HomeMy WebLinkAbout2021-165 PO 20220168- Perrine Industrial ELectrician o ��oi Purchase Order
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FiscalYear2022 Page: 1 of: 1
B City of Ashland'
I ATTN: Accounts Payable20 E. Main Purchase
L Ashland, OR 97520 Order# 20220168
T Phone: 541/552-2010
0 Email: payable@ashland.or.us
V H C/O Wastwater Treatment Plant
E PERRINE INDUSTRIAL ELECTRICIAN l 1195 Oak Street
N 6067 CRATER LAKE HWY p Ashland, OR 97520
CENTRAL POINT, OR 97502 Phone: 541/488-5348
O T Fax: 541/552-2364
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(541) 826-5505 • David Gies T_7-2:75M-77t21_0$lq ate' _F: e e'e.: a els--'ui�- '- o _.ems s_ _ _ -4°Ia" --�5 a. - � - — _
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10/18/2021 333 FOB ASHLAND OR CityAccounts Payable
Rebuild Floway Pump
1 Filter Influent Pump 1.0 $29,995.00 $29,995.00
Per attached Sales Quote COA100621
Goods and Services Agreement(Less than $35,000)
Completion date: June 30, 2022
Project Account:
*************** GL SUMMARY***************
086100-602400 $29,995.00
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By: � Date: /
Au horizec ignature � �3�
- � '.29 995.00
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IFORM•#3 CITY OF
ASH LA\ N •10)
REQUPSITION Dateofrequest •
'•
• Requited date for delivery: .
Vendor Name / e''C i'//1/e g/(9 lL/'/c
Address,.City,,State,Zip ,
. Contact Name&Telephone Number
Email address
SOURCING f11ME�'6lOD
0,Exemptions Competitive Skid nA ' .d Invitation to 131d ❑ )?mernenoy
❑ Reason for exemption: Date approved by Council: ❑ Form 093,Wrilten findings end Authorization
❑ AMC 2.60 (Attach copy of council communication) El Written quote or proposal attached
pi Written quote or proposal attached ,•_(tf council approval required,attach copy of CC)
pli Small Procurement
0 'Utmost for Proposal Csoneralive Procurement
Date approved by Council: ❑ State of Oregon
❑ Direct Award ___(Attach copy di council communication) Contract f!
0 Verbal/Written bid(a)or proposal(s) 0 Request for Qualifications(Public Works) -❑ State of Washington
Date approved by Council: Contract#
• (Attach copy of council communication) ID Other government agency contract
0
Intermediate Procurement Sole Source
GOODS&SERVICES 0 Applicable Form(f15,6,7 or 8). Contract#
Rooter than 30400 and less than 8100.000 ❑ Written quote or proposal attached Intergovemmentai.Agreenment
❑ (3)Written bids&solicitation attached � Fm4,Personaf:Seryicas$�(to$75C A�encypRRONALSBRVIC��, • -Date approved by Council: -
Annual cost to City does not exceed$25,000•
Greater than 30.000 and less than$78,000 al d until
DOD bydirect appointment1—� --- (Daje) Agreement approved by Legal and approvedlsigned by
0 Less than$35,000, Special Procurement CCityAdministrator.AMC 2,50.070(4)
� (3)Written proposals&solicitation attached 0�] Form#9,Request for Approval U.Annual cost to City exceeds$25,000,Council
❑ Form fit;Personal Services$5f(to$75K IaI Written quote or propose.ptlached approval required.(Attach copy of council communication)
Date approved by Council: Ji '�•;/�
Valid until:,.6 --•O-.. V (Date) •
®®scription of SERVICES • • Total.Cost
Agv;A:v ¢'��e4/ Viz, - s
Item# Quantity Unlit ,Description of MATERIiALS _ .Milt Price Total Cost
•
t &c ck. f//eoc .Z'Chen 1- (1//14 99 ?;et
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Per attached quote/proposal TOTAL,COST
•
•
$
Project Number _ ' Account Nalnba l 9. p a DD
Account Number.. _ • Account Number •
'taperrdlute must be charged to the appropriate account numbers forth°financials to accurately roiled the actual expenditures.
ITI)lIoctor.hi.colloboroflot}with ileptrftareatf?uapprove allInrdwnroantiunciwnrspurulmsor,: _ _ __,l _ ,
Bysigning this requisition fa m,I that the !t "spublic contracting !T Director Dote Sur post-Yes%h!o
9 ingcodify y tingg requirements have been satisfied.
Employee: r .•c: ^r►i . 7
d =��— Department H,. ' 1._ .'. r► 2
Department ervisor: ` ‘Nini1 'toorarealarlha1 :5,0gre
p p CityManager: •
moil
4 lV e:
��tlR t�1 S;rlr;tallrlr.�:::1 for ctrrrrnfi'fler r)year: 1.7:N/NO 1, (Equsllo oraroalurtrian41%000) '\—
FI:ianro Ir•c.tor.(Equal to orlueilier Man Sfi,000) Date
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Ponta-Requisition
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Memo
TO: • Gary Milliman
FROM:David.Gies(Wastewater Supervisor) It` fr l f
DATE: 10-7-2021
RE: City Manager Signature Needed for Perrin Industrial Electricians,Inc. Contract
Background:
Rebuild 20 year old membrane filter influent pump.
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Council Action:
No action required of Council.
Other Relevant Information:
Insurance waived or reduced?No
Who to return to if different from sender?N/A
Are all other signatures required collected?Yes
Are all attachments listed included?Yes
CITY OF ASHLAND
20 East MainStreet Tel:541-488.8002
Ashland,Oregon 97520 Fax:541418B-5311
Ivmashland.otus TTY:800.735.2900
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GOODS &SERVICES'AGREEMENT(LESS THAN$35,000) '
PROVIDER: Perrine Industrial Electricians Incorporated
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CITY O F PROVIDER'S CONTACT:Stacey
INSND
20 East Main Street ADDRESS: 6067 Crater Lake Hwy
Ashland,Oregon 97520 Central Point,OR 97502
Telephone: 541/488-5587
Fax: 541/488-6006 PHONE: 541-826-5505
•
This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of
Ashland,an Oregon municipal corporation (hereinafter"City")and Perrine Industrial Electricians Incorporated,
a domestic business corporation("hereinafter"Provider"),toremove,rebuild,reinstall 1 Floway Pumps.
1. PROVIDER'S OBLIGATIONS
1.1 Provide removal, rebuild, reinstall 1 Floway Pumps 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 namedand 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
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page I oro: Agreement between the City of Ashland and Perrine Industrial Electricians Incotporatcd
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• Provider shall supply an endorsement naming the City, its officers, employees
and agents as additional insureds by the Effective Date of this Agreement; and
o 'Be evidenced by a certificate or certificates of such insurance, approved by the
City.
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 applicablerequirements 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 orleasesof equipment,
each potentialsubcontractor 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 •
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$29,995.00 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 $29,995.O0-without express, written approval from the City
official whose signature appears below, or, such official's successor in office. Provide
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 procureany specific amount of
Work from Provider and is'free to procure•similar types of goods and servicesfrom other
providers in its sole discretion,
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Ptigc 2 of 6: Agreement between the City of Ashland and Pcrrine Industrial Electricians incorporated. {{
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3.2 Provider is an independent contractor and not an employee or agent of the City for any
purpose.
3.3 Provider is not entitled to, and expressly waives all claims to City benefits such as health and
disability insurance, paid leave, and retirement.
3.4 This Agreement embodies the full and complete understanding of the parties respecting the
subject matter hereof. It supersedes all prior agreements, negotiations, and representations •
between the parties,whether written or oral.
3.5 This Agreement may be amended only by written instrument executed with the same
formalities as this Agreement.
3.6 The following laws of the State of Oregon are hereby incorporated by reference into this
Agreement: ORS 279B.220, 27913.230 and 279B.235.
