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HomeMy WebLinkAbout2021-173 PO 20210281-David Wisniewski " 'EpirSE . • Purchase Order 11/0 Fiscal Year _2021 Page: 1 of: 1 B City of Ashland • 1 411,-1�i,L_ i iPT,�a L ATTN:Accounts Payable purchase Ashland, OR97520 Order id 102 81 T Phone:641/552-2010 O Email: payable©ashland.or,us . V H 0/0 Public Works Department E DAVID WISNIEWSKI i 51 Winburn Way N 876 CLAY ST p Ashland, OR 97520 ASHLAND, OR 97520 Phone:541/488-5347 R T Fax: 541/488-6006 T1 -;:am.L-�—Edsi IE71ffrrrr; j�lie—•=_—�'_ • Scott Fleu i���_ e'er='�:. Ir -1i1 !I-1 V.• _;._ d• _�4 02123/202- 5954 City Accounts Pa able - — Replace Handicap Ramps • 1 Remove and replace existing handicap accessible ramps at the 1.0 $3,392.00 $3,392.00 intersection of Granit Street and High Street Contract for Goods and Services Less than$25,000 • Completion date: TBD soft 23rd of Feb 2021 weather dependent Project Account: - • ***************GL SUMMARY******k*kk***** 081200-602400 $3,392.00 • • • • • • • • By: AZ/_ Date: / Author] ed ed Signature rE __ _�� 3 392.00 . M j / '14);_e_o_t_,K.-4-1.,---) ');a' 6"•' 1 FORM #3 CITY OIF • A request for a Purchase Order AS REQUISITION tQ�of �-� ,i,./ �0 " 1 ASAP ! request: !!�°J e . �l Required date for delivery: Vendor Name °-1? D• avit!Scott Construction Address,City,State,zip 876 Clay Street Ashland,OR 97520 • • Contact Name&Telephone Number David Scott (541944.4491 Fax Number - SOURCING METHOD . O ):xemnt from Competitive Bidding ' ❑ Emergency ❑ Reason for exemption: 0 invitation to Bid (Copies on file) ❑ Form 1113,Written findings and Authorization ❑ AMC 2.50 Dale approved by Council: ❑ Written quote or proposal attached . ❑ Written quote or proposal attached _.(Attach copy of council communication) (tf council approval required,attach copy of CC) i ElSmall Procurement 0 Request for Proposal (Copies on file) Cooperative I focurement Less than$5,000 Date approved byPropos:_ ❑ Slate of Oregon • ® Direct Award ppCContract# ® Verbal/Written quote(s)or proposal(s) ^(Attach copy of council communication) i] State of Washington Intermediate Procurement ❑ Solo Source Contract ii GOODS&SERVICES 0 Applicable Form((15,6,7 or 8) ❑ Other government agency contract $5,000 to$100.000 0 Written quote or proposal attached Agency ❑ (3)Written quotes and solicitation attached ❑ Form 114, Personal Services$51(to$751( Contract# PERSONAL SERVICES ■ Special •ment Approval Intergovernmental Agreement $5,000 to$75,000 ■ , Request , •,, , ❑ Agency Date original contract approved by Council: ❑ Less than$35,000,by direct appointment ■ quote• •i (Date) ❑ (3)Written proposalslwritten solicitation . :approved (Attach copy of council communication) • 111Form 114, Personal Services$5K to$75K Valid _ _.. — Description of SERVICES Total Cost Remove and replace existing handicap accessible ramps at the intersection , ; •': : ;. . : of Granite Street and High Street(see attached) $3,392.00::::; ::: ::..; Item# Quantity Unit Description of MATERIALS Unit Price Total Cost _ TOTAL COST ® Per attached quotelproposal : : : '' / 'Project NumbeE201.528 2O--. Account Number 08.12.00;7.04299- t0 OVA 00 . Account Number • - • • Account Nttrnber • -__-__- ) • . 'Expenditure must be charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. IT Director In collaboration with department to approve all hardware and software purchases: • IT Director • Date• Support-Yes/No By signing this requisition form,!certify(hat t e ity's public contracting requirements have been satisfied. Employee:\J �� ,.t Department Head: I . e(i4 fat.( •V( ..V1Y q.,n _. 1 to or greater than$5,000) Department Manager!Supervlsor: City Administrator: "b' Equal t r greater than$25,000) Funds appropriated for current fiscal year: E8-1-NO /''.?. Fl rtO !MC;- Equal to or greater an , 00) Date • Form 113-Requisition . Contract for GOODS AND SERVICES Less than $25,000 • C f T Y a rr T CONTRACTOR:David Scott Construction#217973 ASHLAND . CONTACT:David@davidscottconstruction.com • 20 East Main Street ' Ashland, Oregon 97520I ADDRESS:876 Clay Street,Ashland Oregon,97520 Telephone: 541/488-6002 Fax: 541/488-5311 j TELEPHONE: 541-944-4491 . FAX: DATE AGREEMENT PREPARED:09 February 2021 . BEGINNING DATE:TBD soft 17d'of Feb 2021 COMPLETION DATE:'TED soft 23rd of Feb 2021 weather 1 dependent COMPENSATION:$3,392.00 1 . ' GOODS AND SERVICES TO BE PROVIDED: Sawcut,tiar out curb and gutter and ADA path from the boundary ' between 123 nigh Street approximately 17 feet Southeas to where existing flare meets curb on the Southeast side of the Alley entrance.Pour San Diego Buff colored concrete to ODOT requirements to accomaodate new ADA path,curb and gutter.Flare shall be between 4 and 6 feet to achieve pro er slope and