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HomeMy WebLinkAbout2020-059 PO 20200417- Western Emulsions CiTY a LIa Purchase Order prAl ' a Fiscal Year 2020 Page: 1 of: 1 — z � •loJiis l�F� 1 ` �s7� ii BCity of Ashland ATTN:Accounts Payable 20 E. Main Purchase 20200417 Ashland,OR 97520 Order# T Phone:541/552-2010 O Email: payable@ashland.or.us . V H C/O Street Division E WESTERN EMULSIONS i 90 North Mountain Ave • N PO BOX 50538 p Ashland, OR 97520 IDAHO FALLS, ID 83405-0538 Phone:541/488-5313 R T Fax:,541/552-2304 • Tri r-i� r_>�a[alE�is! _.- .r_r.il,irtT�,t :i�i��� �T — �F=n+%i�&It� Avram Biondo_ `._-hU f.Jtcte _'_ ���I I k 1 1(R6i I-- {_I-�=. ,--. 'a11�� ,. _�. - I-l� alil Ti-r �, �[. •� 05/11/2020 2584 FOB ASHLAND ORINET30 City Accounts Payable 1711 1•21 'lt[=i:r. i:?_C_ __.., t Ji!_e;ITO g't�a--' Liai (1 Fi Uri Trucking Services FY20 1 Trucking Services FY20 1 $10,000.0000 $10,000.00 Goods&Services Agreement(Less than$25,000) Completion date: December 31,2020 Project Account: ***************GL SUMMARY*************** 081200-704100 $10,000.00 - By:L f p,2 Date: Si/ Authorizdd"Signature51 j — 110 000.00 . ye., ed--- G ` • FORM#3 ✓(8 CITY OF ASHLAND A request for a KIK:lia e Or ''i. RREQUISBTION I O 0/7d/ 1 Date of request: 03/09/2020 ( Required date for delivery; Vendor Name Western Emulsions,Inc. Address,City,State,Zip 7701 11th Street Contact Name&Telephone Number Pat Mcnalry 641-826-3373 • Email address . SOURCING METHOD ❑ Exempt from Competitive Bidding - 0 Emergency 0 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) Of council approval required,attach copy of CC) O Small Procurement 0 Request for Proposal Cooperative Procurement Not exceeding$5,000 Date approved by Council: 0 State of Oregon ❑ Direct Award (Attach copy of council communication) Contract# ❑ VerbalANrillen bid(s)or proposal(s) ❑ }2eduest for Qualifications(Public Works) 0 Stale 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 6) Contract# Greater than$5,000 and less than$100,000 0 Written quote or proposal attached Intergovernmental Agreement ❑ (3)Written bids&solicitation attached 0 Form 114,Personal Services$5K to$75K Agency PERSONAL SERVICES ❑ Special Procurement 0 Annual cost to City does not exceed$25,000. Greater than$5,000 and less than$75,000 0 Form#9,Request for Approval Agreement approved by Legal and approved/signed by ❑ Less than$35,000,by direct appointment ❑ Written quote or proposal attached City Administrator.AMC 2.50.070(4) O (3)Written proposals&solicitation attached Date approved by Council: ❑ Annual cost to City exceeds$25,000,Council ❑ Form 114,Personal Services$51(to$75K Valid until: _ (Date) approval required.(Attach copy of council communication) Description of SERVICES Total Cost , • Trucking Services for FY20 $1.0,000 Item# Quantity Unit Description of MATERIALS Unit Price Total Cost I] Per attached quote/proposal - TOTAL COST Project Number • __ Account Number 081200 704100 $10,000 - , $ Account Number - Account Number `Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director In collaboration with department to approve all hardware and software purchases: • IT Director Date Support-Yes/No By signing this rrequisition form,l mg,that tthe�City's public contracting requirements have been satisfied. Employee&')CXYCO N rsbAnktiA Department Head:--- ---91( St"v l? , unimr -'(Equal o or greater than$5,000) Department Manager/Supervisor: City Administrator: (Equal to or greater than$25,000) Funds appropriated for current fiscal year. YE /NO r- q _./— 5/12/2 y ' Hance Director-(Equaltoor reaterthan$5,000) Dale Comments: ��m � g Form 113-Requisition GOODS & SERVICES AGREEMENT (Less than$25,000) PROVIDER: Western Emulsions, Inc. CITY 0 F PROVIDER'S CONTACT: Pat Mcnairy ASH LAN D 20 East Main Street ADDRESS: 7701 11th Street Ashland, Oregon 97520 White City, OR 97503 Telephone: 541/488-5587 Fax: 541/488-6006 PHONE: 541-826-3373 This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and Johnny Cat Incorporated, a foreign business corporation("hereinafter"Provider"), for trucking services. 1. PROVIDER'S OBLIGATIONS 1.1 Provide necessary labor and equipment for Distributor Truck Service and Tack 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. 