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HomeMy WebLinkAbout2021-177 PO 20210298- Liquivision Technology a � mom RECCORDER Purchase Order ,M Fiscal Year 2021 Page: 1 of: 1 • B City of Ashland ATTN:Accounts Payable Purchase 20 E. MainOrder# 20210298 Ashland,OR 97520 T Phone: 541/552-2010 O Email: payable@ashland.or.us • V H C/O Water Treatment Plant ELIQUIVISIQN TECHNOLOGY I 90 North Mountain Ave D 711 MARKET STREET P Ashland, OR 97520 O KLAMATH FALLS,OR 97601 Phone:6411488-5345 R T Fax:541/552-2329 • •B00 29-6959 • Alistair Andre • f01L }Ivp,f171. 6.-_ '1,_11.101 I -1_ I_ -i._. 03/09/2021 423 • FOB ASHLAND/NET 30 Cl loco i s .le Sediment Removal WTP Clearwell �. 1 Removal of accumulated sediment from the floor of WTP 1.0 $3,148.00 $3,148.00 Clearwell.Comprehensive Inspection and documentation of entire structure. Goods and Services Agreement(Less than$26,000) Completion date: June 30,2021 Project Account: • ***************GL SUMMARY*********fr***** • 081900-602400 $3,148.00 • • • • • • • By: ,‘d,-/ Date: _ . 'thorized Signature 3 148.00 FORM#3 CITY 4>!: • • �H1LAN�` rr:rrll,' .l ,R, .i :'rt:' i' . '•%'• �t r�a , ---tye REQUISITION if Date of request: 0310212021 - Required date for delivery: 0613012021 Vendor Name Liquivision Technology Address,City,State,Zip 711-Market et,Klamath Falls,OR,07601 Contact Name&Telephone Number sheat Trigg(800)229.6959 ' Email address Ilquivlslonl@dlvingservices.com SOURCING METHOD ❑ Exempt from Competitive Bidding . ❑ Emargencv ❑ Reason for exemption: ❑ invitation to Bid 0 Form 1113,Written findings end Authorization _ ❑ AMC 2,50 Date approved by Council: ❑ Written quote or proposal attached ■ Written i note or.1...-at attached Attach co. of council communication if council a.'rovai re s ufred attach co' of CC (l Small Procurement • Request for Proposal Coonerative Procurement Not.exceeding$5.000 Date approved by Council: 0 Slate of Oregon 0 Direct Award _(Attach copy of council communication) Contract II ❑i VerbaiIWritten hid(s)or proposal(s) ❑ Rearrest for Qualifications(Public Works) 0 Slate of Washington Date approved by Council: Contract II (Attach copy of council communication) 0 Other government agency contract intermediate procurement 0 SolaSource Agency GOODS&SERVICES 0 Applicable Form(05,6,7 or B) Contractf! Greater than$5.000 end lass than$100.000 • 0 Written quote or proposal attached Intergovernmental Agreement: ❑ (3)Written bids&'solicitation attached 0 Form 04,Personal Services 55K to$76K Mem pERSONAl.SERVICES 0 Social Procurement 13I Annual cost to City does not exceed$25,000. Greater than 35.000 and less than$75,000Form 110,Request for Approval Agreement approved by Legal and approvedlsigned by • O Less than 335,000,by direct appointment P] Written quote or proposal attached City Administrator.AMC 2.60.070(4) ❑ (3)Written proposals&solicitation attached Date approved by Council: 0 Annual cost to City exceeds$26,000,Council ❑ Form 114,personal Services 35K to 5751( Valid until: _Date . approval required.(Attach copy of council communication) . Description of SERVICES Total Cost • Removal of accumulated sediment from the floor of dearwell.Comprehensive Inspection and documentation of entire structure. $ 3,148,40 _ item# Quantity Unit ' Description of MATERIALS Unit Price Total Cost ❑ Per attached quotelproposal _ TOTAi.COST $ Project Number_ ,. ..___•.._ _ Account Numbs,: o e 1 e o o.a 0 2 4 0 0 Account Number •_• _ __ Account Number •_ ._ .. .. __ 'Expenditure must b:charged to the appropriate account numbers for the financials to accurately reflect the actual expenditures. . IT Director in co.a'oration with department to approve all hardware and software purchases: -\ , IT Director Date Support-Yes/No . By signing this req t 11,nform,icertify that the Ci1y'spublic contracting requirements cravebeen satisfied, Employee: �.�� kg Department Head: --! r 31 -I ►f (Eq. It.or reaterthan$5,o00) Daparime IMarlow dSupervisor: City Menu or: J (Equal t or gr or than$26,000) Funds appropriated for current fiscal year: 1 N0 :/ -. / V/ 0 .-04:21 • ' Final 6-Director-(Equal to or wafer roan S5 ) Dale Collrnrerrls: Form 113•Requi0on • . GOODS AND SERVICES AGREEMENT(LESS THAN$25,000) PROVIDER: LiquiVision Technology CITY OF CONTACT: Sherri Trigg ASHLAND 20 East-Main Street ADDRESS: 711 Market Street,Klamath Falls,OR 97601 Ashland,Oregon 97520 • Telephone: 541/488-5587 PHONE:, 800-229-6959 Fax: 541/488-6006 EMAIL: liquivision idivingservices.com . This Goods and Services Agreement (hereinafter "Agreement") is entered into by and between the City of Ashland, an Oregon•municipal corporation (hereinafter "City") and LiquiVision Technology, a domestic business corporation ("hereinafter"Provider"), for a comprehensive cleaning and documented inspection of • the Clearwell(holding tank)Iocated at the Water Treatment Plant. i 1. PROVIDER'S OBLIGATIONS 1.1 Provider to remove accumulated sediment from the floor,of the Clearwell (holding tank) and perform a comprehensive inspection of the entire structure, including DVD recording, written documentation with digital pictures,descriptions of the images and.any recommendations will be . provided to the City on a USB flash drive as set forth in the"SUPPORTING DOCUMENTS"attached hereto and,by this reference, incorporated herein. Provider expressly acknowledges that time is of the essence of any completion date set forth in the SUPPORTING DOCUMENTS, and that no waiver or extension of such deadline may be authorized except in the same manner as herein provided for authority to exceed the maximum compensation. The services defined and described in the "SUPPORTING DOCUMENTS"shall hereinafter be collectively referred to as"Work." • 1.2 Provider shall obtain and maintain during the term of this Agreement and until City's final acceptance of all Work received hereunder,a policy or policies of liability insurance including commercial general liability insurance with a combined single limit, or the equivalent, of not less than $2,000,000 (two million dollars)per occurrence for Bodily Injury and Property Damage, 1.2.1 The insurance required in this Article shall include the following coverages: • Comprehensive General or Commercial General Liability, including-personal injury, contractual liability,and products/completed operations coverage; and • Automobile Liability. 