HomeMy WebLinkAbout2012-015 Contract - Liquivision Technology Diving Services Contract for GOODS AND SERVICES Less than $25,000
CITY OF CONTRACTOR: Liquivision Technology Diving Services
ASHLAND CONTACT: Brandon McGraw
20 East Main Street
Ashland, Oregon 97520 ADDRESS: 711 Market Street, Klamath Falls, OR 97601
Telephone: 541/488-6002
Fax: 541/488-5311 TELEPHONE: 541-883-6473
DATE AGREEMENT PREPARED: January 9, 2012 FAX: 541-883-1361
BEGINNING DATE: January 25, 2012 COMPLETION DATE: February 29, 2012
COMPENSATION: $2,690.00 —Additional costs may be incurred per proposal attached as Exhibit C.
GOODS AND SERVICES TO BE PROVIDED: Contractor to remove accumulated sediment from the floors of
two 2 connected Clearwell reservoirs per proposal attached as Exhibit C.
ADDITIONAL TERMS:
NOW THEREFORE, pursuant to AMC 2.50.090 and after consideration of the mutual covenants contained herein the
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 279B.220, 279B.225, 279B.230, 279B.235, ORS Chapter 244 and ORS 670.600 are
made part of this contract.
7. Living Wage Requirements: If contractor is providing services under this contract and the amount of this contract
is$18,890 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. City'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. City may terminate or modify this contract, in whole or in part, effective upon delivery of
written notice to Contractor, or at such later date as may be established by City under any of the following
conditions:
i. If City funding from federal, state, county or other sources is not obtained and continued at levels
Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 1 of 5
sufficient to allow for the purchase of the indicated quantity of services;
ii. If federal or state regulations or guidelines are modified, changed, or interpreted in such a way
that the services are no longer allowable or appropriate for purchase under this contract or are
no longer eligible for the funding proposed for payments authorized by this contract; or
iii. If any license or certificate required by law or regulation to be held by Contractor to provide the
services required by this contract is for any reason denied, revoked, suspended, or not renewed.
d. For Default or Breach.
i. Either City or Contractor may terminate this contract in the event of a breach of the contract by
the other. Prior to such termination the party seeking termination shall give to the other party
written notice of the breach and intent to terminate. If the party committing the breach has not
entirely cured the breach within 15 days of the date of the notice, or within such other period as
the party giving the notice may authorize or require, then the contract may be terminated at any
time thereafter by a written notice of termination by the party giving notice.
ii. Time is of the essence for Contractor's performance of each and every obligation and duty under
this contract. City by written notice to Contractor of default or breach, may at any time terminate
the whole or any part of this contract if Contractor fails to provide services called for by this
contract within the time specified herein or in any extension thereof.
iii. The rights and remedies of City provided in this subsection (d) are not exclusive and are in
addition to any other rights and remedies provided by law or under this contract.
e. Obligation/Liability of Parties. Termination or modification of this contract pursuant to subsections a, b, or
c above shall be without prejudice to any obligations or liabilities of either party already accrued prior to such
termination or modification. However, upon receiving a notice of termination (regardless whether such notice is
given pursuant to subsections a, b, c or d of this section, Contractor shall immediately cease all activities under
this contract, unless expressly directed otherwise by City in the notice of termination. Further, upon termination,
Contractor shall deliver to City all contract documents, information, works-in-progress and other property that are
or would be deliverables had the contract been completed. City shall pay Contractor for work performed prior to
the termination date if such work was performed in accordance with the Contract.
10. Independent Contractor Status: Contractor is an independent Contractor and not an employee of the City.
Contractor shall have the complete responsibility for the performance of this contract.
11. Non-discrimination Certification: The undersigned certifies that the undersigned Contractor has not discriminated
against minority, women or emerging small businesses enterprises in obtaining any required subcontracts.
Contractor further certifies that it shall not discriminate in the award of such subcontracts, if any. The Contractor
understands and acknowledges that it may be disqualified from bidding on this contract, including but not limited to
City discovery of a misrepresentation or sham regarding a subcontract or that the Bidder has violated any
requirement of ORS 279A.110 or the administrative rules implementing the Statute.
12. Asbestos Abatement License: If required under ORS 468A.710, Contractor or Subcontractor shall possess an
asbestos abatement license.
13. Assignment and Subcontracts: Contractor shall not assign this contract or subcontract any portion of the work
without the written consent of City. Any attempted assignment or subcontract without written consent of City shall be
void. Contractor shall be fully responsible for the acts or omissions of any assigns or subcontractors and of all
persons employed by them, and the approval by City of any assignment or subcontract shall not create any
contractual relation between the assignee or subcontractor and City.
14. Use of Recyclable Products: Contractor shall use recyclable.products to the maximum extent economically feasible
in the performance of the contract work set forth in this document.
15. Default. The Contractor shall be in default of this agreement if Contractor: commits any material breach or default of
any covenant, warranty, certification, or obligation it owes under the Contract; if it loses its QRF status pursuant to
the QRF Rules or loses any license, certificate or certification that is required to perform the work or to qualify as a
QRF if Contractor has qualified as a QRF for this agreement; institutes an action for relief in bankruptcy or has
instituted against it an action for insolvency; makes a general assignment for the benefit of creditors; or ceases doing
business on a regular basis of the type identified in its obligations under the Contract; or attempts to assign rights in,
or delegate duties under, the Contract.
16. Insurance. Contractor shall at its own expense provide the following insurance:
a. Worker's Compensation insurance in compliance with ORS 656.017, which requires subject employers to
provide Oregon workers' compensation coverage for all their subject workers
b. General Liab" 'asp ce with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,000, 1 00 2,000,000 or Not Applicable for each occurrence for Bodily Injury and Property
Damage. It shall include contractual liability coverage for the indemnity provided under this contract.
C. Automobil ili 'nsurance with a combined single limit, or the equivalent, of not less than Enter one:
$200,000, $500,00 $1,0 ,000, r Not Applicable for each accident for Bodily Injury and Property Damage,
including coverage for ow ned
, hired or non-owned vehicles, as applicable.
d. Notice of cancellation or change. 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 insurers to
Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 2 of 5
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 of 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 BETWEEN THE
PARTIES. NO WAIVER, CONSENT, MODIFICATION OR CHANGE OF TERMS OF THIS CONTRACT SHALL
BIND EITHER PARTY UNLESS IN WRITING AND SIGNED BY BOTH PARTIES. SUCH WAIVER, CONSENT,
MODIFICATION OR CHANGE, IF MADE, SHALL BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR
THE SPECIFIC PURPOSE GIVEN. THERE ARE NO UNDERSTANDINGS, AGREEMENTS, OR
REPRESENTATIONS, ORAL OR WRITTEN, 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 Council or the Public Contracting Officer is
required before any work may begin under this contract.
21. Certification. Contractor shall sign the certification attached hereto as Exhibit A and herein incorporated by
reference.
Contractor: City of Ashland
By C By 1Luar ae 0 Q
iSignature Department Head
A t I.,3L, 1>. ( 0 rA-,I1 f
Print Name Print Name
v. p ll �tillz
Title Date
W-9 One copy of a W-9 is to be submitted with /O �v5
the signed contract. Purchase Order No.
Contract for Goods and Services Less than$25,000, Revised 06/30/2011, 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:
l� (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.
lu i I - t2 iL
Contractor (Date)
Contract for Goods and Services Less than$25,000, Revised 06/30/2011, Page 4 of 5
{ L:ckuilviSiON TECHNOLOGY
g DIVING SERVICES
OfFraMailing Address Phone:(800)229-8959 Faz(541)8831381 Western Operations
711 MsAet Street liquivision@divingservloes.mm 835 Ms*et street
Klamath Falls,OR 97801 waw.divingservioes.00m Klamath Falls,OR 97601
Greg Hunter 12/28/2011
Ashland,City of Wk: 541-488-5345
1400 Granite St. Fx: 541-488-6014
Ashland,OR 97520 'OR3074411 R1-2T-
We are pleased to provide you the following firm quotation and outline of the conditions of our services.
Reservoir Type Dia. Hgt. Maximum Surface Cubic Price for Price for Price for
or (Feet) Calculated Area Yards Diver Diver Additional
LxW Capacity (S.F.) Sediment Inspection Cleaning& Sediment
Feet (Gallons) 1"deep Only Inspection Per inch
Mobilization Charge- Flat charge to mobilize and demobilize to your location. $450
1. Clearwell 1 BG Concrete 67x67 5 167,900 4,489 13.85 $1,390 $485
2. Clearwell 2 BG Concrete 33x20 5 24,686 660 2.04 $850 $71
Subtotal $2,690
Total •Plus sales tax if applicable $2,690
Scope of Work:
Removal of accumulated sediment from the Floor of the reservoir.The effluent will be disposed of at the districts direction, LVT
understands this will be a sludge pond near the reservoirs.A final and comprehensive inspection will be performed documenting the
condition of the entire structure and recorded on DVD.Written documentation with digital pictures,descriptions of the images and any
recommendations will be provided to the district on a USB flash drive.
Our bids are based on a variety of factors that pertain to the length of time it takes to accomplish our work.The main
consideration is the amount of sediment that has to be removed, 2" of normal sediment is included in this bid.
Initials Please initial the line items below to verify that you have reviewed them.
MArz Entry hatch on top of the reservoir is at least 18" diameter.
VL-T:, The water level is kept within ten (10) feet of the top of the tank.
,K�A�, Tank dimensions are correct.
Scope of work is correct.
1. Placement and disposal of effluent removed from the reservoir is done at the direction of the Customer.
2. Quotes for cleaning assume that the sediment is normal material(such as silt,flocculated material, insects,manganese, rust,
etc.)found in potable water reservoirs that is easily removed by our vacuum system. If the sediment is difficult to remove such
as large amounts of concrete chips,gravel,sand, rocks,detached coating debris,etc.,then our hourly rate shall apply for each
hour(over the first hour)for removing this material.
7
711 Markel Street
' Lia NVOISONON TECHNOLOGY
Klamath Fx: (541)883-1361
Phone: (541)883-6473
3. Unless specified in quote detail we clean all submerged horizontal and angled berms or sloped surfaces 35 degrees or less.
Surfaces exceeding this angle such as the walls can be cleaned but must be listed separately in the quote detail or estimated
by the divers upon inspection. We do not clean surfaces that are out of the water.
4. If any information provided to us is incorrect or if any problems exist that inhibit our ability to complete the job on a timely
schedule,then we will notify you of the problem and reserve the right to add on to the quote based on our estimate of the
additional time it will take to complete the work. Charges for time delays are$200 per hour. This paragraph only applies to any
problems that are your responsibility(i.e. rescheduling with less than 2 business days notice,set up and start of work before
cancelation,etc.)
5. For coating repair in steel tanks we use a two part underwater epoxy. Each rust nodule or area of coating defect is wire
brushed to bare metal and epoxy is applied over the area. The epoxy chemically bonds to the steel,displaces water,and
remains intact with a greater bond than the original coating. All of our repair,sealing and coating materials meet or exceed
NSF 60&61 standards. Repairs are done at the districts direction for the rate of$375 per hour and$35 per tube of Manus or
epoxy.
6. If dechlorination is required it will be charged at$40.00 per hour. If filtration is required then the filter bags will be charged at
$400.00 per bag. Unless specified LVT does not remove the bags they become the districts responsibility to dispose of.
7. If payment is not made within sixty days of the date of the invoice,an interest charge of 3%shall begin to accrue each month on
the unpaid balance. This interest will continue to accrue each month until the balance is paid in full. To avoid any interest
charges,payment must be received or postmarked within the sixty days following the date of the invoice. Statements will be
sent each month to reflect the new balance.
Our cleaning procedure is accomplished utilizing our proprietary vacuum cleaner,the"LiquiVacTM"(Patented). The LiquiVac'
pumps an average of 200 gallons per minute. It has a rotating soft bristle brush that scrubs the floor clean and removes all sediment
without creating turbidity in your reservoir. This is the only way to ensure that all biofilm is removed from the interior surfaces without
getting any of it mixed into the water column. This system also enables us to clean walls.
In a conscious effort to preserve our nations natural resources LVT will provide our reports to the district on USB flash drives. If
you require a printed and bound copy of the reports please notify our office staff.There will be an additional fee of$125 per copy.
In over 20 years of providing diving services we continue to treat every customer as if they were our only customer. We are
dedicated to accomplishing every job with the utmost professionalism,safety and efficiency.
Please sign this quote and FAX both pages back to us with an approximate time frame of when you would like the work done. If
you have any questions please give us a call. We look forward to working with you.
Quote is valid for 90 days.Upon signature the work shall be accomplished at a mutually acceptable date within one year.
Sincerely, I find the above and preceding page of contingencies and procedures
acceptable.
Accepted by: Date:
Brandon McGraw
Contract Administrator Signature:'`�.a C^ Q Title: jaw �(Mdvt-
711 Market Street
VcVMIeSiON TECHNOLOGY
Klamath Fax: (a541)883-1361
Phone: (541)883-6473
Billing/Change Order/Estimate Form
Greg Hunter 12/28/2011
Ashland,City of Phone: Wk: 541-488-5345
1400 Granite St. FAX/Email: Fx: 541488-6014
Ashland,OR 97520 LVT Ref.#: `OR3074411 R1-2T
Team Leader: Diver#1:
Diver#2: Diver#3:
Reservoir Type Dia. Hgt. Maximum Surface Cubic Price for Price for Date
or (Feet) Calculated Area Yards Diver Diver Work
LcW Capacity (S.F.) Sediment Inspection Cleaning& Done
Feet Gallons V deep Only Inspection
Mobilization Charge- Flat charge to mobilize and demobilize to your location. $450
1.Clearwell 1 BG Concrete 67x67 5 167,900 4,489 13.85 $1,390
2. Clearwell 2 BG Concrete 33x20 5 24,686 660 2.04 $850
Subtotal $2,690
Total `Plus sales tax if applicable $2,690
Itemize work: Time or Quantity: Extended:
Sales Tax if any:
Total
Authorization Signature:
Estimation of cost for recommendations that LVT can perform.
Recommendations: Estimated Labor Estimated Material Total Estimate
Total
UP IU:KZ
CERTIFICATE OF LIABILITY INSURANCE �*0IM110111 YYY'
ov1o/12
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(i88)must 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 endomemen e.
PRODUCER 5415825507 NAME Janice Sharp
Great Basin 541584-0052 PHA -5415825507 No 5415845052
026 Main Po Box 6a noDREes: anice.she r8besin.eom
Klamath Falls,OR 97601 °t p.UQUI-1
Matt Hurley
INS AFFORDING COVERAGE NAICC
INSURED Llqulvision Technology Inc. INSURER A:American States Insurance Co. 19704
PO Box 5277 INSURER e:Ube Northwest Insurance
Klamath Falls,OR 87601 INSURER C:Evanston InsurancO Company
INSURER o
DISURER 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.
TYPE OF INSURANCE POLICY NUMBER Immilla POUCYEFF Immmilc= LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00
A X COMMERCIAL GENERAL LIABILITY X 01CG37112390 08101111 08101112 3 200,00
CLAU,IS4AAOE I OCCUR MED EXP(Arty a person) 3 10,000.
PERSONAL S AOV INJURY 3 1,000,00
GENERAL AGGREGATE $ 2,000,00
GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO 3 2,000,00
X POLICY PRO- LOC f
AUTOMOBILE LIABILITY X COMBINED SINGLE LIMIT f 1,000,00
A X ANY AUTO DICG37112390 08101111 08/01112 BODILY INJURY BODILY INJURY(ParPMeo^) f
ALL OWNED AUTOS BODILY INJURY(PMecrldW) 3
SCHEDULEDAUTOS PROPERTY DAMAGE
NIRED AUTOS (PNI)
NON4)WNED AUTOS S
3
UMBRELLA UAS X OCCUR EACH OCCURRENCE f 2,000,00
C X FXCE8E LIAS CLANS AnoE X XOAZ220211 08101117 08101112 AGGREGATE f
DEDUCTIBLE f
X RETENTION 9 10,000 s
WORKERS COMPENSATION X WCSTATU- OTR-
AND EMPLOYERS-wewTr
B NIPR ROFUPMRMV CLMVE Y❑ NIA C43NC52563701 I N01 10101111 10101112 E.L EACH ACCIDENT 3 1,000,00
(Manda m In 1x0 E.L.DISEASE-EA EMPLOYEE 3 1,000,00
U 9["Pr"***N DFOPERA Debi E.L DISEASE-POLICY UW $ 1,000,
IXxICMP110N OF OPERATIONS I LOCATIONSI VENNSFS(ANmI ACORD 701.AAA18mW RMOMYe Sd1&ft ff m epees W Ip&"
The City oef Ashland is shown as additional form
Insured form=0 71100307.0 78360207 and
CERTIFICATE HOLDER CANCELLATION
CITYASH
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City Of Ashland THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
90 North Mountain Avenue ACCORDANCE WITH THE POLICY PROVISIONS.
Ashland,OR 97520
AUTHORED REPRESENTATIVE
IA4-�;L— //"49;
®1988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD
Insurance COMMERCIAL GENERAL LIABILITY
CO TO 35 02 07
e
Policy #01-CG37112390
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
UABIUTY PLUS ENDORSEMENT
This endorsement modif es insurance provided under the following:
COMMERCIAL GENERAL UABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
The City of Ashland
90 North Mountain Avenue
Ashlarid, OR 97520
ADDITIONAL INSURED — BY WRITTEN lease or occupy, subject to the foltwMng
CONTRACT, AGREEMENT OR PERMIT, OR additional provisions:
SCHEDULE (a) This Insurance does not apply to
The following paragraph Is added to WHO IS AN any you o be takes piece
INSURED (Section 10. after you cease to to a farted In
any premises leased to or rented to
4. Any person or organization shown in the Schad- yoIr
uls or for whom you are required by written con- (b) This Insurance does not apply to
tract, agreemard or permit to provide Insurance any structural alterations, new can-
le an Insured, subject to the following additional structlon or demolition operations
provisions: performed by or on behalf of the
a The contract, agreement or permit must be person or organization added as an
In effect during the policy period shown to insured.
the Declarations, and must have been axe- (2) Your ongoing operations for that In-
cuted prior to the 'bodily In jury°, 'property sured, whetter the work is performed
damage". or °personal and advertising by you or for yotg
Injury'. by
b. The poison or organization added as an in- �) The maintenance, operation or use such
pe rg you of equipment leased to you by such
sured by this endorsement Is an insured only person or organization, subject to the
to the extent you are held liable due to: following additional provisions:
(1) The ownership, maintenance or use of (a) This Insurance does not apply to
that pan of premises you own, rem, any occurrence°which takes place
after the equipment lease expires;
Includes Copyrighted Material of Insurance Services Office, Inc..with Its pennleston.
Copyright, Insurance Servkres, 2001
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gents of each person or by t at instead. If the roxueeroa° Wdch
°rgentcat0^' caused do 4odny Wary° or VMParly
(4) permits Issued by any seta or political dardege• Involved to ownstaW. mshdo-
performed by you yaw behalf, ahotaft •ado° or watercraft owned
m a to to %Hcr V adMa d pro- operated by or rented or loaned to any Ire
Tills 6marerme does not apply to Udty This miuslon does not apply to:
InW, Vaparty darn . or (1) A watercraft whte ashore on premises
morel and advert ahy irr!'rry°edslny you own or raid;
out of operates pertained forte elate
or municipality. (2) A watercraft You do not own Old la
ua The insurance wnh reaped b any architect (a) Lose am 62 feet long;and
ongi eer, or surveyor added as an Irmueed (b) Not being used to carry pence or
by lids erdcrsement does not apply to property for a dente;
sandal and aMm In1 out (3) nod � ° ou or on to,ways
PW
to mndedng of or the tenure o vender any cede t0. P Yaa awn or recd.Pror vided to gautow Is not owned by
professional services by or for you, hxtud• rented or loaned to you or the Ire
Irs(1) The prepadng. apP=ft. or fait to (4) conbac assumed oto ender airy Insured
oontraot° for the owersldp, manda-
prepare or approve map, dmvdngs, nanoe or tae of ahoreft or watercraft;or
�dealt or ape toad dwv or
and (5) aSoft out ur° or Vop" demaea°
. inepectlad or er dry (a) to cpemtion of madtinery or
d. Title Insurance does Trot apply to 'bodily paalPraent list a w ld
part ot, a lard veh�te fret wadi
Wiry°or °Properly donaW included within quarry under to delhdton of
de oormupleted operators fez- mobile equlpnerd° t It were not
ads. subject to a ccrnpdscry or thancial
respmrelkilifttr law or other motor ve-
A pmsaft or argantratoMs status as an Insured un• hide hmumrroa law In to state
der tie andonemerd moo when your aparadihns for where It to teenesd or pdrockwily
pmt Instead are cmnpbbxL garaged;or
No oovamge wlt be provided I,in to absence of lids �) the ors�0°er arty of to neddo-
a dommard,rro tebtity would be imposed by law on try or r L(3)eof[Wed d Paragraph
*m o
t(Z) or t(� of lids de>tidtcrd of
you. Coverage often be Hinted to der extend of your yndbfZe equyeerd°.
neftence or taut acoordb�to the appEoeble P�
pbs of ` P) not operated any brad. led h Is
NON-CYYNED WATP.RCRA" AND NON43WKED TENANTS PROPERTY DAMAGE LUUNUTY
AIRCRAFT UABOM
E,wh g.of OOVEFIACIE A(tattled q Is repfacod When a Damage To Promises Renlad To You Un t Is
by the lotoad sham In to Dedaratae. Endu don 1• of Canstage
A.aeodon I is replaced by dw WowhW
out of Out ownomhtp, nmbdanence, for 1 Gamete To Property
entrustment to oliem of any a1 m % °ardo° -Proper*damage°tot
or wateramlt owned or operated by or rented
or bared to airy insured Use Inandes open- (1) Pmpmvte you own. rem or occupy. Incluciltv
alien and 9oaft or mrt�d6rg°. any
Pap e d 4
_ anava�euanw.—
any Ww per, orgarbadon
enhancement.or Wft. f WHO IS AN INSURED —0lAPIAOERS
�or maliderom Of such for any fie fo0ov t8 is added 10 PalaWaph Zs.of WHO 18
meson, MckdrG pr n of k" to a AN WSIMD (Seen ll :
person or damage to arnotm%PmPer4.
(4 Proms you 64 glive away or damim,8 Pawq h(1)does not apply to OXWAve odors,or
Me lompergr damage adeee out of any part to managers at the supervisory teval or abovm
of tlrom P SUPPLEMENTARY PAYMENTS —COVERAGES A
(3) Properly barred to You; AND B — BAIL BONDS — TOM OFF FROM
(4) Personal properly In to oars, *at** or WORK
control of the bceu v4 Paragraph 1 b.of SUPPLEMENTARY PAYMENTS —
(b) That pwdWw pad of real property an which COVEAAGEB A AND B M mptecd by the f I1OWbW
you or any contradws or awmftctore to m for met of bag bonds repaired
or kWbe*an your behd b. Up pedomirgl Operations. if ire property because d aodderde or traffic law violations
damage°aches del d those operatlons,or d S out d tie used array vehtda b whbh
the gaalBy Wuny Usbfilty Coverage applies.
(e) That paAtader part of any property that must We do not have to furnish time bonds.
be restored, mpatmd or replaced bemuse
year wok"was hoomroty W mad On E Paragraph 1.d.at SUIPPLBMlTAITY PAYMENTS —
Paragrapha(1). (3) and(4) of this ezIUSIOn do COVERAGES A AND B is replemd by the tollowbq
not apply to properly danage° (other then d. Ag masorabbe expanses I wwmd by the b.
dema8e by tbe) to pwdm% InrimBng the mn- cured at our request to Becht to in the In-
tam of such preadaea,rented m you.A aeperate veedgeton or defense of the dahn or magm,
fimlt d b u arm applies to Dantege To Provo, bzkdm actual lose Of earnings tip to wo
Mee Ranted To You as descdbed in Section W a day bemuse of tree of nom vrok
—Um1b Of bauronce.
Paragraph(2)of this ezducon does not apply It EMPLOYEES AS INSUREDS — HEALTH CARE
the premises are 'your won° and wme never SERVICES
accepted,rented or held for rental by you. PfGVWM 2a.(1Xd)of WHO WAN INSURED (80dm
Parsgmphe(3),(4J.(a)and(6)of this exclusion g)M defied. melees excluded by separate andonw
do not apply to Palft assumed under a aide. =nL
us&agreement
Paragraph(a)of this exabrebn does not BP*to EXTENDED COVERAGE FOR NEWLY ACGIARED
property damage Included In the products- ORGANIZATIONS
conosted opersdons 1 pmvis an 3a.of WHO IS AN ROAM (seam N M
Paragraph 8.Of LBSTS OF INSUIRANCE (9edton Uq MgRwd by the MmvbW.
M rs11 by the tom a. Oovamge under this pmvWm M afforded
a. Butod to S. above.the Damage To Promisee Only uhcl toe and of on pew
Rented To You Unit M the moat we will pay m DRENDED"PROPERTY DAMAGE„
der Coverage A for damages because of
properly damage^ to any one promises, whlie Bt Wdm o.of COVERAGE A (Seaton D M reple
rontd to yo% or In the ease of damage by the, by the fdwjbw
vAft rmrted to you or WnWarlly omipled by
YOU With pemdeNon of the owner. a. JW* *ry^ or property damage expected
The Denmge To P Aerhtd To Yau tot M the or 6hex exclusion from the st apply t d the Irheumd.
Idghar d the Each Oeaaarrerroe Lbnh shown In the
or exowV d does not apply to 'm the use of
t>ederatone or toe amount sttowrh In the Deobratloire fe Y dernagPr rect p a9 uan Ure use .
as Oamege To Promises Rerdad To You LbnIt roeao tam re Protect persona Or properly.
mrsasotw Pop 3414 EP
—r�gmenneaaeeusuer—
mcnmED DEFINITION OF BODILY BMURY Monipted only by a etrestt, roadway,warm". or
dghtol way of a raura w.
paragraph S.of DEIMONS Medan Y)Is replaced
by the(pllpwkV. INCRFMED MEDICAL EXPENSE LUNIT
8. 'Soft WW mom bodfi9 WW dclums or The idedlml Expense Limit is amended lo SIAM
dome sustained by a perm%Including menlel
angulsh or death remditg from any of theee at KWAILEDGE OF OCCURRENCE
any da e.
The mwft N
TRANSFER OF RIGHTS OF RECOVERY added to Paragraph 2 Dulles In The
EYerd Of Oowrvarm% Offense. Clsim Or 89 of
COMMSCIAL GENERAL
The fodav*0 Is added to Paragraph e.T OI The CONK
NEVIIAI. (NOMRAL LIABILITY CONDITIONS Pro- Knowl
edge of all bOUt' ffanCa°. CIBIm Or °aUit° by
shell don your agent servant or wnpbM
emwM ate Wmwbdga of Sre launedInsured unless as
TVB waive mny VO of W=VM we ffW We What officer of the named bmtlrad has received such madam
any person or argardamflan becs, *1 PIP11,10 We Male for Wry or damage Wising ad of your ong ft UOm the agent BBrVen[Or employes.
operations or ytanr wwlc°done under a contract with UNINTENTIONAL FAILURE TO DISCLOSE ALL
W person or ofgmdmdan and included in dw HAMM
Ieted operaUorna hesard°.Thle watraz
appfies asiy to a ps►aoo a orgarni�lon i wham you The What Is added to Paragraph L Repressida.
ere required by written contract agreemerd or pennd imp of OOAGAESCIAL GENMAL UABIUTY CONDI.
mVAA'W 9=0 rWft Of TIONS (Seddon W
AGGREGATE LWM OF INSURANCE — PER If you wdnbndmu*fait to disclose any hera b ea-
UM71ON we at the bwepdm data of your poft we wm not
For all some xAdah the Instead bey legally ab0 � cedar ft Cwnfap Form because of
gated to pay as damages caused by ,amuenaea° audl le to leeched, on pfrwdu n does not gifted
under COVE A (Seaton &and for all medial our dght to coded addlUaurel prerNmn or eorerdee our
expenses aaueed by accidents wrier COVERAGE C dam of cancellation or mm-n mewaL
Puft
at q,Caen be aftgedd only to gmabm LIBERALIZATION CLAUSE
Paragraphs 2s.and ILIL of Umbs of hsc mm(8e0- The Wwdxp path Is added to COMMBICIAL
don Un apply separately to each of your 9oeadona° GENERAL LIABMY CONDITIONS (Sedan ft
owned by or rented to you. 10. If a revision to this Coverage Part, wMah would
proulde move coverage with no lAcaum° ree m prernlsea kn*ft the smile or mk doing the POW p�
cmme ft ids, or lumbes whom won N in the state dw m In Ore D8deratlale,your poE
Icy vA auMmattmly provide 0ds ad6donat oov
areas on the effec tIm date of ire wAstom
Pape 4d4
--REPRWREDVaw THE r RMCWE.TREORMMM.rRVAACiroMwyaaUOe,wmrrowi FORMS
Policy #01-CG37112390 COMMERCIAL AUTO
CA 7110 03 07
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ R CAREFULLY.
AUTO PLUS ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage Provided by this endorsement, the provisions of the Coverage Form apply unless
modified by the endorsement.
EXTENDED CANCELLATION CONDITION BLANKET ADDITIONAL INSURED
paragraph 2.b. of the CANCELLATION Common SSE ONSURED provision COVERAGE ead by the addition
Policy Condition Is replaced by the following:
of the following:
b. 60 days before the effective date of cer"lation
if we cancel for any other reason. e. Any person or organization for whom you are re•
quired by an Insured contract" to provide knsur-
TEMPORARY SUBSTITUTE AUTO — PHYSICAL ante is an Insured", subject to the following
DAMAGE COVERAGE additional provisions:
C. — CERTAIN TRAILERS, MO (1) The Insured contract" must be in effect
Under paragraph during the Policy period shown in the Decla-
BILE EQUIPMENT AND TEMPORARY SUBSTITUTE rayons, and must have been executed prior
AUTOS of SECTION 1 — COVERED AUTOS, the to the 'bodily Injury"or 'property damage".
following is added:
(2) This person or organization Is an Insured"
if Physical Damage coverage is provided by this Cov- only to the extent you are liable due to your
erage Form,then you have coverage for ongoing operations for that Insured whether
the work is performed by you or for you,and
Any 'auto• you do not own while used with the Per• only to the extent you are held liable for an
mission of its owner as a temporary substitute for a "accident" occurring while a covered 'auto"
covered 'auto° you own that is out of service be. Is being driven by you or one of your em-
cause of its breakdown, repair, servicing, loss' or ployses.
destruction. (3) Thee is no coverage provided to this person
or organization for mbodily Injury' to Its am-
BROAD FORM NAMED INSURED ployses, nor for aproperty, damage• to Its
Property
SECTION 0 —LIABILITY
visio COVERAGE y A.1.WHO 4 Coverage for this or organization
IS AN INSURED provision Is amended by the addition ( ) shall be limited to t e extent of your nap
of the following: Bence or fault according to the applicable
d. Arty business entity newly acquired or formed by principles of comparative negligence or fault.
you during the policy period provided you own (yy The defense of any claim or 'suit" must be
50% or more of the business entity and the tendered by this person or organization as
business entity is not separately insured for soon as practicable to all other Insurers
Business Auto Coverage. Coverage Is extended which potentially Provide Insurance for such
up to a maximum of 160 days following aequisF claim or 'suit".
lion or formation at the business entity.Coverage
under this provision is afforded only until the end
of the policy Period.
Includes copyrighted material of Insurance Services Office, Inc.,with Its permission.
Copyright, Insurance Services Office, Inc., 1997
CA 71 10 03 07 Pap 1 d 6 EP
--f1EPI WWFR=TMEAR=ft TNE0WG�TRWSWn0MWruusU0EMm Kl F0�
(6) The coverage provided will not exceed the PERSONAL EFFECTS COVERAGE
lesser of: A. SECTION 111 — PHYSICAL DAMAGE COVER-
(a) The coverage ardlor limits of this policy; AGE, AA. COVERAGE EXTENSIONS, Is
or amended by adding the following:
(b) The coverage and/or limb required by c. Personal Effects Coverage
the insured contract'. For any Owned 'auto' that is involved In a
(7) A person's or organlzatfonfS steals as an covered -loss', we Will pay up to $500 for
@insured' under this subparagraph d ends apersonal effects' that are lost or damaged
when your operations for that @insured° are as a result of the covered -loss', without
completed, applying a deductible.
EMPLOYEE AS INSURED EXTRA EXPENSE — BROADENED COVERAGE
Under Paragraph A.of Section it —LIABILITY COV- Paragraph A. — COVERAGE of SECTION III —
ERAGE item I. Is added as follows: PHYSICAL DAMAGE COVERAGE Is amended to
add:
Youi %mployee'white using his owned -auto",or an
'auto^ owned by a member of his or her household, S. We will pay for the expense of returning a stolen
In your business or your personal affairs.Provided you covered 'auto'to you.
do not own, hire or borrow that auto'.This coverage
Is excess to any other collectible Insurance coverage. AIRBAG COVERAGE
FELLOW EMPLOYEE COVERAGE Under
PHYSICAL DAMAGEECOVERAGE, of
he following Is
Exclusion S. FELLOW EMPLOYEE of SECTION II — added:
LIABILITY COVERAGE — S. EXCLUSIONS Is
amended by the addition of the following: The exclusion relating to mechanical breakdown does
not a"to the accidental discharge of an alrbag•
However, this exduslon does not apply ti the 'bodily
injury° results from the use of a covered 'auto' you NEW VEHICLE REPLACEMENT COST
own or hire, and provided that any coverage under
this provision only applies In excess over any other Under Paragraph C — LIMIT OF INSURANCE of
collectible Insurance, Section BI —PHYSICAL DAMAGE COVERAGE sec-
tion 2 Is amended as follows:
" BLANKET WAIVER OF SUBROGATION 2, An adjustment for depredation and physical con-
We waive the right of recovery we may have for pay- dition will be made In determining actual cash
ments made for 9rodtiy Injury' or 'property damage' value In the event of a total lass.However. In the
on behalf of the persons or orgerftflorw added as event of a total loss to your "new, vehicle" to
Insureds"under Section II —LIABILITY COVERAGE which this coverage applies, as shown In the
— A.I.D. BROAD FORM NAMED INSURED and declarations,We wilt pay at your option:
AJAL BLANKET ADDITIONAL INSURED. a. The verifiable 'new vehicle' purchase price
you paid for your damaged vehicle, not in-
PHYSICAL DAMAGE — ADDITIONAL TRANS- eluding any Insurance or warranties pur-
PORTATK)N EXPENSE COVERAGE chased;
The first sentence of paragraph AA. of SECTION III b. The purchase price, as negotiated by us, of
— PHYSICAL DAMAGE COVERAGE is amended as a new vehicle of the same make,model and
follows: equipment. not Including any furnishings,
parts or equipment not installed by the
We will pay up to S50 per day to a maximum of manufacturer or manufacturer's dealership.