1.2.2 Each policy of such insurance shall be on an "occurrence" and not a "claims made" form, and shall: • Name as additional insured "the City of Ashland, Oregon, its officers, agents and employees" with respect to claims arising out of the provision of Work under this Agreement; • Apply to each named and additional named insured as though a separate policy had been issued to each,provided that the policy limits shall not be increased thereby; • Apply as primary coverage for each additional named insured except to the extent that two or more such policies are intended to "layer" coverage and, taken together, they provide total coverage from the first dollar of liability; • Provider shall immediately notify the City of any change in insurance coverage • Provider shall supply an endorsement naming the City, its officers, employees and agents as additional insureds by the Effective Date of this Agreement; and • Be evidenced by a certificate or certificates of such insurance approved by the City. Page 1 of 6: Agreement between the City of Ashland and Western Emulsions,Inc. 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. As evidence of the insurance required by this Agreement,the Provider shall furnish an acceptable insurance certificate prior to commencing any Work under this Agreement. 1.4 Provider agrees that no person shall, on the grounds of race, color, religion, creed, sex, marital status, familial status or domestic partnership, national origin, age, mental or physical disability, sexual orientation, gender identity or source of income, suffer discrimination in the performance of this Agreement when employed by Provider. Provider agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. Further, Provider agrees not to discriminate against a disadvantaged business enterprise,minority-owned business,woman-owned business, a business that a service-disabled veteran owns or an emerging small business enterprise certified under ORS 200.055, in awarding subcontracts as required by ORS 279A.110. 1.5 In all solicitations either by competitive bidding or negotiation made by Provider for work to be performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Providers of the Provider's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider the sum of$485.00 - 600.00 per ton, with a minimum charge of$2,280.00 as provided herein as full compensation for the Work as specified in the SUPPORTING DOCUMENTS. 2.2 In no event shall Provider's total of all compensation and reimbursement under this Agreement exceed the sum of$10,000.00 (ten thousand dollars) without express, written approval from the City official whose signature appears below, or such official's successor in office. Provider expressly acknowledges that no other person has authority to order or authorize additional Work which would cause this maximum sum to be exceeded and that any authorization from the responsible official must be in writing. Provider further acknowledges that any Work delivered or expenses incurred without authorization as provided herein is done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement. 3. GENERAL PROVISIONS 3.1 This is a non-exclusive Agreement. City is not obligated to procure any specific amount of Work from Provider and is free to procure similar types of goods and services from other providers in its sole discretion. 3.2 Provider is an independent contractor and not an employee or agent of the City for any purpose. 3.3 Provider is not entitled to, and expressly waives all claims to City benefits such as health and disability insurance,paid leave, and retirement. 3.4 This Agreement embodies the full and complete understanding of the parties respecting the subject matter hereof. It supersedes all prior agreements,negotiations, and representations between the parties, whether written or oral. 3.5 This Agreement may be amended only by written instrument executed with the same formalities as this Agreement. Page 2 of 6: Agreement between the City of Ashland and Western Emulsions,Inc. 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. C 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. 3.11 Deliveries will be F.O.B destination. Provider shall pay all transportation and handling charges for the Goods.Provider is responsible and liable for loss or damage until final inspection and acceptance of the Goods by the City. Provider remains liable for latent defects, fraud, and warranties. 