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HomeMy WebLinkAbout2011-101 Contract - Rivas Construction ::' :T'( RECORDER Ashland Park Commission I" 6/;0~~~~~:': '1 20 E MAIN ST. ASHLAND, OR 97520 (541) 488-5300 Page 1/1 . . "PO:NUMBER, 00049 VENDOR: 003603 RIVAS CONSTRUCTION 3860 CALHOUN RD. MEDFORD, OR 97501 SHIP TO: NORTH MOUNTAIN PARK 620 N MOUNTAIN ASHLAND, OR 97520 FOB Point: Terms: net Req. Del. Date: Speciallnst: Req, No,: Dept: Contact: Jeff McFarland Confirming? No '"c\u.ow" :-:?'Un-itr" .":'":'.,: De'scrintion' ': " " : Uiiitprice ;Ext"'Price~::Tc' . . , Roof repairs to barn @ N, Mountain Park 900,00 Per attached proposal Contract for Goods and Services Beginning date: 06/14/2011 Completion date: 06/30/2011 Insurance required/On file . SUBTOTAL 900,00 BILL TO: TAX 0,00 FREIGHT 0,00 TOTAL 900.00 ;::i~:~AcC9'~ntlNlITrroer:'.~".~~ :':'.b'F'rojectNumbe;~ " ~A'ino~lJ'iftL':.H. . Acco'un(Nurrloer ,I:: . :~P.~iJje#' Nurii~er: I;: , . i, ;~'Affioun~~t:. .. E 211,12,03,04,60211 900,00 /JA ---;j L? ~ ~~/, Authori~ Signature '/ VENDOR COPY I FORM#3 I . CITY Of ASHLAND A request for a Purchase Order REQUISITION 'i:'$ ,-/,i~;; """, ,": Vendor Name Address, City, State, Zip Contact Name & Telephone Number Fax Number Mv~ , Date of request: Required date for delivery: ~~'if-rU~~'~ I -' " SOLICITATION PROCESS D Exemot from ComDemive Biddinq D Ememencv D ~~tten Findings (Form attached) D Invitation to Bid (Copies on file) D Written findings attached D uote or Promsal attached Date approved bv Council: D Quote or ProMsai attached l'i? Small Procurement CooDerative Procurement Less than $5,000 D Reouestlor ProDosal (Copies on file) D State of Oregon Note: Total contract amount, including any Date approved by Council: Contract # amendments may not exceed $6,000 D State of Washington Intermediate Procurement o Sole Source Contract # GOODS & SERVICES D Written Findings (Form attached) D Other government agency contract $5.000 to $100.000 . D Quote or Proposal attached Agency D (3) Written quotes attached Contract # PERSONAL SERVICES D Special Procurement D Intergovemmental Agreement $5.000 to $75.000 D Written Findings (Form attached) Agency D ~~ss than $35,000, by direct appointment D Quote or Proposal attached Contract # D 3 Written nronosals attached Date approved bv Council: Date approved by Council: Unit Description of SERVICES ')etfL~ r~,.-~ @J A/, ;?n ~^ Item # Quantity Des iption of MATERIALS Unit Price Total Cost o Per attached QUOTE ;2 / ( t' ;2. ?J ? Oft t7 ~ t' {B t/'" Account Number ___' __ - __' __' ______ Account Number ___ - __' __' __' ______ Project Number ______. ___ Account Number ___' __ - __' __' ______ Account Number ___' __' __' __ - ______ 'Expendffure must be charged to the appropriate account numbers for the financials to refiect the actual expandilures accurately, Affach extre pages if needed, By signing this requisffion form, I certify that the infonnalion provided above meets the City's public conlrectlng requirements, and the documentation can be provided upon request. ...........- .Ii . Department Head Signature: (~ Funds appropriated for current fiscal year: ~NO At- .:L......J9 ____ Finance Director !/a>/u; r . IOafe Comments: G: FinanceIProoedurelAPlFonnslForm #3 - Requisition.doc Updated on: 6/1312011 ..1\ . Contract for GOODS AND SERVICES Less than $25,000 CITY OF ASHLAND 20 East Main Street Ashland, Oregon 97520 Telephone: 541/488-6002 Fax: 541/488-5311 CONTRACTOR: Rivas Construction CONTACT: Delfino Rivas ADDRESS: 3860 Calhoun Road, Medford, OR 97501 TELEPHONE: 541-512-1337, Cell 541-301-5212 DATE AGREEMENT PREPARED: 06/13/2011 FAX: 541-512-1337 BEGINNING DATE: 06/14/2011 COMPLETION DATE: 06/30/2011 COMPENSATION: $900,00, per attached proposal dated May 6, 2011 GOODS AND SERVICES TO BE PROVIDED: Contractor to remove existing metal roofing and flashing under overhang, Contractor to install Ice and Shield underlayment and 7/16 plywood sheeting to missing 8" strip on porch, Contractor to reinstall existing Snap Lock Metal roofing, flashing and apply silicone caulking as needed, Contractor to remove all debris from job site, Job to be completed on or before June 30, 2011, Per attached ro osal dated Ma 6,2011, 5-YearWorkmanshi Warrant ADDITIONAL TERMS: Contractor leases em 10 ees from Labor Read of Southern Ore on, NOW THEREFORE, pursuant to AMC 2,50,090 and after consideration of the mutual covenants co taine CITY AND CONTRACTOR AGREE as follows: 1. All Costs by Contractor: Contractor shall, provide all goods as specified above and shall at its own risk and expense, perform any work described above and, unless otherwise specified, furnish all labor, equipment and materials required for the proper performance of such work, 2, Qualified Work: Contractor has represented, and by entering into this contract now represents, that any personnel assigned to the work required under this contract are fully qualified to perform the work to which they will be assigned in a skilled and worker-like manner and, if required to be registered, licensed or bonded by the State of Oregon, are so registered, licensed and bonded, Contractor must also maintain a current City business license, 3. Completion Date: Contractor shall provide all goods in accordance with the standards and specifications, no later than the date indicated above and start performing the work under this contract by the beginning date indicated above and complete the work by the completion date indicated above, 4, Compensation: City shall pay Contractor for the specified goods and for any work performed, including costs and expenses, the sum specified above, Payments shall be made within 30 days of the date of the invoice, Should the contract be prematurely terminated, payments will be made for work completed and accepted to date of termination, Compensation under this contract, including all costs and expenses of Contractor, is limited to $25,000,00, unless a separate written contract is entered into by the City. 5, Ownership of Documents: All documents prepared by Contractor pursuant to this contract shall be the property of City, 6, Statutory Requirements: ORS 2798,220, 2798,225, 279B.230, 279B,235, ORS Chapter 244 and ORS 670,600 are made part of this contract 7, Living Wage Requirements: If contractor is providing services under this contract and the amount of this contract is $18,703 or more, Contractor is required to comply with chapter 3,12 of the Ashland Municipal Code by paying a living wage, as defined in this chapter, to all employees performing work under this contract and to any subcontractor who performs 50% or more of the work under this contract Contractor is also required to post the notice attached hereto as Exhibit B predominantly in areas where it will be seen by all employees, 8, Indemnification: Contractor agrees to defend, indemnify and save City, its officers, employees and agents harmless from any and all losses, claims, actions, costs, expenses, judgments, subrogations, or other damages resulting from injury to any person (including injury resulting in death), or damage (including loss or destruction) to property, of whatsoever nature arising out of or incident to the performance of this contract by Contractor (including but not limited to, Contractor's employees, agents, and others designated by Contractor to perform work or services attendant to this contract), Contractor shall not be held responsible for any losses, expenses, claims, subrogations, actions, costs, judgments, or other damages, directly, solely, and proximately caused by the negligence of City, 9. Termination: a. Mutual Consent This contract may be terminated at any time by mutual consent of both parties, b, Citv's Convenience, This contract may be terminated at any time by City upon 30 days' notice in writing and delivered by certified mail or in person, C, For Cause, Cit ma terminate or modi this contract, in whole or in /' '"'u Contract for Goods and Services Less than $25,000, Revised 12/20/2010, Page 1 of 5 ~, Contract for Goods and Services Less than $25,000, Revised 12/20/2010, Page 2 of 5 .including coverage for owned, hired or non-owned vehicles, as applicable, d, Notice of cancellation or chance, There shall be no cancellation, material change, reduction of limits or intent not to renew the insurance coverage{s) without 30 days' written notice from the Contractor or its insurer{s) to the City, e, Additional Insured/Certificates of Insurance, Contractor shall name The City of Ashland, Oregon, and its elected officials, officers and employees as Additional Insureds on any insurance policies required herein but only with respect to Contractor's services to be provided under this Contract As evidence of the insurance coverages required by this Contract, the Contractor shall furnish acceptable insurance certificates prior to commencing work under this contract The contractor's insurance is primary and non-contributory, The certificate will specify all of the parties who are Additional Insureds, Insuring companies or entities are subject to the City's acceptance, If requested, complete copies of insurance policies, trust agreements, etc, shall be provided to the City, The Contractor shall be financially responsible for all pertinent deductibles, self-insured retentions and/or self- insurance. 17, Governing Law; Jurisdiction; Venue: This contract shall be governed and construed in accordance with the laws of the State o!Oregon without resort to any jurisdiction's conflict of laws, rules or doctrines, Any claim, action, suit or proceeding (collectively, "the claim") between the City (and/or any other or department of the State of Oregon) and the Contractor that arises from or relates to this contract shall be brought and conducted solely and exclusively within the Circuit Court of Jackson County for the State of Oregon, If, however, the claim must be brought in a federal forum, then it shall be brought