grading. ADDITIONAL TERMS: I In the event of conflicts or discrepancies among the contract documents,the City of Ashland Contract for Goods and Services will be primary and . take precedence,and any exhibits or ancillary contracts or agreemebts having redundant or contrary provisions will be subordinate to and interpreted in a manner that will not conflict with the said primary CO of Ashland Contract. . NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the ' CITY AND CONTRACTOR AGREE as follows: II 1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and - expense, perform any work described above and, Unless otherwise specified,furnish all labor, equipment and materials required for the proper performance of sech work. 2. Qualified Work: Contractor has represented, and by entering into this contract now represents,that any , personnel assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned in a skilled and worker-like manner and,if required to be registered, licensed or bonded by the • State of Oregon,are so registered, licensed and bonded.Contractor must also maintain a current City business • license. • 3. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no .later than the date indicated above and start performing the work under thiscontract by the beginning date - indicated above and complete the work by the completion date indicated above. - ' 4. Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and • expenses, the sum specified above. Payments shall be made within 30 days of the date of the invoice. Should the , contract be prematurely terminated, payments will,be made for work completed and accepted to date of. termination. Compensation under this contract, including all costs and expenses of Contractor, is limited to , $25,000.00, unless a separate written contract is entered into by the City. 5. Ownership of Documents:All'documents prepar d by.Contractor pursuant to this contract shall be the property of City. 6. Statutory Requirements: ORS 279B.220,279B.225, 279B.230,279B.235,ORS Chapter 244 and ORS 670.600 are made part of this contract. 7. Living Wage Requirements: If contractor is pro./iding services under this contract and the amount of this • contract is$20,142.20 or more, Contractor is required to comply with chapter 3.12 of the Ashland Municipal Code by paying a living wage, as defined in this chapter,to all employees performing work under this contract and to • any subcontractor who performs 50%0 or more of the work under this contract. Contractor is also required to post the notice attached hereto as Exhibit B predominantly in areas where it will be seen by all employees. 8. Indemnification:Contractor agrees to defend, indemnify and save City,its officers, employees and agents harmless from any and all losses,claims, actions,costs,expenses,judgments, subrogations, or other damages • resulting from injury to any person(including injure resulting in death), or damage(including loss or destruction)to • property,of whatsoever nature arising out of or incident to the performance of this contract by Contractor (including but not limited to, Contractor's employes, agents, and others designated by Contractor to perform work or services attendant to this contract). Contractor Shall not be held responsible for any losses, expenses,claims, subrogations, actions,costs,judgments, or other damages,directly,solely,and proximately caused by the negligence of City. • 9. Termination: . a Mutual Consent. This contract may be terminated at any time by mutual consent of both parties. , b. City's Convenience. This contract may be terminated at any time by City upon 30 days'notice in • . I Contract for Goods and Services Less than$25,000, Revised 07/08/2014,Page 1 of 7 • writing and delivered by certified mail or in per on. c. For Cause. City may terminate or mo ify this contract, in whole or in part, effective upon delivery of written notice to Contractor, or at such later da,a as may be established by City under any of the following conditions: i. if City funding from federal,st•te, county or other sources is not obtained and continued at levels sufficient to allow for the purchase of the indicated quantity of services; • ii. If federal or state regulations Pr guidelines are modified, changed, or interpreted in such a way that the services are no longer allowable or appropriatefor purchase under this contract or are no longer eligible for the funding proposed for payments authorized by this contract; or iii. If any license or certificate required by law or regulation to be held by Contractor to provide the services required by this contract is for any reason denied,revoked,suspended, or not renewed. d. For Default or Breach. • i. Either City or Contractor may