1.2.2 Each policy of such insurance shall be on an"occurrence"and not a"claire s made"form, and shall: • Name as additional insured "the City of Ashland, Oregon, its officers, agents and employees" with respect to claims arising out. of the provision of Work under this Agreement; • Apply to each named and additional named insured as though a separate policy had been issued to each,provided that the policy limits shall not be increased thereby; • Apply as primary coverage for each additional named insured except to the extent that two or more such policies are intended to "layer" coverage and, taken together, they pi•ovide total coverage from the first dollar of liability; • Page 1 of 7: Goods and Services Agreement between the City of Ashland and LiquiVision Technology • • • Provider shall immediately notify the City of any change in insurance coverage • Provider shall supply an endorsement naming the City,its officers,employees,and agents as additional insureds by the Effective Date of this Agreement; and • Be evidenced by.a certificate or certificates of such insurance approved by the City. 1.3 Provider shall,at its own expense,maintain Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide workers' compensation coverage for all of its subject workers. 1.4 Provider agrees that no person shall, on the grounds of race, color, religion, creed, sex, marital status, familial status or domestic partnership, national origin, age, mental or physical disability, sexual orientation, gender identity or source of income, suffer discrimination in the performance of this Agreement when employed by Provider. Provider agrees to comply with all applicable requirements of federal and state civil rights and rehabilitation statutes, rules and regulations. Further,Provider agrees not to discriminate against a disadvantaged business enterprise,minority-owned business,woman-owned business, a business that a service-disabled veteran owns or an emerging small business enterprise certified under ORS 200.055,in awarding subcontracts as required by ORS 279A.110. ' 1.5 In all solicitations either by competitive bidding or negotiation made by Provider for work to be performed under a subcontract, including procurements of materials or leases of equipment, each potential subcontractor or supplier shall be notified by the Providers of the Provider's obligations under this Agreement and Title VI of the Civil Rights'Act of 1964 and other federal nondiscrimination laws. 1.6 Living Wage Requirements: If the amount of this Agreement is $22,002.43 or more, Provider is required to comply with Chapter 3.12 of the Ashland Municipal Code by paying a living wage,as defined in that chapter,to all employees performing Work under this Agreement and to any Subcontractor who performs 50%or more of the Work under this Agreement. Provider is also required to post the notice attached hereto as"Exhibit A"predominantly in areas where it will be seen by all employees. 1.7 Assignment: 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 or subcontract shall not create any contractual relation between the assignee or subcontractor and the City. 2. CITY'S OBLIGATIONS 2.1 City shall pay Provider the sum of$3,148.00 (three thousand one hundred forty-eight dollars) as provided herein as full compensation for the Work as specified in the SUPPORTING DOCUMENTS. 2.2 In no event shall Provider's total of all compensation and reimbursement under this Agreement exceed the sum of$3,148.00(three thousand one hundred forty-eight dollars) without express,written approval from the City official whose signature appears below, or such official's successor in office. Provider . expressly acknowledges that no other person has authority to order or authorize additional Work which would cause this maximum sum to be exceeded and that any authorization from the responsible official must be in writing. Provider further acknowledges that any Work delivered or expenses incurred without • authorization as provided herein is done at Provider's own risk and as a volunteer without expectation of compensation or reimbursement. Page 2 of 7: Goods and Services Agreement between the City of Ashland and LiquiVision Technology 3. GENERAL PROVISIONS 3.1 This is a non-exclusive Agreement. City is not obligated to procure any specific,amount of Work from Provider and is free to procure similar types of goods and services from other providers in its sole discretion. 3.2 Provider is an independent contractor and not an employee or agent of the City for any purpose. 3.3 Provider is not entitled to,and expressly waives all claims to City benefits such as health and disability insurance,paid leave,and retirement. 3.4 This Agreement embodies the full and complete understanding of the parties respecting the subject matter hereof. It supersedes all prior agreements,negotiations,and representations between the parties, whether written or oral. 3.5 This Agreement may be amended only by written instrument executed with the same formalities as this Agreement. 3.6 The following laws of the State of Oregon are hereby incorporated by reference into this Agreement: ORS 279B.220,279B.230 and 279B.235. 3.7 This Agreement shall be governed by the laws of the State of Oregon without regard to conflict of laws principles. Exclusive venue for litigation of any action arising under this Agreement shall be in the Circuit Court of the State of Oregon for Jackson County unless exclusive jurisdiction is in federal court, -- in which case exclusive venue shall be in the federal district court for the district of Oregon. Each party expressly waives any and all rights to maintain an action under this Agreement in any other venue,and expressly consents that, upon motion of the other party, any case may be dismissed or its venue transferred,as appropriate,so as to effectuate this choice of venue. 3.8 Provider shall defend,save,hold harmless and indemnify the City and its officers,employees and agents from and against any and all claims, suits, actions, losses, damages, liabilities, costs, and expenses of any nature resulting from, arising out of, or relating to the activities of Provider or its officers, employees,contractors,or agents under this Agreement. 3.9 Neither party to this Agreement shall hold the other responsible for damages or delay in performance caused by acts of God,strikes,lockouts,accidents,or other events beyond the control of the other orthe other's officers,employees or agents. 