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2020-099 PO 20210146- Viking Concrete Cutting Inc
Purchase Order 11)!Al DIY RECORDER Fiscal Year 2021 Page: 1 of: 1 ql'EZIMEi"lig] B City of Ashland LATTN: Accounts Payable Purchase L 20 E. Main 20210146 Ashland, OR 97520 Order# T Phone: 541/552-2010 0 Email: payable@ashland.or.us V H C/O Public Works Department E VIKING CONCRETE CUTTING INC l 51 Winburn Way N 186 AYRES STREET p Ashland, OR 97520 D EAGLE POINT, OR 97524 Phone: 541/488-5347 O T Fax: 541/488-6006 R - _•'�75 5�E=i51§ca�.gf�ej�-_ �F=t� 5 efF�6aE•ia';ieia- __ ------ - --- -- _— c — Scott Fleury .. - _— — -- u �[5��6�3_ �oq.Ia's! -' �• 5y�},��.�P![-t39 g`5�e'��`'F ' =-'- -��!751' •-- - _. -_ .._._-_-_-«_.r__•va---._. •-__ ____.. .- ._ - -mr-car 10/09/2020 5072 _ FOB ASHLAND OR*, 0§01164:-/NET30 Ci Accounts Payable ---£:—�—�'=—•"'""`�� =4r`E a34.. ._a, � �=�?'S=g��----vim tea..��_�,.� ��>�� Airport stormdrain project 1 Airport storm drain project, flash cut asphalt 1.0 $960.00 $960.00 Goods &Services Agreement (less than $25,000) Completion date: 1Z/31/2020 Project Account: *************** GL SUMMARY*************** 085700-704100 $960.00 I I By: Date: Y � Authorized Signature '.960.00 FORM #3. CITY OF A request for a Purchase Orde p / z4 AS H LAN D REQUISITION Date of request: 100/02/�20' Required date for delivery: Vendor Name Viking Concrete Address,City,State,Zip 186 Ayres Street Eagle Point,OR 97524 Contact Name&Telephone Number Bryson Steiner-541-773-2420 Email address - — SOURCING METHOD El Exempt from Competitive Bidding ❑ Emergency El Reason for exemption: ❑ Invitation to Bid 0 Form#13,Written findings and Authorization ❑ AMC 2.50 Date approved by Council: El Written quote or proposal attached ❑ Written quote or proposal attached (Attach copy of council communication) (If council approval required,attach copy of CC) El Small Procurement 0 Request for Proposal Cooperative Procurement Not exceeding$5,000 Date approved by Council:_ ❑ State of Oregon E� Direct Award _(Attach copy of council communication) Contract# ❑ Verbal/Written bid(s)or proposal(s) 0 Request for Qualifications(Public Works) 0 State of Washington Date approved by Council: Contract#_ (Attach copy of council communication) E Other government agency contract Intermediate Procurement El Sole Source Agency GOODS&SERVICES 0 Applicable Form(#5,6,7 or 8) Contract# Greater than$5,000 and less than$100,000 ❑ Written quote or proposal attached Intergovemmental Agreement ❑ (3)Written bids&solicitation attached ❑ Form#4,Personal Services$5K to$75K Agency PERSONAL SERVICES ❑ Special Procurement El 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 ❑ Less than$35,000,by direct appointment 0 Written quote or proposal attached City Administrator.AMC 2.50.070(4) El (3)Written proposals&solicitation attached Date approved by Council: 0 Annual cost to City exceeds$25,000,Council ❑ Form#4,Personal Services$5K to$75K Valid until: (Date) approval required.(Attach copy of council communication) Description of SERVICES Total Cost Airport Stormdrain project, flash cut asphalt $.960.00 Item# Quantity Unit Description of MATERIALS Unit Price Total Cost ❑ Per attached quote/proposal TOTAL COSTS ;$ _ Project Number _ _ _ Account Number 085700 - 704100 _ 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 requisition form,I certify that the City's public contracting requirements have been satisfied. Employee:\Girl U1AJ Department Head: IONIZO 1�"'al to or. •ater han$5,000) Department Manager/Supervisor: City Administrator: ( qua o or greater than$25,000) Funds appropriated for current fiscal year: Y / NO Deffity Finance Director-(Equal to reat tDate lq 9 $5,000) Comments: Form#3-Requisition GOODS AND SERVICES AGREEMENT(LESS THAN$25,000) PROVIDER: Viking Concrete Cutting, Inc. CITY O F PROVIDER'S CONTACT: Bryson Steiner ASHLAND 20 East Main Street ADDRESS: 186 Ayres St. Ashland,Oregon 97520 Eagle Point, OR 97524 Telephone: 541/488-5587 PHONE: 541-884-1399 Fax: 541/488-6006 This Services Agreement (hereinafter "Agreement")g ) is entered into by.and between the City of Ashland, an Oregon municipal corporation (hereinafter "City") and Viking Concrete Cutting, Inc., (a domestic business corporation) ("hereinafter"Provider"), for Airport Storm Drain Project, flash cut asphalt. 1. PROVIDER'S OBLIGATIONS 1.1 Provide Airport Storm Drain Project, flash cut asphalt as set forth in the "SUPPORTING DOCUMENTS" attached hereto and, by this reference, incorporated herein. Provider expressly acknowledges that time is of the essence of any completion date set forth in the SUPPORTING DOCUMENTS,and that no waiver or extension of such deadline may be authorized except in the same manner as herein provided for authority to exceed the maximum compensation. The services defined and described in the "SUPPORTING DOCUMENTS" shall hereinafter be collectively referred to as "Work." 1.2 Provider shall obtain and maintain during the term of this Agreement and until City's final acceptance of all Work received hereunder,a policy or policies of liability insurance including commercial general liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 (two million dollars)per occurrence for Bodily Injury and Property Damage. 1.2.1 The insurance required in this Article shall include the following coverages: • Comprehensive General or Commercial General Liability, including personal injury, contractual liability, and products/completed operations coverage; and • Automobile Liability. • 1.2.2 Each policy of such insurance shall be on an "occurrence"and not a"claims made" form, and shall: • Name as additional insured "the City of Ashland, Oregon, its officers, agents and employees" with respect to claims arising out of the provision of Work under this Agreement; • Apply to each named and additional named insured as though a separate policy had been issued to each,provided that the policy limits shall not be increased thereby; • Apply as primary coverage for each additional named insured except to the extent that two or more such policies are intended to "layer" coverage and, taken together, they provide total coverage from the first dollar of liability; • Provider shall immediately notify the City of any change in insurance coverage • Provider shall supply an endorsement naming the City, its officers, employees and agents as additional insureds by the Effective Date of this Agreement; and • Be evidenced by a certificate or certificates of such insurance approved by the City. Page 1 of 6: Agreement between the City of Ashland and Viking Concrete Cutting,Inc. • 1.3 Provider shall,at its own expense,maintain Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide workers' compensation coverage for all of its subject workers. 1.4 Provider agrees that no person shall, on the grounds of race, color, religion, creed, sex, marital status, familial status or domestic partnership, national origin, age, mental or physical disability, sexual orientation, gender identity or source of income, suffer discrimination in the performance of this Agreement when employed by Provider. Provider agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules.and regulations. Further, Provider agrees not to discriminate against a disadvantaged business enterprise,minority-owned business,woman-owned business, a business that a service-disabled veteran owns or an emerging small business enterprise certified under ORS 200.055, in awarding subcontracts as required by ORS 279A.110. 1.5 In all solicitations either by competitive bidding or negotiation made by Provider for work to be performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Providers of the Provider's obligations under this Agreement and Title VI of the Civil Rights Act of 1964 and other federal nondiscrimination laws. 1.6 Living Wage Requirements: If the amount of this Agreement is $22,002.43 or more, Provider is required to comply with Chapter 3.12 of the Ashland Municipal Code by paying a living wage,as defined in that chapter,to all employees performing Work under this Agreement and to any Subcontractor who performs 50% or more of the Work under this Agreement. Provider is also required to post the notice attached hereto as"Exhibit A"predominantly in areas where it will be seen by all employees. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider the sum of$960.00 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$960.00 without express, written approval from the City official whose signature appears below, or such official's successor in office. Provider expressly acknowledges that no other person has authority to order or authorize additional Work which would cause this maximum sum to be exceeded and that any authorization from the responsible official must be in writing. Provider further acknowledges that any Work delivered or expenses incurred without authorization as provided herein is done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement. 3. GENERAL PROVISIONS 3.1 This is a non-exclusive Agreement. City is not obligated to procure any specific amount of Work from Provider and is free to procure similar types of goods and services from other providers in its sole discretion. 3.2 Provider is an independent contractor and riot 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. Page 2 of 6: Agreement between the City of Ashland and Viking Concrete Cutting,Inc. • 3.5 This Agreement may be amended only by written instrument executed with the same formalities as this. Agreement. 3.6 The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220,279B.230 and 279B.235. 