terminate this contract in the event of a breach of the contract by the other. Prior to such termination the party seeking termination shall give to the other • party written notice of the breach and intent to terminate. If the party committing the breach • has not entirely cured the breach within 15 days of the date of the notice,or within such other period as the party giving the notice may authorize or require;then the contract may be terminated at any time thereafter by a written notice of termination by the party giving notice. ii. Time is of the essence for Co tractor's performance of each and every obligation and duty under this contract. City by written notice to Contractor of default or breach, may at any time terminate the whole or any part of this contract if Contractor fails to provide services called for by this contract within the time specified herein or in any extension thereof. • iii. The rights and remedies of City provided in this subsection (d)are not exclusive and are in addition to any other rights and remedies provided by law or under this contract. e. Obligation/Liability of Parties. Termindtion or modification of this contract pursuant to subsections a, • b, or c above shall be without prejudice to any;obligations or liabilities of either party already accrued prior to such termination or modification. However, upon receiving a notice of termination (regardless whether such notice is given pursuant to subsections a, b, c or d of this section,Contractor shall immediately cease all activities under this contract, unless expressly'directed otherwise by City in the notice of termination. Further, upon termination,Contractor shall deliver to City all contract documents, information,works-in-progress and • other property that are or would be deliverables had the contract been completed. City shall.pay Contractor for work performed prior to the termination date if such work was performed in accordance with the Contract. 10. Independent Contractor Status: Contractor is arli independent Contractor and not an employee of the City. Contractor shall have the complete responsibility for the performance of this contract. 11. Non-discrimination Certification:The undersigned certifies that the undersigned Contractor has not discriminated against minority,women or emerging small businesses enterprises in obtaining any required • subcontracts. Contractor further certifies that it shall not discriminate in the award of such subcontracts, if any. The Contractor understands and acknowledges th t it may be disqualified from bidding on this contract, including •• but not limited to City discovery of a misrepresent 'on or sham regarding'a subcontract or that the Bidder has violated any requirement of ORS 279A.110 or the dministrative rules implementing the Statute. 12. Asbestos Abatement License: If required under ORS 468A.710,Contractor or Subcontractor shall possess an asbestos abatement license. 13. Assignment and/Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work without the written consent of City. Any attemptedlassignment or subcontract without written consent of City shall be void. Contractor 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 City of any assignment or subcontract shall not create any contractual relation between the assignee or subcdntractor and City. 14. Use of Recyclable Products:Contractor shall use recyclable products to the maximum extent economically feasible in the performance of the contract work set forth in this document. 15. Default. The Contractor shall be in default of this agreement if Contractor: commits any material breach or default of any covenant,warranty,certification, or ;bligation it owes under the Contract; if it loses its QRF status pursuant to the QRF Rules or loses any license,certificate or certification that is required to perform the work or to qualify as a QRF if Contractor has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has instituted against it an action fora insolvency; makes a general assignment for the benefit of creditors; or ceases doing business on a regular basis of the type identified in'its obligations under the Contract; or attempts to assign rights in, or delegate duties under, the Contract. 