3.10 If any provision of this Agreement is found by a court of competent jurisdiction to be unenforceable, such provision shall not affect the other provisions,but such unenforceable provision shall be deemed modified to the extent necessary to render it enforceable,preserving to the fullest extent permitted the .intent of Provider and the City set forth in this Agreement. • 3.11 Deliveries will be F.O.B destination.Provider shall pay all transportation and handling charges for the Goods.Provider is responsible and liable for loss or damage until final inspection and acceptance of the Goods by the City. Provider remains liable for latent defects,fraud,and warranties. 3.12 The City may inspect and test the Goods. The City may reject non-conforming Goods and require. Provider to correct them without charge or deliver them at a reduced price, as negotiated. If Provider does not cure any defects within a reasonable time, the City may reject the Goods and cancel..this Page 3 of 7: Goods and Services Agreement between the City of Ashland and LiquiVision Technology Agreement in whole or in part. This'paragraph does not affect or limit the City's rights, including its rights under the Uniform Commercial Code,ORS Chapter 72(UCC). 3.13 Provider represents and warrants that the Goods are new, current, and fully warranted by the • manufacturer. Delivered Goods will comply with SUPPORTING DOCUMENTS and be free from defects in labor,material and manufacture.Provider shall transfer all warranties to the City. 4. SUPPORTING DOCUMENTS The following documents are,by this reference,expressly incorporated in this Agreement,and are collectively referred to in this Agreement as the"SUPPORTING DOCUMENTS:" • The Provider's complete written Quotation dated 02/25/2021. 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 inequity, including,but not limited to: 5.1.1 Termination of this Agreement; 5.1.2 Withholding all monies due for the Work that Provider has failed to deliver within any scheduled completion dates or any.Work that have been delivered inadequately or defectively; 5.1.3 Initiation of an action or proceeding for damages, specific performance, or declaratory or injunctive relief; 5.1.4 These remedies are cumulative to the extent the remedies are not inconsistent,and City may pursue any remedy or remedies singly,collectively,successively or in any order whatsoever. 5.2 In no event shall City be liable to Provider for any expenses related to termination of this Agreement or for anticipated profits.If previous amounts paid to Provider exceed the amount due,Provider shall pay immediately any excess to City upon written demand provided. 6. TERM AND TERIVIINATION 6.1 Term This Agreement shall be effective from the date of execution on behalf of the City as set forth below (the "Effective Date") and shall continue in full force and effect until June 30, 2021, unless sooner terminated as provided in Subsection 6.2. 6.2 Termination 6.2.1 The City and Provider may terminate this Agreement by,mutual agreement at any time. 6.2.2 The City may,upon not less than thirty (30) days' prior written notice,terminate this Agreement for any reason deemed appropriate in its sole discretion. 6.2.3 Either party may terminate this Agreement,with cause,by not less than fourteen(14)days' prior written notice if the cause is not cured within that fourteen (14) day period after written notice. Such termination is in addition to and not in lieu of any other remedy at law or equity. 7. NOTICE Whenever notice is required or permitted to be given under this Agreement, such notice shall be given in writing to the other party by personal delivery, by sending via a reputable commercial overnight courier, or by mailing using registered or certified United States mail, return receipt requested,postage prepaid, to the address set forth below: Page 4 of 7: Goods and Services Agreement between the City of Ashland and LiquiVision Technology • - If to the City: City of Ashland Water Treatment Plant Attn: Alistair Andre 20 E.Main Street Ashland,Oregon 97520 Phone:(541)488-5345 With a copy to: - City of Ashland—Legal Department 20 E.Main Street: Ashland,OR 97520 Phone:(541)488-5350 If to Provider: LiquiVision Technology 711 Market Street Klamath Falls,OR 97601 8. WAIVER OF BREACH One or more waivers or failures to object by either party to the other's breach of any provision,term,condition, or covenant contained in this Agreement shall not be construed as a waiver of any subsequent breach,whether or not of the same nature. 9. PROVIDER'S COMPLIANCE WITH TAX LAWS 9.1 Provider represents and warrants to the City that: 9.1.1 Provider shall, throughout the term of this Agreement, including any extensions hereof, comply with: — (i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316,317,and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to. Provider;and (iii) Any rules,regulations,charter provisions,or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.1.2 Provider,for a period of no fewer than six(6)calendar years preceding the Effective Date of this Agreement, has faithfully complied with: - •(i) All tax laws of the State of Oregon, including but not limited to ORS 305.620 and ORS chapters 316,317,and 318; (ii) Any tax provisions imposed by a political subdivision of the State of Oregon applicable to Provider;and . (iii) Any rules,regulations,charter provisions,or ordinances that implement or enforce any of the foregoing tax laws or provisions, 9.2 Provider's failure tocomply with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Provider's warranty, as set forth in this Article 9, shall constitute a material breach of this Agreement. Any material breach of this Agreement shall entitle the City to terminate this Agreement and to seek damages and any other relief available under this Agreement,at law,or in equity. Page 5 of 7: Goods and Services Agreement between the City of Ashland and LiquiVision Technology • IN WITNESS WHEREOF the parties have caused this Agreement to be signed in their respective names by their duly authorized representatives as of the dates set forth below. CITY OF ASHLAND: LIQUIVISION TECHNOLOGY By: By: . *we, &r T FLgutuf Gassy Maxwell Printed Name