3.7 This Agreement shall be governed by the laws of the State of Oregon without regard to conflict of laws principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is 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 transferred,as appropriate, so as to effectuate this choice of venue.ase may be dismissed or its venue 3.8 Provider shall defend,save,hold harmless and indemnify the City and its officers,employees and agents from and against any and all claims, suits, actions, losses, damages, liabilities, costs, and expenses of any nature resulting from, arising out of, or relating to the activities of Provider or its officers, employees,contractors, or agents under this Agreement. { 3.9 Neither party to this Agreement shall hold the other responsible for damages or delay in performance caused by acts of God,strikes,lockouts,accidents,or other events beyond the control of the other or the other's officers,employees or agents. 3.10 If any provision of this Agreement is found �' by a court of competent jurisdiction to be unenforceable, such provision shall not affect the other provisions, but such unenforceable provision shall be deemed modified to the extent necessary to render it enforceable,preserving to the fullest extent permitted the intent of Provider and the City set forth in this.Agreement. 3.11 Deliveries will be F.O.B destination. Provider shall pay all transportation and handling charges for the Goods.Provider is responsible and liable for loss or damage until final inspection and acceptance of the Goods by the City. Provider remains liable for latent defects, fraud, and warranties. 3.12 The City may inspect and test the Goods. The City may reject non-conforming Goods and require Provider to correct them without charge or deliver them at a reduced price, as negotiated. If Provider does not cure any defects within a reasonable time, the City may reject the Goods and cancel this Agreement in whole or in part. This paragraph does not affect or limit the City's rights, including its rights under the Uniform Commercial Code,ORS Chapter 72(UCC). 3.13 Provider represents and warrants that the Goods are new, current, and fully warranted by the manufacturer. Delivered Goods will comply with SUPPORTING DOCUMENTS and be free from defects in labor,material and manufacture. Provider shall transfer all warranties to the City. 4. SUPPORTING DOCUMENTS The following documents are,by this reference,expressly incorporated in this Agreement,and are collectively referred to in this Agreement as the "SUPPORTING DOCUMENTS:" • The Provider's complete written Estimate dated 09/30/2020. Page 3 of 6: Agreement between the City of Ashland and Viking Concrete Cutting,Inc. 1 5. REMEDIES 5.1 In the event Provider is in default of this Agreement, City may, at its option,pursue any or all of the remedies available to it under this Agreement and at law or in equity, including,but not limited to: 5.1.1 Termination of this Agreement; 5.1.2 Withholding all monies due for the Work that Provider has failed to deliver within any scheduled completion dates or any Work that have been delivered inadequately or defectively; 5.1.3 Initiation of an action or proceeding for damages, specific performance, or declaratory or injunctive relief; 5.1.4 These remedies are cumulative to the extent the remedies are not inconsistent,and City may pursue any remedy or remedies singly, collectively, successively or in any order whatsoever. 5.2 In no event shall City be liable to Provider for any expenses related to termination of this Agreement or for anticipated profits. If previous amounts paid to Provider exceed the amount due,Provider shall pay immediately any excess to City upon written demand provided. 6. TERM AND TERMINATION 6.1 Term This Agreement shall be effective from the date of execution on behalf of the City as set forth below (the"Effective Date"),and shall continue in full force and effect until December 31,2020,unless sooner terminated as provided in Subsection 6.2. 6.2 Termination 6.2.1 The City and Provider may terminate this Agreement by mutual agreement at any time. 6.2.2 The City may, upon not less than thirtydays' 30( ) prior written notice, terminate this Agreement for any reason deemed appropriate in its sole discretion. 6.2.3 Either party may terminate this Agreement, with cause, by not less than fourteen(14) days' prior written notice if the cause is not cured within that fourteen (14) day period after written notice. Such termination is.in addition to and not in lieu of any other remedy at law or equity. 7. NOTICE Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery, by sending via a reputable commercial overnight courier, or by mailing using registered or certified United States mail, return receipt requested, postage prepaid, to the address set forth below: If to the City: City of Ashland—Public Works Department Attn: Chance Metcalf 20 E.Main Street Ashland, Oregon 97520 Phone: (541)488-5587 With a copy to: City of Ashland—Legal Department 20 E. Main Street Ashland, OR 97520 Phone: (541)488-5350 Page 4 of 6: Agreement between the City of Ashland and Viking Concrete Cutting,Inc. • If to Provider: Viking Concrete Cutting,Inc. 186 Ayres St. Eagle Point,OR 97524 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 Viking Concrete Cutting,Inc. CITY OF ASHLAND: VIKING CONCRETE CUTTING,INC. (PROVIDER): • By: �'� By: 5. ' l'= Signature FteutNi /Printed Name Printed Name tet.Naa—L wt5 pcnac-It -er Title itle tgs[20 /D/ - ?-00.0 Date Date (W-9 is to be submitted with this signed Agreement) Purchase Order No. /7'°‘ Page 6 of 6: Agreement between the City of Ashland and Viking Concrete Cutting,Inc. 1 • "7•I • �/ Em mng CONCRETE CUTTI G INC. 186 Ayres Street,Eagle Point,OR 97524 Oregon CCB#162173-California#568236 Office-(541)773-2420 Email-bryson@vikingconcretecutting.corn Proposal / Quote Date:9/30/2020 Project: Ashland Airport Prevailing Wage Project: No Addendum: No Scope: Flat Saw-480'of 8"asphalt- Vacuum Slurry- Haul Offsite Total: $960.00 Clarifications: 1. Viking Concrete Cutting will need a minimum of 5 day notice for all concrete cutting work. 2. Contractor to provide access to all work areas. 3. Contractor to provide required lighting&traffic control If needed. 4. Mobilizations are considered consecutive days of work within the same scope.Any stoppage of work more than 1 day will result in an additional mobilization charge. Exclusions: Layout,Damage to Unknown and/or Unmarked Utilities, Overtime,Traffic Control,Permits,Standby, Covering Openings,Design and/or Structural Issues,Protection of ANY Existing Finished Surfaces, Excavations and/or Compaction(Unless Specified in Quote),Testing/Handling and/or Removal of ANY Hazardous Material,Shoring/Bracing,Fencing(Unless Specified in Quote),Concrete Sawing and/or Breaking of ANY existing Footings Unforeseen,Clean Up Above and Beyond Bask"Broominq':Any/All Third-Party Inspections and/or Cost Related to Inspections. Accepted By: Date: 4/14/2020 • Business Registry Business Name Search Business Registry Business Name Search 04-14-2020 New Search Business Entity Data 11:20 Registry Nbr EEntity 248212-90 DBC ACT Jurisdiction Registry Date Next Renewal Renewal Due? Typentity Status Date OREGON 10-22-2004 10-22-2020 Entity Name VIKING CONCRETE CUTTING INC. Foreign Name New Search Associated Names Type PPB PRINCIPAL PLACE OF BUSINESS Addr 1 186 AYRES ST Addr 2 CSZ EAGLE POINT OR (97524 ( ( Country (UNITED STATES OF AMERICA Please click her for general information about registered agents and service of process. Type • GT REGISTERED AGENT Start Date 10-22- Resign Date 2004 Name I ORGAN (STEINER 1 Addr 1 186 AYRES ST Addr 2 CSZ AGLE POINT bOR 197524 I ( Country UNITED STATES OF AMERICA Type MALI • 1 ING ADDRESS Addr 1 186 AYRES ST Addr 2 CSZ EAGLE POINT OR 97524 Country ITED STATES OF AMERICA Type PRE 'RESIDENT Resign Date Name (MORGAN 1 STEINER I Addr 1 186 AYRES ST Addr 2 CSZ EAGLE POINT OR 97524 Country (UNITED STATES OF AMERICA Type SEC SECRETARY J Resign Date Name ELLEN ..______A I STEINER ( Addr 1 186 AYRES ST Addr 2 . - CSZ EAGLE POINT OR 97524 Country ITED STATES OF AMERICA New Search Name History egov.sos.state.or.us/br/pkg_web_name_srch_inq.show_deti?p_be_rsn=1066293&p_srce=BR_INQ&pJJrint=TRUE 1/2 4/14/2020 Business Registry Business Name Search ' Business Entity Name Name Name Start Date End Date — - Type Status IKING CONCRETE CUTTING INC. EN CUR. 10-22-2004 Please read before ordering Copies. New Search Summary History Image Transaction Effective Name/Agent Action Status Dissolved By Available Date Date Change • 1 NDED ANNUAL 09-29-2019 FI REPORT • NDED ANNUAL 09-13-2018 FI I' PORT • MENDED ANNUAL 10-02-2017 FI PORT • NDED ANNUAL 10-19-2016 REPORT 0 • 1 DMT TO ANNUAL 10-17-2016 FI I' 'T/INFO STATEMENT • ENDED ANNUAL I' PORT 10-08-2015 FI • 1 NDED ANNUAL 10-08-2014 FI REPORT • AL REPORT 09-19-2013 SYS 'AYMENT • AL REPORT 09-13-2012 SYS PAYMENT • AL REPORT 09-16-2011 SYS PAYMENT • AL REPORT 09-16-2010 SYS PAYMENT • AL REPORT 09-15-2009 SYS PAYMENT • AL REPORT 09-18-2008 SYS PAYMENT • AL REPORT PAYMENT 09-11-2007 SYS • AL REPORT 09-14-2006 SYS PAYMENT • NDED ANNUAL 09-22-2005 FI REPORT • 'TICLES OF 10-22-2004 FI Agent 1 CORPORATION ©2020 Oregon Secretary of State. All Rights Reserved. egov.sos.state.or.us/br/pkg web_name_srch_inq.show detl?p_be_rsn=1066293&p_srce=BR_NQ&p print=TRUE 2/2 AR® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 3/31/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Ward Insurance Agency Inc. PHONE Kim Schnetzky FAX PO Box 10167 rA/c.No.Ext):541-687-1117 (A/C.No):541-342-8280 Eugene OR 97440 ADDRESS: kim@wardinsurance.net INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Cincinnati Insurance Company 10677 INSURED VIKICON-01 INSURER B Viking Concrete Cutting, Inc. 186 Ayres St INSURER C Eagle Point OR 97524 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:261415030 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 SUER POLICY EFF POLICY EXP LIMITS LTR _ INSD WVO POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY Y Y EPP 0135156 4/25/2020 4/25/2021 EACH OCCURRENCE $1,000,000 DAMAGE TO D CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $$00,000 • MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY X jEC LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Y Y OM 0135156 4/25/2020 4/25/2021 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) $ A X UMBRELLA LIAB X OCCUR EPP 0135156 4/25/2020 4/25/2021 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DED RETENTION$ $ WORKERS COMPENSATION OTH- AND EMPLOYERS'LIABILITY Y/N PER 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 $ A Scheduled Equipment EPP 0135156 4/25/2020 4/25/2021 Limit:See Schedule Ded:$500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Certificate holder and all entities required by written contract are included as additional insureds on a primary and non-contributory basis with waiver of subrogation as respects to the general liability including completed operations and auto liability as required by written contract per attached endorsements. Subject to policy limits,terms,conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 E Main Street AUTHORIZE REPRESENTATIVE Ashland OR 97520 ©1988-2015 ACORD CORPORATION. All rights reserved. f• ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 1 • • THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. However,any"auto.that Is leased. a. Is effective on the date of acquisition hired,rented or borrowed with a driver or formation,and Is afforded for 160 ® is not a covered'auto". days after such date: CinCIPIUS E. Audio,Visual and Data Electronic Equip- b. Does not apply PP 'bodily(fury or BUSINESS AUTO XC+® men! 'property damage'restatingran SECTION III-PHYSICAL DAMAGE "accident'that occurred beforere you (EXPANDED COVERAGE PLUS) COV- ERAGE,C.Limit of Insurance Is amended acquired or formed the organization: ENDORSEMENT by adding the following: a Does not apply to any newly acquired or formed organization that Is a Joint 4. The most we will pay for all loss"to au- venture or partnership;and din visual or data electronic equipment This endorsement modifies insurance provided by the following: and any accessories used with this d. Does not apply to an insured under equipment as a result of any one'and- any other automobile liability policy, BUSINESS AUTO COVERAGE FORM dent°Is the lesser of; or would be an Insured under such a • a. The actual cash value of the dam- polley but for the termination of such With respect to the coverage provided by this endorsement,the provisions of the Coverage Form appy unless aged cur stolen property as of the time policy or the insuraexhaunce. of such pall- aged by this endorsement of Me'acddenl`, cys limits of Insurance. b3. My of your°employees•while using a . The cost of repairing or replacing g thecovered°auto'in your business or your damaged or stolen property with oth- A Blanket Waiver of Subrogation This provision does not apply unless the valid personal affairs,provided you do not own, written contract has been: er property of like kind and quality;or hire or borrow that°auto% SECTION IV-BUSINESS AUTO CONDI- c. $2,500. TIONS,A.Loss Conditions,5.Transfer of 1. Executed prior la the accident causing c G. Liability Coverage Extensions-Supple- Rights of Recovery Against Others to Us Is 'badity injury cur•property damage^,and Provided the equipment,at the time of the mentary Payments-Higher Limits amended by the addition of the following: 2. Is still in force at the time of the"accident" 'loss'Is: SECTION II•LIABILITY COVERAGE,A. We waive any right of recovery we may have causing'bodily Injury or"property dam- a. Permanently instated In or upon the Coverage,2.Coverage Extensions,a.Sup- against any person or organization because of age', covered'auto°in a housing.opening piementary Payments Is amended by: payments we make for'bodily Injury or D. Employee or other location that Is not normally 'property damage'arising out of the operation P oyee Hired Auto 1. for ballallbg the with 0010 of2)Insurance of a covered"auto'when you have assumed used by the"auto" equipment;cturer far for bonds with$4,000 in(2);and tiabifty for such'bodily Injury or°property 1. Changes in Liability Coverage the installation of such equipment; damage under an"Insured contract', rovid- The followingis added to the Section II• b. Removable from apermanentlyIn- 2. reesodng the ens s with $f 00 in(4).for 9 P a reasonable expenses with$500 in(4). ed the"bodily injury"or'property damage•ac- Liability Coverage, A. Coverage, 1. staged housing unit as described In curs subsequent to the execution or the'in- Who Is an Insured: Paragraph 2.a.above;or H. Amended Fellow Employee Exclusion sured contract'. An'employee"of yours is an"insured' cAn Integral part of such equipment SECTION II-LIABILITY COVERAGE,B.Ex- B- Noncontributory Insurance while operating an°auto•hired or rented elusions,5.Fellow Employee is modified as under a contract or agreement In that F. Who is an Insured-Amended follows: SECTION IV•BUSINESS AUTO CONDI- "employee's°name,with your permission, SECTION II-LIABILITY COVERAGE,A TIONS,B.General Conditions,5.Other In- while pedonning duties related to the Coverage,1.Who Is an Insured is amended Exclusion 5.Fellow Employee is deleted. surance cIs replaced by the following: conduct of your business. by adding the following: I. Hired Auto-Physical Damage c Regardless of the provisions of Par- 2. Changes In General Conditions The followingds. If hired°autos°are covered"autos"for Uabil agraph a. above, this CoverageCoverage,then Comprehensive and Collision Form's Liability Coverage Is primary SECTION IV-BUSINESS AUTO CON- 1. My subsidiary which Is a legally Marren- Physical Damage Coverages as provided un- and we will not seek contribution DITIONS, B. General Conditions, S. rated entity of which you own a financial der SECTION III - PHYSICAL DAMAGE from any other Insurance for any 6a- Other Insurance Is amended by replac- interest of more than 50%of the voting COVERAGE of this Coverage Part are ex- bilk/ assumed tinder an 'insured ing Paragraph 5.b.with the following: stock on the effective date of this cover- tended to'autos° ou contract"Ihal requires liability to be age form. y hire,subject to the for- contract" assumed on a primary nonconlrbulo- b. Far Hired Auto Physical Damage g lowing: ry basis. Coverage the following arc deemed However,the Insurance afforded by this C. Additional Insured byContract to be covered"autos'you own: provision does not apply to any subsidiary 1. The mast we will pay fore actual l0 any that Is an Insured°under anyother au- hire "auto°Is repair or the cash (1) My covered'auto"you lease, lomohile liability call value nr cast to repair or replace,which- SECTION II-LIABILITY COVERAGE,A. hire,rent or borrow;and ry p cy,or would he an Coverage,I.Who Is an Insured is amended •insured•under such policy but for tenni- ever is the least,minus a to l to include as an insured any person 1r argent- (2) rented by covered 'auto' 'employeetired or nation of such policy or the exhaustion of 2. The deductible will he equal to the largest zatian with which you have agreed Ina validy under such policy's limits of Insurance. deductible applicable to any awned'ante written contract to provide insurance as Is af- a contract In that Individual"em- for that coverage,or$1,000,whichever Is P per- 2. Any organization that is newly acquired or forded by this policy. pl0yee's°name,with your formed by you and aver which you main- less. mission•while performing duties tain majority This provision Is limited to the scope of the related to the conduct of your 1 h ownership.The Insurance 3. Hired Aute-Physical Damage coverage valid written contract. business. provided by Ibis provision: a excess over any other collectible Insur- ance. Includes copyrighted material or 150 Includes copyrighted material 01150 AA 28a 01 16 Properties.Inc.with its permission. Page 1 of 4 AA2ta 0116 Properties.Inc.,with Its permission. Page 2 of 4 4. Subject to the above bit,deductible,and K. Transportation Expense-Higher Limits 2. SECTION V-DEFINITIONS is amended P. Unintentional Failure to Disclose Hazards excess provisions we will provide cover- by adding the following.but only for the age equal to the broadest coverage appli- SECTION III-PHYSICAL DAMAGE COV- purposes of this Loan or Lease Gap SECTION IV•BUSINESS AUTO CONDI- cable to any covered"auto"you own in- ERAGE,A.Coverage,4.Coverage Exten• Coverage: TIONS,B.General Conditions,2. anceal- sured under this policy. storm Is amended by replacing$20 per day meet, Misrepresentation or Fraud Is with 550 per day,and$600 maximum with °Total loss"means a"loss°in which the amended by adding the following: Coverage Includes loss of use of that hired au- $1,500 maximum In Extension a.Tmnspor- cost of repairs plus the salvage value no- However,if you unintentionally tall la to,provided It results from an'accident'for gallon Expenses. ceeds the actual cash value. any hazards existing on the effective fall disclose of which you are legally losslisbIes and as aa result of L Airbag Coverage N. Glass Repair Waiver of Deductible this Coverage Form.we will not denycover- which a menemry Is sustained by the 0 P g leasing or rental concern.The mast we will SECTION III•PHYSICAL DAMAGE COV- SECTION III•PHYSICAL DAMAGE COV- age under this Coverage Form because of pay lar any one"accident"Is 53.000. ERAGE,B.Exclusions,3.a.is amended by ERAGE,D.Deductible is amended by adding such failure. If a Ionil for Hired Auto-Physical Damage Is adding the following: the following: Q. Mental Anguish Resulting learn Bodily Inju- shown In the Schedule,then that limit replac- However, the mechanical and electrical •No deductible applies to glass damage if the ry es.and Is not added to,the 050.000 limit Inds- breakdown portion of Ibis exclusion does not glass is repaired In a manner acceptable to us SECTION V-DEFINITIONS,C."Bodily Inju- noted above. apply to the accidental discharge of an airbag. rather than replaced. ry"Is deleted In Its entirety and replaced by J. Rental