16. Insurance. Contractor shall at its own expense provide the following insurance: a. Worker's Compensation insurance in compliance with ORS 656.017,which requires subject employers to provide Oregon workers'compen$ation coverage for all their subject workers • • • Contract for Goods and Services Less than$25,000, Revised 07/08/2014,Page 2 of 7 l , ' b. General Liability insurance with.a combined single limit,or the equivalent, of not less than Enter one:• $200,000,$500,000, $1,000,000,cLi of Not Applicable for each occurrence for Bodily Injury and Property Damage. c. Automobile Liability insurance with a combined single.limit,or the equivalent, of not less than Enter one: $200,000, $500,000, $1,000,000,taitootoo or Not Applicable for each accident for Bodily Injury and Property Damage, including coverage for owne' , hired or non-owned vehicles, as applicable. d. Notice of cancellation or change. Thee shall be no cancellation, material change, reduction of limits' or intent not'ta renew the insurance coverages)without 30 days'written notice from the Contractor or its insurer(s)to the City. e. Additional Insured/Certificates of Insuance. Contractor shall name The City of Ashland, Oregon, and its elected officials, officers and employees as 4dditional Insureds on any insurance policies.required herein but only with respect to Contractor's services to be rovided under this Contract.As evidence of the insurance coverages required by this Contract,the Contrator shall furnish acceptable insurance certificates prior to commencing work under this contract.The cont ctor's insurance is primary and non-contributory.The certificate will specify all of the parties who are dditional Insureds. Insuring companies or entities are subject to the City's acceptance. If requested, complete copies of insurance policies,trust agreements, etc. shall be provided to the City. The Contractor shall be fi lancially responsible for all pertinent deductibles, self-insured ' retentions and/or self-insurance. • ; 17. Governing'Law;Jurisdiction;Venue: This contct shall be governed and construed in accordance with the laws of the State of Oregon without resort to any j risdiction's conflict of laws, rules or doctrines. Any claim, action, suit or proceeding (collectively, "the claim") between the City(and/or any other or department of the State • of Oregon)and the Contractor that arises from or relates to this contract shall be brought and conducted solely - and exclusively within the Circuit Court of JacksonCounty for the State of Oregon. If, however,the claim must be . brought in a federal forum,then it shall be brought and conducted solely and exclusively within the United States District Court for the District of Oregon filed in Jac son County, Oregon. Contractor, by the signature herein of its authorized representative, hereby consents to the in personam jurisdiction of said courts. In no event shall this • section be construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United States Constitution,or otherwise,fro ImI any claim or from the jurisdiction. 18. THIS CONTRACT AND ATTACHED EXHIBITS•CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE . PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT, MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS,AGREEMENTS, OR • REPRESENTATIONS, ORAL OR WRITTEN, NOII SPECIFIED HEREIN REGARDING THIS CONTRACT. ' CONTRACTOR, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES ' THAT HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT,AND AGREES TO BE BOUND BY ITS TERMS AND CONDITIONS. • 19. Nonappropriations Clause. Funds Available andl Authorized: City has sufficient funds currently available and authorized for expenditure to finance the costs of tis contract within the City's fiscal year budget. Contractor understands and agrees that City's payment of amounts under this contract attributable to work performed after the last day of the current fiscal year is contingentbn City appropriations, or other expenditure authority sufficient to allow.City in the exercise of its reasonable administrative discretion,to continue to make payments under this contract. In the event City has insufficient appropriations, limitations or other expenditure authority, City may • - terminate this contract without penalty or liability toiCity,effective upon the delivery of written notice to Contractor, • with no further liability to Contractor. . 20. Prior Approval Required Provision.Approval bythe City of Ashland Council or the Public Contracting Officer is • required before any work may begin under this,contract. 