Printed Name P Y Lk(_. tld2ts TA General Manager Title Title ?Atoll March 3, 2021 ate Date &A is to be submitted with this signed Agreement) Purchase Order No. Page 6 of 7: Goods and Services Agreement between the City of Ashland and LiquiVision Technology • EXHIBIT A CITY OF ASHLAND, OREGON City Dory A Mand LINING ALL employers described • below must comply with City ' . of Ashland laws regulating payment of a living wage. Si 5.74 per hour,,effective June 30, 2020.. • The tilting:Wag. it adjusted anntimlliy every /r June 30 by the Consumer Price index Employees must be paid a of business of that employer; 4Q1Ic and IRS eligible Irving wage: if'theemployerthes ten or cafeteria piens(including More employes,and'has childcare).benefits to the received llriancial assistance amount of wages received by For alf hourstirked.under a ttor tl'�s project or business the employee. can the City of Ashland in service cco"ritraUt between their excess of$22.002.43. Note,. Fag temporary and ern yer avid the City of part-time employees,the Ashland if the'eontratt ,• 'If their emobyer is Ile City of Living Wage does not apply exceeds$22:002.43 or more. Ashland,lneludin t ie•Pa.Ks to.the first 1040 hours welted For all notes eked in a and Recteatien'Department. in'ayear.calendar For manor rt the employee spends more details,please see 5036 or more employee Incatcuiatirig the liaing wage. Ashland Municipal Code 5036 or more in treatmonth employers may add the value Section 3.12.020. ernuworking on a projector portion of health cars.retcemera, For additional information: Gall the Ashland-City Administrator's office at 5141-408-6002 or write to the City Administrator, Oily Hall;20-Easthlain Street,Ashland;OR 9752O,-or visit the City'_swebsite at wwlliw.ashland.or.us: • Notice to Employers: This notroet<nust he:posted predominancy in areas where&can be seen by alltriplayees. V • CITY OF ASHLAND Page 7 of 7: Goods and,Services Agreement between the City of Ashland and LiquiVision Technology • 7.%. Ir."— \ . LQUMISiON TECHNOLOGY I. ' % ' se � DIVING ' SERVICES r ... ..-, 3f � {alli^2 Add i--"r _s� t5 q;EZ3.13i ssar1� srat10_s t , 7i1 tali et Str aic li:uivi is^ clivi _o 'YID our; 3 5 t lsrk-t Street / ?119,.3. .all_.'0:,S.7.,-_01 4',aivi','1g-e:1r1 ..zur7 ilan.at,=alb,..R 97,3711 Alex Andre • 2/25/2021 City of Ashland Wk:541-552-2326 90 N.Mountain Ave. Em:alistairandre@ashland.or.us Ashland,OR 97520 *OR137020R2T_ We are pleased to provide you the following‘1firm quotation and outline of the conditions of our services. • Tank Type Dia. Hgt. Maximum Surface Price for Price for Price for or (Feet) Calculated Area Diver Diver Additional LxW Capacity (S.F.) Inspection, Cleaning& Sediment (Feet) (Gallons) Only Inspection Per Hour Mobilization Charge- Flat charge to mobilize and demobilize to your location. $495 $430 . • 1. Clearwell 1 BG Concrete 67x67 5 167,900 4,489 $1,550 2. Clearwell 2 BG Concrete 33x20 5 24,686 660 $1,350 Pricing is contingent on all work being completed on the same trip. LVT estimates 1 day of work,if more time is needed multiple trips might be required and. additional fees may apply. Subtotal $3,395 Mobilization discount(when completed in conjuction with other work within 75 miles) ($247) Total *Plus sales tax if applicable $3,148 Scope of Work: Removal of accumulated sediment from the floor of the tank.The effluent will be disposed of at the districts direction.A final and comprehensive inspection will be performed documenting the condition of the entire structure and recorded on DVD.Written documentation with digital pictures,descriptions of the images and any recommendations will be provided to the district on a USB flash drive. Our bids are based on a variety of factors that pertain to the length of time it takes to accomplish our work.The main consideration is the amount of sediment that has to be removed,4" of normal sediment is included in this bid. Initials Please initial the line items below to verify that you have reviewed them. Entry hatch on top of the tank is at least 18" diameter.. •The water level is kept within ten (10) feet of the top of the tank. Tank dimensions are correct. : Scope of work is correct. • 1. Placement and disposal of effluent removed from the tank is done at the direction of the Customer. 2. Quotes for cleaning assume that the sediment is normal material (such as silt,flocculated material,insects, manganese,rust,etc.)found in potable water tanks that is easily removed by our vacuum system. If the sediment is difficult to remove such as large amounts of concrete chips,gravel,sand,rocks,detached coating debris,etc.,then our hourly rate shall apply for each hour(over the first hour)for removing this material. • 711 Market Street Klamath Falls,OR 97601 Phone: (541)883-6473 '' LiquiVision Technology Fax: (541)883-1361 3. Unless specified in quote detail we clean all submerged horizontal and angled berms or sloped surfaces 35 degrees or less. Surfaces exceeding this angle such as the walls can be cleaned but must be listed separately in the quote detail or estimated by the divers upon inspection. We do not clean surfaces that are out of the water. 4. If any information provided to us is incorrect or if any problems exist that inhibit our ability to complete the job on a timely schedule, then we will notify you of the problem and reserve the right to add on to the quote based on our estimate of the additional time it will take to complete the work. Charges for time delays are$200 per hour. This paragraph only applies to any problems that are your responsibility(i.e.rescheduling with less than 2 business days notice,set up and start of work before cancelation,etc.)Charge for going remote(if required and not addressed in advance)is$430 per hour. 5. For coating repair in steel tanks we use a two part underwater epoxy. Each rust nodule or area of coating defect is wire brushed to bare metal and epoxy is applied over the area. The epoxy chemically bonds to the steel,displaces water,and remains intact with a greater bond than the original coating. All of our repair,sealing and coating materials meet or exceed NSF 60&61 standards. Repairs are done at the districts direction for the rate of$430 per hour and $40 per tube of Manus or epoxy. • 6. If dechlorination is required it will be charged at$15.00 per hour. If filtration is required