HomeMy WebLinkAbout2021-169 PO 20220162- Left Coast Underground LLC .a'
Purchase Order
FrAl CITY RECORDER
Fiscal Year 2022 Page: 1 of: 1
Eft gkg•P Ae - -$Ll
B City of Ashland
I ATTN: Accounts Payable
20 E. Main Order#Purchase
20220162
Ashland, OR 97520
T Phone: 541/552-2010
0 Email: payable@ashland.or.us -
V H C/O Public Works Department
E LEFT COAST UNDERGROUND LLC I 51 Winburn Way
N 4865 HWY 234#203 p Ashland, OR 97520
WHITE CITY, OR 97503 Phone: 541/488-5347
R T Fax: 541/488-6006
_ ..2111----las -6Td _
.r TIn �S�
E 9 i _Vl I ' 'ti/— � r7 I� �=,k�i t.�°° � .:I-' ��' '- '�=�.���aa�:
— __—_- c? ._ � - ' _ 3 '.r. '- �. _—_- �i5
_ z Kaylea Kathol
KJ - l7Ekl =_ =a a! _ )ri =la€?aiE7Q -7 € €€€ : — P 51.€�T .E° �_€
10/05/2021 6470 FOB ASHLAND OR/NET30 City Accounts Payable
iEliA10.1
.g--
Demolition at 1291 Oak Street
1 Demolition and removal of unused covered building and pole barn 1.0 $40,937.00 $40,937.00
on City-owned property at 1291 Oak Street(aka Hardesty
Property)
Goods and Services Agreement(Greater than $35,000)
Completion date: January 31, 2022
Project Account: E-201834-999
Project Account: E-201834-999
Project Account: E-201834-999
***************GL SUMMARY***************
081200-704200 $4,093.70
086000-704200 $32,749.60
086600-704200 $4,093.70
By: Date:
_..
Authorized nature = $40,937.00
AAAAAA
.76/
FORM#3 • CITY 00
0. ,, 7"2-- f�o H \S�). .NID
A reef t.t(::ii:kW';.t I Ill l'ilrlair( ..)1%.10I'
i`'EcUd$Q'Vn®1N Data of rogue fit
7 [+equirectslate for-delivery:
Vendor Namob loft Coast tlndorground
Address,City,State;Zip 4865 Hwy 234 8203,Wile City,Oregon,07603
Conlact Name&Telophono Number Danny Beard,641 638:2233
Email address fettcoaslundorground®gmall.com
„tot_i CING IVIETHO®.
❑ Exempt front Comnotilivo Bidding ❑ Jnvilotlon to Ski 0 16momoney
❑ Reason for.exemption: _ Cale approved by Council; El Feral d13,Written findings end Authodzel!on
❑ AMC 2,60 ,._(Aliach copy of coundl oommunicallon) 0 ,Wrlgon.quote or proposal necked
❑ Millen quote or proposal attached _(II council approtral required,eltacb copy of CC)
❑ SmallProcurcinont, ❑ :Request for Pranosel CuoserativoProcure Mani
riot exaaedtnci$0.000 Dale approved by Collodi: Ij State of Oregon
❑ DireclAward —(Attach ocpy of mind communication) " Contract',
❑ VadmiliNditenbld(s)arproposal(s) ❑ Rainiest for Qualification(PubltcWorks) ❑. State of Washington '
Dela approved by Coundk Contraolil •
u,�-q(Attach copy of council communicalton) . CIOlhcrflovemment agency contract
stere eto�+Yc�rtroment, Solo Source Agency
GOODS&SERVICED 0 AppfIcabla For it(1I&.B.7 ora) Contract n
Greater then$5,000 tint toes than$100,000 0 'Wrlllon queteor proposal attached JnIerstovemmontal Anreemen(
IN (3)Written bids&sollccallon.attached 0 Form 110,Personal Services 6l(to$761( Agency
PERSONAL SERVICES Date epprovedbyCoundt:• • pAnntielcositoCitydoes.notexceed525000, .
G ‘ , `i 10 , ,so - .,i r Valid unlit • (Date) Agreement approved by Legal and apprnvedisigned by.
IN Loss than$35,000;by'direct appointmentspaolal Procurement gy Adnllnisiratar.AMC 260,070(4)
❑ (3)Written proposals&solkilallon attached 0 Form 119,RequestferApp:aval DI 'Annual coal to Cily exceeds$25;000,Council
❑ fern 114,Personal Services$51(to 576K ❑ Whitten quote or proposal attached approval required,(Attach copy of ceuncll communication)
Date approved by Council.:
Valid until• (Dole)
Description of SERVICES Total Cost
Dernelltion and removal of elruclure.et 1291 Oak Street .
40;93740.
Iters 4/ Quantity Unit Description of MATERIALS IJntt Price Total cost
Peratteohed gttotelproposalriOTAt:IcosT
pB6 000 gv.�$ ,2 7lig;/o� :4 . ._ :,,. ..-. ..
ProJeet-Number? a +'a 0. 9.e a s • AccountNumber.c.a.0 a :o o.r o 4 s`o o ,
09(92-610
Account Numba7 0 0 1.2 0 0.7 e A2 0 0 Account,Numbar o a 0 0 o•4..7:0 4 2 0 o is�,i` q.',Vd,
/QX.C410 �7499V �
't:xporxtifuro must he cltergoilla The approprlole eccourti numbers for Me ffrienclets lo'eccure1el'need lha eclua(oxpe int(uros.,
IT,Dfrentorin.collaboratfon.wi h d_eperlment to approve all hardware and softwareprrrcheses:
1T•Preclor pale •Suppoit Yes/A6
By s$etupMin raqulelllon forst,JcorllfkMet the OA nubile conIraoI tty regttlforev s hoveboen SeiIsllad
Efoptoyoo: r l' -e ‘ Department Howl
I ecgrenteFlBa IMM!)•
Dnpninient Mlinager/Stiperiddor: CifyManayai:. t `,:, �t
• p:yual to orercat Uran$25,900
Funds a•ppropriated for.carrent.ftscal�year. YES/NO :44..x,• _.
Finance DlrBc1Rr=(Egtel fo`gr,'grmfet rrian stI000) 'Pole : - .,.
Chnlllreals;
Eotmit3.Requisklcn
Memo
TO: Gary Milkman,City Manager Pro Tem
FROM: Kaylea Kathol,Public Works Project Manager
DATE: 9/13121
RE: City Administrator Signature Needed for
Background:
,The attached contract is between the City of Ashland and Left Coast Underground LLC,a construction
company, This one-time contract is for the demolition of an unused covered building and pole barn
structure on City-owned property at 1291 Oak St(aka"Hardesty Property"). This building is currently C j
impeding the City from bringing a sewer line onto the property,winch will ultimately allow for the
development of a Public Works operations yard.
Council Action:
This job was not directed by.Council. However,it is a necessary step to.advanee the larger project of
developing the Hardesty. Property into a Public Works operations;yard,which was approved by Council
in the 2022-2040 CIP Program,approved by Council on March 16./021.
Other Relevant Information:
None
Insurance waived orreduced? No
Contractor holds General Liability and Umbrella coverage totaling$2M,as required by City •
procurement rules. Contractor holds,$IM in automobile coverage,whereas the City's standard
requirement is$2M. Staff supports allowing this lower coverage.to,stand.for the following four reasons:
(1)Work will be performed behind closed,locked gates; The property is not open to the public,and
vehicle operations on that property present minimal risk to the public. Moreover,only limited City Staff
have access to the property,ft ether reducing the risk of encounters with the contractor's vehicles.
(2)The property has been utilized historically and Currently as an operations.yard. It is"laid out"in a
manner that allows easy maneuvering of heavy equipment and large vehicles, In other words,the
contractor will NOT be operating vehicles in a high-risk,complex environment where there is a high
likelihood of collisions or encounters with obstacles.
CITY OFASHLAIID
20 East Mah Slrent . Tel:541.488.6402
Asblend,Oregon 97520 Fex:641-4111=5311
www.ashlaatcr us TTY: 500-73r29t1D VA
(3) The contractor has visited the property and has operated a utility vehicle on it within the past 30
days. Familiarity with a work environment,plus experience operating equipment in said environment,
further reduces the already-low risk of vehicle use on this property.
(4) This will be a short duration project, complete within one week. Risk increases as time operating on
a job site increases, simply due to increased exposure. While many of our projects last for months,
which compounds vehicular risk,the short duration of this project further mitigates risk.
Who to return to if different from sender?
Please return to Kaylea Kathol
Are all other signatures required collected?�Se /No
If no,please collect before sending them to the City Administrator.
Are all attachments listed included? itg, o
If no,please include all attachments before sending to the City Administrator.
•
CITY OF ASHLAND •
20 East Main Street Tel:541-488-6002
Ashland,Oregon 97520 Fax:541-488-5311
www.ashland.or.us TTY: 800-735-2900
•
GOODS AND SERVICES AGR] EMEN't(GREATEN TIAAN$35y000)
PROVIDER:: Left Coast Underground,LLC
CITY O.f PRO.VIDER'S CONTACT: Dandy Beard
ASHLAND
20 East Main Street ADDRESS: 4865 Hwy 234,#203
Ashland,Oregon 97520 White City,Oregon 97503
Telephone: 541/488-5587
Fax: 541/488-6006 PRONE: (541)538-2233
This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of
Ashland, an Oregon municipal corporation (hereinafter "City") and Left Coast Underground, LLC, a.domestic
limited liability company(hereinafter"Provider"),for demolition of a permanent structure.
1. PROVIDER'S OBLIGATIONS
1.1 Provide will demolish and remove an unused office building and pole barn located at 1291 Oak Street,
Ashland, Oregon, 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 setforth in the SUPPORTING DOCUMENTS,and that no waiver or extension of such
deadline may be authorized.except iii the same manner as herein provided for authority to exceed the
maximum compensation. The goods and services: defined and described in the "SUPPORTI G
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 conunercial 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.
12;1 The insurance required in ibis Article shall includethe following coverages:
• Comprehensive General or Commercial General Liability, including personal injury,
contractual liability,.and products/conipleted operations coverage; and
• Automobile Liability; and
• Workers'Compensation.
1.2.2 Each policy oisuch insurance shall be on an"occurrence"and not a"claims made" form,and
0411:
• 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_ineteased thereby;
• Apply as primacy coverage,fox: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 ham the first dollar of liability;
• Provider shall immediately.notify the City of any change in insurance coverage
Page 1 of 6: Goods and Se vices Agreement between the:City of Ashland and Left Coast Uixdergrouitd,LLC
A Provider shall supply an endOrserrient naming the City, its officers, employees.and agents
as additional insureds by the Effective Date of this Agreement; and
0 Be evidenced by a certificate or certificates of such insurance approved by the City.
1.3 Provider shall,at its own expense,maintain Worker's Compensation Insurance in compliance with ORS
656;017, which requires subject einployers to provide workers' compensation coverage'for all of its.
subject workers. As.evidence=of the insurance required by,this Agreement,the Provider shall finmsh an
acceptable insurance certificate prior to commencing Any Work.