21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by • reference. • . i . Contract for Goods and Services Less than$25,000, Revised 07/08/2014,Page 3 of 7 Contracto : y City of Ashland By /61 ' By —4.s\i� 1106Signatture D -nt Head tV30str Print Name Print Name Zi 1612021 Title Date W4TKWilOargaTilAilbigtraie (t th O i Purchase Order No. l lkt • • I• • • • Contract for Goods and Services Less than$25,000,Revised d7/0812014, Page 4 of 7 • • EiHIBIT A CERTIFICATIONS/REPRESENTATIONS:Con tractor, under penalty of perjury, certifies that (a) the number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the • number-to be issued to it and (b) Contractor ii; not subject to backup withholding because (i) it its '• exempt from backup withholding or (ii) it has not been notified by the Internal Revenue Service • (IRS) that it is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified it that itis no longer subject to backup withholding. Contractor further represents and warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms, (c) the Work under the Contract shall be performed in accordance with the highest professional standards, and (d) Contractor is qualified, professionally competent and duly licensed to perform the work. Contractor also certifies under penalty of perjbry that its business is not in violation of any ' Oregon tax laws, and it is a corporation authorized to act on behalf of the entity designated above • and authorized to do business in Oregon or is Ilan independent Contractor as defined in the contract documents, and has checked four or more of the following criteria: x (1) I carry out the labor or services at a location separate from my residence or is in a specific portion of my residence, set aside as the location of the business. x (2) Commercial advertising or busin ss cards or a trade association membership are purchased for the business. _x_ (3) Telephone listing is used for the business separate from the personal residence listing. • _x (4) Labor or services are performed only pursuant to written contracts. (5) Labor or services are performed [for two or more different persons within a period of one year. x (6) I assume financial responsibility for defective workmanship or for service not provided as evidenced by the ownership of performance bonds, warranties, errors and omission insurance or liability insurance relating to,the labor or services to be provided. *dm 2- 4 (2-02-1 Contractor � . (Date) Contract for Goods and Services Less than$25,000, Revised 07/08/2014,Page 5 of 7 • • ACC)EP CERTIFICATE OF LIABILITY INSURANCE DATE`MM,°°"YYY) `.� 02/09/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Reinholdt&0'Harra Insurance NAME: Rebecca McGregor FAX 1756 Ashland Street (arc No.Extl: (541)482-1921 ,No:(541)4884458 Ashland,OR 97520 ADDRESS: rmcgregor@reinholdtins.com License#: 800442 INSURER(S)AFFORDING COVERAGE NAIC II INSURERA: Evanston Insurance Company INSURED - INSURER B: Saif Corporation David Scott Construction, LLC INSURERC: 876 Clay St INSURERD: Ashland,OR 97520-1421 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 00018217-251730 REVISION NUMBER: 3 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXPIYLIMITS LTR INSD WVD POLICY NUMBER (MMIDDYYY) (MMIDD/YYYYI A X COMMERCIAL GENERAL LIABILITY Y Y 3AA427415 09/29/2020 09/29/2021 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE $ 2,000,000 X POLICY jEa LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY r- COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED - BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per acddent) $ A X UMBRELLA UAB X OCCUR Y Y EZXS3043305 02/09/2021 09/29/2021 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ $ B WORKERS COMPENSATION 888735 11/01/2020 11/01/2021 X PSTAERTUTE ER OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? Y NIA (Mandatory In NH) EL DISEASE-FA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500,000 • DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) RE:New ADA Path between 123 High Street approximately 17 feet Southeast to where existing flare meets curb on the Southeast side of the Alley entrance. • The City of Ashland,Oregon,and its elected officals,offices and emploees are listed as additional insured with respect to general liability as per Blanket Additional insured form CG2003(12/19)for ongoing operations and CG2039(12119)for completed operations when required by written contract. , (continued on ACORD 101 Additional Remarks Schedule) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Ashland .ACCORDAN E WITH THE POLICTION DATE Y L BE DELIVERED IN ROV SE NS 20 East Main St - Ashland,OR 97520 AUTH ZED REPRESENTATIVE I U (REB) ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) - The ACORD name and logo are registered marks of ACORD • Printed by REB on February 09,2021 at 03:57PM • • AGENCY CUSTOMER ID: 00018217 LOC#: AR ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Reinholdt&0'Harra Insurance David Scott Construction,LLC POLICY NUMBER N/A CARRIER NAIC CODE Multiple Carriers EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM ISA SCHEDULE TO ACORD FORM, • FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance (continued from Description of Operations) Primary and Non-contributory provided by CG2001(04/13)when required by written contract. Blanket Waiver of Subrogation provided by MEGL0241-01(05/16)when required by written contract. 