Reimbursement This coverage far airbags Is excess over any O. Duties In the Event of an Accident,Claim, the following: ether collectible insurance or warranty. lt Loss "Bodily Injury" SECTION III Suoross- meney PHYSICAL DAMAGE is mean buddy injury.sickness or amended by adding the following: M. Loan or Lease Gap Coverage SECTION IV•BUSINESS AUTO CONDI- disease sustained by a person,Including men- tal1. SECTION III - PHYSICAL DAMAGE TIONS,A.Loss Conditions,2.Duties In the pe sonutha and death f sustsoily same 1. We will Pay for rental reimbursement rental l o• person that results from such bodily injury, by you COVERAGE,C Limit of Insurance is Event of Accident,Claim,Suit or Loss,a.ts anises'carried for the reotel ofsickness or disease.'Bodily Injury'does not an'auto'because of a'loss'to a covered deleted In its entirety and replaced by the amended by adding the following: Include mental anguish or death that does not 'auto".Pa ant applies In addition to Um following,but only for private passenger result from bodilyinjury.sickness or disease. YiPP This condition applies only when the'acct- erage you applicable amount of each cow- type'autos"with an enigma!ofral'total or lease, and onlyin the event of a'total loss'to dent'or loss"Is known to: R. Coveragefor Certain Operations In Con- deductible have on this covered"auto".Na such a passengertype°auto': nectlanwith Railroads P deducible applies to coverage. privateP 9 1. You,if you are an Individual; 2. We will pay only far those expenses in- a. The most we will pay for"loss"In any 2. A partner,If you area partnership; With respect to the use of a covered"auto'in creed during the policy period beginning one'acddenl'ts the greater ah operations far or affecting a railroad: 24 hours after the'loss'and ending.re• 3. An executive officer or insurance manag- ardless of the poll ys expiration,with (1) The amount due under the terms er,if you are a corporation;or 1. Sec"on V•Definitions,H.'Insured con- 9P of the lease or loan to tract;1.c.Is amended to mad: the lesser of the following number of your covered private passenger 4. A member or manager,If you are a!Inn- days: type"auto"Is subject,but will not lied liability company. c. An easement or license agreement: a. The number of days reasonably re- Include: 2. Section V-Definitions,H.°Insured can- quired to repair the covered'auto".If (a) Overdue lease or loan pay- tract•,2.0.Is deleted. 'loss'Is caused by theft,this number ments; of days Is added to the number of days it takes to locale the covered (b) Financial penalties imposed "auto'and return It to you;or under the lease due to high h. 30 mileage,excessIve use or days. abnormal wear and lean 3. Our payment is limited to the lesser of the (c) Security deposits not re- following amounts: funded by the lessor, a. Necessary and actual expenses In. (d) Costs for extended warren- curred;or ties.Credit Life Insurance, b. $50 per day. Health.Accident or Disabil- ity Insurance purchased 4. This coverage does not apply while there with the loan or lease;and are spare or reserve'autos"available to you for your operations. (01 Carry-over balances from previous loans or leases,or 5. We will pay under this coverage only that amount of your rental reimbursement ex- (2) Actual cash value of the stolen penes which Is not already provided for an damaged property. under SECTION III-PHYSICAL DAM- h. An adjustment for depreciation and AGE COVERAGE, A. Coverage, 4. physical condition will be made In de- Coverage Extenlons. termining actual cash value at the time of'loss". Includes copydghled material of ISO Includes copyrighted material of ISO AA 206 01 16 Properties.Inc..with its permission. Page 3 of 4 AA 266 0116 Properties,Inc,with Its permission. Page 4 of 4 , THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. 6. Voluntary Property Damage(Coverage a.)and Care,Custody or Control Liability Coverage (Coverage b.) OREGON CONTRACTORS'COMMERCIAL GENERAL LIABILITY limits of Insurance(Each Occurrence) BROADENED ENDORSEMENT Coverage x.51,000 Coverage h.06,000 unless otherwise stated $ Deductibles(Each Occurrence) This endorsement modifies insurance provided under the following: Coverage 0.0250 COMMERCIAL GENERAL LIABILITY COVERAGE PART coverage 6.0250 unless otherwise staled $ COVERAGE PREMIUM BASIS RATE ADVANCE PREMIUM A. Endorsement-Table of Contents: a Area Far Limits In Excess of Coveraar• Begins on Pane. Ir)Payroll ( (Far LimitsInExcess of c Gross Sales 05,000) 05,000) 1. Employee Benefit Llre to ty Courage_.._.._..._..._..._...__...._._..._.__..._..._....._..._.._.._.__.___.2 d�Units 2. Unintentional Failure to Disclose Hazarde...._.__..._..._..._...____._..._.._..._...__..._.._.._..._....6 a Other 3. Damage to Premises Reined to You..__.__..__._..._.__....._...__._..._..._..._....._..._..._...__.__.__B h. Cara, Custod 4. Supplementary Paymente..._..._..._.._.__........................................................__._..._..._..9 or Control y $ 6. Medical Payments...._..._............_..._....._..._..._..._..._..._.....__._..... ............_............._..._..10 6. Voluntary Property Damage(Coverage a.)end Caro,Custody or Control TD`fAL ANNUAL PREMIUM 0 Liability Coverage(Coverage bJ-••—•_..__._...__.__.__.._..._......_..._ _.._i0 11.Property Damage to Borrowed Equipment 7. tau Day Coverage for Newly Formed or Acquired Organizations_.._.._.._...___...__..._..._..._...10 8. Waiver of Subrogation...._......_..._..._.��._..._.._. ..._..__...___._._._..._...__..._........_..._16 Eedr Oagarence Unit $10.000 B. Automatic Addtlanailnsured-Specified ReletonsHps:...._..._..._..__.....__..._..._. ..__11 Deductible: $ 250 X Managers or Lessors of Premises; .._.._.._. x Lessor of Leased Equipment; x Vendors; x State or Political Subdivisions-Permits Relating to Premises; C. Coverages: x State or Political Subdivision1. E -Permits;and Liability e 2) defende and duty to X Contractors'Operations Employee Benefit lllly Coveragends when we li- 10.Broadened Contractual Llab -WorkIilhin 50'of Railroad Property_ cave used upiheappe gily p rty_.____._..._..._...__..._.._16 a. The fV ERAG Is 0 SECTION t cable Iof ment or 12.Employ Damage to ds-Spedc Eqfieri Heantlth C_..._ervices._...__..._..._..._.,W...__.__..._.._..._..._.16 •COVERAGES:Employee Benefit in the payment st e. 12.Employees aslnsureds-Spedfied HeaNh care Services:...._...___..._........__..._......__........_...16 Liability Coverage. )ud9mems or settle. X Nurses X EmergancyMedcelTedtnidans;and (1) Insuring Agreement mance. x Paramedics (a) We will pay thou sums that No other a aol am or rob 13.Broadened Notice ofOccurrence._._..._........__._..._.............._..._..._..._....._..._..._..._..._...__....16 the Insured becomes legal' ity to Pay sums or perform obligated to pay as dam- ads or services Is covered ages caused by any act,er- unless explicitly provided for ror or omission of the in- under Supplementary Pay. B. Limits of Insurance; salad,or of any other per- menu, The Commerdal General liability limits of Insurance apply to the Insurance provided by this endorsement, son for whose acts the In- (b)This insurance applies to except as provided belovr. steed Is legally liable,to er- Wi h this Insurance op. for damages only If the ad,gy. 1. Employee Benefit Liability Coveragegentlyar comission,ommitted is retie plies.We will have the right mm00" In the Each Employee Limit $ 1,000,000 and duty to defend the In- administration" of your Aggregate Unit $ 3,000,000 sired against any o oo. 'employee benefit program; Deductible: $ 1,000 seeking those damages. and Howeverwe will have no 3. Damage to Premises Rented to You duty to de end against any 1) Occurs during the poI- Theesseraf: "suit'seeking damages to Icypedad;or witch this Insurance does a. The Each Occurrence Limit shown In the Declarations;or not apply.We may,at our 2) Occurred prior to the discretion, Investigate any effective date (fhb h. $000,000 unless otherwise slated 0 report of an ad,error or endorsement provided: omission settle 4. Supplementary Payments claim or natal d that may a) You did not have n,But: knowledge of a su a. Bail bonds: $ 1.000 claim or°suit'on b. Loss of earnings $ 360 1) The amount we vel pay or before the ef- for damages Is limited fetdive dale of this 6, Medical Payments as described In SEC- endorsement. Medical Expense Limit $ 10,000 TION Ill-LIMITS OF You will be INSURANCE;and deemed to have Indudes eopydgtaed meter's'of insurance Includes mpyrlgleed matedal of insurance GA 233 OR 0910 SanNees OM.,Inc.,odOh Its permission. Page 1 of 16 GA233 OR 0910 Services Office,Inc.,with l5 permission. Page 2 of16 • knowledge of a 1) Failure of any Invest- (3) Coerdon, demotion, tors are Insureds,but only claim or "suit' menti to perform; evaluation, reassign- with respect to their duties when any"author- moot,discipline,dela- as your officers or directors. Red represenla. 2) Errors In providing tin- motion, harassment, Your stockholders are also tine"; formation on past per- humillatim,iiscrimina- Insureds,but only with no- formence of Investment ion or other employ. sped to their Iiabllly as I) Reports all,or vehicles;or ment-related practices, stockholders. any part,of the 3) Advice gives to anyads or omissions;or ed, error or (e) A trust,you are en Insured omission to us person with rasped to (4) Consequential liability Your trustees are also In- or any other that person's decision as a result of(1).