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.sub"contracts 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 Providersof the Provider's obligations under
this Agreement and TitleVI of the Civil Rights Act of 1964 and other federal nondiscrimination laws,
1.6 Living Wage Requirements: If the amount of this Agreement is $22,310.46 or more, Provider is
required to comply with Chapter 3.12.ofthe 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
perforins.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$40,937.00(forty thousand nine hundred and thirty-seven U. S.
dollars) as provided herein as fill 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$40,937.00 (for ty thousand nine hundred mid thirty-seven U. S. dollars) without.the
.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 expensesancurmed:wiitliout auithorization 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 fioiin
Provider and is free.to procure sirnila types of.goods and services front other providers in its sole
discretion.
3.2 Provider isan independent contractor and.not an employee or agent of the City for any purpose;
Pup of6'Goods,uutscrivicesAgreement betiveen the City of Ashland and Left Coast.Underground,LLC
•
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 Provider shall not assign this Agreement or subcontract any portion of the Work to be provided
.hereunder without the prior written consent of the City. Any attempted assignment or subcontract
without written consent of the City shall be void. Provider shall be fully responsible for the acts or
omissions of any assigns or subcontractors and of all persons employed by them,and the approval by
the City of any assignment om subcontract.shall not create any contractual relation between the assignee
or subcontractor and the City.
3.5 This Agreeniei t embodies thefull arid complete under`stainding of the parties respecting the subject
matter hereof. It supersedes all prior agreements,.negotiations,and representations between the parties,
whether written or oral,
3.6 TMs Agreement May be amended only by written instrument executed with the same formalities as this
Agreement.
3.7 The following laws of the State of Oregon are hereby incorporated by reference into this Agreement:
ORS 279B;220,279B.230 and 2713.235.
3.8 This Agreement shall be governed by the.laws of the State of Oregotiwithout 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.forJackson County unless exclusive jurisdiction is in federal court,
in which case eitclusive.venue.shall b.e in the federal district court for the district.of Oregon. Each party
expressly waives any and all rights to maintain:an action under this Agreement in any other.venue,and
expressly consents that, upon motion of the other party, any case may 'be dismissed or its venue
transferred,.as appropriate,se as to effectuate this.choice.of venue,
3.9 Provider shall defend,'save,hold harmless and indemnify the City and it"s 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,
3.10 Neither party to this Agreement shrill hold the other responsible for damages or delay in performance
caused by acts of God,strikes,lockouts,-accidents,or other events beyond thecontrol of the other or the
other's officers,employees or agents.
3.11 If any provision of this Agreement is found by a court of competent jurisdiction to be tmenforceable,
such provision shall not affect the,other pro.Visions,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.
3.12 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.
'3.13 The City may. inspect.and test the Goods. The City.may reject noiz-coiiforining Goods arid require.
Provider to.doffed 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
Pingo 3 of 6: Goods and Services Agreement between the City of Ashland.and Left Coast U.ndcrground,.LLC
Agreement in whole or in part. This paragraph does not affect.Or limit the City's tights,including its
rights under the Uniform Commercial Code,ORS Chapter 72'(UCC).
3.14 Provider represents and warrants that any Goods provided to the City are new, current, and fully
warranted by the manufacturer:Delivered Goods will comply with SUPPORTING DOCUMENTS and
be free f om defects in labor,material and manufacture:Provider shall transfer all warranties to the City.
4. SUPPORTING DOCUMENTS
4.1 The following documents are, by this reference, expressly incorporated in this Agreement, and are
eollectively referred to in this Agreement as the"SUPPORTING DOCUMENTS:"
• The City's Written Invitation.to Bid dated August 18;2021.
• The Provider's complete written bid dated August 29,2021.
4.2 This .Agreement and the SUPPORTING DOCUMENTS shall be construed to be mutually
complimentary and supplementary wherever possible. In the event of a conflict which cannot be so
resolved,the provisions of this Agreement itself shall control over any conflicting provisions in any of
the SUPPORTING DOCUMENTS. In the event of conflict between provisions of two of the
SUPPORTING DOCUMENTS,the several supporting documents shall be given precedence in the order
listed in Article 4.1.
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 theWorlc 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 Citymay pursue
any remedy or remedies-singly,collectively,:successively or hi any order whatsoever,
5:2 In no event shall City be liable to Provider for any expenses related to termination of tliis-Agreement or
"for anticipated profits: Ifprevious amounts paid to Provider exceed the amount due,Provider shall pay
immediately any excess toCity ul on written demand provided.
6. TERM AND TERMINATION
6.1 -Term
This Agreement shall be effective from the date of execution on behalf 011ie City'as set forth below
(the"Effective Date")and shall continue m full force and effect Until January 31,:2022;unless sooner
terminated as provided in Subsection 62;
6.2 Termination
6.2.1 The:City and Provider may terminate this Agreement by_mutual.agieement at any time.
6.2.2 The City may,Upon not less than thirty (30) days' prior-written notice,terminate this Agreement
.for any reason deemed appropriate in its sole discretion.
6,2:3Either.patty may.,terniinate this Agreement,with cause;by not less than fourteen(14)days' prior
written notice;if the cause is net,cured within that fourteen(14)day period after written notice..
Snell termination is in addition to:and not in lieu of any Other remedy-a-0aw or,equity,
Pane 4 of& Goods and services Agreement between the City of Ashland and'Lett Const Underground,LLC
•
7. NOTICE
Whenever notice is required or permitted to lie 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: 1(ayle<i Kathol,PMP
20 B, Main Street
Ashland,Oregon 97520
Phone: (541)4S8-5587
With a Copy to:
City of Ashland—Legal Department
20 C. Main Street
Ashland,Oregon 97520
Phone:(541)488-5350
If to Provider.:
Left Coast Underground,LLC •
Attn: Danny Beard
4865 Hwy 234,#203
White City,Oregon 97503
8. WAIVER OP 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 316,3.1 7, and.318;
(ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to
Provider;and s
(iii) Any rules,regulations,charter provisions,.or ordinances that implement or enforce any of
the foregoing tax laws or provisions.
t'ngc 5'of6: Goods and Services Agreci ei t between the:C_ity of Ashlatrd and Left'Coast Underground;LLC
9.2 Provider's 4on►piy wEtll the u►x•laws of the State;of Omen And all applicable tax lnws of any
politicail subdivision ol'tlie Stade Of Oregon shall constitute it material breach Otitis Agrecnieni. Further,
any violation of*Provider'ti wauitntty, ats set forth in this 4ticie 9,shall eonstittitc a Material breach of
this Agreement. Any material 'breach of this Agreemmnt shall entitle the City to 10111110We 'this
Agreement and to seek damages and any other relief availnble under this Agreement,at law,or in equity,
IN WITNESS WHEREOF the parties hove caused ibis Agreement to be signed in their nespeelivo a►umes
by their duty authorized representatives its of the dales set forth bt:lti'v.
CITY t •4 S 1..AM): LEIrI' COAST UNDERGI O IN ,LLC(PROVIDE ft):
ti _ By: .��.._.rL -
City Mauugur Pro Toni Signal are
tin ..G oh6e,arl
Printed Name - • 'dated Name
rl>
Dtile 'Title
Mato
Purchase Order Ido. -D/6 (W-9 is to be submitted with this signed Agreement)
APPROVED AS TO YORK;
-Interim City Atto►rtey
f
1 0-21
Date
f
•
Puke(amsn
I 6: (tooth,: al Semi=Agreeunl hott con.Ilio Cil)'of ANhlanti anal Lull f.on I Underground;L.t..0
I•
EXHIBIT A
CITY OF ASHLAND, OREGON
City of Ashland
LIVING
ALL employers described WAGE
below must comply with City
of Ashland laws regulating
payment of a living wage.
$15.96 per hour, effective,June 30,.2021.
The Living Wage is adjusted annually every
June 30 by the Consumer Price.Index.
Employees must be paid a portion of the business of of health care,retirement,
Hying wage:
their employer,if the 401K,and IRS eligible
employer has ten or more cafeteria plans(Including
employees,and has received childcare)benefits to the
> For all hours worked under a financial assistance for the employee's amount of wages.
service contract between their project or business from the
City of Ashland over > Note; For temporary and
employer and the City of
Ashland if the contract $22,310.46; part-time employees,the
exceeds$22,310,46 or more, Living Wage does not apply
➢ If their employer is the City of to the first 1040 hours worked
> For all hours worked in a Ashland,Including the Parks in any calendar year. For
month,if the employee and Recreation Department, more details,please see
spends 50%or more of the Ashland Municipal Code
employee's time in that month > In calculating the living wage, Section 3.12.020.
working on a projector employers may add the value
For additional information:
Call the;Ashland City Manager's office at 541-488-6002 or write to the City Manager;
City Hall,20 East Main Street,Ashland,OR 97520,or visit the City's website at www.ashland.or.us.
•
Notice to Employers: This notice must be posted in areaswhere it can be seen by all employees,
CITY OF
ASHLAND
1
,
ACORD.
Cllent0I 183942 LEFTCOASI
ACORDU CERTIFICATE OF LIABILITY INSURANCE DATEIMNI021..YYY)
9/09!2021.
THIS'CERTIFICATE IS ISSUED AS A,MATTER OF INFORMATION ONLY AND CONFERSNO RIGHTS UPON THE CERTIFICATE HOLDER,THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND,OR ALTER THE COVERAGE AFFORDED DY 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,ondorsed,
It SUBROGATION IS WAIVED,subject to the terms and conditions of the pollcy,-cortaln policies may require'an endoreomont.A statement on
this certiflcato.does not confer any rights to the cortificato holdorIn lieu of such endorsoment(s).
PRODUCER CONTACT
NAME: Ann McCants
Propel InsuranceOt E 541'494-7721 (nr
721 Fax
�Ac.INa Rail: c,Nal: 541 494-7729
Medford Commercial Insurance neiMAa•.sann.mccants@propelinsuranae.com
ooREs:
P 0 BOX 935 INSUREH(S)AFFORDING COVERAGE NAiC F1
Medford,OR 97509INSURER A:Pioneer SpeciallyInsurnncoCompany 40312
INSURED INSURER B I i
Loft Coast Underground LLC
INSURER cI
4865 Highway,234#203 INSURER D t
White City,OR'97503
INSURER E I
1 DMURERF:
COVERAGES 'CERTIFICATE NUMBER: 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
'NOTWITHSTANDING OTWITHSTANDING ANY'REQUIREMENT,TERM,CR'CONDITIONOF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THC INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS:SUBJECT TO ALL THE.TERMS,
I�BEXCLUSIONS AND CONDITIONS OF'SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAiD CLAIMS.
NipTYPEOFINSURANCE AoPLl^,UBR ppOUGYEFF POLICY EX�PP LIMITS
INSR MO POLICY NUMBER __DIANOIY I IMMma YA-
A X COMMERCIAL GENERAL LIABILITY CPP1243323 0710112021 07/0112022,EACMH�cccpuRpRENce. x1,000;000
—1cLAl1.M-MtCe ❑X occuR $RF,NI;RSp ,[e IL nco, 6100,000
X PD Dad:1,000 MED EXP CAO ono Orson) 310,000 l
PERSONAL BAOVINJURY 51,000,000
GEM AGGREGATE LIMIT APPLIES PER: GENERAL AGOR GATE 62,000,000,
1POLICY Fl JEST ®'Loc PRODUCTS-CAMP/OP AGO S2,000,040
OTHER; 3
A AUTCMCDILELiABILITY CPP1243322 0710112021 07/011202?, =INGLSUMT $1,000,000
ANY AUTO BODILY INJURY'(For person) $
— OWNED SOHEDULED BODILY INJURY(Prcacc)den1) $
_ AUTOS ONLY K
N�pFO NO-0WNED PROPERTY DAMAGE
X AUTOSONLY X AUTa90NLY, 4ar=Irani) •
• S
A X UMBRELLALIAO IX OCCUR UM131041205 071011202/ 0710112022 EACH OCCURRENCE s1;000,000
EXCESS"9 1{-- CLAIMS-MADE AGGREGATE s1 ODO OOO _
Dad I I RETENnONS - - • S
WORKERS COMPENSATION q
AND EMPLOYERS'LiAUILITY TM_
STATUTE I OP'
//,,ryrygqP�Ta�rIETOWPA ERIEXECUTIVEE.L.EACH ACCIDENT $
GFFICEFiTtEM18EREDED7 DillNJA
(MnndataryInNHI E.L.UISEASE-EAEMPLOYEE $
U,yyros desn@o under
UES4tRIPTIONOFOPERATIONSbEep CL.GISEASE-POLICY LIMIT S
OESCRIPTiON OF OPERATIONS l LOCATIONS')VEHICLES)AGORD.101,Add(1lanal Romorlrs Echo dine,m sib o attach ail Ii moie oil acd rs required)
The GL&Auto pollcy.Includes blanket additional insured and blanket waiver of subrogation endorsements
[provisl,ons]that provide additional insured/WOS status to the certificate holder when there is a written
contract between the named Insured and the certificate holder that requires suoh status..
RE:Demolition of Permanent Structures al 1201 Oak Street Ashland Oregon
•
CERTIFICATE HOLDER CANCELLATION
CityOf BHOULDANY.OF.THEABOVE DESCRIBED POLICIESBECANCELLED BEFORE
THE EXPIRATION DATE THEAPOF. NOTICE.WILL BE DELIVERED'IN
20 East Maln•Strcot ACCORDANCE -WITH THE POLICY PROVISIONS.
Ashiand,'OR 97520 •
AUTHORIZED REPRESENTATIVE
— I
0 1980.4015 ACORD CORPORATION.All rights rasorvod.
i ACORD 25(2016103) 1 011 The ACORD name and logo are registered marks of ACORD
41S4767210IM4764713 LMK00
i
}
This page has been lefl blank inlcnlionally.
1 1,
COMMERICAL GENERAL LIABILITY
WN GL 39 DB 18
COMMERCIAL GENERAL LIABILITY ENHANCEM ENT ENDORSEMENT
The Commercial General Liability Enhancement Endorsement is an optional endorsement that provides coverage en-
hancements. The following is a summary of broadened coverages prot1ded by this endorsement. No coverage is pro-
vided by this summary, refer to following endorsement for changes In your policy.
SUMMARY OF COVERAGES PAGE
Bodily,Injury And Property Damage Liability
• Non Owned Watercraft Up To 50 Feet ... 2
Property Damage Liability
• Elevators - . 3
+ Flre, Lightning, Explosion Or Sprinkler Leakage Exception. 3
• Borrowed Equipment ($25,000 Per Occurrence,'$50,000 Aggregate,
$2,500 Deductible Per Occurrence 3
Supplementary Payments—Amended
• Ball Bonds Up To$5,000.. _ 4.
• Loss of Earnings Up To$500/Day - - 4
Who Is An Insured Amendments
+ Employee Bodily Injury To A Co-Employee 4
• Newly Formed Or Acquired Organizations For Up To 180 Days 4
• Blanket Additional Insured—Vendors—.As Required By Contract' 4
• Blanket Additional Insured--Lessor Of Leased Equipment - 6
• Blanket Additional Insured--Managers Or Lessors Of Premises 6
a Blanket Additional Insured —State Or Governmental Agency Or Subdivision
Or Political Subdivision Permits Or Authorizations 7
• Blanket Additional Insured —State Or Governmental Agency Or Subdivision
Or Political Subdivision—Permits Or Authorizations Relating To Premises 8
Damage To Premises Rented To You $300,000 9
Medical Payments increased Limit — $10.000 Or Amount Shown on Declarations 9
Conditions
• Knowledge of Occurrence, Offense,Claim Or Suit Amended 9
• Unintentional Failure To Disclose Hazards 9.
• Waiver of Subrogation 10
insured Contract Amended 10
Personal And Advertising Injury Redefined
• Televised,Videotaped Or Electronic Publication - 10
WN GL 39 0,8 18 includes copyrighted material of the insurance Service Office,Mo.,with permsslon, Page 1 of 10
•
COMMERCIAL GENERAL LIABILITY
INN GL 39 0818 •
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
COM MERCIAL GENERAL LIABILITY ENHANCEMENT ENDORSEMENT
This endorsement modifies the.insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
With respect to the coverage provided by this endorsement, the provisions Of the Coverage Form apply unless modified by
this endorsement. The SECTIONS of the Commerciel General'Liability Coverage Form Identified in this endorsement will
be amended as shown below.
SECTION I—COVERAGES AMENDMENTS (3) Parking an"auto" on,or on the ways next to,
COVERAGE .A — BODILY INJURY AND PROPERTY premises you own or rent, provided the"auto"
DAMAGE LIABILITY 'Is not owned by.Or rented or loaned to you or
the insured;
A. Non Owned Aircraft Or Watercraft (4) Liability assumed under any "Insured con-
Item 2.exclusions, Paragraph g.is replaced by the tract"for the ownership, maintenance or use
following: of aircraft or watercraft; or
g. Aircraft, Auto Or Watercraft (5) "Bodily injury" or "property damage" arising
°Bodily injury'or"property damage"'arising out of out of:
the ownership, maintenance, use or entrustment (a) The operation of machinery or equipment
to others of any aircraft, "auto" or watercraft that is attached to, or part of, a land
owned or operated by or rented or ipaned to any vehicle that would qualify under the
insured. Use Includes operation and "loading or definition of"mobile equipment' lf•itwere
unloading'. not subject to a compulsory or financial
This exclusion applies even if the claims against responsibility law or other motor Vehicle
any insured allege negligence or other wrong- insurance law where it Is licensed or
doing in the supersion, hiring, employment, principally garaged; or
training or monitoring.of others by that insured, If (b) The operation of any of the machinery.or
the"occurrence" which caused the"bodily Injury' equipment listed In Paragraph f,(2) or f.
or"property damage inwl;.ed in the.:ownership; .(3) 01 'the definition of "mobile equip-
maintenance, use or entrustment to others of any tent".
aircraft, 'auto" or watercraft that is owned or B. Damage To property Coverage Extensions
operated by or rented or loaned 10 any:insured.
tris exclusion does not apply to: Item 2. Exclusions, Paragraph j. Is replaced by the
following:
(1) A watercraft while ashore on premises you j. Damage To Properly
own'or rent;
(2) A watercraft you do not own that is: "Property damage' to:
(a) Less than 50 feet Iorig; and (1) Property you own, rent,.or occupy,Including
any costs or expenses incurred by you, or
(b) Not being used to carry persons or prop- any other person, organization or entity, for
erty for a charge; repair, replacement, enhancement, restore-
This Subparagraph (2)applies to any person, (ion Or-maintenance of such property for any
'who with.your expressed or implied consent, reason, including prevention of injury' to a
thither uses Or is responsible for the use of the person or damage to another's property;
watercraft; (2) Premises you sell, give away or'abandon, if'
the"property damage" arises out of any part
of those premises;
WN GL 39 0818 includes-copirlghtedmaterial of the Insurame.Sorvicearfice,lna.;withis perrrisslori. Page 2 of 10
(3) Property loaned to you; The insuranceprovided for "property damage" from
(4) Personal property in the care,custody or con- the use of elevators and for "properly damage" to
trol of the insured; borrowed equipment is excess over any other valid
That particular part of real property on which and collectible;property insurance(including any de-
(5) yoa .or .any r part
re or subcontractors
bri which ductible 'portion thereof) available to the insured
working directly or indirectly on your:behalf whether primary, excess,contingent or on any other
are performing operations, If the "property basis.
damage" arises out of those operations;-ar C. Damage To Premises Rented To You
(6) That particular part of any property that must Item 2.Exclusions, the last paragraph is replaced by
be restored, repaired or replaced because the following:
'your work"was incorrectly performed on it. Exclusions;c.through n.do not apply to damage by
Paragraphs (1), (3) and (4) of this exclusion do not fire, lightning, explosion or sprinkler leakage to
apply to!'property damage" (other than damage by premises while rented to you or temporarily occupied
fire, lightning, explosion or sprinkler leakage) to by you with permission of the owner. A separate limit.
premises, including the contents of such premises, of insurance applies to this coverage as described in
rented to you for a pertod of seven or Bawer Paragraph 6, of SECTION til LIMITS OF
consecutive days. A separate limit of insurance INSURANCE.
applies to Damage To Premises Rented To You as
described in SECTION ill—LIMITS OF INSURANCE. COVERAGE B — PERSONAL AND ADVERTISING '
However, the provisions of this paragraph do, not INJURY LIABILITY
apply if coverage for Damage To Premises Rented To
Yeti is excluded by endorsement. D. Personal And Advertising Injury
Item 2. Exclusions Is amended by replacing Sub- 4 fl
Paragraph (2) of this exclusion doss not apply if the paragraphs b.and c.with the following:
premises are "your work" and were never occupied,
rented or held for rental by you. b. Material Published With Knowledge Of Falsity
Paragraphs (3) and (4) of this exclusion de not apply 'Personal and. advertising Injury" arising out of
to the use of elevators. 'oral, written, televised, videotaped or electronic
publication, in any'manner, of material, if done by
Paragraphs (3), (4), (5) and (6) of.this exclusion do or at the direction of the Insured with knowled9e
not apply to liability assumed under a sidetrack of its falsity.
agreement. c. Material Published Prior To Policy Period
Paragraph (4) of this exclusion does' not apply to Personal and advertising Injury" arising out of
"property damage" to borrowed equipment vynlle not oral, written, televised, .videotaped or electronic
being used to perform operations at the jobsite. publication,:in any manner, of material whose first
Subject to Paragraph 2.of SECTION ill.-LiMITS OF publication took place before the beginning of the
INSURANCE, the rules below fix-the most we will pay
polidy period.
for"property damage" under this provision:
(1) $26,000 any one"occurrence", 'regardless of the SUPPLEMENTARY PAYMENTS COVERAGES A
number of persons or organizations who sustain AND B
damages because of that'occurrenbe"; E, Supplementary Payments—CoveragesAand B
(2) $50,000 annual aggregate; and Item 1. Is amended by replacing Subparagraphs b.
(3) We will pay only for damages In excess of$2,600 and d.vtihth the following:
as a result of any one"occurrence", regardless of b. Up to $5,000 for cost of ball bonds required be-
the number of persons or organizations who causeof accidents or traffic law ilolatiensarising
sustain damages because of that 'occurrence". out of the use of any vehicle to which the Bodily
We may,or if required by law, pay all or any part , injury Liability Coverage applies. We do not have
of any deductible amount, if applicable; to effect to furnish these bonds.
settlement of any claim Or"suit". Upon notice of d. All reasonable expenses incurred by theinsured
our payment of a'deductible amount, you shall
promptly reimburse us for the part of the at our request to assist us in the investigation or
deductible amauni we paid. defense of the claim or°suit",including actual loss
of earnings up to$500 a day because of time off
Paragraph (6) of this exclusion does not apply to from Work."property damage" included in the "products-corn- '
pleted operations hazard".
WN GL 39 08 18 includes copyrighted material of the Insurance-Seivice.Office,tnc.,wlth its peririsslon. Page 3 of 16
Y
SECTION II—WHO IS AN INSURED AMENDMENTS The'rollowing,are added:
A. Employee Bodily injury To A Co-Employee C. Blanket Additional Insured — Vendors — As Re.
Paragraph 2.a.(1) is replaced by the following; quired By Contract
However, none of these "employees" or "volunteer 'I. Section i1--Who Is An Insured Is amended to
workers" are insureds for"bodily injury" or"personal include as an additional insured any persons) or
and advertising injury": • organizetion(s) (referred to throughout this
endorsement 'as vendor) 'with whom you have
(a) To you,to your partners or members (If you.area
partnership or joint venture), to your members (If agreed In a written contract, executed prior to
loss, to name es an additional 'Insured, but only
you are a limited liability company), to a co-
• with respect -to "bodily Injury" or "property
"employee" While in the course of his or her damage" arising out of"your products":which are
employment or performing duties related to the distributed or sold in the regular course of the
conduct of your business; or to .your other
'volunteer workers" while performing duties vendor's business,
related to the conduct oh/our business; However,
(b) To the spouse, child, parent, brother;or sister of a. The insurance afforded to such vendor only
the co-"employee'.' or "volunteer worker" as a applies to the extent permitted by law; and
consequence of Paragraph (1)(a)above; b. If coverage provided to the vendor Is required •
(c) For which there is any obligation to share by a.contract or agreement, the insurance
damages with or repay someone else who must afforded to such vendor will not be broader
pay damages because of the Injury described in than that which you are required by the
Paragraph (1)(a) or(b) above; or contract or agreement to provide for such
(d) Arising out of his or her providing or failing to vendor.
provide professional health care ser ices, 2. With respect to the Insurance afforded to those
However, if a suit seeking'damages for"bodily injury" vendors, the •following additional exclusions
or "personal and advertising Injury" to any 'co- apply'
"employee" or other'volunteer worker arising out of a. The insurance afforded the vendor does net
and in the course of the co"employee's" or"volunteer apply to:
worker's" employment or while' performing duties (1) "Bodily injury" or "property damage" for
related to the conduct of your business, or a suit which the vendor is obligated to pay dam=
seeking damages brought by the spouse, child, ages by reason of the assumption of
parent, brother or sister of the co-"employee" or other liability in a contract dr agreement. 'this
'volunteer worker", Is brought against-you or a co- exclusion.does not apply to liability for
'employee" or a"volunteer worker", we Will reimburse damages that the vendor would have in
the reasonable costs'that you incur in providing a the' absence of the contract or
defense to the co"employee" Or 'volunteer worker" agreement;
against such matters. Any reimbursement made (2) Any express warranty unauthorized by .
pursuant to this sub-section will be in addition to the you;
limits of liability set forth in the Declarations,
(3) Any physical or chemical change in the
B. Newly Acquired Organizations ,product made intentionally by the vendor;
Paragraph 3.a.Is replaced by the following: (4) Repackaging, except when unpacked
a. Coverage under this provision is afforded, only solely for the purpose of inspection,
until the 180th day after you acquire' or form the demonstration; • testing, or . the
organization or the end of the policy period, substitution of parts under Instructions
whichever Is earlier; from 'the manufacturer, and then
repackaged in the original container;
1
WN GL 39 0818 Includes copyrighted material of the Insurance Service Mice,ino.;w hits permission. Page 4 of 10
.
(5) Any failure to make such Inspections, 4. With respect to the Insurance afforded to these
adjustments, "tests or servicing as the ' vendors, the following is added To Section.III —
vendor has agreed to make'or normally Limits Of Insurance:
undertakes to make in the usual course if coverage provided to the vendor is'required by
of business, in connection with the a contreot or agreement, the most we will pay on
distribution or-sale.of the products; behalf of the vendor is:
(6) Demonstration, lnstallellen, servicing or
repair operations, except such a. The minimum amount required by the
operations performed at the vendor's contract or agreement; or
premises in connection with the sale of b, The Limits of Insurance shown in the
the product; Declarations;
(7) Products which;after distribution or sale whichever is-less.
. by you,have been labeled or relabeled or
used es a container, part or ingredient of This endorsement shall not Increase the
any other thing or substance by or for the applicable Limits of insurance shown in the
Vendor; or Declarations.
(8) "Bodily Injury or "property damage" 5.. With respect to the insurance afforded to these
arising out of the,sole negligence. of the additional insureds, the following additional
vendor for its own acts or omissions or exclusion applies:
those of its employees or an one else
y This insurance does not apply to:
acting on its behalf. However, this a. "Bodily Injury", "property damage" or
exclusion does not apply to: "personal and advertising injury" arising out
(I) The exceptions contained in of the rendering of, or the failure.to render,
- Subparagraphs (4)or(6);or any professional architectural,engineering or
(Ii) Such inspections,adjustments, tests surveying services, including: -
or servicing as the vendor has (1) The preparing, approving, or failing to
agreed to make or normally prepare or approve, maps, shop
undertakes to make in the usual drawings, opinions, 'reports, sur eys, ,
course of business, in connection field orders, change orders or drawings
with the distribution or sale of the and specifications;or
products. (2) SupenAsory, inspection, architectural Cr
3. This Provision C. does not apply: engineering activities.
a. To any Insured person or organization from This exclusion applies even if the claims
whom you have acquired such products, or against an additional insured allege
any Ingredient, part or container, entering negligence or other wrongdoing In the
into, accompanying or containing such •.supervision, hiring, einployment, training
products; or monitoring of others by that.Insured, If
b. To any vendor for which coverage as en addi- the "occurrence" which caused the
tional insured specifically Is scheduled by "bodily Injury" or "property damage', or
endorsement; or the offense which caused the "personal
c. When liability included within the "products- and advertising Injury", invoitied the
completed operations hazard' has been ex- rendering of or failure to render any
'eluded for such product either by-the prodi- professional services by you with respect
alone .of the coverage part or by'endorse- to your . providing. engineering,
menta architectural or surveying services in
your capacity as an engineer, architect or
surveyor.
Wl‘i GL 39 08 18 Includes cop/righted material of the insurance SerrIce office,ino.,with Its permission. Page 5 of 10
.
4, With respect to the insurance afforded to these
D. Blanket Additional Insured — Lessor Of Leased additional insureds, the following additional
Equipment exciusioit applies:
1. Section II—Who Is An Insured Is amended to This irtsurAnce does not apply to:
include as an additional insured any person(e) Or .
"Bodily Injury", 'property damage" or
organizations) from whom you lease equipment '
or Organization(s)
"personal and advertising !duty" arising out
when you and such persons)
have agreed in writing in a contract or agreement, of the rendering of, or the failure to render,
executed priortoloss, that such persons) :or any professional architectural,engineering or
organization(s) be added as an additional Insured suneYing senAces, including:
on your policy. Such person(s)ar organization(s) (1) The preparing, appro'ing, or falling to
is an Insured only with respect tO liability for prepare qr approtig, maps, shop
"bodily injury", "property darnage" or "personal drawings, opinions, reports, surveys,
and advertising Injury"caused,in whole or in part, field orders, change orders or drawings
by your maintenance, operation or use of and specifications;or
equipment leased to you by such persons) or (2) Supervisory, Inspection, architectural or
organization(s). engineering activities.
However, the insurance afforded to such This. exclusion applies even IF the claims
additional insured; against an additional Insured allege
a. Only applies to the extent permitted by law; negligence or other wrongdoing in the
and supervision, hiring; employment, training or
b. Will not be broader than that which you are monitoring of others by that insured, if the
required by the contract or agreement to "occurrence"which caused the"bodily injury"
provide for such additional insured. . Or "property damage", or the offense which
A person's or Organization's status es an addi- caused the"personal and advertising injury",
tional insured under this endorsement ends when invoiced the rendering of or failure to render
thole contract or agreement with you for such any professional services by you with respect
leased equipment ends. to your providing engineering, architectural or
2. With respect tO the insurance afforded to these surveying services in your capacity as an
additional insureds, thisinsurance does not apply engineer, architect or surveyor.
to any "occurrence" which takes place after the. E. Blanket Additional Insured — Managers Or Les-
equipment lease expires. sors Of PremIses
3. With respect to the Insurance afforded to these 1. Section 11--Who Is An Insured is amended to
additional insureds, the following is added to include as an additional insured any person(s) or
Section III—Limite Of Insurance: organizations) with whom you have agreed in a
If beverage provided to the additional Insured Is written contract, executed prior to lois,to name
required by a.contract or agreement, the most We as an additional insured, but only with respect to
Will pay on behalf of the additional insured Is: liability arising out of the ownership, maintenance
a. The minimum amount required by the or use Of that.part(lithe premises teased to you,
contract or agreement,; or subject'to the following additional exclusions:
b. The Limits of Insurance shown in the This Insurance does not apply to:
Declarations; a. Any"occurrence"which takes place after you
whichever Is less. . cease to be a tenant.in that premises.
This •endorsement shall not increase the b. 'Structural alterations, new construction or
applicable Limits of lnsuranae shown in the demolition operations performed by or on
Declarations. behallef such additional insured.
WM GL 39 0818 Includes copgrlghied material of the Insurance Service Office,hrc.;villh its permission. Page 6 6110
i
i
i
However: F. Blanket Additional Insured State Or
a. The insurance afforded to such- additional Governmental Agency Or Subdivision Or Political
insured only applies to the extent permitted Subdivision —Permits Or Authorizations
by law;and Section 11.—Who;Is An insured is amended to in-
b. if coverage provided to the additional insured dude as an additional insured anyy state or
is required by a contract or agreement, the governmental agency or subdiision or political
insurance afforded to such additional insured subdivision with whom you have agreed in a written
will not be broader than that which you are contract; executed prior to loss, to name as an
required by the contract or agreement to additional insured, subject to the following provisions:
provide for Such additional,insured. 'I. This Insurance applies only with respect to op-
2, With respect to the insurance afforded to these orations performed by you or on your behalf for
additional insureds, the following is added to which the state or governmental agency or sub-
Section III—Limits Of Insurance: division or political subdivision has issued a
If coverage provided to the additional Insured Is permit or authorization.
required by a contract or agreement; the most We However:
will pay on behalf of the additional insured Is: a. The insurance afforded to such additional
a. The minimum amount required by the insured only applies to the extent permitted
contract or agreement; or by law; and
b. The Limits of Insurance shown in the b. if coverage prodded to the additional insured
Declarations; is.required by a contract or agreement, the
whichever Is less, insurance afforded tbauch additional insured
This endorsement shall not increase the will not be broader than that which you are
applicable Limits of Insurance sin the required by the contract, or agreement to
a
pP prbyioe for such additional insured.