30 Day's notice of cancellation provided by endorsement MEGL1879(07/05)for reasons other than non-payment of premium. Workers Comp: • ACORD 101(2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by REB on February 09,2021 at 03:57PM 1 1 COMMERCIAL GENERAL LIABILITY CG 20 33 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS -- AUTOMATIC STATUS WHEN REQUIRED IN A WRITTEN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II —Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured any person or additional insureds, the following additional organization for whom you are performing exclusions apply: operations when you and such person or This insurance does not apply to: organization have agreed in writing in a contract or agreement that such person or organization be 1. "Bodily injury", "property damage" or"personal added as an additional insured on your policy.Such and advertising injury" arising out of the person or organization is an additional insured only rendering of, or the failure to render, any with respect to liability for"bodily injury", "property professional architectural, engineering or damage" or "personal and advertising injury" surveying services, including: caused, in whole or in part, by: a. The preparing, approving, or failing to 1. Your acts or omissions;or prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, 2. The acts or omissions of those acting on your change orders or drawings and behalf; specifications;or in the performance of your ongoing operations for b. Supervisory, inspection, architectural or the additional insured. engineering activities. However,the insurance afforded to such additional This exclusion applies even if the claims against insured: any insured allege negligence or other 1. Only applies to the extent permitted by law;and wrongdoing in the supervision, hiring, 2. Will not be broader than that which you are employment, training or monitoring of others by required by the contract or agreement to provide that insured, if the "occurrence" which caused for such additional insured. the "bodily injury"or"property damage", or the offense which caused the "personal and A person's or organization's status as an additional advertising injury", involved the rendering of or insured under this endorsement ends when your the failure to render any professional operations for that additional insured are architectural,engineering or surveying services. completed. CG 20 33 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 2 • 2. "Bodily injury" or "property damage" occurring C. With respect to the insurance afforded to these after: additional insureds, the following is added to a. All work, including materials, parts or Section III—Limits Of Insurance: equipment furnished in connection with such The most we will pay on behalf of the additional work, on the project (other than service, insured is the amount of insurance: maintenance or repairs)to be performed by 1. Required by the contract or agreement you have or on behalf of the additional insured(s) at entered into with the additional insured;or the location of the covered operations has been completed;or 2. Available under the applicable limits of b. That portion of'your work"out of which the insurance; injury or damage arises has been put to its whichever is less. intended use by any person or organization This endorsement shall not increase the applicable other than another contractor or limits of insurance. subcontractor engaged in performing operations for a principal as a part of the same project. Page 2 of 2 ©Insurance Services Office, Inc.,2018 CG 20 33 1219 • COMMERCIAL GENERAL LIABILITY CG 20 39 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN WRITTEN CONSTRUCTION AGREEMENT WITH YOU (COMPLETED OPERATIONS) This endorsement modifies insurance provided under the following: • COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Section.II — Who Is An Insured is amended to 2. Supervisory, inspection, architectural or include as an additional insured any person or engineering activities. organization for whom you have performed This exclusion applies even if the claims against operations when you and such person or .any insured allege negligence or other wrongdoing organization have agreed in writing in a contract or in the supervision, hiring, employment, training or agreement that such person or organization be monitoring of others by that insured, if the added as an additional insured on your policy.Such - 'occurrence" which caused the "bodily injury" or person or organization is an additional insured only "property damage"involved the rendering of or the with respect to liability for"bodily injury"or"property failure to render any