3.7 This Agreement shall be governed by the laws of. the State of Oregon without regardto
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 ether 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 theactivities 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. s
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
Page 3 of(: Agreement between.the City of Ashland and Perrinc Industrial Electricians Incorporated
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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 Quote dated 10!,0612021.
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;
5.1.2Withholding 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; j
5.1.3lnitiation of an action or proceeding for damages, specific performance, or declaratory
or'injunctive'relief;
5.1.4These 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 j
6.1 Term
This Agreement shall be effective from the date of execution on behalf of the City as set forth
below (the "Effective Date") and shall continue in full force and effect until June 30, 2022,
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.
6.2.2The City may, upon notless than thirty (30) days' prior written notice, terminate this.
Agreement for any reason deemed appropriate in its sole discretion.
6.2.3Either 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 t
Pugs 4 orb: Agreement between the City of Ashland and Pet rine Industrial Electricians Incorporated
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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: David Gies
20 E. Main Street
Ashland, Oregon 97520
Phone: (541)488-5587
With a copy to: I
City of Ashland—Legal Department
20 E. Main Street
Ashland, OR 97520
Phone: (541)488-5350
If to Provider:
Periine Industrial Electricians Incorporated
6067 Crater Lake Hwy • {
Central Point,OR 97502
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.
9.1.2Provider, for a period of no fewer than six (6) calendar years preceding the Effective
Date of this Agreement, has faithfully complied with: 33
(i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and
ORS chapters 316, 317, and 318;.
(ii) Any tax provisions imposed- by a political subdivision of the State of Oregon
applicable to Provider; and
(iii) Any rules, regulations, charter provisions, or ordinances that implement or
enforce any of the foregoing tax laws or provisions.
Page 5 of 6: Agreement between the City of Ashland and Perrino Industrial Electricians Incorporated
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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
availableunder 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.
CIT 't!F SF LAND: Perdue Ind�t tri Ciectri 'has bear orated(PROVIDER):
A
By: ,, i �
'J lG d
City NAV WA—Q4
Q4 Signature
t�,{,, ' Printed Name Printed Name
\0 k,L
Date - #
Title
(
O Date _ _ 1
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Purchase Order No. (3-9-9 is to be submitted with this signed Agreement)
Page 6 of Agreement between the City of Ashland and Pcrrine.lndttstrial Electricians.Incorporated
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PERRINE ELECTRIC INC C0Ai00621
6067 CRATER LAKE:HWY
CENTRAL POINT,OR 97502
541-826-5505 fax 541-826-1259
SALES QUOTE -
CUSTOMER 10/06/2021
Dates 1
. 1 T
ATTN: DAVE -First Contact
CITY OF ASHLAND. Quote Issued 30 DAYS •
• Accept/Reject
- � 1
Quantity Price TOTAL
QUOTE
FLOWAY PUMP • -
SJN
• 75HP 1.STAGE 12DOM PUMP
SHAFT DRIVER TIME 4 WEEKS
BR I LEAD TIME 1 WEEK
!BEARINGLEAD TIME 1'WEEK
RING PACKING LEAD TIME 1 WEEK
10-RING
CLEAD TIME 7 WEEKS
COUPLING
TOP LINE LEAD TIME 1.WEEKUPLING LINE SHPT LEAD TIME 7 WEEKS
SHAFT ULEAD TIME-1 WEEK
NE
RETAINER BEARING LEAD TIME 1 WE
++BEARING TYPE H
!GASKET LEAD TIME 1WEEK
ISHAFT PUMP BOWL LEAD TIME 4 WEEKS
BEARING"SLV LEAD TIME 1 WEEK
IMPELLER 12DOM-C LEAD TIME 3 WEEKS
•
COLLET IMPELLER LEAD TIME 1 WEEK
COLLAR,SAND LEAD TIME 1 WEEK
BEARNG SUCTION LEAD TIME 1 WEEK
• .STRAINER BASKET LEAD TIME 1 WEEK
CUP-BASKET STRAINER LEAD TIME 1 WEEK ••
• LABOR REMOVAL,&INSTALL
PUMP SHOP LABOR
CRANE REMOVAL LABOR _
MOTOR PARTS AND LABOR
MISC PARTS
•
PLUS SHIPPING CHARGES
PRICE PER EACH
$29,995.00
Customer
Taxes
TOTAL i $29,995.00
Notes
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A►c R® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
`.� 12/01/2020
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 Misty D•Whorley
Hart Insurance Agency - Medford
PO Box 1240 PHO h (541).779-4232 NE FAX
PO
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,);
Grants Pass OR 97528 ADMEN mwhorleyOhaztineuranoe.com •
INSURERIS)AFFORDINGCOVERAGE NAIC#
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INSURERA:American Hallmark Insurance Co 43494
INSURED • (541) 026-5505 INSURERS:
Perrino Industrial 'Electricians Inc
INSURER C:
6067 Crater Lake Hwy INSURER U
•
Central Point OR 97502 • INSURERS:
INSURER F:
COVERAGES CERTIFICATE NUMBER:Cart ID 3.7762. 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 ADDL SUER POLICY EFF POLICY PPLTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY) (MMIDDIYYYY) LIMITS
•A X COMMERCIALGENERALLIABILITY i
EACH OCCURRENCE . $ 1,000,000
CLAIMS-MADE X OCCUR X 44CL477531 12/22/2020 12/22/2021 pRREEM$AMAGES(Ea occurrrence) $ 100,000
MED EXP(Any ono person) $ 5,000
PERSONALSADVINJURY ^ $ . 1,1/00,000
GEN'LAGGREGATE LIMITAPPLIESPER: GENERAL AGGREGATE $ 2,000,000
POLICY I�EC rI LOC
PRODUCTS-COMP/OP AGG $ 2,000,000
.OTHER: $
AUTOMOBILELIABILITY (Ea BINEDaccidentSINGLE LIMIT $ 1,000,060
A X ANY AUTO 44CL47753) 12/22/2020 12/22/2021 BODILYINJURY(Perperson) $
OWNED 'SCHEDULED BODILY INJURY(Per accident) $
_AUTOS ONLY AUTOS
HIRED NON-OWNED PROPER DAMAGE
AUTOS ONLY AUTOS ONL •
Y
(Peracci t) $
$
A X UMBRELLA LIAB X OCCUR 44CL477531 12/22/2020 12/22/2021 EACHOCCURRENCE $ '1,000,000 _
EXCESS LUIS CLAIMS•MADE
AGGREGATE 5 1,000,000 _
DED X RETENTION$ 10,000 $ •
WORKERS COMPENSATION
AND EMPLOYERS'LIABIUTY YIN S STATUTE 1 ERH
ANYPROPRIETORIPARTNER/EXECUTIVE EL.EACH ACCIDENT $
OFFICERIMEMBEREXCLUDED7 NIA
(Mandatory In NH)
EL DISEASE-EA EMPLOYEE $
If yes,describe under
DESCRIPTION OF OPERATIONS below EL DISEASE-POLICYLIMIT $ •
$
DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schadulo,may be attached if more space Is required)
Policy includes automatic additional- insured. where required by written contract per attached-24E9767
•
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE 'WILL BE DELIVERED IN
City of Ashland ACCORDANCE WITH THE POLICY PROVISIONS.
•20 S Main.Street • AUTHORIZED REPRESENTATIVE
Ashland OR 97520
@1988-2015 ACORD'CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD'name and logo are registered marks of ACORD
Page 1 of 1
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General Liability Additional Coverages
The following Additional Coverages are added to the COMMERCIAL GENERAL LIABILITY COVERAGE FORM.
• A.Blanket Additional Insured Coverage ,
1.SECTION II-WHO IS AN INSURED of the.COMMERCIAL GENERAL LIABILITY COVERAGE FORM is amended
to include as an insured any person or organization(referred to as Additional Insured)whom you are required to add
as an Additional Insured on this policy under:
a.A written contract or agreement;and
b.Where a certificate of insurance showing that person or organization as an.additional insured has been issued
c.When the written contract or agreement and certificate of insurance are currently in effect,or becoming in effect
during the terriof the policy and executed prior to the"bodily Injury,""property damage,"or"personal and advertising
injury."
2.The insurance provided to the Additional Insured is limited as follows:
a.The Additional Insured is only an additional insured for:
(1)"Bodily injury,""property damage,"or"personal and advertising injury"caused in whole or in part by negligent acts
or omissions of the Named Insured or anyone directly or indirectly employed by the Named Insured or for whose acts
a Named Insured may be liable.
(2)Liability arising out of your ongoing operations for the Additional Insured by or for you.A person's or organization's
status as an insured under this coverage ends when your operations forthat insured are completed,
b,.The Limits of.Insurance applicable to the Additional Insured are those specifiedin the written contract or
agreement but not more than the Limits of Insurance specified in the Declarations for this policy.The Limits of
Insurance applicable to the Additional Insured are inclusive of and notin addition to the Limits of insurance shown in
the Declarations for the Named'Insured.
• 3:In addition tathe other exclusions applicable to Section;l,Coverages A.,B.and C.of the
COMMERCIAL GENERAL LIABILITY COVERAGE FORM,the Insurance provided to the Additional Insured does not
apply.to:
a."Property damage"to: I
(1)Property owned,used,occupied by,,loaned or rented to the Additional Insured;
(2)Property in the care,custody or control of the Additional Insured or over which the Additional Insured are for any {
purpose exercising-physical control;or
(3)"Your work"performed for the Additional Insured.
b."Bodily injury, "property damage,'or"personal and advertising injury"arising out of an architect's,engineer's or
surveyor's rendering or failure to render any professional services'for you,for the Additional`Insured or for others,
including,;but not limited to: -
(1)The preparing,approving or failure to prepare or approve maps,drawings,opinions,:reports,surveys,change.
orders,designs or specifications;or
(2)Supervisory,inspection or engineering services.
c."Bodily injury"or"property damage"occurring after:
(1)All work,including materials,parts or equipment furnished in connection with such work,'on the project(other than
service,maintenance or repairs)to be performed by or on behalf of the additional insured at the site of the covered
operations has been completed;or
(2)That portion of"your work"out of which the injury or damage arises has been put to its intended use by any
• person ororganization otherthan another contractor or subcontractor engaged;in performing operations fora
principal as a:part of the same project.
4.SECTION IV—COMMERCIAL GENERAL LIABILITY CONDITIONS,Paragraph 4.Other Insurance,is amended to
add the following subparagraph:
d.Additional insured's Other Insurance As Excess Insurance
To the extent required by an"insured contract,*this insurance is primary on behalf of'the Additional Insured;and any
other insurance maintained by the'Additional Insured is excess and not contributory with this insurance.If the
"insured contract"does not require this provision,then Paragraph a.above will apply.
B.Mobile Equipment Broadened Coverage
V.12.f.(1)of the COMMERCIAL GENERAL LIABILITY COVERAGE.FORM is replaced by the following:
(1)Equipment designed:primarily for: l
(a)Snow Removal;
(b)Road maintenance,but not construction or resurfacing;or
(c)Street cleaning.
Except the above provisions do not apply to self-propelled vehicles of less than 1,000 pounds gross vehicle weight .
which are not intended for use on a highway.
C.Aggregate Limit Per Project
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MP 97 67 10 10 Includes copyrighted material of Insurance.Services Office,Inc.and Page 1 of 2
American Association of Insurance Services,Inc.,with their permission
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The General Aggregate Limit under SECTION III-LIMITS OF INSURANCE of the COMMERCIAL GENERAL
LIABILITY COVERAGE FORM applies separately to each of your projects away from premises owned by or rented to
you.Page 22 of 25 Includes copyrighted material of Insurance Services Office, Inc.and MP 97 671010.American
Association of Insurance Services,Inc.,with their permission D.Blanket Waiver Of Transfer Of Rights Of Recovery
Against Others To Us
The Transfer Of Rights Of Recovery Against Others To Us Condition(SECTION IV—COMMERCIALGENERAL
LIABILITY CONDITIONS)is amended by the addition of the following:
We waive any right of recovery we may have against any person or organization to whom you by written contract or
written agreement have waived your own right or recovery for loss caused by that person or organization because of
payments we make for injury or damage arising out of your ongoing operations or"your work"done under a written
contractor written agreement with that person or organization and included in the."products-completed operations
hazard."
This provision does not apply unless the written contract or written agreement has been executed prior to the
"occurrence"or offense giving rise to the"bodily injury"or"property damage."
E.Voluntary Property Damage Coverage
1.We will,at your request,pay but notdefend any claim for"property damage"to the property, of others'otherwise
excluded under A.2.j.(4),(5)and(6)of the COMMERCIAL GENERAL LIABILITY COVERAGE FORM provided that:
a.Such"property damage"takes place while such property is in your care,custody or control,or is propertyof others
over which you,for any purpose,are exercising or have exercised physical control;and
b.Such"property damage"takes place away from any premises you own,rent or lease;and
c.Such"property damage"takes place within the"coverage territory'and during the policy term;and
d.Such"property damage"takes place only during your operations that are known to us,are scheduled on the policy
and for which a premium has been charged.
2.The insurance under this additional coverage does not apply to"property damage"to property:
a.Held by,you for servicing,repair„storage or sale at premises owned by,rented or leased to you;
b.While being transported by or caused by the ownership,maintenance,,operation,use,"loading or unloading"of any
"auto,"watercraft or aircraft;or
c.Owned or occupied by or rented to you.
3.Deductible This additional coverage will apply only to that amount of any loss In each"occurrence"that exceeds
$500.The terms of the policy with respect to your duties In the event of"occurrence,"claim or"suit"and the
Company's right to investigate,negotiate and settle any claim or"suit"apply irrespective of the application of the
deductible amount of$500.
We may pay any part or all of the deductible amount of$500 to effect settlement of any claim or"suit"Upon
notification of the action taken,you must promptly reimburse us for such part of the deductible amount as has been
paid by us..
4.Limits of Liability
The Limit of Liability for this additional coverage shall not exceed$2,500 for each"occurrence"and is the limit of the i
Company's liability for all damages on account of each claim or"suit"covered herein.The annual aggregate Limit of
Liability is$2,500 and'is,subject to the above provisions respecting each claim,the total limit of the.Company's
liability for all damages. ;
5.Settlement
In the event of loss covered by this additional coverage;you shall,if requested by us,replace the property or furnish
the labor and materials necessary for repairs thereto at actual cost'to you,excluding'prospective profit or overhead
charges of any nature.Any property so paid'for or replaced shall,at our option,become the property of the Company.
Payment hereunder shall not constitute an admission of liability of you or,except as stated herein,of the Company.
MP 97 67 10 10 Includes copyrighted material of Insurance Services Office,Inc.and Page 2 of 2
American Association of insurance'Services,Inc.,with their permission
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www.saif.com
Work.
S Lite;
Oregon.
Oregon Workers' Compensation
Certificate.of Insurance
Certificate holder:
CITY OF ASHLAND
20 EAST MAIN STREET
ASHLAND,OR 97520
' ' s
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
Perrino Industrial Electricians Inc SAIF Corporation
6067 Crater Lake Hwy Portland Service Center
Central Point,Or 97502-8424 503.673.5283 servic@saif.com
Issued 10/07/2021 Limits of liability -
Policy 461372 Bodily Injury by Accident $500,000 each accident
Period 07/01/2021 to 07/01/2022 . Bodily Injury by Disease $500,000:each employee
Body Injury by Disease $500;000 policy limit
Description of operationsllocations/special items
Provide removal,rebuild,and reinstall of Floway Pump I
Important
This certificate is issued as a matter of information only and confers no rights to the certificate holder.This certificate
does notamend,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 andthe
certificate holder.
Authorized representative
e/t (- e
Chip Terhune
President and CEO
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400 High Street SE
Salem.OR 97312
P:800.285.8525
Policy_OLCA cortiticate00nsurance F:503.584.9812
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