Declarations. 2. This insurance does not apply to:
3. With respect to the Insuranceafforded to:thesea. ''Bodily .Injury", "property damage" or "per
additional Insureds, the following additional•
sonal and advertising injury"arising out of op-
exclusion applies: ,°rattans Performed,.for the federal govern-
This insurance does not apply to: merit,state or municipality;or •
a. "Bodily injury", "property damage" or b. "Bodily injury"or"property damage" included
"personal arid advertising injury" arising out within the "products-completed operations
of the rendering of, or the failure to render, tieiard".
any professional architectural,•engineering or 3. With respect to the insurance afforded to these
surveying services, Including: additional insureds, the following is added to
(1) The preparing, approving, or tailing to Section III—Limits Cif insurance:
prepare or app MAR, maps, Shop .
if-coverage provided to the additional insured is
drawings, opinions, reports, surveys,
field orders, change orders or drawings required by a contractor agreement,, the most we
and specifications;or will pay.on behalf Of the additional insured is:
(2). Supervisory, inspection, architectural or a. The minimum amount required by the
engineering acifvliies. contract or agreement; or
This exclusion applies. even if the claims
b. The Limits of Insurance shown in the
Declarations;
against an additional insured_ allege
negligence or :other wrongdoing iii the whichever is less.
supervision, hiring, employment, training Or -This endorsement' shall not increase the
monitoring of others by that insured, if the applicable Limits of Insurance shown in the
"occurrence"which caused the"bodily injury" Declarations.
or "property darnage",. or the offense which
caused the"personal and advertising injury",
involved the rendering 'of or failure to render •
any professional services by ycu With teapot
to your providing engineering, architectural or .
surveying ser4ices in your capacity as an
engineer, architect or surveyor.
WN GL 39 0818 Includes copyrighted material of the Insurance Service Mee.lec.,wlib its pemisslon. Page 7•°f 9D
4. With respect to the Insurance,afforded tothese b. 1110 construction, erection or removal of
additional insureds, the --following additional elevators; or
exclusion applies; c. The ownership, maintenance or use of any
This insurance does not apply to: elevators co.ered by this Insurance.
a, "Bodily injury", "property damage" or However,
"personal and advertising injury" arising out a. The insurance afforded to such additional
of the rendering Of, or the failure to render, insured only applies to the extent permitted
any professional architectural,engineering pr by law; and
surveying services, including: b. if coverage provided to the additional.insured
(1) The preparing, approving, or falling to is required by a contract Or agreement, the
prepare or approve, maps, shop insurance`afforded tosucti additional insured
drawings, opinions, reports, surveys, will not be broader than that which you are
field orders, change orders or drawings required by the contract or agreement to
and specifications;or provide for such additional Insured.
(2) Supervisory, inspection, architectural Or 2, With respect to the insurance afforded to these
engineering activities, additional Insureds, the following Is added to
This exclusion applies even if the claims Section III-Limits Of Insurance:
against an additional Insured allege If coverage provided to the additional Insured is
negligence or other wrongdoing in the required by a contract or agreement, the most we
supervision, hiring, employment, training or will pay on behalf of the additional Insured is:
monitoring of others by that insured, If the
"occurrence"which caused the'bodily injury" a. Theminimum amount required by the
or "property damage", or the offense which contract or agreement; or
caused the"personal and advertising Injury'; b. The Limits of insurance shown in the
involved -the rendering of or failure to render Deoiarations;
any professional services-by you with respect whichever is less.
to your providing engineering, architectural or
surveying services in your capacity as an This endorsement shall not increase the
engineer, architect or surveyor, applicable Limits of Insurance shown in the
G. Blanket Additional Insured — State Or Declarations.
Governmental Agency Or Subdivision Or Political 3. With respect to the Insurance afforded to these
Subdivision—Permits Or Authorizations Relating additional Insureds, the following additional
To Premises exclusion applies:
Section 11-Who Is An Insured is amended to in- This insurance does not apply to:
elude as an additional insured any state or a. "Bodily injury", "properly damage" or
governmental agency or subdivision or political "personal and advertising Injury" arising out
subdivision with whom you have agreed In a written of the rendering of, or the failure to render,
contract, executed prior to loss; to name as an any professional architectural,engineering or
additional insured, subject to the following -provision: surveying services, including:
1. This insurance applies only with respect to the,lot-, (I) The preparing, approving, or falling to
lowing hazards for which the state or prepare or approve, maps, shop
governmental agency or subdivision Or political drawings, opinions, reports, surveys,
subdivision hasissued a permit or authorizationfield orders,-change orders or drawings
in connection with premises you own, rent or and specifications;or
control and to Which this Insurance applies: '(2) Supervisory, inspection, architectural or
a. The existence, maintenance, repair, engineering activities,
construction, erection Or removal of -
•adyertising signs, awnings, canopies, cellar
entrances, coal holes, driveways, .manholes,
marquees, hoist 'away openings, sidewalk
vaults, street banners or decorations and
similar exposures; or
v
WN GL 39 08 18 includes copyrighted material of the Insurance Servlco Orfico;frc„with Its perrrissian, Page 81010
t
This exclusion applies even if the claims SECTION IV -- COMMERCIAL GENERAL LIABILITY
against an additional insured allege CONDITIONS AMENDMENTS
negligence or other wrongdoing in the
supervision, hiring, employment, training or A. Knowledge OF Occurrence
monitoring 'of others by that insured, 1f the item 2; Duties In The Event Of Occurrence, 01.
"occurrence"which caused the"bodily injury" Tense, Claim or Suit is amended by adding the ici-
er
"property damage", or the offense which lowing:
caused the"personal and advertising injury", e. You must give us or our authorized representa-
Involved the rendering of or failure to render the prompt notice of an "occurrence", claim or
any professional services by you with respect loss only when the"occurrence", claim or loss is
to your providing engineering, architectural or known to:
surveying services 'in your capacity as an
engineer, architect or surveyor. (1) You,If you are en individual;
(2) A partner, if you are a partnership; 1
i
SECTION III—LIMITS OF INSURANCE AMENDMENTS (3) An executive officer or insurance manager, if
you are a corporation; or
A, Damage To Premises Rented To You (4) A member or manager, if you are a limited
Paragraph 6.is replaced by the following: liability company.
6. Subject to Paragraph 5. above, the most we will B. Other Insurance
pay under Coverage A for damages 'because of Item 4. Other Insurance, b. Excess Insurance (1)
property damage to any one premises, while
rented to you, or In the case of damage by fire, (a)(II)is replaced by the following:
lightning, *explosion ,or sprinkler leakage, while (ii) 'That is fire, lightning, explosion or sprinkler leak--
rented
eak-rented to you or temporarily occupied by you with age insurance for premises :rented to you or
permission of the owner is the greater of: temporarily occupied by you with permission of
the owner; •
a. $300,000; or C, Unintentional Failure To Disclose Hazards
b. The amount shown next to the Damage To Item 6:Representations is replaced'by the following:
Premises Rented To You Limit In the Decla-
rations. 6. Representations And Unintentional Failure To
However; the provisions of this paragraph do not Disclose Hazards
apply If Damage To Premises Rented To You a. Dy accepting this'policy,you agree:
Coverage is excluded by endorsement. -(1) The statements in the Dociorations are
B. Medical Expense Limit accurate and complete;
Paragraph 7. Is replaced with the following: (2) Those statements are based upon repre-
sentations you made to us;and
7. Subject to Paragraph 6. above, the most we will (3). We have issued this policy in reliance
pay under Coverage C for all medical expenses upon your representations.
because df bodily injury sustained by any ane
parson is the greater of: b. If you unintentionally fall to disclose any haz-
ards existing at the inception date of your
a. $10,000; or policy, we will not deny coverage under this
b. The amount shown next to the Medical Ex- Coverage Pert because of such failure.
pense Limit in the'Declarations. However, this provision does not affect our
This insurance does not apply if coverage for tight to collect additional premium or exercise
Medical Expenses Is excluded either.by the pro- our right of cancellation or non-renewal.
visions of the coverage part or by endorsement.
•
WN GL 39 0818 Includes copyrighted material of.11.0 Insurance SenrIce Office,inc.,wiih ifs perrrission. . Page 9 of 10
. •
D. Waiver of Subrogation SECTION V—DEFINITIONS AMENDMENTS
Item 8, Transfer of Rights of Recovery Against A, Insured Contract Amended
Others to Us is hereby amended by the addition of paragraph 9,a.'is repiaced by the following:
the following;
We waive any right of recovery we may have because S. A contract for a lease of premises, However, that
Portion of the,cotact
of payments we make for Injury or damage arising out for a lease of premises that
of your ongoing operations, or"your work"done under indemnifies any person or organization for
damage by Gro, lightning; explosion or sprinkler
a written contract, executed prior to loss, requiring
such waiver with that person or organization and leakage to premises while rented to you or
included in the "products-completed, operations temporarily occupied by.you with permission of
hazard". However, our rights may only be waived the owner Is not an'insured coniract
prior to the "occurrence" giving rise to the injury or B. Personal Md Advertising Injury Redefined
damage for which we make payment .under :this Paragraph 14. d.and e.are replaced by the following:
Coverage Part. The Insured must do nothing after a
loss to impair our rights. At our request, the insured d. Oral, written, televised, videotaped or electronic
will bring "suit"or transfer those rights to us and help publication of material that slanders or libels a
per
us enforce those rights. son or organization or disparages a person's
or organization's goods, products or service;
e, Oral, written, televised, videotaped or electronic
publication of material that violates a person's
right of privacy;
•WN GL 39 08 18 .
f3Includes copyrighted nriterhal of the Insurance twee Mice,inc.,wllh Its pert ssion. Page 10 of 10
COMMERCIAL GENERAL LIABILITY
WN GL 139 0618
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
ADDITIONAL INSURED - CONTRACTORS -
OPERATIONS AND COMPLETED OPERATIONS -
WITH ADDITIONAL INSURED REQUIREMENT
iN CONSTRUCTION CONTRACT
•This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. Additional Insured_Operations (2) That portion of'your work" out of whish
A. Section II—Who Is An Insured is amended the injury or damage arises has been put
to include as an additional Insured: to its'intended use' by any person or or-
(1) Any person or organization for whom you ganization other than another contractor
are performingson opeorgaationsnization
whenryou ayou or subcontractor engaged in performing
such person or Organization have agreed operatioos for a principal as a part of the
in writing in a contract or agreement that same project.
suchperson or organization be added as 2 Additional Insured—Completed Operations
an additional Insured onyour policy;and A. Section II--Who is An Insured is amended
(2) Any.other Person or organization you are to include as an additional insured:
required to add as an additional insured (1) Any person or organization for Whom you
under the contract or agreement de- are performing operations when you and
scribed in Paragraph 1.above. such:person or Organization have agreed
Such persons)or organization(s)Is an add- in writing in a contract or agreement that
• Lionel Insured only with respect to liability for such person or organization be added as
"bodily Injury, "property damage" or "per- an additional insured on your policy;and
sonal and advertising Injury'caused,in (2) Any other person or organization you are
whole or In part,by:. required to add as an additional insured
a. Your acts or omissions;or under the contractor agreement de-
b. The acts or omissions of those acting on scribed in Paragraph 1.above.
your behalf; Such person(s)or organization(s)Is an addl-
tlonal Insured only with respect to liability for
in the performance of your ongoing opera- "bod'iiy lrijury", "property damage" or "per-
tions for the additional insured. canal and advertising injury"caused;.in whole
B. With respect to Additional Insured -Opera- or Part,by:
tions,coverage Is limited as follows: a. Your°acts oromissions;or
This Insurance.does not apply to "bodily in- b. The.acts or omissions of those acting on
Jury"'or"property damage"occurring after: your behalf;
(1) All .work, including materials, parts or and included in the"products-completed op-
equipment furnished In connection .with orations hazard",
such work',on project(ether than ser,
vice, maintenance or repairs)to be per-
formed
erformed by-or on behalf of the additional
Insured(s) at the location of.the covered
operations has been completed;or
WN GL 139 0618 Page 1 of 2
Includes copyrighted material of insurance Services Oflioe,Ino.,with Its permission.