3.12 The City may inspect and test the Goods. The City may reject non-conforming Goods and require Provider to correct them without charge or deliver them at a reduced price, as negotiated. If Provider does not cure any defects within a reasonable time, the City may reject the Goods and cancel this Agreement in whole or in part. This paragraph does not affect or limit the City's rights, including its rights under the Uniform Commercial Code, ORS Chapter 72 (UCC). 3.13 Provider represents and warrants that the Goods are new, current, and fully warranted by the manufacturer. Delivered Goods will comply with SUPPORTING DOCUMENTS and be free from defects in labor, material and manufacture.Provider shall transfer all warranties to the City. 4. SUPPORTING DOCUMENTS The following documents are,by this reference,expressly incorporated in this Agreement,and are collectively referred to in this Agreement as the "SUPPORTING DOCUMENTS:" • The City's written ITB dated 2/3/2020. • The Provider's complete written proposal dated 2/10/2020. 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 or in equity, including,but not limited to: Page 3 of 6: Agreement between the City of Ashland and Western Emulsions,Inc. 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 December 31St 2020,unless sooner terminated as provided in Subsection 6.2. 6.2 Termination 6.2.1 The City and Provider may terminate this Agreement by mutual agreement at any time. 6.2.2 The City may, upon not less than thirty (30) days' prior written notice, terminate this Agreement for any reason deemed appropriate in its sole discretion. 6.2.3 Either party may terminate this Agreement, with cause, by not less than fourteen (14) days' prior written notice if the cause is not cured within that fourteen (14) day period after written notice. Such termination is in addition to and not in lieu of any other remedy at law or equity. 7. NOTICE Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery, by sending via a reputable commercial overnight courier, or by mailing using registered or certified United States mail, return receipt requested, postage prepaid, to the address set forth below: If to the City: City of Ashland—Street Division,Public Works Department Attn: Avram Biondo 20 E. Main Street Ashland, Oregon 97520 Phone: (541)488-5313 With a copy to: City of Ashland—Legal Department 20 E. Main Street Ashland, OR 97520 Phone: (541) 488-5350 Page 4 of 6: Agreement between the City of Ashland and Western Emulsions,Inc. If to Provider: 8. WAIVER OF BREACH , , - One or more waivers or failures to object by either party to the other's breach of.any provision,term,condition, or covenant contained in this Agreement shall not be construed as a waiver of any subsequent breach,whether or not of the same nature. 9. PROVIDER'S COMPLIANCE WITH TAX LAWS 9.1 Provider represents and warrants to the City that: 9.1.1 Provider shall, throughout the term of this Agreement, including any extensions hereof, comply with: (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider; and (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.1.2 Provider, for a period of no fewer than six(6) calendar years preceding the Effective Date of this Agreement, has faithfully complied with: (i) All tax laws of the State of Oregon, including but not limited,to ORS 305.620 and ORS chapters 316, 317, and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider; and (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.2. Provider's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Provider's warranty, as set forth in 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. Page 5 of 6: Agreement between the City of Ashland and Western Emulsions,Inc. e CITY OF ASHLAND: _ Western Emulsions,Inc. (PROVIDER): By: - By: 170-71-'Mc-Na4 3 dm 3trator Signature DE cutiaanuemr 44reA.D 'cam' ,FLy Pat McNairy Printed Name Printed Name S ,rit° Regional Sales Manager Date Title 4/29/2020 Date Purchase Order No. 7 (W-9 is to be submitted with this signed Agreement) Page 6 of 6: Agreement between the City of Ashland and Western Emulsions,Inc. � 7 ® A�v CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/28/2020 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: Allison Gatlin Idaho-Hub International Transportation Insurance S PHONE 208-522-1260 Nc,No):208-522-1267 900 Pancheri Drive (A/C.No.Ext): Suite B E-MAIL allison.gatlin@hubinternational.com Idaho Falls ID 83402 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Workers Compensation Fund 10033 INSURED IDAHASP-01 INSURER B:WCF National Insurance Company 40517 Idaho Asphalt Supply, Inc. Western Emulsions Inc. INSURER C: Johnny B Transport, LLC INSURERD: P.O. Box 50538 INSURER E: Idaho Falls ID 83405 INSURER F: COVERAGES CERTIFICATE NUMBER:2104040402 REVISION NUMBER: I 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 I 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 LTR INSR VD POLICY NUMBER .(MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per.person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) • UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 4012665 1/1/2020 1/1/2021 X STATUTE OTH- ER B AND EMPLOYERS'LIABILITY y/N 4012708 1/1/2020 1/1/2021 ANYPROPRIETOR/PARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED7 - - - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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. To Whom This May Concern AUTHORIZEDREPRESENTQTIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AccPRD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/28/2020 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: Allison Gatlin Idaho-Hub International Transportation Insurance S PHONE 208-522-1260 FAX 900 Pancheri Street Suite B (AIC,No,Ext): (A/C,No):208-522-1267 Idaho Falls ID 83402 ADDRESS: allison.gatlin@hubinternational.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Commerce&Industry Insurance Company 19410 INSURED IDAHASP-01 INSURER B:AIG Specialty Insurance Company 26883 Idaho Asphalt Supply, Inc. Western Emulsions Inc. INSURER C: P.O. Box 50538 INSURER D: Idaho Falls ID 83405 INSURERE: INSURER F: • COVERAGES CERTIFICATE NUMBER:1067682521 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. INSRLTRADDL TYPE OF INSURANCE NSD SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS {MM/DD/YYYYI (MM/DD/YYYY) B X COMMERCIAL GENERAL LIABILITY 1802936 8/1/2019 8/1/2020 EACH OCCURRENCE $1,000,000 DAMAGE CLAIMS-MADE X OCCUR PREM SESO(Ea occurrence) $1,000,000 MED EXP(Any one person) $25,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO LOC PRODUCTS-COMP/OPAGG $2,000,000 X POLICY JECT OTHER: $ A AUTOMOBILE LIABILITY 7058783 • 8/1/2019 8/1/2020 COMBIaaccideNEnt)SID NGLE LIMIT $1,000,000 (E X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE _ $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? - ----- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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. To Whom This May Concern AUTHORIZED REPRESXTIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • F CITY OF Fol #2ASHLAND INVITATION TO BID—TRADE SERVICES INTERMEDIATE PROCUREMENT Release date: 2-3-2020 Requested by: Avram Biondo Street Division,Ashland Public Works 541-552-2345 avram.biondo@ashland.or.us ashland.or.us Bids are due by: 2-13-2020 Project name: 2020 City of Ashland Contract Trucking Job site location: City of Ashland Oregon ' Project completion required by: December 31,2020 Bids may be faxed,emailed or hand delivered.Contractors shall submit bid on their company letterhead. Informal email bids and/or late bids will not be accepted.Terms or discounts which are conditioned upon payment within a certain time will not be considered for purposes of comparison of bids. The successful contractor will be required to enter intoa contract with the City for the services and provide insurance certificates in their own name for General Liability,Automobile and Workers' Compensation.Workers' Compensation insurance is mandatory.Subcontracting will not be permitted. ' • "OR EQUAL":Any brand name listed in the specifications as"or equal"or"or equivalent"shall establish the minimum requirements for quality;utility, durability,function,purpose,etc.Other product brands may be offered that are equal to or better,than the product brand name.Bidder may show cost difference,alternates and options in the space provided in the quote.This clause is not meant to be restrictive,but to set the minimum standard.THE CITY SHALL DETERMINE,IN ITS SOLE DISCRETION,WHETHER A PRODUCT OFFERED IS"EQUAL."When the designation is"or equal"or "equivalent"City shall make its decision after Bid Closing. • SCOPE OF SERVICES Supply equipment,personnel,material, and trucks necessary to provide following services to the City of Ashland.Please provide hourly rates and any minimums for service for the following trucking:, 12 