(2)or swede,but only with respect Insurer; to participate or not to (3)above, to their duties as trustees. padldpate in any plan Il) Rerelvee a Included in the "em- This overeaten applies (2) Beds of the following Is also en written or ver- ployee benefit pm- whether the Insured may be Insured: bat demand or gram". held liable as en employer Balm for darn- or In any other capacity and (a) Each of your"employees" ages because (f) Workers' Compensation to any obligation to share who Is or was authorized to of the ad,error and 3lmilar Laws damages with or repay administer your"employee or omission; Any daim arising out of your someone also who must benefit program". and failure to comply with the pay damages bemuse of (b) My persons,organizations mandatary provisions of an the In}hry. or °em to es" having There Is no other y p eppembla Nsur- workers'compensation,ton- (3) Supplementary Payments proper temporary yotherim- enca employment compensation tion to beneist your"em- Insurance, "If Insuranm,nodal security or SECTION I COVERAGES, *yea benefit program"If (2) Exclusions disability benefits law or any SUPPLEMENTARY PAY- you de,but only until your This insurance does not apply to: similar law. B also apply tto is Cuvve Coverage.AND pointed. (g) Is sp- a Bodily Ina Property (9) ERISA () Damage r personal anDamages for which anyIn- h. Who Is an Insured (a) Your legal representative if g you die,but only With re. Advertlsing Injury awed Is mpose because atided-of G- Asby ov rag,SEC IO II-W LO il- sped to duties as suds. 'Bodily Injury', 'property ary b I esed l a eReby INSURE,SECTION Ir WHO IS That l your rrights wig damage"or"personal and re a the Employee Re- AN INSURED by deleted In Its entirety have an your rights ende du- Act of Income Security and replaced bythafollowing: ties antler Ws Coverage edvartising ijury'. Act of 1974, as now or 6 Dishonest, Fraudulen hereafter emended, or by (1) lfyeo are designated In the Dec- ( ec- Pert. () t' any similar federal,elate or laretians es: (3) Any organization you newly ea- Criminal or Malig(ous Act local lavrsuanquire or farm,other than a part- Damages arising out of any (a) spouse arel'Insureds,your nersiip,Joint venture or limited Intentional, dshenest, (h)Available Benefits only with respect to the con- 0ahifiry company,and over which fraudulent,criminal or mat- My claim for benefits to the dud of a badness of which you maintain ownership or ma- does act,error or omission, rodent that such benefits are you are the sole owner. Jetty Interest,Wil qualify as a committed by any Insured, available, with reasonable Named Insured If no other skid- Including the willful or reck- effort and cooperation of the (b)A partnership or joint von- lar Insurance applies to that or- less violation ofany statute. Insured from the applicable lure,you are an Insured. gedzation. However, coverage c Failure to Perform a Con- funds eceved or other mi- Your members,your part- under this provision: () nem,and Neil-spouses are toot IeNtlelnshaanca. a also Insureds but only with () Is afforded only until the Damages arising out of fel- (i) Taxes,Fines erPenalties respect to the conduct of 180th day after you acquire or the or ore of performance of eon- Taxes, fines or penalties, your business, libelorrn o d of the polity prod, trad by any Insurer. Including those Imposed (a) A limned liability company, whichever is earlier,and d Insutfiolenc of Funds under the Internal Revenue you re an Insured.Your () Y Cade or any similar state or members are also insureds, (b) Does not apply to any not, Damages arising cut of an local law. but only with respect to the error or omission that was Insuffdency of funds to Pm Eto conduct of your badness. committed before you or- meet any obligations under (I) i yYour managers are insur- quired or formed the crowd- any plan included In the racticesment-Related ds,but onlywith respect to codes. 'employee benefit program". Any liability arising out of their duties as your manag- c. Limits of Insurance any: arsAs respects Employee Benefit Debit- onceInadequacyof Perform- once o1 Investment l Ad- (1) Refusalto employ; (d) An organization other than a iy Coverage,SECTION IS-LIMITS Vice Given With Respect partnership,Joint venture or OF INSURANCE Is deleted In Its en- to Participation (2)Termination of em- ployment; limited Ilahity company,you tlrety and replaced by the following: An claim basedu on: are ve Insured.Your rex- Y P valve officers"and direa- • Indudes copyrighted material of Insurance Includes copyrigfted material of Insurance GA 233 OR 09 10 Services once,Ina.,with Its permission. Page 3 of 16 GA 233 OR 0910 Services Office,Inc,with Its permission. Paged of 16 Ii( • (1)The Limits of Insurance shown In amount stated In the Dada- may result In a claim. surance may also Section B.Limits of Insurance, rations as applicable to To the extent possible, apply. 1.Employee Benefit Liability Each Employee.The limits notice should Include: Coverage and the rules below of Insurance shall not be m- d. No Insured will,except fix the most we will pay regard- doted by the amount of this (1)What the act,error at that Insured'own less of the number of deducible. or omicron was cost,voluntarily make a and when It oc- payment,assume any p (a) Insureds; (h)The deductible amount stared;and blgation,or Incur any (h) Claims made or "suits" stated In the Declarations expense vAlhout our draught, applies to all damages sus- (2)The names and consent. tabled by any one "ern- addresses of any. (a) Persons or organizations ployae", Including such one who may suf- (2) Item 5.Other Insurance is de- making claims or bringing "employee'" dependents far damages ase kited In Its entirety and replaced "sults"; end beneficiaries,bemuse result of the ad, by the following: of(d)Acts.errors or omissions;or scene to widdt his Incur-errors or ands- error Is made b, If a claim Is made or 5• Other Insurance once apples. if other valid end collectible (a) Benefits ndudod In your scat"Is brought against "employee benefit pmgrem'. (c) The terms of this Insurance, any Insured,you must Insurance Is available to the Including those with respect Insured for a loss we cover (2) The Aggregate Limit shown In to: (1) Immediately re- under this Coverage Part, Section B.Limits of Insurance, cad the specifics our obligations are limited 1.Employee Benefit Liability 1) Our right and duty to of the claim or as follows: Coverage of this endorsement Is defend the Insured 'sale and the date the most we win pay for a0 dart against any 'sults" received;and a. PYmary Insurance ages because of ads,errors or seeldng hose dartis omtsdons negligently committed ages,and (2) Notify us as soon This Ieeoc t e ee prl- In the°administration"of your as practicable. mar}, applies,I(hh In- "employee benefit program". 2) Year doles, and the You must tae to It that surance Is rima daces on any other the we receive written no- obligations ere not of- (3) (2)Suabojed to the limit describyesed In event Insured,errorIn lice of the Balm or tested unless an of the (2)t showe.the Each E.Limits eventofeo dalm, or 'bulr es soon as predi- other Insurance Is also Limit se Won B.Employee omission,or cable. prima Then,we MI of Insurance, 1. Employee primary. Benefit Liability Coverage or apply Irtespectite of he rip- share with all that cher c You end any other W- ilds endorsement Is the most we pllmunn of the deductible volved Insured mush Insurance •by the will pay for all damages sus- amount. method desaihed In b, tarried by any one.employee., (1) Immediately send below. Including damages sustained by (d) e may pay any part or ell us copies of any such 'employee's" dependents !the deductible amount to demands,notices, b. Method ol9haring d end beneficiaries,as a result of I - settlement t'and,upon no- es of any <IeIm or` summonsor le- If all of the other Incur- (a) An act,error or omission;or tiGmtion of the ecfion taken, - galpapers re- ante permits contribu- tion (b)A series of related a you shall promptly robe ° tion by equal shaths, lion with the dalm we w{ti follow this reg,rd- deme us for such part of thewe er`suit, method also.Under this ears or he amount regard- have pale amount we approach each insurer less ofla the amount of time have paid. (2) Authorize rd to and contributes equal that lapses between such talo records and q ads,errors or omission d. Additional Conditions amcume until It has iother Information; negligentlycommitted n the As respects Employee Benefit LI- pall ar eo applicable a of (3) Cooperate with us the Insurance or none of Tessabe neon" of your "em- COM Coverage, SECTION BI- In the Investigation the lose romans, ployee benefit program". COMMERCIAL GENERAL dasfd- or settlement or whichever comes first. low CONDITIONS is emended as fd- the dalm or de- However,the amount pain under lows: fonsa against the R any of the doer in- this cee,and lrenl shall jo not ex- "curt.and stanm tribu not pby e d,and will be subject to the (1) Item 2.Duties In the Event of mit contribution by limits end restrictions that apply Occurrence,Offense,Claim or (4) Assist us, upon equal shares,we win la the payment of benefits In any Suit Is deleted in Its entirety and contribute bylimits. plan Included In the"employee replaced by the following: our rceuest,In the enforcement of Under this method, benefit program". 2. Duties In the Event of an any right against each sewon er'se ore is Act,Error or Omission,or any person or or- (4) (a) Oar obAmount ts Claim or SUR ganrzalion which suranmie limit to the total i (a) Our sen behalfgen tpayee in- maa. You must see to It diet the be Insured tablo e- pilcable limits of Insur- sties on onlyy to in- we are notified as soon cause of en ad. once oral Insurers. amount applies to the predicable elan ad. error or omission c, No Coverage cow ff the de u ex- error omission which to width this In- cess of the deductible Includes mpytlgleed matedal of Insurance Indudes copyrighted material of insurance GA 233 OROS 10 Sellas Office,Inc.,with lb permission. Page 5 of 16 GA 233 OR 0910 Services Office,Inc,with Ira permission. Page S of 16 • • • This Insurance shell not providing some or all of the ages ore claimed and The exduslons under SECTION cover any loss for following benefits to 'em- to which the Insured I-COVERAGES,COVERAGE which the Insured la en- ployees",whether provided must submit or does A. BODILY INJURY AND tilled to recovery under through a"cafeteria plan"or submit with our eon- PROPERTY DAMAGE LIABIL- any other Insurance In otherwise: sent; ITY,2.Exclusions,other than I. force previous to the ef- War and the Nuclear Energy festive date of this a. Group fife Insurance; N. Any other eltematne Liability Exclusion,em deleted Coverage Part. group aaldent or dispute resolufion pro- and the fallowing are added: heart Insurance;den- edng In which such e. Additional Definitions hal,,vision and hearing damages are claimed This insurance does not appy to: acts Employee Heneflt LI- plans; and flexible and to which the N- M fes pspending accounts; shred submits with our (a) 'Property damage". ability Coverage, SECTION V - provided that no one consent;or 1) Assumed In any con- DEFINITIONS Is amended as fol- other than an "em- trod;or • lours: ployee"may subscribe c. An appeal of a dvfi pro- (1)The following detnifions are to such benefits and seeding. 