S
•
L
B. With respect to Additional Insured —:Corn- D. With respect to the insurance afforded to
plated Operations,coverage is limited as fol- these additional insureds, the following Is
lows: added 10 Section III Limits Of Insurance:
(1) A person or organizatlon'sstatus as an!n- If coverage provided tothe additional insured
sured under Additional insured -- Com- is required by a contract or agreement, the
Opted Operations continues only for the most we will pay on behalf of the additional
period of time required by any.written.con- insured Is:
tractor agreement. (1) The minimum amount required by the
(2) The insurance provided to the additional contract or agreement;or
insured does not apply to'bodily Injury", (2) The Limits of Insurance shown in the Dec-
"property damage"or"personal and ad- laralions;
vertising injury-"arisingoutof"yourwork"
Whichever 1s Jess,
for which a consolidated(wrap-up)insur-
ance
nsurance program has been provided by the This endorsement shall not increase the ap-
prime contractor-project manager or plicable.Llmits of insurance shown in the Dec-
owner of the construction project in which laralions.
you are Involved. E. With respect to the insurance afforded to
3. Primary and Noncontributory these additional insureds, the following addi-
The following Is added to the Other insurance frenal exclusion applies:
Condition and supersedes any provision to the This insurance does not apply to:
contrary: "Bodily injury", "property damage" or "per-
Primary And Noncontributory insurance sone!and advertising injury"arising out of the
This insurance is primary to and will not seek con- rendering of,or the failure to render,any pro-
fessional architectural,engineering orsurvey-
Iribution from any other insurance available to an ing services,Including:
additional insured underyour policy provided that;
(1) The additional insured Is a Named Insured un- (1) The.preparing, ,approving, or falling to
der such other Insurance;and prepare or approve, maps, shop draw-
ings, opinions, reports;surveys, field or-
(2) You have agreed In writing in a contract or ders, change orders or drawings and
agreement that this Insurance would be prl- speclficatlons;or
mary and would not seek contribution from 2 Su erviso Inspection, architectural or
any other Insurance available te.the additional O p rye p
insured. :engineering activities.
4. Other Provisions Applicable to Additional in- This exclusion applies even if the claims
sured -- Operations and Additional Insured against an additional insured allege negli-
Completed.Operations Bence or other wrongdoing In the supelvislon,
hiring, employment, training or monitoring of
A. The Amendment of Insured Contract DOM- others_by that insured, if the "occurrence
don(Endorsement CG 24 26)does not apply which.caused the"bodily'injury" or"property
to-an additional Insured. damage",or the offense which caused the •
B. The coverage provided under Paragraph f.'of •"personal and advertising injury",involved the
the definition of"Insured contract"under Sec- rendering of or failure to render any profes-
tion V—Definitions does not apply to an ad- clonal services'by you with respect.lo your
ditional insured under this endorsement un- providing engineering,architectural orsurvey-
less_ required by a written contract or ing services in your capacity as an engineer,
agreement. architect or surveyor.
C. The Insurance afforded to`such additional in-
sured only appliestothe extent permitted by
law;and •
if coverage provided to the addIiionai,Insured
is required by a contract or agreement,the in-
surance afforded to'such additional Insured
will not be broader than that which you are re-
quited by the contractor agreement to provide
for such additional insured.
WNGL13906118 Page2of2
.includes copyrighted material of.lneuranco'Senlace Office,Inc..with Its permission.
WN CA 27 06 16
BUSINESS AUTO ENHANCEMENT ENDORSEMENT•
The Business Auto Enhancement Endorsement Is an optional endorsement that provides coverage enhancements.
The following is a summary of broadened coverages provided by this endorsement. No coverage is provided by this
summary,refer to following endorsement for changes in your policy.
SUMMARY OF COVERAGES PAGE
Accidental Airbag Deployment Coverage 4
Auto Loan/Lease Gap Coverage 4
Blanket Additional Insured 2
Blanket Waiver of Subrogation 5
Broadened Definition of Insured Includes:
Newly Acquired Organizations for up to 180 Days 2
Employees as Insureds 2
Subsidiaries In Which You Own 50%or More 2
Deductible Waiver for Glass Repair 3
Employee Hired Auto 2,5
Fellow Employee Coverage 3
Hired Auto Physical Damage Coverage 4
Knowledge of Accident,Claim,Suit'or Loss 5
Loss Of Use Expenses-Amended 3
Personal Effects 3
Rental Reimbursement Coverage 4
Supplementary Payments-Amended:
Ball Bonds up to'$5,000 2
Loss of Earnings up to$50D/Day 2
Transportation Expense Limits—Amended 3
Unintentional Failure to Disclose Hazards 5
WN CA 27 06 16 Includes copyrighted materiel of Insurance Services Ohio°,Inc.,with Its permission. Page 1 :of 6
• ,
WN CA 27 06 16
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY
BUSINESS AUTO ENHANCEMENT ENDORSEMENT
This endorsement modifies the insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to the coverage provided by this endorsement, the.provisions of the Coverage Form apply unless
modified by this endorsement. The SECTIONS of the Business Auto Coverage Form identified In this endorsement
will be amended as shown below.
SECTION II -- COVERED AUTOS LIABILITY g. Any"employee" of yours is an "insured"while
COVERAGE AMENDMENTS operating a covered "auto" hired or rented
A. Who Is An Insured under' a contract or agreement In the
"employee's" name, with your permission.
SECTION II — COVERED, AUTOS LIABILITYwhile performing duties related to the conduct
COVERAGE,A. Coverage, 1.'Who is An insured of your business.
is amended to add: B. Blanket Additional Insured
d. Any legally incorporated subsidiary of yours in SECTION II — COVERED AUTOS LIABILITY
which you own more than 50% of the voting COVERAGE, A. Coverage, 1. Who Is An
stock on the effective date of this coverage Insured, paragraph c. is amended to add the
form. following:
However, "insured" .does not include any Any person or organization who is required under a
subsidiary of yours that Is an "insured" under written contract or_ agreement between you and
any other automobile Lability policy, or would that person or organization, that is signed and
be an "insured" under such policy but for executed by you before the "bodily injury" or
termination of such policy or the exhaustion on 'property damage" occurs and that is in effect
such policy's limits of insurance, during the policy period, to be named ..as an
additional insured is an "insured" for Liability
e. Any organization which is newly acquired or Overage, but only for damages to which this
formed by you and over which you maintain insurance applies and ..only to the extent that
majority ownership, However,coverage under persons or organization qualifies'as an "insured"
this provision: under the Who;is An insured provision contained in
(1) is afforded only for the first 180 days after Section Il.
you acquire or form the organization or Liability Coverage Extensions-Supplementary
unto the end of the policy period, C. Layme is pp ry
whichever comes first;
(2) does not apply to "bodily injury" or SECTION II -. COVERED AUTOS LIABILITY
"property damage" that results from an COVERAGE; A. Coverage, 2. Coverage
"accident"that occurred before you formed Extensions, a. Supplementary Payments is
or acquired the organization; amended by replacing subparagraphs (2) And (4)
with the following
(3) does not apply to any newly acquired or
formed organization that Is a joint venture (2) Up to $5;000 for costof bail bonds(including
or partnership;and bonds for related traffic law violations)required
because of arr"accident"we cover. We do not
(4) does not apply to an "insured"under any •have to furnish.these bonds.
other automobile liability policy; or would
be an Insured"under such a policy but for (4) All reasonable expenses incurred by the
termination of such policy or the `insured" at.our.request, Including actual loss
exhaustion of such policy's limits 'of of earnings up to $500 a day because of time
Insurance. off from work.
f. Any "employee" of yours is an "Insured"while
using a covered 'auto"you don't own, hire or
borrow in your business or your personal
affairs.
WN CA 27 06 16 Inaludos copyrighted material of Insurance$eruicas Oleo,Ina.,with its permission, Page 2 of 5
D. Fellow Employee Coverage D. Glass Repair-Deductible Waiver
SECTION II - COVERED AUTOS LIABILITY SECTION III — PHYSICAL DAMAGE
COVERAGE, B. Exclusions, 5. Fellow COVERAGE,A. Coverage,3. Glass Breakage--
Employee,the following is added: Hitting A Bird Or Animal — Falling Objects Or
Missiles.is amended by adding the following:
Co-Employee Lawsuit Defense Cost
Reimbursement No deductible will apply to glass breakage if such
glass is repaired, In a manner acceptable to us,
If a suit seeking damages for"bodily injury"to any rather than replaced:
fellow "employee" of the "insured" arising out of
and in the course of the fellow "employee's" E Hired Auto Physical Damage
employment or while performing duties related to SECTION III — PHYSICAL DAMAGE
the conduct of your business, or a suit seeking COVERAGE,A. Coverage is amended by adding
damages brought by the spouse,, child, parent, the following:
brother or sister of that. fellow "employee", is
brought against you, we will reimburse reasonable 5. Hl red Auto Physical Damage
costs that you incur in The defense of such
Matters. Any reimbursement made pursuant to If hired"autos"are'covered"autos"for Liability
this sub-section will be iin addition to the limits of Coverage and if Comprehensive, Specified
liability set forth in the Declarations. Causes of Loss, or Collision coverages are
provided under this coverage form for any
SECTION 111 — PHYSICAL DAMAGE COVERAGE "auto" you own, then the Physical Damage.
SECTONill AMENDMENTS Coverages provided are extended.to "autos"
you hire of like klrid and use, subject to the
A. Transportation Expense-7-Limits Amended following:
SECTION Ill -- PHYSICAL DAMAGE a, The most we will pay for any one 'loss" is
$50.000 or the actual cash value or cost to
COVERAGE, A. Coverage, 4. Coverage
Extensions, a. Transportation Expenses is repair or replace,whichever Is less,minus
a deductible,
amended by replacing$20 per day/$600 maximum 9
limit with$50 per day1$1000 maximum. b. The deductible will,be equal to the largest
deductible applicable to any owned "auto"
B. Hired Auto Physical Damage — Loss Of Use for that coverage. Any Comprehensive
Expenses—Limits Amended deductible does not apply to"loss"caused
SECTION Ill — PHYSICAL DAMAGE
by fire or lightening;
COVERAGE, A, Coverage, 4. Coverage c, Hired Auto Physical Damage coverage is
Extensions, b. Loss of Use Expenses Is excess over any other collectible
amended by replacing the $20 per day/$600 insurance;and
maximum limit with $50 per dayi$750 maximum
IimiL d. Subject.to theabove limit, deductible and
excess provisions we will provide-
C. Personal Effects Coverage coverage equal to-the broadest coverage
applicable to any covered"auto"you own.
SECTION Ill — PHYSICAL DAMAGE
COVERAGE. A. Coverage, 4. Coverage If a limit for Hired Auto Physical Damage is
Extensions is amended by adding the following: indicated in the Declarations, then that limit
replaces,and is not added to,the$50,000 limit
c. Personal Effects indicated above.
We will pay up to.$500 for "loss" topersonal
effects,which are:
(1) Owned by an Insured";and
(2) In or on your covered"auto."
This coverage applies only in the event Of the total.
theft of your covered"auto."No deductible applies
to this coverage
WN CA 27 06 16 Includes copyrighted nia"teriot at hsuronca Sordces Office;Inc.,with its permission, Page 3 of 5
•
•
F. Rental Reimbursement G. Accidental Airbag Deployment Coverage
SECTION iII—PHYSICAL DAMAGE COVERAGE SECTION III — PHYSICAL DAMAGE
A,Coverage;is amended by adding the following: COVERAGE, A. Coverage is amended by adding
the fellowing:'
6, Rental Reimbursement
This coverage applies only to a covered"auto"
7. Accidental Airbag Deployment Coverage
of the private passenger or light truck type as We will pay to reset or replace factory Installed
follows: airbags) in any covered "auto" for accidental
discharge, other than discharge due to a
a. We will pay for rental reimbursement collision'loss.
expenses incurred:by you for the rental.of
a private passenger or light truck type This coverage is applicable only if
"auto" because of "loss_" to a covered comprehensive coverage applies to the
private passenger or light truck type covered"auto".
"auto". Payment applies in addition to the
otherwise applicable amount of eachThis coverage is excess over any other
coverage you have on a'covered ;privates collectible insurance or reimbursement by
passenger ar light truck 'type "auto." No manufacturers warranty.
deductibles apply to this coverage.
H. Auto LoanlLease Gap Coverage
b. We will pay only for those expenses SECTION Ill PHYSICAL DAMAGE COVERAGE,
24 hours Incurred hours after the "oduring the policyPeriodbeginning item A., Coverage, is amended by adding the
s" and ending, ioJlawing:
regardless of the policy's .expiration, with
the lesser Of the following number of days: 8. Auto Loan/Lease Gap Coverage
(1) The number of days reasonably This coverage appliesonly to a covered"auto"
required to repair or replace the described or designated in the'Schedule or in
covered private passenger ,or light the Declarations as including physical damage
truck type "auto". if "loss" is caused coverage.
by theft, this hunter of days is added
to the number of days it takes to In the event of a covered total "loss" to a
locate the covered private passenger covered"auto" described or designated in the
or light truck type `auto" and return it Schedule or in the Declarations, we will pay
toyou;or any unpaid amount due on the lease or loan
(2) 30 days, for a covered"auto"less:
c. Our payment is Verified to the lesser-of the a. The ' amount paid under the Physical
following amounts: Damage Coverage Section ori the policy;
and
(1) Necessary and actual expenses b, Any:
incurred;or
(2) $50 per day, up to a maximum of (1) Overdue lease/loan payments at the
$1,000. time of the"loss";
d. This coverage does not apply while there (2) Financial penalties Imposed 'under a
are spare or reserve private passenger or lease for excessive use, abnormal
light truck type"autos"available to you for wear and tear or high mileage;
your operations. (3) Security deposits,not returned by the
e. If 'loss" results from the total theft of a lessor;
covered"auto of the private passenger or
light truck type, we will pay under anis (4) Costs for extended..warranties, Credit
coverage only that amount of your rental Life Insurance, Health, Accident or
reimbursement 'expenses which Is not Disability Insurance purchased with
already-provided for under SECTION III— the loan or lease;.and
PHYSICAL DAMAGE COVERAGE, A.
Coverage,4.coverage Exten'slons. (5) Carry-over balances from previous
loans or leases.
For the purposes of this Rental
Reimbursement coverage, light truck Is
defined as a truck with a gross vehicle weight-
of 10,000 lbs. .or less 'as defined by: the
manufacturer as the maximum'loaded weight
the auto Is designed to carry.
WN CA 27 06 16 Includes copyflebtod motorini of Inaurnnoo Services Wilco,inc.,with-Itspnrmiselon• Page 4 of b
SECTION IV — BUSINESS AUTO CONDITIONS C. Unintentional Failure to Disclose Hazards
AMENDMENTS
SECTION IV — BUSINESS AUTO •CONDITIONS,
A. Duties In The Event Of Accident, Claim, Suit Or B. _General Conditions, 2. Concealment,
Loss Amended Misrepresentation 'or Fraud, is amended by'
SECTION IV — BUSINESS AUTO CONDITIONS, adding the following paragraph:
A. Loss Conditions, 2. Duties In The Event Of If you unintentionally fail to disclose any hazards
Accident, Claim,Suit Or Loss,a.is amended by existing at the Inception date of the policy, er
adding the following: during the policy period in connection with any
This condition applies only when the"accident" or additional hazards, we will not deny coverage
T
his"o known to: under this'Coverage Part because of such failure.
(1) You,if you are an individual; D. Employee Hired Auto
(2) A partner,if you are a partnership; SECTION IV— BUSINESS AUTO CONDITIONS,
B. General Conditions, S. Other Insurance,
(3) An executive officer or insurance manager, if" paragraph .b. is deleted and replace by the
you are a.corporation;or following:
(4) A member or manager: if you are .a limited b. For Hired Auto Physical Damage Coverage,
liability company. the following are deemed to be a covered
But, this section does not amend the previsions 'autas'.you awn:
relating 'to notification of police, protection or (1) Any covered"auto"you lease, hire, rent or
examination of the property which was subject to borrow,
the"loss". (2) Any covered"auto"hired or rented by your
B. Blanket Waiver of Subrogation "employee" under a contract in that
individual "employee's" name, with your
Section IV—BUSINESS AUTO CONDITIONS,A. permission,while performing duties related
Loss Conditions, S. Transfer of Rights of 'to the conduct of your business.
Recovery. Against Others to Us, is amended by However, any "auto" that is leased, hired,
adding the following exception: rented or brrowed with a driver is not a
However, we waive any right of recovery we may covered"auto
have against any person or organization to the.
-extent required of you by a written contract signed
and executed prior to any "accident" or loss",
provided that the"accident" or"loss"arises out of
operations contemplated by such contract, The
waiver applies only to,the person or organization
designated in such contract.
•
WN CA.27 06 16 Inaludus.copyrighted muturlul of Insururicu,5urdcos Officio,Inc.,With itc pormissiori. Page 6 of 6
This page has been left blank intentionally,
1
1
I
CllentII:183942 LEFTCOASI
ACORD,„ CERTIFICATE OF LIABILITY INSURANCE DATE(NhmD1YYYYl
9/09!2421
,THIS CERTIFICATE IS ISSUED ASA NIATTER.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 HOT 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 SUDROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require on endorsement:A statement on
this corilticale does not confer any righls"to lho corlllicate hokierIn lieu of such endorsemont(s)..
PROLUCER fiR ACT Therese Pritchett
Propel Insurance "eD'Im E„ 644 494-7744 BBS 877-1326
Medford Workers Compensation tec,om
P 0 Box 836 AeoREss;_tlioresD.,pritchett�propelinsuranl:e.com.
Medford,x938 97601 IHSUnEitisjA FORDINOCDVERAOE NATO?
INSURER A:SAIF Corporation 36196 {
INSURED INSURER B:
Left Coast Underground LLC
4865 Highway 28411!203 ie+suRERc: -_�
White City,OR 97603 ulsuRRD:
INSURER e I
INSURER Ft
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVESEEN!ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR 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 PAJD.CLAIMS.
If++SR APDL sue _._..
LTR 7YPEOFINSURANCE ems1YND_ POLICY NUMBER (M' •0 ) (;gf•;T `•) LIMITS
COMMERCIAL GENERALLIABILITY EACH OCCUR PENCE $
CVdt4$.MADE nOGCUR PREpIISESiE�ouuf°ncol $
MED EXP(Any onoperson) '8
PERSONAL situ/INJURY S _
GEI'TLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 6
POLICY I I J a n Lob PROOt1CTS-COM PlOPAGG 6
OTHER: $
AUTOMOBILE LIABILITY MHO'NED smote LIMIT
.— IEA eoeicnnn
ANY AUTO BODILY INJURY.(Per pump) 5
' 'OV?IED —SCHEDULED BODILY INJURY(Pardonq 5
AUTOS ONLY AUTOSaod1
FpR�p NON•01ANEDPROPERTY D1MAGIt
_AUTOS ONLY _Aures ONLY ucddo 9
c$
__.
UMBRELLA LIAR .__OCCUR EACH OCCURRENCE 3
®
EXCESS UAB CLAW6•MADE AGGREGATE S'
_ DED RETENTIONS S
YJORKERSCOMPENSATION PE I.x STH.
A 87x332 48!01/2021 08lDi12O22 X �sT�,rtrrr• R.
AND EMPLOYERS LIABILITY
ANNAyP D pMRETI PoPARrrNNERIEXECUTIVE Y f N EL EACH ACCIDENT 51,000,000
4FF1C�RrMEh1B£REXCLUOED7 a NIA
(Mandatory InNH) E.L.DISEASE-EA EMPLOYEE $1,000,000
DESCRIPTION OF OPERATIONShu:av E.L:DISEASE-POUCYLIMIT $1,000,000
•
DESCRIPTION OFOPERATIONS f LOCATIONS IVEHICLES.(ACORD 1E1,AddRional Romarlis 8aI:edule,maybe altschad If mon apace Is toqulmd) ,
**Workers Comp Information"" '
Members Excluded:
Danny Beard,Member
Project:Demolition of Permanent Structures at 1291 Oak Street,-Ashland;OR
CERTIFICATE HOLDER CANCELLATION ;ff
City of Ashland 'BHDULD ANY OF THE ABOVE.DESCRIBED POLICIES hE CANCELLED BEFORE
THE'-EXPIRATION•DATE THEREOF,_ NOTICE WILL'RE DELIVERED IN
20 East Main Street ACCORDANCE '.WITH THE POLICY FaOvisIONs:
Ashland,OR 97820 -
AtTrHORIZED REpRESSNTATWE
Ii
O 1988 2018 ACORD CORPORATION.All rights reserved.