then the filter bags will be charged at$200.00 per bag. Unless specified LVT does not remove the bags they become the districts responsibility to dispose of. 7. If payment is not made within sixty days of the date of the invoice, an interest charge of 3%shall begin to accrue each month on the unpaid balance. This interest will continue to accrue each month until the balance is paid in full. To avoid any interest charges,payment must be received or postmarked within the sixty days following the date of the invoice. Statements will be sent each month to reflect the new balance. Our cleaning procedure is accomplished utilizing our proprietary vacuum cleaner,the"LiquiVacTM"(Patented). The LiquiVacTM pumps an average of 200 gallons per minute. It has a rotating soft bristle brush that scrubs the floor clean and removes all sediment without creating turbidity in your tank. This is the only way to ensure that all biofilm is removed from the,interior surfaces without getting any of it mixed into the water column. This system also enables,us to clean walls. In a conscious effort to preserve our nations natural resources LVT will provide our reports to the district on USB flash drives. If you require a printed and bound copy of the reports please notify our office staff.There will be an additional fee of $125 per copy. In over 20 years of providing diving services we continue to treat every customer as if they were our only customer. We are dedicated to accomplishing every job with the utmost professionalism,safety and efficiency. Please sign this quote and FAX both pages back to us with an approximate time frame of when you would like the work done. If you have any questions please give us a call. We look forward to working with you. Quote is valid for 90 days. Upon signature the work shall be accomplished at a mutually acceptable date within one year. Sincerely, I find the above and preceding page of contingencies and procedures _ ) acceptable. Percr Cl Accepted by: Date: Patty Bowers General Manager Signature: Title: • • 711 Market Street G� Klamath Falls,OR 97601 + LIquiVision Technology Phone: Fax: 541)883-6361 Billing/Change Order/Estimate Form Alex Andre 2/25/2021 City of Ashland Wk:541-552-2326 90 N.Mountain Ave. Em:alistairandre@ashland.or.us Ashland,OR 97520 *OR137020R2T_ Team Leader: Diver#1: Diver#2: Diver#3: Tank Type Dia. Hgt. Maximum Surface Price for Price for Date or (Feet) Calculated Area Diver Diver Work LxW Capacity (S.F.) Inspection Cleaning& Done (Feet) (Gallons) Only Inspection Mobilization Charge- Flat charge to mobilize and demobilize to your location. $495 1.Clearwell 1 BG Concrete 67x67 5 167,900 4,489 $1,550 2. Clearwell 2 BG Concrete 33x20 5 24,686 660 $1,350 Pricing is contingent on all work being completed on the same trip. LVT estimates 1 day of work,if more time is needed multiple trips might be required and additional fees may apply. • Subtotal $3,395 Mobilization discount(when completed in conjuction with other work within 75 miles) ($247) • Total *Plus sales tax if applicable $3,148 Itemize work: Time or Quantity: Extended: • Sales Tax if any: Total Authorization Signature: Estimation of cost for recommendations that LVT can perform. Recommendations: Estimated Labor Total Estimate Total i ® DATE(MM/DD/YYYY) ACCORD CERTIFICATE OF LIABILITY INSURANCE 3/4/2021 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 THErISSUING 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 CONTNAME:ACT Janice Sharp Great Basin Insurance, Inc. _ PHONE FAX 826 Main Street LAIC.No.Ext):541-882-5507 (AIc,No):541-884-0052 Klamath Falls OR 97601 , ADDRESS: janice.sharp@gr8basin.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Great American Insurance Group 16691 INSURED LIQUTEC 01 INSURER B:West American Insurance Company \ 44393 Liquivision Technology Inc. 711 Market St. INSURER C:LM Insurance Corp 33600 Klamath Falls OR 97601 INSURER D:StarStone National Insurance Company • 25496 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1351223744 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN-MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y OMH2205785 9/1/2020 9/1/2021 EACH OCCURRENCE $1,000,000 • DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $50,000 X Pollution-1M MED EXP(Any one person) $5,000 . PERSONAL&ADV INJURY $1,000,000^ 'GEN'LAGGREGATE LIMIT APPLIESPER: - GENERAL AGGREGATE $2,000,000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG $1,000,000 OTHER: $ B AUTOMOBILELWBILITY . Y BAW57943787 8/1/2020 8/1/2021 COM(EaacBcideINEDnt)SINGLE LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS — HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY _ AUTOS ONLY (Per accident) _ $ D UMBRELLALIAB X OCCUR Y AA8230A20MAA 9/1/2020 9/1/2021 EACH OCCURRENCE $5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION$ $ C WORKERS COMPENSATION WC5-39S-319580-020 10/1/2020 - 10/1/2021 X STATUTE OTH- ER AND EMPLOYERS'LIABILITY• Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE I I NIA E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $1,000,000 • DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) The City of Ashland is additional insured per the attached endorsement forms:Marine Commercial Liability Blanket Additional Insured Endorsement GA12391 and Business Auto Coverage Enhancement Endorsement AC 85 01 06 18. • . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE • THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN • '-ACCORDANCE WITH THE POLICY PROVISIONS. City of Ashland 20 East Main Street AUTHORIZED REPRESENTATIVE Ashland OR 97520 t� i ? tL . .-() f • I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016/03) The ACORD name and logo are registered marks of ACORD . COMMERCIAL AUTO AC 85 01 06 18 THIS ENDORSEMENT. CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. If the policy to which this endorsement is attached also contains a Business Auto Coverage Enhancement Endorsement with a specific state named in the title, this endorsement does not apply to vehicles garaged in that specified state. COVERAGE INDEX SUBJECT PROVISION NUMBER ACCIDENTAL AIRBAG DEPLOYMENT 13 ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT 4 AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS 21 AMENDED FELLOW EMPLOYEE EXCLUSION ' 6 AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE 15 BODILY INJURY REDEFINED 25 EMPLOYEES AS INSUREDS (Including Employee Hired Auto) 3 EXTRA EXPENSE-BROADENED COVERAGE 11 GLASS REPAIR-WAIVER OF DEDUCTIBLE 17 HIRED AUTO COVERAGE TERRITORY 23 HIRED AUTO PHYSICAL DAMAGE (Including Employee Hired Auto) 7 LOAN /LEASE GAP (Coverage Not Available In New York) 16 NEWLY FORMED OR ACQUIRED SUBSIDIARIES 2 PARKED AUTO COLLISION COVERAGE(WAIVER OF DEDUCTIBLE) 18 PERSONAL EFFECTS COVERAGE 12 PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE 9 PHYSICAL DAMAGE DEDUCTIBLE -VEHICLE TRACKING SYSTEM 14 PRIMARY AND NON-CONTRIBUTORY -WRITTEN CONTRACT OR WRITTEN AGREEMENT 24 RENTAL REIMBURSEMENT 10 SUPPLEMENTARY PAYMENTS 5 TOWING AND LABOR 8 TRAILERS -INCREASED LOAD CAPACITY 1 a TWO OR MORE DEDUCTIBLES 19 UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS 20 WAIVER OF TRANSFER OF RIGHTS OF RECOVERYAGAINST OTHERS TO US 22 s • SECTION I-COVERED AUTOS is amended as follows: 1. TRAILERS-INCREASED LOAD CAPACITY The following replaces Paragraph C.1. Certain Trailers, Mobile Equipment And Temporary Substitute Autos of SECTION I-COVERED AUTOS: "Trailers" with a load capacity of 3,000 pounds or less designed primarily for travel on public roads. ® 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 1 of 7 • SECTION II-LIABILITY COVERAGE is amended as follows: 2. NEWLY FORMED OR ACQUIRED SUBSIDIARIES SECTION II - LIABILITY COVERAGE, Paragraph A.1. - Who Is An Insured is amended to include the following as an "insured": d. Any legally incorporated subsidiary of which you own more than 50 percent interest during the policy period. Coverage is afforded only for 90 days rfrom the date of acquisition or formation. However, "insured" does not include any organization that: • (1) Is a partnership or joint venture; or (2) Is an "insured" under any other automobile policy except a policy written specificall y to apply In excess of this policy; or (3) Has exhausted its Limit of Insurance or had its policy terminated under any other automobile , policy. Coverage under this provision d. does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization. - 3. EMPLOYEES AS INSUREDS SECTION II - LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured is amended to include the following •as an "insured": , e. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow but only for g a acts within the scope of their employment by you. Insurance provided by this endorsement is excess over any other insurance available to any "employee"., • f. Any "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee's" - name, with your permission, while performing duties related to, the conduct of your business and within the scope of their employment. Insurance provided by this endorsement Is excess over any other insurance available to the "employee". 4. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION II -.LIABILITY COVERAGE, Paragraph A.1. Who Is An Insured is amended to include the • following as an "insured": g. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed in a written contract, written agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "Insured". However, such person or organization is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto"; (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or written agreement, or the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit. The "insured" is required to submit a claim to any other insurer to which coverage could apply for defense and indemnity. Unless the "insured" has agreed in writing to primary noncontributory wording per enhancement number 24,this policy is excess over any other collectible insurance. 5. SUPPLEMENTARY PAYMENTS SECTION II - LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments,.Paragraphs (2)and (4)are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations ) required because of an"accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, Including actual loss of earnings • • up to$500 a day because of time off from work. © 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 2•of 7 • • • 6. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by law, fellow "employees" are not entitled to the protection afforded to • the employer by the workers compensation exclusivity rule, or similar protection, the following provi- sion is added: SECTION II - LIABILITY, Exclusion B.5. Fellow Employee does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire if you have workers compensation insurance in force for all of your "employees" at the time of "loss". This coverage is excess over any other collectible insurance. SECTION III-PHYSICAL DAMAGE COVERAGE is amended as follows: 7. HIRED AUTO PHYSICAL DAMAGE Paragraph A.4. Coverage Extensions of SECTION III -PHYSICAL DAMAGE COVERAGE, is amended by adding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos": a. You hire, rent or borrow; or • b. Your "employee" hires or rents under a written contract or agreement in that "employee's" name, but only if the damage occurs while the vehicle is being used in the conduct of your business, subject to the following limit and deductible: a. The most we will pay for "loss" in any one "accident" or"loss" is the smallest of: (1) $50,000; or (2) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, minus a deductible. b. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. c. Subject to the limit, deductible and excess provisions described. in this provision, we will provide coverage.equal to the broadest coverage applicable to any covered "auto" you own. d. Subject to a maximum of $1,000 per "accident", we will also cover the actual loss of use of the hired "auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial loss. e. This coverage extension does not apply to: (1) Any "auto" that is hired, rented or borrowed with a driver; or (2) Any "auto" that is hired, rented or borrowed from your "employee" or any member of your "employee's" household. a Coverage provided under this extension isexcess over any other collectible insurance available at the time of 'loss". 