2) Loss mused by or re- adied: such benefits are made 8. 'Employee"means a person selling from any of the generally available to actively employed,fommerly following: 1, "Administration"means: those"employees'who employed,on leave of dr a. Providing Information to satisfy the plan's eligi• Bence or disabled, r m- a) Weer end Isar, "employees", Including Nay requirements; tired.'Employee'Includes a h) Rust, corrosion, their dependents end b. Profit sharing plans, leased worker".'Employee" fungus,decay,de- benefidades, with re- employee savings does not Include a-tempo- tederation, hidden sped to eligibility for or plans,employee stock rary worker. or latent defect or scope of 'emphyee ownership plans,pen- 2. Unintentional Failure to Disclose Hoz- arty quality In benefit programa, Non plans end stork suds property that subscription plans,pro- causes It t°dam- b. Interpreting the "em- sided that no one other SECTION IV-COMMERCIAL GENERAL age or destroy it- ployee benefit pro- than en °employee" LIABILITY CONDITIONS,7.Represen- self grams", may subscribe to such tallons Is hereby amended by the add- d) Smog; e. Handling records In benefits and such tion of the fallowing: connection with the benefits are made gen- d) Mechanical break- "employee benefit pro- erally available to all Based on our dependence upon your rep- down inducting p "employees" who ere resenlations as to casting hazards,If un- rupture or bursting grams",or eligible under the plan Intentionally you should fall to disdose all caused by ten- d. Effecting,continuing or for such benefits; such hazards at the Inception date of your Wilmot force; terminating any "em- poky,,we,,,ill not reject coverage under ployee's" parfldpeton c. Unemployment incur- this Coverage Pert based solely on such e) Selling, sacking, In any benefit Included ante, sada) security failure. shrinking or ex- In the'employee been- benefits,workers'corn- pension;or p y'°8 pensation and disebllfoy 3. Damage to Premises Rented to You fit program'. benefits;andf) Nesting orInfesta- Hoer, "edmlnlstrefon' a. The lest Subparagraph of Paragraph lion,or discharge does wevnot fnelude; d. Vacation plans,Induct- 2. SECTIONN -I COVERAGES, or release of waste Ing buy and sell pro- COVERAGE A.-BODILY INJURY products or sacra. a. Handling payro0 dacha grams; leave of eh- AND PROPERTY DAMAGE,2.LI- dons, by insects, tions;or senor programs, In- ABILITY Exclusions Is hereby de- birds, rodents or eluding military,mater- leted end replaced by the fdloWng: other animals. le. The falure to effect or nity, family, end OA maintain any Insurance leave;tuition assistance Exclusions e.through q.do not apply (b) Loss caused directly or Indl- or adequate limas of plans; transportation to damage by fire,explosion,light- redly by any of the fellow- coverage of Insurance, end health club suhsl- Nng, smoke or soot to promises leg: Including but not limited dies, while rented to you or tempora os- to unemployment In- copied by you with permission of the 1) Earthquake, volcanic surence,cadet security (2) The following definitions ere dc- owner. eruption, landslide or benefits,workers'corn- leted In their entirety and re- b. The Insurance provided under SEC- any other earth move- pensation and disability placed by the following: TION I-COVERAGES.COVERAGE moot; benefits. 21,"Suit" means a dull pro- A.BODILY INJURY AND PROP- 2) Water that bands up or 2. 'Cafeteria plans' means deeding In which money ERTY DAMAGE LIABILITY applies overflows from a sewer, plan authorized by eppgra- damages because of en act, to'property damage"arising out of drain or sump; hie law to allow'employees" error or omission to which water damage to premises that are to elect to pay for certain this Insurance apples are both rented to and occupied by you. 3) Water underthe ground benefits with re-ttax dollars. alleged."Suit"Includes: surface pressing on,or P g (1) As respects Water Damage Le- flowing r seeping 3. 'Employee benefit pro- a. An arbitration proceed- galUahifity,es provided In Para- through: grams"means a program Ing In which such dart- graph 3.h.above: Incudes copyrighted material of Insurance Incudes copyrighted material of Insurance GA 233 OR 09 10 Services Office,ins,with lb permission. Page 7 01G GA 233 OR 0910 Services Office,Inc.,with its perrdssion. Page 8 of 16 1 I • a) Foundations, one"occurrence"to which b. Care,Custody or Control Liability deductible amount as has been walls, floors or this insurance applies. Coverage paid by us. paved surfaces; (3) The amount we vrill pay Is!irked SECTION 1-COVERAGES,COV- 7. 180 Day Coverage for Newly Formed or h) Basements, as desm3ed In Section B.Lint. ERAGE A.BODILY INJURY AND Acquired Organizations whether paved or its of Insurance,3.Damage to PROPERTY DAMAGE LIABILITY.2. not or Premises Rented to You of!lila Exclusions,j.Damage to Property. SECTION II-WHO IS AN INSURED Is e) Deers,windows or endorsement Subparagraphs(3),(4)and(5)do not amended as follows: other openings. 4. Supplementary Payments apply to"property damage"to the Subparagraph a, of Paragraph 4. Is property of others described therein. hereby deleted and replaced by the fol- (e) Loss caused by or resulting Under SECTION I-COVERAGE,SUP- With respect to the insurance provided by loving: from water that leaks or PLEMENTARY PAYMENTS-COVER- flows from plumbing,heat- AGES AAND B: this section of the endorsement Um fol- a. Insurance under Ns provision Is ih(- Ing,oar conditioning, lowing additional provisions apply: g,ou fire Pare pbyforded only ordfthe n or any ager protection systems mused a ph 2.is replaced the fol- a. The Limits of Insurance shown In the you acquire or form the organization by or resulting from freeing. awing: Declarations are replaced by the rim- or the end of the po0cy period, unless: Up to the limit shown In section B. Its designated in Section B.Limits of whichever Is earlier, Limits of Insurance,4.a.Bell Bonds Insurance,6,Voluntary Properly 9. Waiver ofSubrogatlon 1) Youdid your best of thio andomement for oast of ball Damage and Care, Custody or maintain hoot In thea bonds required Control Liability Coven of this SECTION IV-COMMERCIAL GENERAL building or sredure;a or traffic law violations adsing out of endorsement with respect to cover- LIABILITY CONDITIONS,9.Transfer of 2) You drained the equip- the use of any vehicle to which the age provided by this endorsement Rights of Recovery Against Others to ment and shut off the Bodily Injury Liability Coverage op- These limps me Inclusive of end not Us Is hereby emended by the addition of water suppy if the heat plies We do not have to furnish In addition to the limits bcng re- the following: was not maintained. these bonds. placed. The Umits of Insurance We waive any rightcry may shown In sedim B.Limits of him.- have bemuse o of recovery we (d) Loss to or damage to h. Paragraph 4.is replaced by the fol- ante,6.Voluntary Property Dam- payments we make for 1) healing,air lowing: ageand Care.Custody or Control Injuryordamagearisingoutofyouronge- ce Plumbing,g, fire pro- All reasonable expensesLiability Coverage of this endorse- leg operations or"your work'done under s to by ment fix the most we will pay In any a written contract requiring such waiver tertian systems, or the insured at our request to assist us one"occurrence"regardless of the with that person or organization and b- other equipment or cup- In the Investigation or defense of the number of. coded In the"products-completed opera- offences;or calm or"suit",Including actual loss of lions hazard".However,our rights may 2) The interior of any earnings up to the Irl shown In See- (1) Insureds; only be waived prior to the"occurrence" lion B.Limits of Insurance,4.b. giving dee to the injury or damage for hue g or Structure,or Loss of Earnings of this endorsement (2) Claims made or"suite brought; which we make payment under this Cou- to personal property In per day bemuse of time off from or erase Part.The Insured must do nothing the bulking or structure work. ager a loss to Impair caused by or resiting (3)Pe rseno or nging"coons making p Ir our rights.'ot our rens- - caused rain,snow,sleet 5. Medical Payments claims cur hringing"euitd. quad,se Insured to will hdngelp us r force or lee,whether driven ter those rights to us end help us enforce byvind or not. The Medical Expense Unit of Any One b. DeductOhle Clause those rights. Person as slated N the Declarations Is (1) Our obOgagan to pay damages 9. Automatic Additional Wonted-Speci- e. Limit of Insurance amended to the limit shown In Section B. on your behalf applies any to the fled Relationships The Damage to Premises Rented to Limits of Insurance,5.Medical Pay- amount of damages for each You Unit as shown in the Declare- manes of this endorsement. "occurrence"which are In excess a, The following Is hereby added to dons Is amended as follows; 6. Voluntary Propedy Damage and Can, of the deductible amount stated SECTION II-WHO IS AN INSURED: Custod or Control