yd.bob tail Regular truck and transfer Super transfer Mega dump Mechanical sweeper and/or Regen Air sweeper Vac truck Tack distributor truck(include cost of tack per gallon CSS-1 or City approved alt.) Lowboy * Include average net weight hauled by trucks and number of trucks available Please note any special requirements to perform work,number of available trucks, and lead time needed to schedule work in bid. *Contractors my bid on one, any number,or all requested services *Services will be on an as needed basis. *Please provide Firm Pricing from 2-13-2020 to 12-31-2020 *Maximum amount of contract not to exceed$75,000.Multiple contracts may be awarded. *Upon award, Company must complete a"Goods.and Services" contract with the City of Ashland. Sample attached. All Pricing Must Be Held Firm For 30 Days • rgi Form#2—Intermediate Procurement,Invitation to Bid,Trade Services,Page 1 of 2,2/10/2020 Method of Award: ORS 279B.070 Intermediate Procurements, (4)If a contract is awarded, the contracting agency shall award the contract to the offeror whose quote or proposal will best serve the interests of the contracting agency, taking into • account price as well as considerations including, but not limited to, experience, expertise,product functionality, suitability for a particular purpose and.contractor responsibility under ORS 279B.110. • 1 { y I { 1 • • C:\Users\biondoa\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\182YMAODU-13-2020 trucking Form#2- Intermediate Procurement Invitation to Bid-TRADE SERVICES.doc 2 • Avram Biondo From: Avram Biondo Sent: Monday, February 10,2020 7:35 AM To: klamathfalls@albina.com Subject: ITB 2020 City of Ashland Contract Trucking Attachments: 1-13-2020 trucking Form#2-Intermediate Procurement Invitation to Bid-TRADE SERVICES.doc;SAMPLE GOODS AND SERVICES AGREEMENT more than $25K_KLB.04.30.18.docx Good morning, Please see attached ITB and sample contract for as needed trucking services for the City of Ashland. We are looking for Firm Price through Dec.31st,2020 for the following: 12 yd. bob tail Regular truck and transfer Super transfer Mega dump Mechanical sweeperand/or Regen Air sweeper Vac truck Tack distributor truck(include cost of tack per gallon CSS-1 or City approved alt:) Lowboy . Any additional relevant types of trucking services. Please include number of trucks available,weights hauled by trucks, any minimums and special requirements.You may submit bids for any number of trucking services,from one type to all. Multiple contracts may be awarded. Please submit all bids on company letterhead via Email, Fax,or hand delivery by February 13th,2020 10:00 AM PST If you could confirm receipt of this ITB,it would be greatly appreciated. Lastly,feel free to contact if you have any questions and have a great day, Avram Avram Biondo Street Supervisor Public Works Street Division V City Of Ashland V 90 N. Mountain Ave.,Ashland,Oregon 97520 (541)488-5313 This email transmission is official business of the City of Ashland,and it is subject to Oregon Public Records Law for disclosure and retention.. If you have received this message in error,please contact me at(541)552-2345.Thank you 1 Avram Biondo - From: Avram Biondo Sent: Monday, February 03,202010:33 AM To: Cory Cushman; Robert Lyon;Milt.catter@hgc-inc.net; Barton,Jon; joe.soares@kniferiver.com;mayrock319@gmail.com;Scales@CPlpaving.com; marcl1 @charter.net;CPI@ceritralpipeline.net; pat.mcnairy@westernemulsions.com;info@hgc- inc.net;info@mmservicesllc.com Subject: RE: ITB 2020 City of Ashland Contract Trucking CORRECTION Hello all, I made a mistake in the below email.The due date should read February 13th,2020 10:00 AM PST. I apologize for any confusion. Avram Biondo Street Supervisor Public Works Street Division City Of Ashland 90 N. Mountain Ave.,Ashland, Oregon 97520 (541)488-5313 This email transmission is official business of the City of Ashland,and it is subject to Oregon Public Records Law for disclosure and retention.' If you have received this message in error, please contact me at(541)552=2345 .Thank you From:Avram Biondo Sent:Monday, February 03,2020 10:15 AM To:Cory Cushman<cory@johnnycatinc.com>; Robert Lyon<rlctrucks@hotmail.com>; Milt.catter@hgc-inc.net; Barton, Jon<Jon.Barton@kniferiver.com>;joe.soares@kniferiver.com;mayrock319@gmail.com;Scales@CPlpaving.com; marcll@charter.net;CPI@centralpipeline.net; pat.mcnairy@westernemulsions.com;info@hgc-inc.net; info@mmservicesllc.com - Subject: ITB 2020 City of Ashland Contract Trucking • I Hello all, Please see attached ITB and sample contract for as needed trucking services for the City of Ashland. We are looking for Firm Price through Dec. 31St,2020 for the following: 12 yd. bob tail Regular truck and transfer Super transfer Mega dump Mechanical sweeper and/or Regen Air sweeper Vac truck Tack distributor truck(include cost of tack per gallon CSS-1 or City approved alt.) Lowboy Any additional relevant types of trucking services. Please include number of trucks available,weights hauled by trucks, any minimums and special requirements.You may submit bids for any number of trucking services,from one type to all. Multiple contracts may be awarded. 1 Please submit all bids on company letterhead via Email, Fax,or hand delivery by July 16th,2019 2:00 PM PST. If you could confirm receipt of this ITB it would be greatly appreciated. Lastly,feel free to contact if you have any questions and have a great day, Avram Avram Biondo Street Supervisor Public Works Street Division City Of Ashland 90 N. Mountain Ave.,Ashland,Oregon 97520 (541)488-5313 This email transmission is official business of the City of Ashland,and it subject to Oregon Public Records Law for disclosure and retention. If you have received this message in error,please contact me at(541)552-2345.Thank you • I , 2 - s a ns Western Emulsions, Inc. vi.•• • Asphalts• Emulsions • Road Oils . iov 7701 11th Street,White City OR 97503 Phone: 541-826-3373 Fax: TO: City of Ashland ATTN:Jaime 20 E Main Street Ashland, OR 97520 • Phone: (541)552-2010 Fax: - RE: 2020.Emulsion Supply PROJECT NUMBER: BID DATE: February 10, 2020 Product TONS _ Price/Ton Tax Effective Freight Per FOB Excluded Thru Ton HPTC_D33 10.00 $485.00 10/31/2020 $0.00 White City CSS-1H 10.00 $600.00 10/31/2020 $0.00 White City DISTRIBUTOR SERVICE $0.00/TON OR $2,280.00 Minimum Charge $285.00/HOUR (WHICHEVER IS GREATER) Contract Special Provisions: Spreader charge is$285.00/HR.8 Hour Minimum gate to gate. 1> All Product Will Conform to Agency specifications. 2> Western Emulsions,Inc.reserves the right to ship from any supply facility on a freight equalized basis. 3> This price quotation is made expressly subject to the Terms and Conditions of the Western Emulsions,Inc.standard purchase agreement. 4> Freight will be billed separately by a common carrier. • 5> Freight is subject to a fuel surcharge at time of delivery. 6> The above prices on the above quantities are valid for 5(five)days from the date of the quotation and if accepted within the stated period will remain effective thru the 2020 season. Miscellaneous incidental charges are as follow: All prices based on a 0-ton minimum. Full freight charges to destination and 1/2 freight charges will be assessed on returned. product. No credit will be given for anti-strip or diluted materials. Unloading time:0.00 hours free then$0.00 per hour thereafter. Overnight holdover:$0.00.per night. Restocking fee for returned product:$0.00, Equipment charge for job-site • pump-off,flat fee per occurrence(no polymer modified asphalts)$0.00. Thank you for giving us the opportunity to prepare this bid. Pat McNairy Western Emulsions,Inc. • Accepted By: Firm:City of Ashland Date: Quote Number:0000061821 Bid Number:0000061821 2/14/2020 Business Registry Business Name Search • Business Registry Business Name Search 02-14-2020 New Search Business Entity Data 13.19 Entity_ Entity Next Renewal 7I Registry Nbr Type Status Jurisdiction Registry Date Date Renewal Due. 1086177-96 FBC ACT ARIZONA 02-11-2015 02-11-2021 Entity Name (WESTERN EMULSIONS, INC. Foreign Name( 1 ) New Search Associated Names Type PPB PRINCIPAL PLACE OF BUSINESS Addr 1 7165 N PIMA,CANYON DRIVE Addr 2 #151 CSZ TUCSON (AZ 185718 1 I Country IUNITED STATES OF AMERICA Please click here for general information about registered agents and service of process. Type IAGT REGISTERED AGENT Start Date 02-11- Resign Date 2015 Of 158720-88 CORPORATION SERVICE COMPANY Record Addr 1 11127 BROADWAY STREET NE STE 310 - Addr 2I CSZ (SALEM (OR 97301 ( I Country IUNITED STATES OF AMERICA Type (MAL(MAILING ADDRESS I I i Addr 1 7165 N PIMA CANYON DRIVE Addr 2 #151 - CSZ (TUCSON (AZ 185718 I I Country IUNITED STATES OF AMERICA 1 Type IPRE (PRESIDENT I L Resign Date I Name PAUL I IERSLAND I Addr 1 2535 N 15TH AVE