and conducted solely and exclusively within the United States District Court for the District of Oregon filed in Jackson County, Oregon, Contractor, by the signature herein of its authorized representative, hereby consents to the in personam jurisdiction of said courts, In no event shall this section be construed as a waiver by City of any form of defense or immunity, based on the Eleventh Amendment to the United States Constitution, or otherwise, from any claim or from the jurisdiction, 18, THIS CONTRACT AND ATTACHED EXHIBITS CONSTITUTE THE ENTIRE AGREEMENT BE1WEEN THE PARTIES, NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES, SUCH WAIVER, CONSENT, MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR THE SPECIFIC PURPOSE GIVEN, THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING THIS CONTRACT CONTRACTOR, BY SIGNATURE OF ITS AUTHORIZED REPRESENTATIVE, HEREBY ACKNOWLEDGES THAT HE/SHE HAS READ THIS CONTRACT, UNDERSTANDS IT, AND AGREES TO BE BOUND BY ITS TERMS AND CONDITIONS, 19, Nonappropriations Clause, Funds Available and Authorized: City has sufficient funds currently available and authorized for expenditure to finance the costs of this contract within the City's fiscal year budget Contractor understands and agrees that City's payment of amounts under this contract attributable to work performed after the last day of the current fiscal year is contingent on City appropriations, or other expenditure authority sufficient to allow City in the exercise of its reasonable administrative discretion, to continue to make payments under this contract In the event City has insufficient appropriations, limitations or other expenditure authority, City may terminate this contract without penalty or liability to City, effective upon the delivery of written notice to Contractor, with no further liability to Contractor. 20, Prior Approval Required Provision, Approval by the City of Ashland Councilor the Public Contracting Officer is required before any work may begin under this contract 21, Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by reference, Contractor: By ;p~~,,?/ J!!-rA~ Ignat re D (/j::( .A/'f)! Print Name 17-l//1S City of As;et By (~ Department Head '})~ ~bx:r~c,.,- Print Name Mn /11 'Date (3 w N r )<- Title W-9 One copy of a W-9 is to be submitted with the signed contract Purchase Order No, (J(7C)/fl1 Contract for Goods and Services Less than $25,000, Revised 1Z/20/2010, Page 3 of 5 EXHIBIT A CERTIFICATIONS/REPRESENTATIONS: Contractor, under penalty of perjury, certifies that (a) the number shown on the attached W-9 form is its correct taxpayer ID (or is waiting for the number to be issued to it and (b) Contractor is not subject to backup withholding because (i) it is exempt from backup withholding or (ii) it has not been notified by the Internal Revenue Service (IRS) that it is subject to backup withholding as a result of a failure to report all interest or dividends, or (iii) the IRS has notified it that it is no longer subject to backup withholding, Contractor further represents and warrants to City that (a) it has the power and authority to enter into and perform the work, (b) the Contract, when executed and delivered, shall be a valid and binding obligation of Contractor enforceable in accordance with its terms, (c) the work under the Contract shall be performed in accordance with the highest professional standards, and (d) Contractor is qualified, professionally competent and duly licensed to perform the work, Contractor also certifies under penalty of perjury that its business is not in violation of any Oregon tax laws, and it is a corporation authorized to act on behalf of the entity designated above and authorized to do business in Oregon or is an independent Contractor as defined in the contract documents, and has checked four or more of the following criteria: ,~~- N~ u-; . , W f)( , .--..... 4- (1) I carry out the labor or services at a location separate from my residence or is in a specific portion of my residence, set aside as the location of the business, (2) Commercial advertising or business cards or a trade association membership are ~-- purchased for the business, (3) Telephone listing is used for the business separate from the personal residence listing, (4) Labor or services are performed only pursuant to written contracts, (5) Labor or services are performed for two or more different persons within a period of one year. ~", (6) I assume financial responsibility for defective workmanship or for service not provided as evidenced by the ownership of performance bonds, warranties, errors and omission insurance or liability insurance relating to the labor or services to be provided, ?F,/~ p(,~J Contractor G'-Ir;-~ /} (Date) Contract for Goods and Services Less than $25,000, Revised 12/20/2010, Page 4 of 5 - -' RIVAS CONSTRUCTION Licensed - Bonded - Insured CCB# 129589 - PhoDe and Fax(541) 512-1337 - Cell# 301-5212 Ashland Parks and Recreation, 340 S, Pioneer Street Ashland, OR 97520 541- 779-0473 541-488-6099 May 6th ,2011 Altn: Jeff Mcfarland We hereby propose to furnish the materials and perfonn the label' necessary fonhe completion of job performed al :North MOlUllain Nature Ccnter, Tear off existing Snap Lock Metal. lnstalllce and Shield W1dedayment, lnS1al1 7/16 plywood to missing 8 Inch strip on porch. Install Snap Lock Metal to original installment. I!-vJaS ~S-lru.l.+l<M Will All debris removed from job site, ~\K.- jO b LoMpi~-kcl C.n Or b::-for~ ::::Ju.;,c.. 3D, LC II Total Labor and rvlarerial: )_9.9fJ,QQ 5 year Workmanship Wa:Tal1ly Respectfully Submitted }tJ t.fi< -:- ~ Y<J, ~4v Acceptance of Proposal &/ Rivas Construction 3860 Calhoun Rd Medford, Oregon 97501 ,;d L€U -l ~ 9- ~ 1'9 SB^!t1 oU1ilsO e~f;:9D l ~ 60 unr Rivas Construction 3860 Calhoun Rd. Medford. OR 97501 Home Phone & Fax # 541-512-1337 Cell # 541-301-5212 Fax Transmittal Form ...fd4+UtNtJ ~~ 1)#, To: <T8Ft=:rt.j fJ) C Fa..vICll"'lOl From: f):.{ f~h() ~lVa~ (!2lUt.s lcm':J1-r-ltCtl ~Ii ') Name: ,- Date Sent: (., { C} III CC: ::r:nfo for P.a:J' /?epv'r @ f...k/v~'(, (2h-kt-&un Phone: SLi \ - 30 {- S- d--old-' Numberof Pages: Fax: <)'ff- YBg- (O()q 9 Message: . <Rirr~,: , Ow- LUtJrll.if5: (flrnp ; 5 o/..IJlL.e- ..f-t~ j ~ t-..a~ QC(cL.-; () P CoTL-{-t~ tJve-~/-171~$G -:L:P jOlL- ~ O-h'j ,~uL-S+l~~ c-r'L ~ a#-d:'&1~1 .:r+tf<HV1lL~d:~ ~~- ,'d LSSh':,9-,V<; se^!~ QU!lISO e,seo " 60 "nr AG~ CERTIFICATE OF LIABILITY INSURANCE CPIDME "~:';:"~, "HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER11FICATE HOLDER, THIS :ER"oICATE DOES NOT AFFIRNATIVEL Y OR NEGATIVELY AMEND. EXTEND OR A~TER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(SJ, AUTHORiZED 'lEPP,ESENTATIVE OR PRODUCER, ANO THE CERTIFICATE HOLDER. I e eertl cate 110 Sf san . t e po ICy Ie:s) m1Jst e en orse . I 0, $U jeet to the t~rm$ and conditions of the polby, ..ertaln policies may r~uire 8n endorsemen:. A. statement on this certlflcale does not conferright8 to tile certificate holder inliQU of su:n endorse:ment~61. Hart :tr.surL"'1ee J.123 Royal Ave. Medford OR 97504 Phone I ..i4.1-779-4212 54~~772-3963 .. N.\I<Ie, ~._--- 1"'~Nor;.ol, 1='", !-~Ul;E. Lc:.ISTr,..~,,:c. , __+--_______~V"PII~.~(::wt1U.Ql; i NlIfl!lh.: Brookwocd J::DsuJ:anc:.e CO i=.~~t 'Q;OO'J<'E~ Fax; $IRIVAC~~._________ 'r--~-- I Ill.le, """..-,,, ~ivac Construction DelfIn,) Vi(~ria Rivas cilia 3860 C-.lho\,:.r:l Rd. Medforcl OR 97501 IlNI!lUR~" . ~~l'l:Fl~' II>4"""tIll). r-' : ~""~"l' r~""t"" ;OVERAGES CERTIFICATE NUMBER: REVIS/ON NUMBER: r"'~1:I rocunH Itl.O.T THt ~OII;IE~OI "lS'JW!CE unmllaCl'.' 1iO~ !E;~ ~o 'C"l"OCI! I~:l~.......t MoCVI ~T..t( 'C..:c-- 'E~.oc 1N"..oc"'f::l, 1'<01\'<1,1; ;.....~."'C...Of1 RIE.:tU'~;:lilt'T '€R"'()'l.r.tNOll"I':>~ 01''''''' ':';CJo;'r-"G',,~ 1)'_ ooc;~""H, ....," Hl~PE:;:T :?W~ICII"ts ~._l\T,f1:;.>TE.....~ If ~IJ!;CUl""""~RT"'". fU"'SU"""r.e~""'fC4lC~Oet It'!.! PO,,{;I!;!ICI;SC..IIIID.-.UIN I~ ISi.U.'l!C' TOi\l.L "l!!lllllMII. I.1"Z.~(M,y;g 1.:1:1'<0'1"""501' ~IIQ; POu:::E!. l"1"T,; $_.......... ....... se~"Il,.:tuel::)...IP""~CV0iW3 i~~-+--- !Aiio.~ .~FI ~l!Qf_~~ '''SA .....01: PCluC'O'.....,._ i,~~- I '--, A ! oX : CO'JloC!~...at_U'4l!~Ul"T r--~ ~_..J__.J ~MM. I C ~---'----~-- !~IA(;<3,ll,i;~,..al....,.....UE31.U ,--- 0 ::>: POl.K;'! ~~ ! "'Ill:..CDI.tU"eLIT"t OR.C3S0238 J06/04l./10 : 06/04111 ;~~t- , I - I I If,lCtiClC:;lJll!lll.fNCE I I ,- . ~nolluH;:1I jl16 0" 1"'- ,"flE"r6€&t~I"""'''OIl I I 106/04/12 , I I i I ! ; ~llIml ,,@"~A"'. u.o.a,LIl"'I' ~X:l'" L~.l, OIHI, 000 , i. :00. (l00 ==r~S,OO) ....""'-.~""'. _._ "~,.oo,o.o , G:lN['W,AGGRc(Jo.T'll .2,000,1)00 11RO:JIJCT$.C:uo.oo_ ) 2,000,000' " I. I "1---"'-- . x ORC360238 :l~oc ....~y..l;l~ I COoolfIlNEDSI'O.E!.Nlt ~"=of..\) ~ leaxvl'lJlfl.,IlW_ I ! - I j'-- .....lOlllti"=Jo.UTO! I ......OJ.ClII;II.T~l'...ill"liq>\'[~..IJ~r.~ , C~"1:(IH'f"'~O'I ;:xcu.Jeo"~' r C""''''''':<ry'' ~"l i">..,A....'."'..' , ,);~,':.(...Q'QO>[Ml'()h~"'_ V'~ : Dl.. I I I I i i J ! i ::~:.::~I:...~~~l~____._ ~t~~-~_._---- .~~~~:~<---_._+----- -r-;--------- t.o.:.I<e>:e:..;S(III.ooa i ~ ~~--__ _ 1.1_____..-__ I ., 'e,t:~J_tll"\JTcn ~ ".~O'Ulo& I "'~OM~"l;ms -E."-~",,.. t E'::U'~'.a.u !- OK",'Cr'eu; ~OC~l;'l: ! i ~"'JIll;-\WJI:. ! "iTtoY.,,.... ~ I "'<'l'I\'J1'eQiI;>!~'o.Tl~ ! "~'''OOU:'''''l'......".m ---------- , " u..r.o.Cf1~:;a"T ~I. DI""-$e-e.o.iW\.c~e .' ~ . II.. D~'~':'.ltn-':-:~'----T;--_n__._.- ~ u::~,~r_-:l' "~~,"11Ch" .()I"....T'l:)IoI$"e~'t"$ "',<cr, ....O!'l~ 'o..A<SOIIlr:l"..,..,..,.... 'c_......_ ,,..... ___I ~ertitica~e ~old8r 18 lis~9d 8$ aa4itional insursd per attacbed form CL507Q 12/05 :ERTIFICA TE HOLDER CANCELLATlON ASHLcn ItiOUI.:",~.t 0" r.,! ~ Dl!'C"I,~gl"tll.l;If.:SDe CAlrC!~.!OU'Cl.;! M EXl'lllAl">'1 a.o.I'1iint;qcw, ~orlCl wu 11:118."_.. .oeeQIOItAllCl!""":'Itnc~I'Il<l~"L I City of Ashland- A~'IlO~Il:.l:D'Ii_UNT"'Ml MiChell~ ,CORD 25 (2009109) 1!l19aa,2009 ACORD CORPO The ACORD name er<d logo ere registered mark! of ACORD €'d L€€h~l9-~t>S se^'l:j OU~lea Sl€:eo ~ ~ 60 ucr COM;\.fERCLU GE;..'ERAL L1ABIUTY CL 6670 12 OS THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT-EXCESS- ONGOING OPERATIONS Trjs endorsement modifies insurance provided undei the following: COMMERCIAL GENERAL L1A3IUTY COVERAGE FORM WI,n respect to ;he insurance provided by COVERAGE A BODILY I NJURY AND PROPERTY DAMAGE LIABILITY of SECTION I-COVERAGES, SECTION II-WHO IS AN INSURED is amended to include as an additional insured ("Additional Insured") any personl.) or organization(s) whom you are requireo to add to this policy as an additionai insured under a written agreement in effect or becoming effective during the policy period. This insurance applies only to "bOdily injury" or "property damage" that occ~rs subsequent to execution of the written agreement and subsequent to the issuance of a certificate of insurence indicating such person(s) or organization(s) as edditional insured(s). ' The insurance orovided hereby to the Additional InsUred(s) is limited as fo:lows: 1. The insurance afforded hereby is excess over any other valid and collectible insuranoe, whether such other insurance is prima:y, excess, contingent, or otherwise. Where the Additional Insured has valic and collectible insurance in excess of a self-insured retention. this insurance is excess over the combined jjrnits of such insurance and the self-insured retention, Where the Additional InsL;red does not have valid and collectible insurance applicable to a claim that would be covered by the policy, the Additional Insured shall have a selt-insured retenticn cf the first million dollars of any covered loss and t~e insurance afforded hereby shall be excess over such self-insured retention; 2. The insurance afforded hereby to any /I.dditional insured is limited to imputed liability specifically resulting from the concuct of the Named Insured for which any Additional insured is held liable, but only with respect to lia!:>illty arising out of your ongoing operations preformed for that additional insured. A person or organization's s1atus as an addilional insured under this endorsement ends when your operations for t;'lat insured are completed or abando;led. 3. The Jimits of insurance applicab!e to :he insurance afforded hereby are those specified in the written agreement or in the Declaraticns or Schedules of this policy, whicnever is less, The limits of insurance applicable to the insurance afforded hereby are inclusive of and not in addition to tne limits of insurance shown in the Declarations or Schedules of this policy. 4. This endorsement does not provide any additional insured coverage provided under the "products and completed operations hazard" and any coverage p'ovided under this endorsement for any additional insured will never be broader trlan coverage provided to any named insured. The insurance afforded hereby does not appl'f to "bodily injury" or "property damage" arising out of the rendering of or failure to re~der any serv;ces by an archttect, engineer, or surveyor inc;uding, but not limited to: CL 6070 12 05 jid L88~.l~9->v9 se^'CI OUUI80 8l8:90 > > 60 unr COMMERCLU GE.NERAL LIABILITY CL 6070 12 05 i. Preparing, approving; or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or specifications; or 2. Supervisor{, inspe,~tion, or engineering services. , Any other policy terms, conditions, limitations, exclusicns, and definitions apply to this endorsement. CL 6070 12 05 9'd LSU-Z~9-~j19 SBAI/j oUljleo BSS:gO ~ ~ 60 unr !lIAWCK INSURANCE 011 cnATEn LAKE AVE ....'tDFORD, Oft 97~!)4 PROGRESSIVE' Commercial Auto Insurance Coverage Summary This is your Renewal Declarations Page Policy number: 01580900-6 lJr,dclwlrtter.by: Arllsa'l i11d lrJ((ers Ca5u:JI:y Co Februa-y.i6,2011 Polj(y Pi!rioj' Apr 2, ;011 . Oct 2. 