8. TOWING AND LABOR SECTION III - PHYSICAL DAMAGE COVERAGE,"Paragraph A.2. Towing, is amended by the addition of the following: We will pay towing and labor costs Incurred, up to the limits shown below, each time a covered "auto" classified and rated as a private passenger type, "light truck" or "medium truck" is disabled: a. For private passenger type vehicles, we will pay up to$75 per disablement. b. For"light trucks", we will pay up to $75 per disablement. "Light trucks" are trucks that have a gross vehicle weight (GVW)of 10,0002pounds or less. c. For "medium trucks" , we will pay up to $150 per disablement. "Medium trucks" are trucks that have a gross vehicle weight (GVW) of 10,001 -20,000 pounds. However, the labor must be performed at the place of disablement. 2017 Liberty Mutual Insurance • AC 85 01 0618 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 3 of 7 9. PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE • Paragraph A.4.a. Coverage Extensions, Transportation Expenses of SECTION III - PHYSICAL DAMAGE COVERAGE, is amended to provide a limit of$50 per day and a maximum limit of $1,500. 10. RENTAL REIMBURSEMENT SECTION III-PHYSICAL DAMAGE COVERAGE,A.Coverage, is amended by adding the following: a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "accident" or "loss", to an "auto" for which we also pay a "loss under Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those ex- penses incurred after the first 24 hours following the "accident" or"loss" to the covered "auto." b. Rental Reimbursement requires the rental of a comparable or lessor vehicle, which in many cases may be substantially less than $75 per day, and will only be allowed for the period of time it should • take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. ra c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your tools and equipment from the covered "auto". This limit is excess over any other collectible insurance. d. This coverage does not apply unless you have a business necessity that other "autos" available for your use and operation cannot fill. e. if "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses,.which is not already provided under Paragraph 4.Coverage Extension: f. No deductible applies to this coverage. g. The insurance provided under this extension is excess over any other collectible insurance. If this policy also provides Rental Reimbursement Coverage you purchased, the coverage provided by I this Enhancement Endorsement is in addition to the coverage you purchased. For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined in provision 12.B. 11. EXTRA EXPENSE-BROADENED COVERAGE Under SECTION Ill - PHYSICAL DAMAGE COVERAGE, A. Coverage, we will pay for the expense of returning a stolen covered "auto" to you. The maximum amount we will pay is$1,000. 12. PERSONAL EFFECTS COVERAGE A. SECTION III-PHYSICAL DAMAGE COVERAGE,A.Coverage, is amended by adding the following: If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" .is stolen, we will pay, without application of a deductible, up to $600 for "personal effects" stolen with the "auto." a The insurance provided under this provision is excess over any other collectible insurance. n B. SECTION V DEFINITIONS is amended by adding the following: For the purposes of this provision, "personal effects" mean tangible property that is worn or carried by an "insured." "Personal effects" does•not include tools, equipment, jewelry, money or securi- ties. 13. ACCIDENTAL AIRBAG DEPLOYMENT SECTION III-PHYSICAL DAMAGE COVERAGE,B.Exclusions is amended'by adding the following: If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to the accidental discharge of an airbag. Any insurance we provide shall be excess over any other collectible insurance or reimbursement by manufacturer's warranty. However, we agree to pay any deductible applicable to the other coverage or warranty. 0 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc.,with Its Permission. Page 4 of 7 14. PHYSICAL DAMAGE DEDUCTIBLE-VEHICLE TRACKING SYSTEM SECTION HI-PHYSICAL DAMAGE COVERAGE,D.Deductible, is amended by adding the following: Any Comprehensive Deductible shown in the Declarations will be reduced by 50% for any "loss" caused by theft If the vehicle Is equipped with a vehicle tracking device such as a radio tracking device or a global position device and that device was the method of recovery of the vehicle. 15. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION III - PHYSICAL DAMAGE COVERAGE, B. Exclusions, Paragraph a. of the exception to exclu- sions 4.c. and 4.d: is deleted and replaced with the following: Exclusions 4.c. and 4.d. do not apply to: a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not de- signed solely for the reproduction of sound, if the equipment is: (1) Permanently installed in the covered "auto" at the time of the "loss" or removable from a housing unit that is permanently installed in the covered "auto"; and (2) Designed to be solely operated by use from the power from the "auto's" electrical system; and (3) Physical damage coverages are provided for the covered "auto". If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this equipment, then our obligation to pay for, repair, return-or replace damaged or stolen property will be reduced by a$100 deductible. 16. LOAN/LEASE GAP COVERAGE(Not Applicable In New York). A. Paragraph C. Limit Of Insurance of SECTION III PHYSICAL DAMAGE COVERAGE is amended by adding the following: The most we will pay for a°total loss" to a covered "auto" owned by or leased to you in any one "accident" is the greater of the: 1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is subject at the time of the "loss" less the amount of: a. Overdue payments and financial penalties associated with those payments as of the date of the "loss"; b. Financial penalties imposed under a lease due to high mileage, excessive use or abnormal wear and tear; c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insur- ance purchased with the loan or lease; d. Transfer or rollover balances from previous loans or leases; e. Final payment due under a"Balloon Loan"; f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of a covered."auto"; a g. Security deposits not refunded by a lessor; • h. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement on a a covered "auto'; I. Any amount representing taxes; j. Loan or lease termination fees; or 2. The actual cash value of the damage or stolen property as of the time of the "loss". An adjustment for depreciation and physical condition will be made in determining the actual cash value at the time of the "loss". This adjustment is not applicable in Texas. B. Additional Conditions This coverage applies only to the original loan for which the covered "auto" that incurred the "loss" serves as collateral, or lease written on the covered "auto° that incurred the "loss". ® 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 5 of 7 uP C. SECTION V-DEFINITIONS is changed by adding the following: As used in this endorsement provision, the following definitions apply: "Total loss" means a"loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. A "balloon loan" Is one with periodic payments' that are insufficient to repay the balance over the term of the loan, thereby requiring a large final payment. 17. GLASS REPAIR-WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION III -PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: No deductible applies to glass,damage if the glass is repaired rather than replaced. 18. PARKED AUTO COLLISION COVERAGE(WAIVER OF DEDUCTIBLE) - Paragraph D. Deductible of SECTION III -PHYSICAL DAMAGE COVERAGE is amended by the addition Q of the following: The deductible does not apply to "loss" caused by collision to such covered "auto" of the private passenger type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as maximum loaded weight the "auto" is designed to carry while it is: a. In the charge of an "Insured"; b. Legally parked; and c. Unoccupied. The "loss" must be reported to the police authorities within 24 hours of known damage. The total amount of the damage to the covered "auto" must exceed the deductible' shown in/the Declarations. This provision does not apply to any "loss" , if the covered "auto" is in the charge of any person or organization engaged in the automobile business. 19. TWO OR MORE DEDUCTIBLES Under SECTION Ill - PHYSICAL DAMAGE COVERAGE, if two or more company policies or coverage forms apply to the same "accident", the following applies to Paragraph D.Deductible: a. If the applicable Business Auto deductible is the smaller (or smallest) deductible, it will be waived; or b. If the applicable- Business Auto deductible is not the smaller (or smallest) deductible , it will be reduced by the amount of the smaller (or smallest) deductible; or c. If the "loss" involves two or more Business Auto coverage forms or policies, the smaller (or smallest) deductible will be waived. - For the purpose of this endorsement, company means any company that is part of the Liberty Mutual Group. z • SECTION IV-BUSINESS AUTO CONDITIONS is amended as follows: 20. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV- BUSINESS AUTO CONDITIONS, Paragraph B.2. is amended. by adding the following: a • If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the Incep- tion date or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will • not be prejudiced. . However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and we have the right to collect additional premium for any such hazard or exposure. 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 6 of 7 21. AMENDED'DUTIES IN THE EVENT OF ACCIDENT,CLAIM, SUIT,OR LOSS SECTION IV -BUSINESS AUTO CONDITIONS, Paragraph A.2.a. is replaced in its entirety by the follow- ing: a. In the event of "accident", claim, "suit" or "loss", you must promptly notify us when it is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; • (3) Member, if you are a limited liability company; (4) An executive officer or the "employee" designated by the Named Insured to give such notice, if you are a corporation. To the extent possible, notice to us should include: (a) How, when and where the "accident" or"loss" took place; (b) The "insureds" name and address; and (c) The names and addresses of any injured persons and witnesses. 22. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph A.5. Transfer Of Rights Of Recovery Against Others To Us, is amended by the addition of the following: If the person or organization has In a written agreement waived those rights before an "accident" or "loss", our rights are waived also. 23. HIRED AUTO COVERAGE TERRITORY SECTION IV - BUSINESS AUTO CONDITIONS, Paragraph B.7. Policy Period, Coverage Territory, is amended by the addition of the following: f. For"autos" hired 30 days or less, the coverage territory is anywhere in the world, provided that the "insured's" responsibility to pay for damages Is determined in a"suit", on-the merits, in the United. States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. This extension' of coverage does not apply to an "auto" hired, leased, rented or.borrowed with a driver. 24. PRIMARY AND NON-CONTRIBUTING IF REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREE- MENT The following is added to SECTION IV-BUSINESS AUTO CONDITIONS, General Conditions, B.5.Other Insurance and supersedes anyprovision to the contrary:' . This Coverage Form's Covered Autos Liability Coverage is primary to and will not seek contribution from any other insurance available to an "Insured" under your policy provided that: 1. Such "Insured" is a Named Insured under such other insurance; and 2. You have agreed in a written contract or written agreement that this insurance would be primary a and would not seek contribution from any other insurance available to such "insured". SECTION V-DEFINITIONS is amended as follows: 25. BODILY INJURY REDEFINED ' a Under SECTION V-DEFINmONS, Definition C.is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental nguish, mental injury, shock, fright or death resulting from any of these at any time. O 2017 Liberty Mutual Insurance AC 85 01 06 18 Includes copyrighted material of Insurance Services Office Inc.,with its Permission. Page 7 of 7 `*193`09/08/2020*OMH 2205785 05 Great American Insurance Company "' 161456 GAI 2391 (Ed.06 16) MARINE COMMERCIAL LIABILITY . BLANKET ADDITIONAL INSURED ENDORSEMENT We agree that this policy shall include as Additional Insureds any person or organization to whom the Named Insured has agreed by written contract or written agreement to provide coverage,but only with respect to operations performed by or on behalf of the Named Insured and only with respect to an"occurrence": 1. Otherwise covered by this policy;and 2. That occurred subsequent to the making of such written contract or written agreement. All other terms and conditions of this policy remain unchanged. • • • • r • GAI 2391 (Ed.06/16) (Page 1 of 1)