I Addr 2 CSZ IDAHO FALLS I 83401 Country ITED STATES OF AMERICA Type SEC SECRETARY Resign Date Name THERESA I (WOODMAN I I Addr 1 2535 N 15TH AVE Addr 2_ _ _ _ _ _ CSZ IDAHO FALLS IID 183401 r I country'UNITED STATES OF AMERICA New Search egov.sos.state.or.us/br/pkg web_name srch_inq.show detl?p_be_rsn=1745251&p_srce=BR_INQ&pprint=TRUE 1/2 2/14/2020 Business Registry Business Name Search Name History Business Entity Name Name Name Start Date End Date Type Status WESTERN EMULSIONS, INC. EN ' CUR 02-11-2015 Please read before ordering Copies. New Search Summary History Image Transaction Effective Name/Agent Available Action Date Date Status Change Dissolved By AMENDED ANNUAL 12-27-2019 FI !REPORT AMENDED ANNUAL 01-08-2019 FI ' REPORT AMENDED ANNUAL 12-29-2017 FI REPORT AMENDED ANNUAL 01-11-2017 FI ' " REPORT AI AMENDED ANNUAL 01-26-2016 FI REPORT CHANGE OF REGISTERED 03-24-2015 FI AGENT/ADDRESS APPLICATION FOR 02-11-2015 FI Agent AUTHORITY © 2020 Oregon Secretary of State. All Rights Reserved. egov.sos.state.or.us/br/pkg_web_name_srch_inq.show_detl?p_be_rsn=1745251&p_srce=BR_INQ&pprint=TRUE 2/2 DATE(MM/DD/YYYY) A`coR 0® CERTIFICATE OF LIABILITY INSURANCE 5/6/2020 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 Idaho-Hub International Transportation Insurance S PHONE Allison Gatlin FAX 900 Pancheri Street Suite B (A/C,No,Ext):208-535-3742 (A/c.No):208-522-1267 Idaho Falls ID 83402 ADDRess: allison.gatlin@hubinternational.com • INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Commerce&Industry Insurance Company 19410 INSURED IDAHASP-01 INSURER B:AIG Specialty Insurance Company 26883 Western50538 Emulsions Inc. P.O. BoxINSURER c:AIG Casualty Company 19402 Idaho Falls ID 83405 INSURERD:WCF National Insurance Company 40517 INSURER E: INSURER F: . COVERAGES CERTIFICATE NUMBER:1847116437 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 LTR INSD VD POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) B X COMMERCIAL GENERAL LIABILITY 1802936 8/1/2019 8/1/2020 EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $1,000,000 MED EXP(Any one person) $25,000 PERSONAL&ADV INJURY $1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY f PRO- JECT LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY 7058783 8/1/2019 8/1/2020 COMBacciINdent)SIED NGLE LIMIT -$1,000,000 (Ea X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) _ C UMBRELLA LIAB X OCCUR 1804341 8/1/2019 8/1/2020 EACH OCCURRENCE $25,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ D WORKERS COMPENSATION 4012708 1/1/2020 1/1/2021 X STATUTE ETH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVEN/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Employer's Liability is underlying on the excess policy EGU1804341. CERTIFICATE HOLDER • CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 East Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 (/Ka(J/C.' ©1988-2015 ACORD CORPORATION. All rights reserved., ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DATE(MM/DD/YYYY) A 9 o® CERTIFICATE OF LIABILITY INSURANCE 1/28/2020 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 t confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Allison Gatlin Idaho-Hub International Transportation Insurance S PHONE 208-522-1260 FAX No):208-522-1267 900 Pancheri Drive IA/C.No.Ext): E-MAIL Suite B ADDRESS: ellison.gatlin@hubinternational.com . Idaho Falls ID 83402 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Workers Compensation Fund 10033 INSURED IDAHASP-01 INSURER B:WCF National Insurance Company 40517 Idaho Asphalt Supply, Inc. Western Emulsions.Inc. INSURER C: Johnny B Transport, LLC INSURER D: P.O. Box 50538 INSURER E: Idaho Falls ID 83405 INSURER F: COVERAGES CERTIFICATE NUMBER:2104040402 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) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEDAMAGE RENTED $ CLAIMS-MADE OCCUR PREM SESO(Ea occurrence) $ MED EXP(Any one person) $ • - PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY — AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ '$ A WORKERS COMPENSATION 4012665 1/1/2020 1/1/2021 X B AND EMPLOYERS'LIABILITY Y/N 4012708 1/1/2020 1/1/2021 STATUTE OTH- ER ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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. To Whom This May Concern AUTHORIZED REPRESEN TIVE (�Y`/�' ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD