person or organization,we will waive any right of recovery we may have against that person or organization 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 that person or organization for which you have agreed to in,a written contract to provide said waiver. Includes copyrighted material of Insurance CSGA 4087 12 12 Services Office, Inc.,with its permission. Page 1 of f COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WiTH YOU - COMPLETED OPERATIONS ONLY This endorsement modifies insurance provided under the following: • COMMERCIAL GENERAL LIABILITY COVERAGE PART A SECTION II " WHO IS AN INSURED is This Insurance does not apply to: amended to include as an additional Insured #, "Bodily injury",any person or organization when you and such "property damage"or"per- person or organization have agreed in writing sonal and advertising injury"arising out of in a contract or agreement that such person or the rendering of,or the failure to render, organization be added as an additional insured any professional architectural, engineer- on your policy,but only with respect to"bodily ing or surveying services,including: injury', "property damage" or "personal and a. The preparing,approving,or falling to advertising injurymused.In whole or in part, prepare or approve, maps, shop by'your work"performed for the additional in- drawings, opinions, reports. surveys, sured and included In the"products-completed field orders, change orders or draw- operations hazard" ings and specifications;or If not specified otherwise In the written con- tract or agreement, a person's or organize- b. Supervisory, inspection, architectural tIon's status as an additional insured under this or engineering activities endorsement ends one year after your opera- 2. "Bodily injury"or "property damage" tions for that additional insured are completed. in out of p "fo a - P g your work for which a consoli- The written contract or agreement must be dated (wrap-up) Insurance program has currently in effect or become effective during been provided by the prime contrac- the term of this Coverage Part The contract tor/project manager or owner of the con- or agreement must be executed prior to the struction project in which you are involved. "bodily Injury" "property damage"or"personal and advertising injury"to which this endorse- 3. 'Bodily injury","property damage"or"per- ment pertains. sons! and advertising injury'to any em- ployee of you or to any obligation of the. However, additional insured to indemnify another 1. The insurance afforded to such additional because of damages arising out of such insured only applies to the extent permit- ted injury" by law,and 4. 'Bodily injury","property damage"or"per- t. If coverage provided to the additional In- sonal and advertising injury"for which the sured Is required by a contract or agree- Namedthisipoli Insured is afforded no coverage ment, the insurance afforded to such ad- ditional under policy of insurance. insured will not be broader than C. With respect to the insurance afforded to that which you are required by the con- these additional Insureds, SECTION III•LIM- tract or agreement to provide for such ad- ITS OF WSURANCE is amended to include: ditlonal insured. ed B. With respect to the insurance afforded to are those applicable to the additional contractinsuor specified in the written or these additional insureds, the following addl- agreement or in the Declarations of this Coy- tional exclusions apply: erage Part, whichever is less. If no limits are Includes copyrighted material of ISO CS1A408(08109)-A- Properties.Inc.,with its permission. Page 1 of 2 specified In the written contract or agreement, My coverage provided herein will be excess the limits applicable to the additional insured over any other valid and collectible insurance ere those specified in the Declarations of this available to the additional insured whether Coverage Part.The limits of insurance are in- primary, excess. contingent or on any other clusive of and not in addition to the limits of hi- basis unless you have agreed in a written con- surance shown in the Declarations. tract or written agreement executed prior to d. With respect to the insurance afbrded to any loss that this insurance MI be primary. This insurance will be noncontributory only If these additional insureds, SECTION IV - you have so agreed In a written contract or COMMERCIAL. GENERAL LIABILITY CON- written agreement executed prior to any loss DITIONS,4..Other Insurance Is amended to and this coverage is determined to be primary. Include: Includes copyrighted material of ISO CSIA405(08109)-A- Properties.Inc.,with its permission. Page 2 of 2 • BBB! 905384 A Human Resource Management Company February 13, 2020 BUTLERS GLASS SERVICE INC 319E MCANDREWS RD MEDFORD, OR 97501 Re: Barrett Business Services, Inc. ("BBSI") Letter of Self-Insurance for Workers' Compensation Coverage As the named addressee of this Letter, your company's required workers' compensation coverage is provided through BBSI's state approved Self-Insured Workers' Compensation Plan by way of your co-employment contract with BBSI. Additional information is as follows: State: Oregon Workers'Compensation Limits: Employer Liability Limits: Self Insurance Certification #: 1068 Statutory $5,000,000.00 Each Accident $5,000,000.00 Disease Coverage Limit by Client $5,000,000.00 Disease; Each Employee Other Comments (place an"X"if applicable): X Named "Letter Holder": Josephine County Building"Maintenance 705 NW Dimmick St Grants Pass, OR 97526 X Other: Contract effective 1/1/16, renewed through 1/1/21. Subject to 30 days' notice of cancellation. Additionally, BBSI's self-insured program is further supported by an excess workers'compensation insurance policy with ACE American Insurance Co.. Copy of certificate is available upon request. For additional information, please contact your local BBSI office at: MEDFORD (541) 772-5469 2045 Cardinal Way Suite 100 Very truly yours, Medford, OR 97504 Michael L. Elich President and Chief Executive Officer doe:LOSI-2