LlabiO Coven a In section B.Limits of Insur- (2) Paragraph 6.of SECTION III- y ty g once, 6.Voluntary Property (1J Any person ra organization be- LIMITS OF INSURANCE Is a. VoluntaryProperty Damage Cow. soled(hre Paragraph red t be- LIMITS p rty g Conroe and Care,Custodyege of ow tonal Insure)whew to as are hereby deletedgend replaced by cogs Control Liabilirsm00ty Coeerags of a quires Insured)as an addu ere the(drawing: this ansa ydillnot The Ilan of al We will pay far"property damage"to insurance rio not be reduced l required to add en repo Part 6. Subject to 5. above, the property of others arising out of op- the application of such deduct insured under this Coverage Part Damage to Premises orations Incidental to the Insurer's ble amount. by reason oft to You Limit Is the business when: (a) A written contend or agree- most we will pay under Damage Is mused byt (2) Condition 2.Duties In the Event t COVERAGE A. BODILY (1) he N- ment;or shed;or of Occurrence,e,o cud,0 Claimm INJURY AND PROPERTY or Suit,applies to each claim or (b) An oral agreement or can- DAMAGE LIABILITY, far (2) Damage omni while In the In- "suit"Irrespedlve of the amount. trod where a certificate of damages bemuse of-prop- red'a possession. Insurance showhng that per- arty damage"to premises (3)We may pay any part ur all of son or organization as an Mlle rented to you or tem- With deductible amount to effect set- parartly occupied by you these your regardless of fault dement of any claim or"suit" Issued, nal Insured has been with permission of the and,upon ou of the ac- owner, arising out of any titan yshall n taken,you shall pramply re- Is en Insured,provided: Imbmse us for such part of the Incudes copyrighted matedal of Insurance includes copyrighted material of Insurance GA233 OR0910 SarNres Office,Inc..with its permission. Page 9 of 16 GA233011 0910 SenAces Office,Ins,whin IS permission. Page 10 13f16 • (a) The written or oral contract or use of equipment leased e) My faikire to Part with respect or agreement is to you by such persons)or make such teepee- to such products. argenizatices(s). However, tbns,adjustments, 1) Currently In effect or this Insurance does not ap- lasts or servicing (d) Any state or political subdi- becones effective dur- ply to any "acaarenee" as the vendor has vision with which you have Ing the policy period; which takes place after the agreed to make or agreed per Paragraph and egripment lease expires. normally under- 9.a.)1)above to provide In- . takes to an , takes to make In prance,subject to the fol- 2) Executed®'or offense (a) My person or organizafion the usual course of louring additional provision: to which this insurance to to below as von- badness,In em- This insurance applies only would apply;and dor)with whom you have neaten with the with respect to the following greed per Paragraph distribution or sale (b)They are net specifically 9.241)above to provide tin- of the products; or political subdivision has hazards for ubdh the state named as an additional In- ounce,but only with re- eared under any other pro- sped la"bodily injury/or f) Oemonstratlm,In- Issued a permit In canna:- vision an a:vision of, or endorsement 'property damage arising or sem,servicing ton with premises you We added to, this Coverageout of your products"which or repair opera- rent or control and to which are distributed or sold In the tans,except such this irsuranm applies: Pert. regular course of the van- operations mainte- (2) per- Only the following persons or or- dols business, eu act to formed at the yen- 1) The repair, ruA Mnonce,recur, ortrco- edsiundorthue additional endorsement,laser- the foluns: ng edditlxnd oz- cora cirmises th tan, softea, or ing e suranc r coverageproend elusions: connection with coeval of advertising Insurance coverage provided to the sale of thene- uait additional Insureds Is gm- 1) The Insurance afforded signs,product; ,cellar entrances ca lied as provided herein: the vendor does not coal holes,driveways, apply to: g) Preclude which, (a) The manager or lessor of a after distribution or manholes, marquees, teased to a) 'dodgy Injury" ar sale h v hots( away openings, premises you with y you,have whom you have agreed per 'property damage" been labeled or re- sidewalk vaults,street far which the van banners,or decorations Paragraph 9.a.(1)above la car is obligated to labeled or used as and denier exposures; Insurance,but onlyga container,part or with respell to liadlty aril- pay damages by ingredient of any or Ing out of the ownershireason Of the es- other thing or sub-maintenance or use of that sumpton of Ilabitiry stance by m far 2) The construction,ereo- part of a premises leased to In a contract r the vendor,or ten,or removal of ele- velars;or you,subject to the folbwng agreement. This exclusion does not h) 'Bodily Injury" or additional exclusions: 3) The ce,ownership,use main- apply to that for isngrty damage' elevator,or use d any This Insurance does not op- vender rw that the arising out c the elevates covered by ply to: In the rabenhave negligence,ssof for this frsurance. 1) My'occrrenm"which In the absence of vendor, of etre lakes the centred or vendor, Its em (a) Myastale or political shave place crier you agreement; elseeac n sen Its agree with which you aph cease to be a tenant In else acting en I5 That premises. bj My express war- greed per Paragraph tan unauthorized behalf. surae)above to provide in- tasty o- 2) Structural alterations, by you; 2) This Insurance does not l uran p subject to the Rd- 2) construction or apply to any Insured lowing provisions demolition operations c) Any physical or person or orgarization: 1) This Insurance applies performed by or on be- chemical charge half of such additional In the product a) From whom you eraenywist respect rperformed to co- heir Insured. made intentionally have acquired on your by h thevenden such products,or you or on year behalf b Any person or organizafion y for which the slate s () any Ingredient, from which you lease d) Repackaging, ex- political subdivision has equipment with whom you cept when un- part or ac- have , issueda pandit. P compaB into, ao- 9.24 agreed per provide In- packed solely for contai containing oris 2) This 'encedoes not seen)above to person(s) Por the purpose ofm In- products; such applyptot'bodily injury", sorganloo Such Insureds, s, spates, demon- products;or 'Persona damage"vor but onlytito aree tent that tr sub testing,or 'Personal and adverts- but d out of the only t f the extent that the ander of b) When liab0ity Ing Injury"griper out of the 1pertyy damage'or . "pInjury; parts under theIn- elu"prod"Within the operations the da or dorm d al stoat damage'or'pal sW tonsufact fromer,and completed for the son. or political Is r and advertising pear(noel- manufacturer,ged tons hopera- subdivision. g caused by ss defib- then repackagedeon- been hazard"has nonce,eels or omissions, in Ito the original cm- been is ludedCove un- (f) For rego,work" ny performed or the maintenance,operation Leiner, der this Coverage In Oregon,any person or Incudes copyrighted material of Insurance Incudes copyrighted material of Insurance GA 233 OR 09 10 Services Office,Inc.,with its permission. Page 11 of 16 GA 233 OR 09 10 SenAces Office,Inc.,with Its permission. Page 12 of 16 II • organization with which you (a) Subparagraphs(e).(U and cltectural or en 1. have agreed per Paragraph (g)do not apply to I In- neerin g primary to other Insurance 9.a,1 above to provide In- y g activities available exceptto the additional surance,but onlto the ex- included"property 3) Professional services Insured then tent that the fltrots-completed Is operations do not Include services 1) As otherwise provided caused by your work'per- hazard; within construction In SECTION IV - formed far that additional In- submeans,methods,tech- COMMERCIAL GEN- sured and only to the extent (b) paragraphs(a),(d),(e) popes,sequences and ERAL LIABILITY that suds tiabgty Is caused and(g)do not apply to on- procedures employed CONDITIONS, E. by your negligence or the Iy Injury'. 'property darn- by you In connection Other Insurance, b. negegence of those acting age"or"personal and ad- µ0h construction work Excess Insurance',or on your behalf.A person or vertidng Injury'arising out you perform. • organization's status as an of the side negligence or 2) Per any other valid and Insured under this provision willful misconduct of the ad- (d) Subparagraphs(f)and(g) collecb0le Insurance of this endorsement=nth- digonal Insured or Its"err- do not apply to"bodily In- available to the add- ues for only the period of pioyees'or jury ar'property damage" gond insured asanad- arising out ofyk'for diganal Insured by at- the or but (c) Subparagraph(f)and(g)do which a consolidateddaled(wrap- tadment of an n- te no eventbeya agreement,the expi- not apply to'bodily Injury", up)Insurance program has doraement to another ration date of this Coverage 'property damage"or"per- been provided by the prima Insurance policy that Is Part.If there Is no written easel and advertising Injury" contractor/project manager wrxten on an excess contract or agreement,or If arising out of ar of the construction bads.In ouch rasa,the no period of time Is required 1) The rendering of, or project ect t In tNUds you ere In- coverage provided un- volved. der this endorsement by the written centred or failure to render, any shall also be excess, agreement,a person or or- professional services b. Only With regard to Insurance pro- ganizaton's status as an In- by you or en your be- vided to an addigonal Insured desk). (2) Condition 11.Conformance to eared under this endorse- half,but only with re- noted under Paragraph 9.a.