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2021-205 PO 20210272- PCE Pacific Inc
Purchase Order ,M • Fiscal Year 2021 Page: 1 of: 1 B City of Ashland E 20 E. Main Purchase Ashld, OR 97520 Order# 20210272 T Phone: 5411552-2010 O Email: payable@ashland.or,us V H C/O Water Treatment Plant E PCE PACIFIC INC I 90 North Mountain Ave N 22011 26TH AVE SE p Ashland, OR 97.520 0 BOTHELL,WA 98021 • Phone:541/488-5345 R T Fax: 541/552-2329 I) 111=[.- - Alistair Andre 02/17 2021 1352 FOB ASHLAND'OR/NET30 Cit Accounts Pa able New EIM 3-Ph Actuator 1 Onsite installation support and-start-up/commissioning of(1)new 1.0 $12,888.00 $12,888.00 EIM model MCA-3 460V/3-phase actuator. Goods and Services Agreement Completion date: June 30, 2021 Project Account: ***************GL SUMMARY*************** 081900-602400 $12,888,00 • • • • • • • By: /AweDate: L AJ' on ed Signature 4.±_'ngl — ..12 888.00 l 1 `I FORM #3 • CITY OF ASHLAND . A I't:l,uo:;3: t)t' t'tti :il ,!;i (>2 5 7- 7 REQUISITION 7 EQUISIT1®N7 Date of request: 0211712021 • Required date for delivery: , 06/3012021 Vendor Name PCE PACiFIC,INC - Address,City,State,.Zip 22011.26th AVE,SE BOTHELL,WA 98021 Contact Name&Telephone Number Stephen Trone 425 487-9600 Anne Logman 425 487-8707 field service Email address • stephen.trone@pcepaciflc.com anne.logmancl7,pcepacific.com SOURCING METHOD , ❑ Exempt from Competitive Bidding - ❑ Emergency ❑ Reason for exemption: 0 Invitation to Bid 0 Form#13,Written findings and Authorization , • ❑ AMC 2,60 Date approved by Council: 0 Written quote or proposal attached ❑ Written quote or proposal attached jAttach copy of council communication) _(If council approval required,attach copy of CC) ❑ Small Procurement ❑ Request for Proposal Cooperative Procurement Not exceeding$5,000 Date approved by Council: 0 State of Oregon ❑ Direct Award __(Attach copy of council communication) Contract# ❑ VerbailWritten bids)or proposai(s) 0 Request for Qualifications(Public Works) 0 Slate of Washington Date approved by Council: Contract 11 __,(Attach copy of council communication) 0 Other government agency contract Intermediate Procurement 0 Sole Source Agency GOODS&SERVICES 0 Applicable Form(115,6,7 or 8) Contract# Greater than$5,000 and less than$100,000 ❑ Written quote or proposal attached Intergovernmental Agreement ❑Q . (3)Written bids&solicitation attached 0 Form 1f4,Personal Services$51(to$75i( Agency PERSONAL SERVICES 0 Special Procurement _ 0 Annual cost to City does not exceed$25,000. Greater than$5,000 and less than$75,000 0 Form 119,Request for Approval Agreement approved by Legal and approvedlsigned by ❑ Less than$35,000,by direct appointment 0 Written quote or proposal attached City Administrator.AMC 2.50.070(4) ❑ (3)Written proposals&solicitation attached Date approved by Council: ❑ Annual cost to City exceeds$25,000,Council ❑ Form 114,Personal Services$5K to$75K Valid until: -_ (Date) approval required.(Attach copy council communication) Description of SERVICES Total Cost $ Item# Quantity Unit Description of MATERIALS Unit Price Total Cost 1 1 EIM Actuator,MCa3-3,460v13ph wl 4-train limit switch, 8468.00 8468.0 2 1 onsite installation support&start up of actuator 4420,00 4420.00 0 Per attached quotelproposal . , TOTAL COST Project Number •_ _ _ Account Number 0 t! 1 0 0 0.6 0 2 4 0 0 • 128I88.00 Account Number • Account Number • 'Expenditure must he charged to the appropriate account numbers for the financials 10 accurately reflect the actual expenditures. IT Director In el aboration with department to approve all hardware and software purchases: IT Director Date Support-Yes/No By signing this re.. Ili on form,I certify that the City's public contracting requirements have been satisfied` Employee: 4 t/---1-- Department Head: 2.� 19l2o� ( nalt rgreaterthan$5,000) Department.Man•geriSupervisor: City Manager: • (Equal go or,.�eater than$25,000)- Funds appropriated for current fiscal year: r. _--..-_A/ f/ ti.3" — Fin ace ifirector-(Equaltoorgreatorth a5,00 Date Comments: • Form 113•Requisition - GOODS AND SERVICES AGREEMENT (LESS THAN$25,000) -' PROVIDER: PCE Pacific Inc. CITY O.F PROVIDER'S CONTACTS: Stephen Trone,Anne Logman ASH LAND 20 East Main Street ADDRESS: 22011 ---26Th Ave SE,Bothell,WA 98021 Ashland,Oregon.97520 Telephone: 541/488-5587 PHONE: 425.487-9600 Fax: 541/488-6006 EMAIL: Stephen.trone(a pcepacific.com Anne.Logman@pcepacific.com pcepacific.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 PCE Pacific, Inc., (a foreign business corporation) ("hereinafter"Provider"), for onsite installation support and start-up/commissioning of(1)new Ent.model MCA.:.3.-.460V/3-phase_actuator...._-.-_........... ._.........-..._.._-................. 1. PROVIDER'S OBLIGATIONS 1.1 Provide onsite installation support and start-up/commissioning of (1) new EIM model MCA-3 460V/3-phase actuator 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. • Workers' Compensation 1.2.2 Each policy of such insurance shall be on an "occurrence" and not a "claims made" form, and shall: • Name as additional insured "the City of Ashland, Oregon, its officers, agents and employees" with respect to claims arisingout of the provision of Work under this Agreement; • Apply to each named and additional named insured as though a separate policy had been issued to each,provided that the policy limits shall not be increased thereby; • Apply as primary coverage for each additional named insured except to the extent that two or more such policies are intended to "layer" coverage and, taken together, they provide total coverage from the first dollar of.liability; • Provider shall immediately notify the City of any change in insurance coverage Page 1 of 7,Goods and Services Agreement between the City of Ashland and PCE Pacific,Inc. 1 � a _ • 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 ._ .otential subcuntra tar•or-su iter shall-be-notified he Providersofthe Provider's-obligations under p----- pp. _ . . g 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 F. provided,hereunder withoutthe 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 $12,888.00 (twelve thousand eight hundred and eighty-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$12,888.00 (twelve thousand eight hundred and eighty-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 PCE Pacific,Inc. 3. GENERAL,PROVISIONS - F 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 or the other's officers,employees or agents. 3.10 If any provision of this Agreement is found by a court of competent jurisdiction to be unenforceable, such provision shall not affect the other provisions, but such unenforceable provision shall be deemed modified to the extent necessary to render it enforceable,preserving to the fullest extent permitted the intent of Provider and the City set forth in this Agreement. 3.11 Deliveries will be F.O.B destination. Provider shall pay all transportation and handling charges for the Goods.Provider is responsible and liable for loss or damage until fmal inspection and acceptance of the Goods by the City. Provider remains liable fox 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 PCE Pacific,Inc. � 4 � 3 - i 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 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 ST012921D-1 dated February 8, 2021 and Field Service Estimate#AL16780 dated February 5,2021. 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 in equity, including,but not limited to: 5.1.1 Termination of this Agreement; 5.1.2 Withholding all monies due for the Work that Provider has failed to deliver within any scheduled _completion-dates-or any--Work-that-have-been-delivered-inadequately-or defectively; - 5.1.3 Initiation of an action or proceeding for damages, specific performance, or declaratory or injunctive relief; 5.1.4 These remedies are cumulative to the extent the remedies are not inconsistent,and City may pursue any remedy or remedies singly, collectively, successively or in any order whatsoever. 5.2 In no event shall City be liable to Provider for any expenses related to termination of this Agreement or for anticipated profits. If previous amounts paid to Provider exceed the amount due,Provider shall pay immediately any excess to City upon written demand provided. 6. TERM AND TERMINATION 6.1 Term This Agreement shall be effective from the date of execution on behalf of the City as set forth below (the "Effective Date"), and shall continue in full force and effect until 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 PCE Pacific,Inc. If to the City: City of Ashland Attention: Alistair Andre Water Treatment Plant 20 E.Main Street Ashland,Oregon 97520 ) Telephone: (541)488-5345 With a copy to: City of Ashland Attention:Legal Department • 20 E. Main Street Ashland, OR 97520 Telephone: (541)488-5350 If to Provider: PCE Pacific, Inc. Attention: Stephen Trone,Anne Logman --------._....------------ - 22011--26th Ave SE-- _._...------------------------------------------._...._..._.---------' Bothell, WA 98021 Telephone: (425)487-9600 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 apolitical subdivision of the State of Oregon applicable to Provider; and . (iii) Any rules, regulations, charter provisions, or ordinances that implement or enforce any of the foregoing tax laws or provisions. 9.2 Provider's failure to comply with the tax laws of the State of Oregon and all applicable tax laws of any political subdivision of the State of Oregon shall constitute a material breach of this Agreement. Further, any violation of Provider's warranty, as set forth in this Article 9, shall constitute a material breach of Page 5 of 7,Goods and Services Agreement between the City of Ashland and PCE Pacific,Inc. this Agreement. Any material breach of this Agreement shall entitle the. City to terminate. this Agreement and to seek damages and any other relief available under this Agreement,at law,or in equity. IN WITNESS WHEREOF the parties have caused this Agreement to be signed in their respective names by their duly authorized representatives as of the dates set forth below. CITY OF ASHLAND: PCE PACIFIC,INC: By: .! I 141 I I 1111 By: Signature /eG�..' z j w.rl .2- -Printed Name Printed Name Title Title ZI t b(202_, - 1z e t --- ---D-ate----- ---------_.--------------- - ]Date—.... Purchase Order Noy (W-9 is to be submitted with this.signed Agreement) • - f _ I Page 6 of 7,Goods and.Services Agreement between the City of Ashland and PCE Pacific,Inc. • • • • � l CITY OF ASHLAND, OREGON 4 Exhibit A City of Ashland LIVING- ALL employers,described WAG E below must comply with City of Ashland laws regulating • payment of a living wage_ EIEM per hour effective June 30, 2020• The Living Wage Is adjusted annually every • June 30 by the Consumer Price Index. Employees must be paid a portion of business.of their 4D1 K and IRS eligible • living •wage: employer,if the employer has cafeteria plans(,including ten or more employees,and childcare)benefits to the • has received fiLian tial amount of wages received by Far all hours mita under a assistance for the project or the employee. business from the City of smite contact between their employer and the City of Ashland in excess of > dote: For temporary and al land if the contract $22,002.43. part-time employees,the Living age does root apply exceeds$22,002.43 or more. > if their employer is the City of to the first 1C40 hours worked Far all hours worked in a Ashland,including the Parks in any calendar year. For month if oe employee spends am d Recreation Department, mare details,please see SC%or more of the Ashland Municipal Code employees time in that month > In oak:Mating the living wage, rection 3.12.020. working on a project or employers may add the valine of health care,retirement, For additional information: • • • • Call the Ashland City Atirninistrators office at 541-4B6-6002 or write to tie City r,dmini:strator, • City Hail,20 East Main Street,Ashland,OR g7520,or visit the City's website at www.ashland.on.us. • • • Notice to Employers: This notice must be pasted predominantly in areas where it can be seen by all employees. • CITY OF ASHLAND Page 7 of 7,Goods and Services Agreement between the City of Ashland and PCE Pacific,Inc. • s ' ' x; PCE PACIFIC Quotation ` Emerson Impact Partner EMERSON,. . Date: 2/8/2021 Attention: Kevin Caldwell Company: City of Ashland Quote#: ST012921D-1 Address: RFQ #: • Phone: 541-552-2414 From: Stephen,Trone Email: Kevin.Caldwell@ashland.or.us Phone: (425)487-9600 Reference: EIM replacement Email: stephen.trone@pcepacific.com PCE Pacific is pleased to offer the following quotation for your consideration.Please carefully review materials of construction, , conditions of service and all details,including specifications stated or on attachments,to verify our understanding of your requirements. Product availability and quoted lead times are subject to change prior to sale. Item Description Qty Unit Price Total Price Lead Time to Ship 1 EIM Actuator, MCA3-3,460V/3 ph, with 4-train limit 1 $8,468.00 $8,468:00 Allow 14-16 switch, Potentiometer, Motor Overload relay, and remote weeks to pushbutton module ship,ARO 2 Onsite installation support and start-up/commissioning 1 $4,420.00 $4,420.00 to be of EIM actuator(line 1). Detail AL16780 attached. / scheduled Total: $12,888.00 Shipping: Delivery Terms: Payment Terms: Due Immediately Pricing Valid: 30 Days A 3%convenience fee will be added for credit card payments Please refer to quote#ST012921D-1 on PO and , PCE Pacific, Inc. address your order to: 22011 26th Ave SE Bothell,WA 98021 US P (800)321-4723 F(425)487-1.114 UNLESS PREVIOUSLY NEGOTIATED TERMS AND CONDITIONS OF SALE BETWEEN BOTH PARTIES APPLY,THIS PROPOSAL INCORPORATES HEREIN AND MAKES A PART HEREOF BY REFERENCE"EMERSON PROCESS MANAGEMENT LLLP.STANDARD TERMS AND CONDITIONS FOR THE SALE OF GOODS AND CONSULTING SERVICES'WHICH ARE AVAILABLE ON OUR WEBSITE AT https://www.pcepacific.com/Ip/pcetc/. BY PURCHASING OR ACCEPTING DELIVERY OF GOODS OR CONSULTING SERVICES PURSUANT TO THIS PROPOSAL THE BUYER AGREES TC BE BOUND BY EMERSON PROCESS MANAGEMENT LLLP.STANDARD TERMS AND CONDITIONS FOR THE SALE OF GOODS AND CONSULTING SERVICES UNLESS OTHERWISE AGREED TO IN WRITING BY BOTH PARTIES Page 1 of 1 x; PCE PACIFIC Emerson Impact Partner EMERSON,. PCE Pacific, Inc. 22011 —26th Ave SE Bothell, WA 98021 Phone:425-487-9600 Fax:425-487-1114 • Field Service Estimate # AL16780 Page 1 of 1 February 5,2021 To: Kevin Caldwell Prepared By: Anne Logman Company: City of Ashland OR cc: Jason Goebel Phone: 541-552-2414 Phone: 425-487-8707 Cell: Fax: 425-487-1114 Email: Kevin.caldwellaashland.or.us Email: Anne.Logman a(").pcepacific.com Onsite installation support and start-up/commissioning of(1) new EIM model MCA-3 460V/3-phase actuator. Estimate includes travel, expenses, parts and on-site labor(detail below) $4,420. Scope of work and Assumptions: • One(1)valve/instrument technician to travel to site one time for work scope. Estimate based on travel from Everett WA and travel and onsite Monday-Friday,day shift,no holidays. • Estimate based on 1 day onsite,8 hours, day shift. • Scope: 1)provide guidance and expertise for safe removal of existing EIM actuator(serial#43305A)and installation of new EIM actuator(per PCE Quote ST012921D)-City to provide lifting personnel&equipment; 2)coordinate with City-provided electrician for unlanding wires from existing actuator and landing wires on new actuator; 3)set switches,test travel limits, set/confirm travel stops,function test to ensure proper function of all actuator components and features; 4)witness function testing from customer control system if possible; 5)make recommendations for future maintenance or replacements, as needed; 6)provide field report within 1 week of last onsite date. • Standard PPE(facial covering, hard hat, safety glasses,steel toe boots). There will be no confined space or respirator-required work. • If site specific training is required, customer to provide on first on-site day. Estimated 1 hour or less. • Customer to provide: 1)safe access to equipment;2)personnel and equipment to lift existing actuator off of valve and lift new actuator onto valve;3)electrician to unland wires from existing actuator and land wires on new actuator;4)machining of stem nut,etc. if needed(if PCE manages machining or other services,,invoicing will reflect 15%administrative fee) • Total Estimated Labor and Travel Time Cost: $2,790.00 Parts: Recommended: one EIM blank stem nut(machining to be performed locally if needed). Budgetary Estimate: $800.00 plus shipping Expenses: Mileage=$1.00 per mile; Meals Per Diem=$60 per day; Other=Billed @ PCE Pacific cost Total Estimated Expenses: $830.00 Level 1 Valve/Instrument Technician,2021 Labor,Travel &Standby Rates: Standard(ST)=$155.00/hour(up to 8 hours per day, Monday—Friday); Overtime(OT)=$216.00/hour(over 8 hours per day but under 12 hours per day, Monday through Friday and up to 8 hours on Saturdays); Premium(DT)=$288.00/hour(over 12 hours per day Monday through Friday,all hours over 8 hours on Saturdays, all hours on PCE Pacific scheduled holidays and on Sundays). Please note: This quotation is an estimate only, based on information provided. Invoices will reflect actual time and materials. In addition to travel and expenses,a minimum of four hours onsite labor will be charged for all field jobs. Standby/waiting/site-specific training time will be charged at the prevailing labor rates. Availability of personnel cannot be guaranteed prior to receipt of Purchase Order and confirmation by PCE Pacific, Inc. Prices quoted are valid for work completed on or before 9/30/21. Unless specified above, sales, use,or other state or municipal taxes are not included. Any orders placed are subject to current PCE Pacific"Mechanical Service Rates"and to current."PCE Services Terms and Conditions of Sale which is available at our website htto://www.ocepacific.com/Ip/pcetc/. A 3%Convenience Fee will be charged for Credit Card payments. Prices are in US dollars. Thank you for this opportunity. If you have any questions regarding this quotation or if I can be of any assistance please do not hesitate to call me at 425-487-8707 or via email: Anne.Logman( oceoacific.com. -, / , �.....1 PCEPACI-01 ' LBUSCIO ACO/RO" DATE(MM/DD/YYYY) 4...------- CERTIFICATE OF LIABILITY INSURANCE 2/10M2021 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 Laura Buscio NAME: Hub International Northwest LLC PHONE PO Box 3018 (A/c,No,Ext):(206)838-1015 I FAX (AIC,No): Bothell,WA 98041 ADDRIESS:laura.buscio@hubinternational.com INSURER(S)AFFORDING COVERAGE ' NAIC# - INSURER A:Alaska National Insurance Company - 38733 INSURED INSURER B:Ohio Casualty Insurance Company 24074 PCE Pacific Inc. INSURER C 22011 26th Ave SE INSURER D: Bothell,WA 98021 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 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. 1NSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMMIDD/YYYY1 IMMIDD/YYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ` 1,000,000 CLAIMS-MADE X OCCUR 20EPS31306 5/13/2020 5/13/2021 DAMAGE TO RENTED 100,000 X X PREMISES(Ea occurrence) $ X WY Stop Gap MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY --x PE a LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: WA STOP GAP $ 1,000,000 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea acciden) $ X ANY AUTO X X 20EAS31306 5/13/2020 5/13/2021 BODILY INJURY(Per person) $'% OWED SCHEDULED AUTOS ONLY AUTOS BODILY INJURYp (Per accident) $ AUTOS ONLY _ AUUTOS ONLY (Perr accra nt)AMAGE $ • ' $ A UMBRELLA UAB X OCCUR • EACH OCCURRENCE $ 5,000,000 X EXCESS UAB CLAIMS-MADE 20ELU31306 5/13/2020 5/13/2021( AGGREGATE $ 5,000,000 DED X RETENTION$ 10,000 $ A WORKERS COMPENSATIONX STATUTE ORH AND EMPLOYERS'LIABILITY E 20EW531306 5/13/2020 5/13/2021 1,000,000 OFFICER/MEMBERR EXCLUDED?ECUTIVE Y/N N/A E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Commercial Umbrella ECO58034042 5/13/2020 5/13/2021 $5,000,000 xs 5,000,000 ( DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Wyoming Stop Gap included under policy#20EWS31306 Employers Liability limits:,$1,000,000 each accident/$1,000,000 each employee/$1,000,000 policy limit. City of Ashland is an additional insured and insurance is primary and non-contributory per the attached.Waiver of subrogation applies per the attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City ACCORDANCE WITH THE POLICY PROVISIONS. 20 E Main Ashland,OR 97520 AUTHORIZED REPRESENTATIVE , r _ ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD /7 Alaska National k INSURANCE COMPANY CONTRACTORS'GENERAL LIABILITY ENHANCEMENT ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Coverage afforded under this extension of coverage endorsement does not apply to any person or organization covered as an additional insured on any other endorsement now or hereafter attached to this Coverage Part. SCHEDULE OF COVERAGES ARE SUMMARIZED BELOW 1. Miscellaneous Additional Insureds 14. In Rem Actions 8 additional insured extensions. • 1. MISCELLANEOUS ADDITIONAL INSUREDS Primary and Noncontributory Insurance Section II Who Is An Insured is amended to 2. Damage To Premises Rented to You include as an additional Insured any person or Limit increased to$500,000. organization described - in Paragraphs 2.a. through 2.h. below whom you are required to add 3. Medical Payments as an additional insured on this policy under a Limits increased to$15,000. written contract or written agreement. However, Reporting period increased to three years from the written contract or written agreement must be: the date of accident. / 1. Currently in effect or becoming effective 4. Non-owned Watercraft during the term of this policy; and Increased to 50 feet. 2. Executed prior to the "bodily injury", 5. Supplementary Payments "property damage"or"personal injury and Cost of bail bonds increased to$10,000. advertising injury", but Daily loss of earnings increased to$500. Only the following persons or organizations 6. Newly Formed Or Acquired Organizations are additional insureds under this Coverage extended to the end of the policy period endorsement and coverage provided to such or the next anniversary of this policy's effective additional insureds is limited as provided date. herein: 7. Liberalization Clause a. State or Governmental Agency or Subdivision or Political Subdivi- 8. Unintentional Failure To Disclose Hazards sions 9. Notice of Occurrence Any state or governmental agency or subdivision or political subdivision 10. Broad Knowledge of Occurrence that has issued a permit in connection with operations performed 11. Bodily Injury-Extension of Coverage by you or on your behalf and that you are required by any ordinance, law or 12. Expected Or Intended Injury building code to include as an Reasonable force - bodily injury or property additional insured on this coverage damage. part is an additional insured, but only 13. Blanket Waiver of Subrogation with respect to liability for "bodily Waiver of subrogation where required by written injury", "property damage", "personal contract or written agreement. and advertising injury" arising out of such operations. ANIC GL 1187 07 16 Page 1 of 6 (�0 Alaska National k INSURANCE COMPANY The insurance provided to such state e. Owners or Other Interests From or political subdivision does not apply Whom Land Has Been Leased to any "bodily injury", "property damage"or"personal and advertising An owner or other interest from whom injury" arising out_ of operations land has been leased by you but only performed for that state or political with respect to liability arising out of subdivision. the ownership, maintenance or use of that specific part of the land leased to b. Controlling Interest you and subject to the following additional exclusions: Any persons or organizations with a controlling interest in you but only This insurance does not apply to: with respect to their liability arising out of: ' (1) Any "occurrence" which takes place after you cease to lease (1) Their financial control of you, or that land;or (2) Premises they own, maintain or (2) Structural alterations, new con- control while you lease or occupy struction or demolition operations these premises. - performed by or on behalf of such additional insured. This insurance does not apply to structural,alterations, new construc- f. Co-owner of Insured Premises tion and demolition operations performed by or for such additional A co-owner of a premises co-owned insured. by you and covered under this insurance but only with respect to the c. Managers or Lessors of Premises co-owners liability as co-owner of such premises. A manager or lessor of premises but only with respect to liability arising out g. Lessor of Equipment of the ownership, maintenance or use of that specific part of'the premises Any person or organization from leased to you and subject to the whom you lease ,equipment. Such, following additional exclusions: person or organization is an additional insured only with respect to This insurance does not apply to: their liability for "bodily injury", "property damage" or "personal and (1) Any "occurrence" which takes Advertising injury" caused, in whole place after you cease to be a or in part, by your maintenance, oper- tenant in that premises; or ation or use of equipment leased to you by such person or organization. (2) Structural alterations, new con- A person's or organization's status as struction or demolition operations an additional insured under this performed by or on behalf of endorsement ends when their written such additional insured. contract or written agreement with you for such leased equipment ends. d. Mortgagee,Assignee or Receiver With respect to the insurance A mortgagee, assignee or receiver afforded these additional insureds, but only with respect to their liability the following additional exclusions as mortgagee, assignee, or receiver apply: and arising out of the ownership, maintenance, or use of a premises by This insurance does not apply: you. (1) To any "occurrence" which takes This insurance does not apply to place after the equipment lease structural alterations, new construc- expires; or tion or demolition operations performed by or for such additional insured. ANIC GL 1187 07 16 Page 2 of 6 /(0 Alaska National INSURANCE COMPANY (2) To "bodily injury", "property operations hazard" for the damage", or "personal and additional insured. However, advertising injury" arising out of even if coverage within the the sole negligence of such "products-completed operations additional insured. hazard" isrequired by the written contract, such coverage is h. Owners, Lessees or Contractors available to the additional insured only if the "bodily injury" or (1) Such person or organization is an "property damage"occurs prior to additional insured for "bodily the end of the time period during injury", "property damage" and which you are required by the "personal and advertising injury" written contract to provide such if, and only to the extent that, the coverage or the expiration date of injury or damage is caused by the policy,whichever comes first. negligent acts or omissions of you or your subcontractor in the Any insurance provided to an additional performance of "your work" to insured designated under Paragraphs 2.a. which the written contract through 2.g. above does not apply to "bodily applies. This person or organi- injury" or "property damage" included within zation does not qualify as an the products-completed operations hazard." additional insured with respect to injury or damage caused in whole Primary And Noncontributory Insurance or in part by independent negligent acts or omissions of The following is added to the Other Insurance such person or organization. Condition and supersedes any provision to the (2) However, this insurance does not contrary: apply to "bodily injury", "property damage" or "personal and This insurance is primary to and will not seek advertising injury" arising out of contribution from any other insurance available to an architect's, engineer's, or an additional insured under your policy provided surveyor's rendering of or failure that: to render any professional services including: (1) The additional insured is a Named Insured under such other i. the preparing, approving, or insurance; and failing to prepare or approve maps, drawings, opinions, (2) You have agreed in writing in a reports, surveys, change contract or agreement that this design or insurance would be primary and orders, ocations; and would not seek contribution from any other insurance available to ii. supervisory, inspection, or the additional insured. engineering services. Section III -Limits of Insurance, the following is added: (3) The insurance provided to this additional insured, does not With respect to the insurance afforded to the cover "bodily injury" or "property additional insureds described in Paragraphs a. damage" caused by your through h. above, the most we will pay on behalf negligent acts and omissions in of such additional insured is the amount of the performance of "your work" that occurs within the "products- insurance: completed operations hazard", unless the written contract (1) Required by the contract or contains a specific requirement agreement; or that you procure completed operations(coverage or coverage (2) Available under the applicable within the "products-completed Limits of Insurance shown in the Declarations; whichever is less. ANIC GL 1187 07 16 Page 3 of 6 /(0 Alaska National INSURANCE COMPANY • This provision shall not increase the applicable 4. NON-OWNED WATERCRAFT Limits of Insurance shown in the Declaration. A. If endorsement CG 21 09, CG 21 10, CG 24 2. Damage To Premises Rented to You 50, or CG 24 51 is attached to the policy, Paragraph A. 2. g. (2) (b) is replaced by the SECTION III — LIMITS OF INSURANCE, , following: Paragraph 6. is replaced by the following: (b) A watercraft that you do not 6. Subject to Paragraph 5. above, the own that is: Damage to Premises Rented to You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while , (i) Less than 50 feet long: rented to you, or in the case of damage and by fire, while rented to you or temporarily occupied by you with permission of the (ii) Not being used to carry owner. persons or property for a charge. If a limit is shown for Damage to Premises Rented to You the most we will pay under B. If Paragraph A. does not apply, Paragraph g. Coverage A for damages because or "property (2) of 2. EXCLUSION under SECTION I — damage" to any one premises is the Limit shown COVERAGES, COVERAGE A — BODILY in the Declarations or $500,000, whichever is INJURY AND PROPERTY DAMAGE greater. LIABILITY is replaced by the following: 3. MEDICAL PAYMENTS (2) A watercraft that you do not own that is: A. Section III—Limits of Insurance, Paragraph 7.is replaced by the following: (a) Less than 50 feet long; and 7. Subject to Paragraph 5. above the (b) Not being used to carry Medical Expense Limit is the most we will persons or property for a pay under Coverage C for all medical charge. expenses because of "bodily injury" sustained by any one person. 5. SUPPLEMENTARY PAYMENTS If a limit is shown for Medical Expense in A. Under Section I-Supplementary Payments the Declarations the most we will pay - Coverage A-and B, Paragraph 1.b., the under Coverage C for all medical limit of$250 shown for the cost of bail bonds expenses because of "bodily injury" is replaced by$10,000; sustained by any one person is the Limit shown in the Declarations or $15,000, B. In Paragraph 1.d., the limit of$250 shown for whichever is greater. daily loss of earnings is replaced by$500. B. This, provision 5. (Medical Payments) does 6. NEWLY FORMED OR ACQUIRED not apply if Section I - Coverage C Medical ORGANIZATIONS Payments is excluded either by the provisions of the Coverage Part or by Paragraph 3.a.of Section ll-Who Is An Insured endorsement. is deleted and replaced by the following: C. Paragraph 1.a.(3)(b) of Section I-Coverage Coverage under this provision is afforded only C - Medical Payments, is replaced by the until the end of the policy period or the next following: anniversary of this policy's effective date after you acquire or form the organization, whichever is (b) The expenses are incurred earlier. and reported to us within three years of the date of the • accident; and • • ANIC GL 1487 07 16 Page 4 of 6 • 7 Alaska National k INSURANCE COMPANY 7. LIBERALIZATION CLAUSE 10. BROAD KNOWLEDGE OF OCCURRENCE If we adopt a change in our forms or rules which The following is added to Paragraph 2.of Section would broaden coverage for contractors under IV- Commercial General Liability Conditions - this endorsement without an additional premium Duties in The Event of Occurrence, Offense, charge, your policy will automatically provide the Claim or Suit: additional coverages as of the date the revision is effective in your state. You must give us or our authorized representative notice of an "occurrence", offense, claim, or"suit" 8. UNINTENTIONAL FAILURE TO DISCLOSE only when the "occurrence", offense, claim or HAZARDS "suit' is known to: SECTION IV — COMMERCIAL GENERAL (1) You, if you are an individual; LIABILITY CONDITIONS — Paragraph 6. — Representations is replaced by the following: (2) A partner, if you are a partnership; 6. Representations (3) An executive officer or the By accepting this policy, you agree: employee designated by you to give such notice, if you are a a. The statements in the Declarations are corporation; or accurate and complete; (4) A manager, if you are a limited b. Those statements are based upon liability company. representations you made to us; and 11. EXPANDED BODILY INJURY c. -We have issued this policy in reliance Section V - Definitions, the definition of "bodily upon your representations. injury" is changed to read: The unintentional omission of, or "Bodily injury" means bodily injury, sickness or unintentional error in, any information you disease sustained by a person, including death, provided to us which we relied upon in humiliation, shock, mental anguish or mental issuing this policy will not prejudice your injury by that person at any time which results as rights under this insurance. However, this a consequence of the bodily injury, sickness or provision does not affect our right to collect disease. additional premium or to exercise our rights of cancellation or nonrenewal in accordance 12. EXPECTED OR INTENDED INJURY with applicable laws and regulations. Exclusion a. of Section I - Coverage A - Bodily 9. NOTICE OF OCCURRENCE Injury and Property Damage Liability is replaced by the following: The following is added to Paragraph 2. of Section IV- Commercial General Liability Conditions - a. "Bodily injury" or "property damage" Duties In The Event of Occurrence, Offense, expected or intended from the Claim or Suit: standpoint of the insured. This exclusion does not apply to "bodily Your rights under this Coverage Part will not be injury" or"property damage" resulting prejudiced if you fail to give us notice of an from the use of reasonable force to "occurrence", offense, claim or "suit" and that protect persons or property. failure is solely due to your reasonable belief that the "bodily injury" or "property damage" is not covered under this Coverage Part. However, you shall give written notice of this "occurrence", offense, claim or "suit" to us as soon as you are aware that this insurance may apply to such "occurrence", offense, claim or"suit." ANIC GL 1187 07 16 Page5of6 sy0 Alaska National k INSURANCE COMPANY 13. BLANKET WAIVER OF SUBROGATION However, this waiver applies only when you have agreed in writing to waive such rights of recovery The Transfer Of Rights Of Recovery Against in a contract or agreement, and only if the Others To Us Condition (Section ,IV - contract or agreement: Commercial General Liability Conditions).is amended by the addition of the following: 1. Is in effect or becomes effective during the term of this policy; and We waive any right of recovery we may have against any person or organization because of 2. Was executed prior to loss. payments we make for injury or damage arising out of: 14. IN/REM ACTIONS 1. Your ongoing operations; or Any action in rem against any vessel owned, operated by or for, or chartered by or for you will 2. "Your work" included in the "products- be treated in the same manner as though the completed operations hazard." action were in personam against you. This endorsement changes the policy to which it is,attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is ' required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Policy No. Insured Endorsement No. 26 Countersigned By Includes copyrighted material of Insurance Services Office, Inc.,with its permission ANIC GL 1187 b7 16 Page 6 of 6 1 /(0 Alaska National INSURANCE COMPANY DESIGNATED CONSTRUCTION PROJECT(S)GENERAL AGGREGATE LIMIT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): All projects. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by damages or under Coverage C for medical "occurrences" under Section I — Coverage A, and expenses shall reduce 'the Designated for all medical.expenses caused by accidents Construction Project General Aggregate Limit under Section I — Coverage C, which can be for that designated construction project. Such attributed only to ongoing operations at a single payments shall not reduce the General designated construction project shown in the Aggregate Limit shown in the Declarations nor Schedule above: shall they reduce any other Designated 1. A separate Designated Construction Project Construction Project General Aggregate Limit General Aggregate Limit applies to each for any other designated construction project designated construction project, and that limit shown in the Schedule above. is equal to the amount of the General 4. The limits shown in the Declarations for Each Aggregate Limit shown in the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, except General Aggregate Limit shown in the damages because of "bodily injury" or Declarations, such limits will be subject to the "property damage" included in the "products- applicable Designated Construction Project completed operations hazard", and for medical General Aggregate Limit. expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or"suits"brought;or c. Persons or organizations making claims or bringing"suits". CG 25 03 05 09 Page 1 of 2 • /(01) Alaska National INSURANCE COMPANY BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: • BUSINESS AUTO COVERAGE FORM - Various provisions in this endorsement restrict SECTION IV — Business Auto Conditions, coverage. Read the entire policy carefully to Paragraph A. 5. — Transfer of Rights of Recovery determine rights, duties, and what is and is not Against Others To Us is amended to include: covered. 5. Transfer of Rights of Recovery Against Throughout this policy, the words "you" and "your" Others to Us refer to the Named Insured shown in the Declarations. The words "we", "us", and "our" refer to This condition does not apply to any the company providing this insurance. person(s) or organization(s) to the extent that subrogation against ,that person or Other words and phrases that appear in quotation organization is waived prior to the "accident" marks have special meaning. Refer to SECTION V— or the"loss" under a contract with that person DEFINITIONS in the Business Auto Coverage Form. or organization. The coverages provided by this endorsement apply SECTION II — COVERED AUTO LIABILITY per "accident" and, unless otherwise specified, are COVERAGE, Paragraph A.2.a. (2) —Supplementary subject to all of the terms, conditions, exclusions and Payments is replaced by the following: deductible provisions of the policy, to which it is attached. (2) Up to $10,000 for cost of bail bonds (including bonds for related traffic law SECTION H — COVERED AUTO LIABILITY violations) required because of an COVERAGE, Paragraph A.1. Who Is An Insured is "accident"we cover. We do not have amended to include: to furnish these bonds. d. Any "employee" of yours while operating • SECTION II — COVERED AUTO LIABILITY an "auto" hired or rented under a COVERAGE,.Paragraph A.2.a. (4) —Supplementary contract or agreement in an "employee's" Payments is replaced by the following: name, with your permission, while performing duties related to the conduct (4) All reasonable expenses incurred by of your business. the"insured" at our request, including actual loss of earnings up to $500 a e. Any person or organization for whom you day because of time off from work. have agreed in writing to provide insurance such as is afforded by this Coverage Form, but only with respect to liability arising out of ,the ownership, maintenance or use of"autos"covered by this policy. If such person or organization has other insurance then this insurance is primary to and we will not seek contribution from the other insurance. ANIC CA 1150 10 13 - Page 1 of 4 r � Alaska National t INSURANCE COMPANY c. "Loss" caused by falling objects or SECTION II — COVERED AUTO LIABILITY missiles. COVERAGE, Paragraph A.2.c.—Voluntary Property Damage is added as follows: However, you have the option of having glass breakage caused by a covered "auto's" c. Voluntary Property Damage collision or overturn considered a"loss"under Collision Coverage. At your written request, we may make a voluntary payment for Property Damage Glass Repair—Waiver of Deductible caused by an "insured", but without liability to a third party, up to$25,000.We No deductible applies to glass breakage, if will not make a Voluntary Property the glass is repaired rather than replaced. Damage payment to anyone who is an "insured" under this policy. SECTION III — PHYSICAL DAMAGE COVERAGE, Paragraph A.4.a. — Transportation Expenses is SECTION III — PHYSICAL DAMAGE COVERAGE, replaced by the following: Paragraph A.2.—Towing is replaced by the following: a. Transportation Expenses Towing We will pay up to $200 'per day to a We will pay up to $500 for towing and labor maximum of $1,500 for temporary costs incurred each time a covered "auto" transportation expense incurred by you that is a: because of the total theft of a covered "auto"that is a: a. Private passenger; (1) Private passenger; b. Truck; (2) Truck; c. Pick-up truck; (3) Pick-up truck; d. Panel ; or (4) Panel; or e. Van (5) Van type vehicle under 20,000 lbs. of Gross Vehicle Weight is disabled. However, the type vehicle under 20,000 lbs. of Gross labor must be performed at place of Vehicle Weight. We will pay only for disablement. those covered "autos"for which you carry SECTION III — PHYSICAL DAMAGE COVERAGE, either Comprehensive or Specified Paragraph A.3. — Glass Breakage — Hitting a Bird fCauses of Lossryanspoto Coverage. We will pay or Animal—Falling Objects or Missiles is replaced nr temporary transportation expenses by the following: incurred during the period beginning 48 hours after the theft and ending, Glass Breakage—Hitting a Bird or Animal regardless of the policy's expiration, —Falling Objects or Missiles when the covered "auto" is returned to use or we pay for its"loss". If you carry Comprehensive Coverage for the damaged covered "auto", we will pay the following under Comprehensive Coverage: a. Glass Breakage; b. "Loss" caused by hitting a bird or animal; and ANIC CA 1150 10 13 Page 2 of 4 • ,y0 Alaska National k INSURANCE COMPANY (2) Specified Causes of Loss only if the SECTION `II - PHYSICAL DAMAGE COVERAGE, Declarations indicate that Specified Paragraph A.4.b. - Loss of Use Expenses is Causes of Loss Coverage is provided replaced by the following: for the"auto"withdrawn from service; or b. Loss of Use Expenses--Hired, Rented, (3) Collision only if the Declarations or Borrowed Automobiles indicate that Collision Coverage is provided for the "auto" withdrawn We will pay expenses for which an from service. "insured" becomes legally responsible to pay for loss of use of a vehicle hired, SECTION III - PHYSICAL DAMAGE COVERAGE, rented or borrowed without a driver under Paragraph A.4.d. - Airbag Coverage is added as a written rental contract or agreement. follows: We will pay for loss of use expenses, if caused by: d. Airbag Coverage (1) Other than Collision, only if the We will pay for the cost to repair, replace, Declarations indicate that or reset an airbag that inflates for any Comprehensive Coverage is provided reason other than as a result of a for the vehicle withdrawn from collision, if the Declarations indicate that service. the covered "auto" has Comprehensive • Coverage or Specified Causes of Loss (2) Specified Causes of Loss only if the Coverage. Declarations indicate that Specified Causes of Loss Coverage is provided SECTION III - PHYSICAL DAMAGE COVERAGE, for the vehicle withdrawn from Paragraph A.4.e. - Rental Reimbursement service. Coverage is added as follows: (3) Collision only if the Declarations e. Rental Reimbursement Coverage indicate that Collision Coverage is provided for the vehicle withdrawn We will pay up to $75 per day for rental from service. reimbursement expenses incurred by you for the rental of an "auto" because of However, the most we will pay for any "loss"to a covered"auto"that is a: expenses for loss of use is$200 per day, to a maximum of$1,500. (1) Private Passenger; SECTION III - PHYSICAL DAMAGE COVERAGE, (2) Truck; Paragraph A.4.c.-Non-Transportation Loss of Use Expenses is added as follows: (3) Pick-up truck; • c. Non-Transportation Loss of Use (4) Panel; or Expenses (5) Van We will pay up to $2,000 for non- transportation expense incurred by you, type vehicle under 20,000 lbs. of Gross because of "loss" to a covered "auto", if - Vehicle Weight. Payment applies in caused by: addition to the otherwise applicable amount of each coverage you have on a (1) Other than Collision, only if the covered "auto". No deductibles apply to Declarations ; indicate that - this coverage. Comprehensive Coverage ie provided for the"auto"withdrawn from service; ANIC CA 1150 10 13 Page 3 of 4 Z(c)) Alaska National k INSURANCE COMPANY (1) We will pay only for those expenses SECTION IV — BUSINESS AUTO CONDITIONS — incurred during the policy period Paragraph B.5.b. — Other Insurance is replaced by beginning 24 hours after the "loss" the following: and ending, regardless of the policy's expiration, with the lesser of the b. For Hired Auto Physical Damage following number of days: Coverage, the following are deemed to be covered"autos"you own: (a) The number of days reasonably required to repair or replace the (1) Any covered "auto" you lease, hire, covered"auto". rent, or borrow; and (b) 30 days. (2) Any covered "auto— hired or rented by your "employee" under a contract (2) This coverage does not apply while in that individual "employee's" name, there are spare or reserve "autos" with your permission, while available to you for your operations. performing duties related to the conduct of your business. (3) The Rental Reimbursement Coverage described above does not However, any"auto" that is leased, hired, apply to a covered "auto" that is rented or borrowed with a driver is not a described or designated as a covered covered"auto". "auto" on Rental Reimbursement Coverage Form CA 99 23. SECTION V — DEFINITIONS — Paragraph C. — "Bodily injury"is replaced by the following: SECTION IV — BUSINESS AUTO CONDITIONS — Paragraph B.2. —Concealment, Misrepresentation Or C. "Bodily injury" means bodily injury, sickness or Fraud is amended by adding Unintentional Failure disease sustained by a person including death or to Disclose Hazards at the end of Paragraph B.2. as mental anguish resulting from any of these. follows: Mental anguish means any type of mental or emotional illness or disease Unintentional Failure to Disclose Hazards If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. However, this provision does not affect our right to collect additional premium or exercise our right of cancellation or non-renewal. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Policy No. Insured Endorsement No. 5 Countersigned By ©Insurance Services Office, Inc.,2009 ANIC CA 1150 10 13 s Page 4 of 4 • (�0 Alaska National INSURANCE COMPANY UTAH WAIVER OF SUBROGATION ENDORSEMENT This endorsement applies only to the insurance a written contract that requires you to obtain this provided by the policy because Utah is shown in Item agreement from us.) 3.A. of the Information Page. This agreement shall not operate directly or indirectly We have the right to recover our payments from to benefit anyone not named in the Schedule. Our anyone liable for an injury covered by this policy. We waiver of rights does not-release your employees' will not enforce our right against the person or rights against third parties and does not release our organization named in the Schedule. (This agreement authority as trustee of claims against third parties. applies only to the extent that you perform work under SCHEDULE Any person or organization for whom the Insured has agreed by written contract to furnish this waiver. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective ori the date issued at 12:01 A.M.standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Policy No. Insured Endorsement No. 8 Countersigned By WC 43 03 05(07 00) • Z(0 Alaska National INSURANCE COMPANY ALASKA BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from Additional,premium charge for this endorsement shall anyone liable for an injury covered by this policy. We be 1.85% of the total standard premium for this policy, will not enforce our right against any person or subject to a$250 minimum annual charge per policy. organization. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M. standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Policy No. Insured Endorsement No. 14 Countersigned By WC 99 03 13 (01 12) • /10? Alaska National t. INSURANCE COMPANY • WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from a written contract that requires you to obtain this anyone liable for an injury covered by this policy. We agreement from us.) will not enforce our right against the person or organization named in the Schedule. (This agreement This agreement shall not operate directly or indirectly applies only to the extent that you perform work'under to benefit any one not named in the Schedule. SCHEDULE Any person or organization for whom the Insured has agreed by written contract to furnish this • waiver. This endorsement changes the policy to which it is attached and, unless otherwise stated, is effective on the date issued at 12:01 A.M.standard time at your mailing address shown in the policy. The information below is required only when this endorsement is issued subsequent to commencement of the policy. Endorsement Effective Policy No. Insured Endorsement No. 5 • Countersigned By WC 00 03 13(04 84) • cif 1 State of Wyoming Department of Workforce Services UNEMPLOYMENT INSURANCE TAX PO BOX 2760 Robin Sessions Cooley,J.D. Mark Gordon CASPER,WY 82602 Director Governor. 307.235.3217•Fax:307.235.3278 Elizabeth Gagen,J.D. www.wyomingworkforce.org Deputy Director • UNEMPLOYMENT INSURANCE CERTIFICATE OF GOOD STANDING CERTIFICATE ONLY VALID AS ISSUED TO: PCE PACIFIC, INC. EFFECTIVE DATE: 2/25/20 EXPIRATION DATE: 2/25/21 PROJECT: A review of the Department files indicates that PCE PACIFIC, INC. is in compliance with the Wyoming Unemployment Insurance requirements as of the effective date shown above. • This certificate holds you,the recipient, harmless for unpaid Unemployment Insurance debt owed by the certified company during the period set forth above. If you continue to use PCE PACIFIC, INC.. after the expiration date of this certificate, you may be held liable for their unpaid Unemployment Insurance debt pursuant to Wyoming Statute 27-3-502(f). To request a new Unemployment Insurance certificate, please email the request to theresa.maile@wyo.gov PCE PACIFIC, INC. 22011 26TH AVE SE BOTHELL, WA 98021 • As public servants,we work hard every day to help ensure safe and fair workplaces with qualified workers • • � 0fi, �y �' State of Wyoming or v Department of Workforce Services ``;` ,f 5221 Yellowstone Rd ss ysa3$ Cheyenne, WY 82002 Mark Gordon 307.777.6763-Fax:307.777.5298 Robin Sessions Cooley,J.D. Governor http://www.wyomingworkforce.org Director Elizabeth Gagen,J.D. Deputy Director Recipient: Employer: PCE PACIFIC, INC. P C E PACIFIC INC Attn: JOELLEN THOMPSON 22011 26TH AVE SE 22011 26TH AVENUE SE - BOTHELL,WA BOTHELL, WA 98021 98021 WORKERS'COMPENSATION CERTIFICATE OF GOOD STANDING Mail Date: 1/28/2021 EXPIRATION DATE: 1/28/2022 Job Reference: On file This is to certify that the above named employer is in compliance with the Wyoming Workers'Compensation Act. The account is in good standing as of the above date. Wyoming Workers' Compensation monthly/quarterly payroll reports shall be submitted and payments made on or before the last day of the month following the month for which the earnings are computed and paid. Prime contractors may verify good standing of a sub-contractor's business by contacting the Division by telephone, after the initial certificate has been issued. In private work, a contractor is liable for the payment of Workers' Compensation premiums for the employees of any subcontractor, if the subcontractor primarily liable has not paid the premiums as provided in the Act, pursuant to Wyoming Statute 27-14-206. Contractors should request a Certificate of Good Standing from the subcontractor before making final settlement of the contract. If you have any further questions or concerns, please contact our office at 307-777-6763. Sincerely, Office Support Specialist Division of Workers' Compensation • PCE PACIFIC INC Page 1 of 2 , STATE OF WASHINGTON Department of Labor& Industries Certificate of Workers' Compensation Coverage May 5, 2020 • WA UBI No. 602 546 491 L&I Account ID 107,437-00 Legal Business Name PCE PACIFIC INC Doing Business As PCE PACIFIC INC Workers' Comp Premium Status: Account is current. Estimated Workers Reported Quarter 1 of Year 2020"76 to 100 (See Description Below) Workers" Account Representative Employer Services Help Line, (360) 902-4817 Licensed Contractor? No What does"Estimated Workers Reported" mean? Estimated workers reported represents the number of full time position requiring at least 480 hours of work per calendar quarter. A single 480 hour position may be filled by one person, or several part time workers. Industrial Insurance Information Employers report and pay premiums each quarter based on hours of employee work already performed, and are liable for premiums found later to pe due. Industrial insurance accounts have no policy periods, cancellation dates, limitations of coverage or waiver of subrogation (See RCW 51.1 2.050 and 51.16.190). https://secure.lni.wa.gov/verify/Details/liabilityCertificate.aspx?UBI=602546491&LIC=&V... 5/5/2020 PCE PACIFIC INC Page 2 of 2 https://secure.lni.wa.gov/verify/Details/liabilityCertificate.aspx?UBI=602546491&LIC=&V... 5/5/2020