$1,500 for temporary transportation expense Incurred If the same model is not available pay the
by you because of the total theft of a covered 'auto' purchase price of the most similar model
of the private passenger type. available;
Paso 2 016
—REPRW OFROMTMEAROMNr.TKCRMEMKTRAMMA M"%VMCLUDEADDffC KFORKS••••
a. The market value of your damaged vehicle. a. Actual cash value of the damaged
not Including arty furnishings parts or equip- property as of the time of the Jose l.less stolen
an
ment not Installed by the manufacturer or adjustment for depredation and physical
manufacturer's dealership. condition; or
This coverage applies only to a covered 'auto" b. Balance due under the terms of the loan or
of the private passenger, light buck or medium lease that the damaged covered -auto' Is
tmdk We (20,000 lbs or less gross vehicle subject to at the time of the Joss', tees any
weight)and does not apply to Initiation or set up one or all of the following adjustments:
costs associated with loans or leases. (1) Overdue payment and financial
penalties associated with those
TWO OR MORE DEDUCTIBLES payments as of the date of the
Joss'.
Under SECTION M — PHYSICAL DAMAGE COV-
ERAGE, N two or more "company' policies or cover- (2) Financial penalties Imposed under a
age Jamie apply to the same accident, the following lease due to high mileage, exces-
applies to paragraph D. Deductible: sire use or abnormal wow and fir'
a. If the applicable Business Auto deduct- (3) Costs for extended warranties, Cre-
ible is the smaller(or smallest) deduct- dit Life Insurance, Health, Accident
this it will be waived;or or Disability Insurance purchased
with the loan or lease.
b. If the applicable Business Auto deduct-
ible Is not the smaller (or smallest) de- (4) Transfer or rollover balances from
ductibte it will be reduced by the amount previous loans or leases.
of the smaller (or smallest) deductible; (S) Final payment due under a 'Balloon
or Low..
e. If the lose involves two or more Busi. (g) The dollar amount of any
ness Auto coverage forms or policies un-repaired damage that occurred
the smaller(or smallest) deductible will prior to the 9otal loss"of a covered
be waived. •auto".
For the purpose of this endorsement (7) Security deposits not refunded by a
-company' means: lessor.
a. Safeco Insurance Company of America (S) All refunds payable or paid to you
b. American States Insurance Company as a result of the early terrNnation
of a lease agreement or any war.
e. General Insurance Company of America ranty or extended service agree-
d. American Economy Insurance Company ment on a covered *auto".
e. First National Insurance Company of (9) Any amount representing taxes.
America (10) Loan or lease termination fees
L American States Insurance Company of
Texas GLASS REPAIR —WAIVER OF DEDUCTIBLE
g. American States Preferred Insurance Under paragraph D. — DEDUCTIBLE of SECTION BI
Company — PHYSICAL DAMAGE COVERAGE, the following is
h. Saf000 Insurance Company of Illinois added:
LOANJLEASE GAP COVERAGE No deductible applies to glass damage If the glass Is
repaired rather than replaced.
Under paragraph C — LIMIT OF INSURANCE of
SECTION III — PHYSICAL DAMAGE COVERAGE, AMENDED DUTIES IN THE EVENT OF ACCI-
the following is added: DENT, CLAIM, SUIT OR LOSS
4. The most we will pay for a total 9oss-In any one The requirement In LOSS CONDITION 2.8. —
%cddent'is the greater of the following,subject DUTIES IN THE EVENT OF ACCIDENT. CLAIM,
to a$1,500 maximum limit: SUIT OR LOSS — of SECTION IV — BUSINESS
AUTO CONDITIONS that you must notify us of an
CA 71 10 03 07 Page 3 d 6 EP
J
—REPRWWMW ARCNVL oeaRCau rRAN&-= rwr DOM=rmmrwwa.FORM— \
'accident°applies only When One `accident'is known deductible ge equal o the broadest coveragewapplleable
to: to arty covered -auto"you own.
(1) You, if you are an Individual;
HIRED AUTO PHYSICAL DAMAGE COVERAGE—
(2) A partner.if you are a partnership;or LOSS OF USE
(3) An executive officer or Insurance manager,0 you SECTION III — PHYSICAL DAMAGE AA.b. Form
are a corporation. does not apply.
UNINTENTIONAL FAILURE TO DISCLOSE Subject to a maximum of$1,000 per accident,we will
HAZARDS cover loss of use of a hired °auto' fi 0 results from
SECTION P4 — BUSINESS AUTO CONDITIONS — an accident, you are legally liable and the lessor in.
0.2.Is amended by the addition of the following: curs an actual finandal loss.