(2)Sub- Specific Written Contract or mend ends when your cp. sped to either or both paragraphs(f1 and(g above,SEC- Agreement Is hereby added: eratlons for that Insured are of the following opera- TION III-LIMITS OF INSURANCE Is completed. flans: amended to Include: 11.Conformance to Specific Written Contract or (g)For'your work"performed a) Providing ngi- The limits applicable to the additional Agreement In the "coverage ternary nearing, otveglarcNtec- Insured are those specified in the but not In Oregon,any per- tural or surveying written contract or agreement or a. With respect to add4 0 or organization With services to others; the Declarations of this Coverage Lionel Insureds de- vdtdu you have agreed per and Part,whichever are less If no grails scribed In Paragraph Paragraph 9.a.(1)above to are spedfied In the written contract or 9.a.(2)(Rabove°My: provide Insurance,but only b) Providing,or hiring agreement,or if there Is no written with respect to Ilntdlity aria- Independent pro- If a vrinen contract or centrad or ereemeonthe Limed ap- ing out of your Wick'per- fessianels to pro- plicebla to the additional Insured are agreement between formed for that edditianal Lis- vide, engineering, those specified in the Declarations of you and the adg at Insured specifies cured byyou ar on your be- ardr0edural or this Coverage Part.The emits of In- halt A person or organla- urveyen services sumfoethatnce are Inclusive of and not In coverage for the addi- tion's status as an Insured In connection with addition to the limits of insurance Ilona!insured: under Ws provision of this canstrudion work shown in the Declarations endorsement continues for you perform. (1) Be provided by the Ser- only the period of time re- e, SECTION IV-COMMERCfAL GEN- Insurance Ser- gulred by the wriften con- ERAL Subject to Paragraph 3) ERAL LIABILITY CONDITIONS Is vices Office eddi- tractoragreement,butinna below, professional hereby amended as follows genet Insured form vent beyond the aspiratico services Include; number CO 32 61, date of this Coverage Pam, a) Preparing apprav- (1) amended o'Odhdflnsrtranee Is CG 32 62 or CO If there Is no written contract Mg, or felting to emended to Include: 3263;or or agreement or if no period prepare or of lime is required by the ap- (a) Where or agreement,gby a wriaes (2) Include coverage written contract orprove,maps,shop contract or r maryanthis foera comons;or ed op- agree- drawings, opin- Insurance is pdmaryand/or mations;or ment,a person or organize- Ions,reports,sur- noncontributory as respells Soda status as an Insured Ways,field orders, any other Insurance policy (3) Include u coveragd under this endorsement change orders,or Issued to the addgonat In- faryourwark`, ends when your operations drawings and sired,and such other In- and wham the emits or far that Insured are con. spedfications;and strance poll shall be ex- pleted. ass end/or nommntribut- coverage provided to b) Supervisory or in- leg wfitchnver a more additional Insured is (3) Any Insurance provided to an applies,with wato rpelddice than addtanal Insured designated performed activities part this Insurance was specifically - underPeregreph9.a.2: performed as dam quked In that written • () of any related ar- (h) Any Insurance provided by this endorsement shall he the terms or agreement, Para- Iia of Pam- incudes copyrighted material of Insurance Includes copyrigtted material of Insurance GA 233 OR 0910 Service;Office,Inc.,vAth Its permission. Page 13 of 16 GA233 OR 0910 Services Office,Inc,with Its permission. Page 140116 • graphs 9.a.(3)(a)or 9,b, agreement mredfies (2) Deductible Clause a. Names; love,or any combine- the Insurance Services Ilan thereat shall he In. Office additional In- (a) Our obligation to pay dam- h. Emergency Medeal Technicians;or terpreted as providing sired farm number CG ages on your behalf applies e. Paramedics, the limits or coverage 20 10 but does net only to the amount of dam- requGed by the terms of spodyvddch edition,or ages for each"occurrence" In the jurisdiction where an"occurrence" the written centrad or specifies an edition that which are In excess of the or offense to which this Insurance applies agreement,but arty to does not evict, Para- Deducible amount stated In takes place. the extent that such ten. graphs 9a.3.b. and Section B.Limits o1 Insur- Its or coverage Is In- 9.h. of this endorse- once,11.of this endorse- 13.Broadened Notice of Occurrence abided within the terms ment shall not apply men%The Omits of Insur- ed the Coverage Part to and Paragraph anon will not be reduced by Paragraph a.of Condition 2.Duties In which this endorsement 9.a.(3)(a) of this at- the epplicatlon of such De- the Event of Occurrence, Offense, Is attached. dorsement that apply. dudible amount. Claim or Suit(SECTION IV-COMMER- CIAL GENERAL LIABIUTY CONDI- b. With respect to adds- 10.Broadened Contractual Liability-Wark (b) Condition 2.Duties In the TIONS)Is hereby deleted and replaced by Venal Insureds de- Within SO'of Retread Property Event of Occurrence,Of. the fdlovdng: sorbed In Paragraph tense,Claim or Suit,ap- 9a.(2)(g)above only: Itis hereby agreed that Paragraph 1.11)of plies to each claim or"suit" a. You must see toil that we are notified DetnNVon 12.-Insured Contract"(SEC- Irrespective of the amount. as soon as practiceble of an"occur- If a written Contract or TIONV-DEFINITIONS)Is deleted. ranee"or an offense which may result agreement between (o) We may pay any part or all In a claim To the extent possible,no- you and the additional 11.Property Damage to Borrowed Equip- of the deductible amount to lice should include: Insured specifies that melt effect settlement of any coverage for the add- claim or"suit"and,upon no- (1) How,when and where the"oc- tlanel insured: a. The(otowing Is hereby added to EY- Motion of the action taken, crrrence"or offense took place; duslon j.Damage to Property of you shall promptly relm- a. Be provided by the Paragraph 2..Exclusions of SEC- bureaus for such pad of the (2)The y names end addresses of Insurance Ser- TION I-COVERAGES,COVERAGE deducide amount as has any Injured persons and wit- ykes Ofroe add- A. BODILY INJURY AND PROP- been paid by us. passes;and banal insured form ERTY DAMAGE LIABILITY: (3) The nature and location of any number CG 20 1012.Employees as Insureds - Specified Injuryor damage arising out of Paragraphs(3)and(4)of this exdu- Health Care Services r CO 20 37 cion do not apply to tools or equip- the"ocourenoa'or offense. (where edition ment loaned to you,provided they am It Is hereby agreed that Paragraph This requirement applies only when spedfled);or not being used to perform operations 2.a.(1)(d)of SECTION II-WHO IS AN the"occurrence"or offense is known b. Include coverage at the time allow. INSURED,does not apply to your"em- to an"authorized representative". for completed op- h, With respect to the insurance pm- plowed.who provide professional health • orations;or sided byhis section of the endore- care seMces an your behalf as duly b e. Include coverage ment,te fallowing additional amyl- sensed: for yourwork; stens apply. and where the limits or (1) The Chits of Insurance shown in coverage provided to the Declarations are replaced by the additional Insured Is the Omits designated in Section more restrictive than B.Limits of Insurance,11.of was spedlieally re- this endorsement with rasped to quired In that written coverage provided by this en- contract or agreement, dorsement,These Omila are In- the terms of Para- elusive of and not In addition to graphs 9.a.(3)(a), the Omits being replaced.The 9.0.(3)(b)or 9,b.above, Limits of Insurance shown in - or any combination Section B.Limits of Insurance, thereof,shall be inter- 11.of this endorsement fix the preted as providing the most we will pay in any one"cc- limits or coverage re- crrrence" regardless of the gulled by the terms of number of the written contract or (a) Insureds; agreement,but only to the extent that such Om- (h) Claims made or "suits" Its or coverage is In- brought;or eluded within the terms of the Coverage Part to (a) Perrins or organizations which this endorsement maldng claims or bring Is clothed.If,however, "suits"• the written contract or I Includes copyrighted materiel of Insurance Incudes copyrighted material of Insurance GA 233 OR 09 10 Services office,Inc.,with Its permission. Page 16 of 16 GA 233 OR 09 10 SeMces Office,Ina,with Its pemNssion, Page 16 of 16 i I • www.saif.com saih : Oregon Workers' Compensation Certificate of Insurance Certificate holder: CITY OF ASHLAND PUBLIC WORKS DEPARTMENT 20 EAST MAIN STREET ASHLAND, OR 97520 The policy of insurance listed below has been issued to the insured named below for the policy period indicated.The insurance afforded by this policy is subject to all the terms,exclusions and conditions of such policy; this policy is subject to change or cancellation at any time. Insured Producer/contact Viking Concrete Cutting Inc Ward Insurance Agency Inc Viking Concrete Cutting Chris Christensen 186 Ayres Rd 541.687.1117 chris@wardinsurance.net Eagle Point,Or 97524-6526 Issued 04/20/2020 Limits of liability Policy 912438 Bodily Injury by Accident $1,000,000 each accident Period 10/01/2019 to 10/01/2020 Bodily Injury by Disease $1,000,000 each employee Body Injury by Disease $1,000,000 policy limit Description of operations/locations/special items All operations Important This certificate is issued as a matter of information only and confers no rights to the certificate holder.This certificate does not amend,extend or alter the coverage afforded by the policies above.This certificate does not constitute a contract between the issuing insurer,authorized representative or producer and the certificate holder. CANCELLATION: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED TO THE POLICYHOLDER AND CERTIFICATE HOLDER IN ACCORDANCE WITH THE POLICY PROVISIONS AND OREGON LAW. SAIF WILL ENDEAVOR TO PROVIDE WRITTEN NOTICE WITHIN 30 DAYS WHENEVER POSSIBLE. Authorized representative )6>_. Kerry Barnett President and CEO 400 High Street SE Salem,OR 97312 P:800.285.8525 Policy_OLCA CertificateOtlnsurance F:503.584.9812