ACORD 26(2016103) 1 cif 1 The ACORD name and logo aro regIstoted INarka of ACORD
184787125)r 4679663 LAHOO
� 1
CITY O F SUPPORTING DOCUMENT:
,
FORM#2 ASH LD_ ••• .
INVITATION TO I3ID—JD A.4,11 S !+'. VII .,
INTERMEDIATE PROCUREMENT
Release date:8/18121
Requested by(name/dept/telephoneffaxlemall):Kayla'Kathool,Public Works,541-552-2119,kavloa.kathel@ashland.or.us
Bids are duo by(time/day/date):2:00 PM on September 7,2021
Project name:Demolition of Permanent Structures
Job site location(name/address): 1291 Oak St,Ashland,OR 97520
Project completion required by(date):October 31,2021
Preferred method of shipment for materiels/equipment(ifapplicable): FOB Ashland—Freight Prepaid
Bids May be faxed,emailed or hand delivered.Contractors shall submit bid on Ihelr company letterhead, Informal email
bids and/orlate bids will not be accepter!.Terms or discounts which are conditioned upon payment within a certain time
will not be considered for purposes of comparison of bids.
The successful contractor will be required to cater into a centred with the City for the services and provide insurance
certificates in their own name for General Liability,Automobile and Workers'Compensation,Workers'Compensation
Insurance is mandatory.Subcontracting will not be permitted.
"OR EQUAL":Any brand name tistcd in the specifications ns"or equal' "or equivalent"stint]ostnblislrthe minimum requirements for quality,utility,
durability.futnction,•purpose,eto.'Oiher product brands maybe offered that are equal t&or better thanthe product brand name.Bidder may show cost
difference,alternates and options in the apace provided in the quote.This clause is not meant to be restrictive,but to set Iho minimum standard.Tim CITY
SHALL Ui3TGRMINE,IN rr8 SOLE DISCRETION,WHETHER A PRODUCT OFFERED IS"EQUAL."QUAL."When the designation is"or equal"or
"equivalent"City shall make its decision alter Bid Closing..
•
..
.SCOPE OF SERVICES
Demolish and remove two connected structures,including foundation,contents,and exterior
appurtenances. Main structures to be demolished include without limitation an office building;
an attached open-sided pole barn style garage,and a concrete slab. Provide all equipment,
materials,and.labor.need to complete the job.
The office building is about 2,500.square feet. It,includes Multiple Overhead doors,2 large,
glazed barn-style sliding doors,and several man doos. The office building has a corrugated
metal roof and a finished interior. It is assumed to be wood framed,although not all framing is
visible.
The attached open-sided pole barn style garage is about 2,500 square feet. It includes 16 steel
posts approximately 4 inches diameter and 10 to 12 feet in height. The lumber roof framing
includes a mixture of 2x4 and 2x6. It has a corrugated metal roof and plywood siding on two
Sides. A concrete slablramp,approximately 1,060 square feet,next to the pole barn.must be
demolished as well
Them is no domestic Water or sewer service to either building.,Electricity has been disconnected.
Hazardous materials assessment found no'asbestos, The report can be provided upon request.
111/A1
Form 112-Intermediate Procurement,Invitation 10 BId,Trade Services,Page 1 of 2,8!18/2021
4
Insurance Requirements:
Contractor must carry a policy ,or policies of liability insurance including commercial general
liability insurance with a combined single limit, or°the equivalent, of not less than $2,0003000
(two million dollars) per occurrence for Bodily Injury and Property Damage. The insurance
required shall include the following coverages:
o Comprehensive General or Commercial General Liability, including personal
injury;contractual liability, and productslcoi>tipleted'operations coverage; And
• Automobile Liability.
Attachments:
• Attachment A—Site map
• Attachment B—Specifications for demolition
• Attachment C—Goods and Services Agreement template
.A site visit may be arranged by contacting the Project Manager listed at the top of this
solicitation.
All Pricing Must Be I-Ield Firm For 30 Days
Method of Alvaro:ORS 27913..070 Intermediate Procurements'.(4)If Contract!s awarded,the contracting agency shall
award the contract to the offeror whose quote or p•oposal will best serve the liiteirests of the contracting agency, taking into
account price as i veil as considerations including, but not to, experience,expertise,product functionality,suitability
fa.a particrtlarpurpose and contractor'respoiisibiltty ander ORS 279B.Ho. •
•
C:\pub-wrksleng12Q18 Project Yet x12018-3d Hnnlesty Proporty=1291 Oak St14r.401i111Soiplus r3,uilclings
RemovallSalicitntiontilTB Panamint-Struclure.Deinolition HEudesty,doc I
1
,Ia1TTACl-IIUlE1!!T Ati'.
Site Map4.1
rrr d
YA4, Iil ' .e.
for Demolition
'n'snln:,�i. �.
at 1291Oak Street �rli,tJ" ', '�•
Ashland, OR , ! ii„,, =4-
{�' ,;bV Nava+l�9 �,• I ,
[ 1 ;i
i1 A ,i e 1
II �' ,t' 1 , ./
f' ? " I �t 1'x,1.
it
V
�; N ': 'I
II I, 1f- I '' �h ry i
I' +I I' ' '' 'I D'1 ` ;,p1`-• \ O rtr,g7�i'.iIK
Legend i ,Wkn&34 „ -%
Willi
Buildings to be demolished J •
''t ''•,Sources ri$ME E GanWin'(J'SG,S,
A Iii --:AsNlnil�J jp p'METT1IhEar'China'lMENT P,,.$1
H nth t(on_cj),Esri-,
'i I II r' '• Ir • ` , ,Korea;Esri,(Tlialland),NGCC;(c) '
i '- • SUnlir4 ry' ,``i4ti�S., OpengtreelrOpicontnbulors,and the GIS't
80 40 0 80 Feet • .• I n,ru ' +I '� •Usa'r Cornmujityr , _ ;
ATTACHMENT B:
SPECIFICATIONS FOR DEMOLITION OF BUILDING STRUCTURES
PART 1-GENERAL
1.01 Description of Work-Comply with local,state,and federal regulations to remove and
properly dispose of structures and contents. Inoludes above ground and below ground elements,
contents of structures,and exterior features including concrete slabs,walkways,planters,trash,
rubbish,foundations,sidewalks,steps,'and driveways from the site;furnishing and compaction of
backfill material;furnishing and placing topsoil;finish grading of disturbed areas;placing and
removing safety fencing;and.payment Of any permit or disposal fees,
1.02 Submittals-Submit a work plan to the City a minimum of 96 hours prior to commencing
activities. At a minimum,the plan will include.a schedule of work,key contact information,and
disposal location.
1.03 Special Requirements
A. Work may only be performed Monday through Friday,between the hours of 7:00 AM and
5:00 PM,
B. Ensure access of fire hydrants is maintained at all times
1.04 Measurement and Payment
A. Measurement:Lump sum item;no measurement will be made.
B. Payment:Payment will be at the lump sum price.
PART 2-PRODUCTS
2.01 Backfill Material-Utilize native materials to the extent available. If additional backfill is
required,furnish imported mineral soil containing no•organic material. •
PART 3-EXECUTION
3,011 General
A. Protect existing fire hydrants,street lights,traffic signals,utility poles,fire alarm boxes,wire
cables,underground utilities,and other appurtenances in the.vicinity of the demolition site.
B, Provide correct type and class of fire extinguisher's on site and in.equipment.Provide fire
extinguishers adjacent to any areas where cutting torches are used.
C. Inspect the site for its character and the type of structures to be demolished.The City
'assumes no responsibility for the.condition of existing buildings,structures,and other
property within the demolition area,or the condition of the.property before or after the
solicitation for proposals.
D. Pay all disposal,costs;:including costs related,to disposal of specialty items such as household
'hazardous"wastes,appliances,yard wastes,or electronics.
t `
E. Backfill any holes that result from demolition/removal work. Utilize native materials to the
extent available. If additional backfill is required,utilize imported mineral topsoil containing
no organic material. Smooth and shape backfilled holes to blend with surrounding surface
elevations.
3.02 Utility Disconnections-Not applicable
3.03 Tree Protection—Protect adjacent trees from damage during demolition. At a ininimuni,
provide chain link fence around drip lines for duration of work. Fence must be at least six feet in
height.
3.03 Protection of the Public-Adjacent Property:Protect structures,parking lots,driveways,
utilities, lawns,and other property elements frora damage from the demolition activities.Provide
sheeting or shoring as necessary to protect adjacentprgperty.
3.04 Environmental Requirements
A. Dust Control:Comply with all applicable air pollution requirements of the County and State.
Use water or appropriate chemicals for control of dust in the demolition area,on hauling
equipment,on adjacent roadways,and when grading the`site.
B. Litter:Prevent the generation.of litter during demolition and collect all litter from the
demolition area at the end of each Working clay.Load trucks to preventiealcage or blowing of
debris.
C. PCB:Fluorescent light fixtures and ballasts appear to be of a vintage that could contain
polychlorinated biphenyl(PCB).Contractor is to assume PCBs are present and must dispose
of light fixtures and ballasts according to state and federal regulations for PCB.
3.05 Salvage-Salvage of materials from demolished structures described in the.contract
documents is allowed.Remove all salvaged materials from the site by the end of each day's work.
Only the Contractor's authorized workers are allowed to salvage or demolish the structure or its
contents.
•
•
II
if
•
•
Left Coast Underground (
4865 Hwy 23411203
111;:`0:(
White Clty,OR 97603 0 -15.4001:1041,4.
_.
81292021 327
I+�fiit7.Il1e14i1F7 -
City Of Ashland
51 Winburn Way
Ashland,OR 97520
s
...___•
14)3.0.14'_ _S
"Demo Project at 1291 Oak St, Ashland,OR 97520" 40,937.00 40,937.00
This Price Includes the following; ;
Mobilization, Tree Protection, Demo, Dust control, Haul •
away, Trucking, Dump fees.
Total $40,937.00
..E4onp 5e1-622.5020
M ,
CITY OF
ASHLAND
memoTO: File
FROM: Kaylea IC4thoi
DATE: 8/18/2021
RE: Record of Solicitation Attempts,Demolition of Structure on 1291 Oak St
The following construction contractors were contacted for Demolition ITB on 8/18/21:
• Brittania Enterprises—Declined to bid,phone.
• Reggie DeVorel DeVore Electric—Did not respond
• Taylor Site Development-Did not respond,
• Danny Beard/Left Coast Underground—Submitted bid
• Will McFall-Submitted bid
CITY OF ASHLAND
20 East Main Street TO 541480.8002
Oland,Oregon 97520 Fax:541.4110.5311
wwx.es5land,or.9 TTY;8110.735.2000 ��
McFall Excavation.LLC Estimate
106 VICTORIA WAY
OR 97502 Date Esliinate
917/2021 9
Name Address
City orAshland
20 East Main St.
Ashland,OR 97520
•Project
Description Qty Rate Total
Demolition orPertnonent Structures at 1291 Oak St 48,500.00 48,500,00
Total 548,500.00