professional architectural, damage"caused, in whole or in part, by your work" engineering or surveying services. performed for that additional insured and included in the"products-completed operations hazard". C. With respect to the insurance afforded to these However,the insurance afforded to such additional additional insureds, the following is added to Section III—Limits Of Insurance: insured: The most we will pay on behalf of the additional 1. Only applies to the extent permitted by law;and insured is the amount of insurance: 2. Will not be broader than that which you are 1. Required by the contract or agreement you have required by the contract or agreement to provide entered into with the additional insured;or for such additional insured. B. With respect to the insurance afforded to these 2. Available under the applicable limits of additional insureds, the following additional insurance; • exclusion applies: whichever is less. This insurance does not apply to: This endorsement shall not increase the applicable "Bodily injury" or"property damage" arising out of limits of insurance. the rendering of, or the failure to render, any professional architectural,engineering or surveying services, including: 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications;or • • CG 20 39 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER:3AA427415 MARKEL' EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL'GENERAL LIABILITY COVERAGE FORM SCHEDULE Name Of Person Or Organization: Any person(s)or organization(s)with whom the Named Insured agrees, in a written contract executed prior to the'occurrence",to waive rights of recovery Additional Premium: $300 The following is added to Condition 8. Transfer Of Rights Of Recovery Against Others To Us under Section IV — Commercial General Liability Conditions: We waive any right of recovery we may have against any person or organization shown in the Schedule,of this endorsement.This waiver applies only to the person or organization shown in the Schedule of this endorsement. All other terms and conditions remain unchanged. • MEGL 0241-01 0516 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. Progressive PROGRESS/UE° Pr Box 94903 COMMERCIAL Cleveland,OH 44101 1-800-444-4487 Policy number: 03263842-0 Underwritten by: Artisan and Truckers Casualty Co February 11,2021 Page 1 of 2 Certificate of Insurance Certificate Holder Additional Insured CITY OF ASHLAND 20 E MAIN ST ASHLAND,OR 97520 Insured Agent/Surplus Lines Broker • DAVID SCOTT CONSTRUCTION USAA INS AGCY INC LLC 9800 FRDRCKSBRG HSVCW 876 CLAY ST SAN ANTONIO,TX 78288 ASHLAND,OR 97520 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s)indicated. This Certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change,alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations,endorsements,and conditions of these policies. Policy Effective Date: Feb 11,2021 Policy Expiration Date: Feb 11,2022 Insurance coverage(s) Limits Bodily Injury/Property Damage $1,000,000 Combined Single Limit Uninsured Motorist Bodily Injury $1,000,000 Combined Single Limit Any Auto Bodily Injury/Property Damage $1,000,000 Combined Single Limit Description of LocationNehicles/Special Items Scheduled autos only 2000 FORD EXCURSION 1 FMNU41 S3YEA01672 Uninsured Motorist Property Damage $20,000 w/$200 Ded($300 if Hit&Run) Personal Injury Protection $25,000 2017 IPTTRAILER 7G71 BD423HF000161 • 111 r Continued Policy number: 03263842-0 • Page 2 of 2 Certificate number 04221 A08842 Please be advised that additional insureds and loss payees will be notified in the event of a mid-term cancellation. Form 5241(10/02) 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER:3AA427415 MARKEL® EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION BY US AS REQUIRED BY CONTRACT TO ADDITIONAL INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Number Of Days: 30 The following is added to the Cancellation condition: We will provide.written Notice of Cancellation to an additional insured stating when, not less than the number of days shown in the Schedule above, cancellation will become effective. This condition only applies if: 1. The policy is cancelled by us; 2. Cancellation is for reasons other than: a. Nonpayment of premium; or b. Non-payment of any deductible reimbursement; 3. You are required by written contract to provide the additional insured with such notice; and 4. You agree to provide us with a list of the applicable additional insureds, including their complete mailing addresses, within 7 days of our request. If notice is mailed, proof of mailing is sufficient proof of such notice. All other terms and conditions remain unchanged. MEGL 1879 0715 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. •