20i 1 Page 1 d 2 progre5siveagent.c:om Online Service V;dke pa)'m.ents, ~;1~:< bdl;n,. ijC1i"ity, prin: policy dOCUIT;t:!nls,;:r chi!ck l~e 5(a:us Qi a (Iairr.. "Jamed insured tiElF, NO R:VAS DElH ~O R'VAS CONS TR 3860 CAlHOllJ RO MEOFO!lO. OR ~7501 541-779-7005 BLALOCKIN5~RANCE ~r;;1Ia:t ,'Ct.f ag,::~,l fGr persvrlaliled S€!'VICf'. 800-444-4487 rOI (~storrer servll~'~ ~OUI- i:Qef11 is l!na~,;il.;ble 01 ie. "'.:or! 3. da,m. n"js Renewa: Declaretioi':S P.:g2 is effecti'.e-:mly if the IT.ir.ir:1L.m arrcunt due 1(i rP.n~w Y')UI policy;~ received O' po;:marke.c hi u.p,i, 2, 2011. "(:..ur cove"age t:egins on April /. 2011:H 12:01 a,r,1. This pollry- expites on Gctober 2, 2Cl11 at . 2:01 a.rr.. '(::pur i'')SLlance policy 2nd any poiie, end:'Jrse-me;'1ts (amain a full expian3tir,n of your cO'lef'3ge. T~e poky limii:, shown fer an aL to may not :)E combined ',o\Iith the limits f",-the scme coverage on another auto, l~i'1less lho:? poli:y COIi:ract aII0\\'5 the ;tacklrg of limits. Tne policy cantrad is form 59i 2 (O,/O~.). The contrnG is modified by terms 28)2JR {'iO/OS}, 1652CR (05/09;, S7D1 (02;':;5), 43520R (10,05:, 488fOR (09l0S), 2228 (07/05) an.j Z435 \' ?!C6) Trle namej in'iured organization type is. a sole propr'etorship. Outline of coverage De;.C'i,:.tiOfl Lirr:its Dtd~ctib!. :lr&miulr i.idbility 10 Others Bod:!y hju")' liatility Prope.1~ Da l1ag~ Uabi liry Linili~'~,e;' 'Mct~'ri5t' ea'di~' I~iiu~' Unin;;ured '~1otc"risi' Prc;p~.1y' D~;mage S245 $SC,OOO eadi personl$100,OCO each w:-dent $2s,DOO eac(; accident "....... '''''''' ~~~.o~a.I.~~)~'J. _~~~~0!:-:':. Complehensive S~~. ~~? .S_ov~~~9~. ,~c~_ed~ Ie .. Collisi.Jr, .~~, ~~~~ .~o~e:a.qe S.(~edl;le ... .' Total 6 month polley premium ........". .""..... ......................"..n..".......... ..... ... .~~~..~.~~.~~~~ ~~~~.b ~~~.'.~~?.:~.~~..~~~!.~e.~~. ,.. 23 $2G,GOO Il,JCr, accident t2W 14 1300 hit & ,un $ '1 5,GOO each ("~;~on to i 7 48 Lim.~ of liability I~s:; dedUCTible 218 limit of liabi!ity I~'i) deduciible $576 Rated driver 1. DElfI,':O ,IVAI Fclr.'l6~!lOP!.IGSI1J21 o (O:itji111e(1 Ld L88h':~9-~V9 SBA!t1 OU);j8Q "8890 ~ ~ 60 unr Auto coverage schedule L 2008 Cbevrolet K1500 Silverado ,!IN: lGCEK19J98Z183794 Liability ~.~~.i~. u-wtJ.sr LIMP: PIP ........,........... ............ Premium $246 $23 $14 $27 Camp C"",,, Cnli5i:Jn C::n~9G1 Physical Damage DEducti'>lt . Frtmium De:luciblf P;tlflIUrn ..,...,,,..... ............, Premium $500 $48 $50e $218 Premium discounts Po~cy Slated Amount: Ga"ging Zip Code: $41,000 97501 01580900-6 Business Expe.ien<e, P31d in Full and ~.newal ForrnG41i9 Ot\(O~.21 gd L88h~(9-(VS se.^'l:J ou~180 Pc:I(j'numbor: 01580900,6 DELF:NO llVAS Pag(l 2 of.2 Radius: 50 Auto Toul 998:90 ~ ~ eo unr 5576 IEii !! - === ...... == - g ~ E ^ Iiilil ~ ..... ~== ~i& ~ iiii alii g ilifi ~ iIiI g ..... t:~ . lEi g- 0= ""'" N- ~- B"" 4- ~~