0 you unintentionally fall to disclose any hazards ex- RENTAL REIMBURSEMENT COVERAGE
W"at the inception date of your policy, we will not A. We will pay for rental reimbursement expenses
deny coverage under this Coverage Form because of Incurred by you for the rental of an "auto" be-
such failure. However, this provision does not aged cause of a covered loss" to a covered 'auto'.
our right to collect additional premium or exercise our pent applies In addition to the otherwise ap-
rigM of cancellation or non-renewal. placable amount of each coverage you have on a
covered °auto'. No deductibles apply to this
HIRED AUTO — LIMITED WORLD WIDE COVER- coverage.
AGE
B. We will pay only for those expenses Incurred
Under Section N — Business Conditions. Paragraph during the policy period beginning 24 hours alter
13.7.b.e(1) is replaced by the following: the loss"and ending, regardless of the policy's
(1) The 'accident" or loss" results expiration,with the lesser of the following number
from the use of an °auto' hired for of days:
30 days or less. 1. The number of days reasonably required to
repair or replace the covered -auto". If
RESULTANT MENTAL ANGUISH COVERAGE loss" is caused by theft, this number of
days is added to the number of days it takes
SECTION V —DEFINITIONS —C. is replaced by the to locate the covered "auto" and return it to
following: you.
So* injury' means bodily injury. sickness or dis- 2. 30 days.
ease suslained by a person including mental anguish C. Our payment is limited to the lesser of the fol.
or death resulting from any of these. lowing amounts:
HIRED AUTO PHYSICAL DAMAGE COVERAGE 1. Necessary and actual expenses Incurred.
If hired "autos' ere covered 'autos" for Liability oov- 2. $50 per day.
emgg and H Comprehensive, Specified Causes of D. This coverage does not apply while there are
Loss or Collision coverages are provided under this spare or reserve "autos'available to you for your
Coverage Form for any °auto' you own, then the operations.
Physical Damage Coverages provided are extended
to 'solos"you hire or borrow. E. If loss" results from the total theft of a covered
"auto" of the private passenger type, we will pay
The most we will pay for lose to any hired -auto' Is under this coverage only that amount of your
$50,000 or Actual Cash Value or Cost of Repair, rental reimbursement expenses which Is not al-
whichever Is smallest, minus a deductible. The de- ready provided for under the PHYSICAL DAM-
duCtIble will be equal to the largest deductible appll- AGE COVERAGE Coverage Extension.
cable to any owned °auto' of the private passenger F. The Rental Reimbursement Coverage described
or fight truck type for that coverage. Hired Auto Pity- above does not apply to a covered "auto"that is
8lost Damage coverage i excess over any other col- described or designated as a covered -auto"on
leclole Insurance. Subj ect to the above limit
Pape 4 d 6
—R®IWOEDFROMMAFMKW THE0RIM&TRANLCTgMMTRWMWEADOffa hFORMS
Rental Reimbursement Coverage Form the manufacturer for the installation of a
CA 99 23. radio.
AUDIO, VISUAL AND DATA ELECTRONIC C. Limit of Insurance
EQUIPMENT COVERAGE With respect to this coverage, the LIMIT OF IN-
SURANCE provision of PHYSICAL DAMAGE
A. Coverage COVERAGE is replaced by the following:
1. We will pay with respect to a covered "auto" 1. The most we wilt pay for loss" to audio,vi-
for loss" to arty electronic equipment that sual or date electronic equipment and any
receives or transmits audio, visual or data accessories used with this equipment as a
signals and that Is not designed solely for the result of any one "accident"is the lesser of
reproduction of sound.This coverage applies
only If the equipment is permanently Installed a. The actual cash value of the damaged
in the covered "auto" at the time of the or stolen property as of the time of the
loss"or the equipment is removable from a loss"; or
housing wit which Is permanently installed b. The cosy of repairing or replacing the
In the covered "auto" at the time of the damaged or stolen property with other
loss", and such equipment is designed to property of like kind and quality.
be solely operated by use of the power from
the "auto's"eledrical system,in or upon the c. $1,000.
coed 'auto". 2. An adjustment for depredation and physical
2. We vall pay with respect to a covered "auto" condition will be made in datemdning actual
for loss" to any accessories used with the cash value at the time of the loss".
stectrortie equipment described In paragraph 3. If a repair or replacement results in better
A.I.above. than like kind or quality, we will not pay for
However, this does not Include lapel, the amount of the betterment.
records or discs. D. Deductible
3. If Audio, Visual and Date Electronic Equip 1. If loss" to the audio, visual or data ales
Equip-
merit Coverage farm CA fth n or CA Audio. W 94 trontc equipment or accessories used with
s attached t this pocky, then the Audio, Vb this equipment Is the resat of a loss"to the
suet and Data Electronic Equipment Cover- covered "auto" under the Business Auto
age described above does not apply. Coverage Form's Comprehensive or Co06
B. Exclusions sion Coverage, then for each covered "auto"
The exclusions that apply to PHYSICAL DAM our obligation to pay for, repair,return or re-
AGE COVERAGE, except for the exclusion reM- place damaged or stolen property will be re-
AGE C Audio, Visual and Data Electronic duced by the applicable deductible shown In
n9 the Declarations. Any Comprehensive Cov-
Equlpment, also apply to this Coverage. In adds- erage deductible shown in the Declared=
Von, the following exclusions apply: does not apply to loss" to audio, visual or
We will not pay for either any electronic equip. data electronic equipment caused by fire or
ment or accessories used with such electronic lightning.
equipment that is: 2. If loss" to the audio, visual or data elec-
t. Necessary for the normal operation of the tronic equipment or accessories used with
covered "auto" for the monitoring of the this equipment is the result of a lose"to the
covered 'auto's"operatng system; or covered "auto" under the Business Auto
Coverage Forth's Specified Causes of Loss
Coverage. then for each covered "auto"our
a. an integral part of the same whit rousing obligation to pay for, repair,return or replace
any sound reproducing equipment de- damaged or stolen property will be reduced
signed solely for the reproduction of by a$100 deductible.
sound if the sound reproducing 3. If loss" occurs solely to the audio,visual or
equipment is permanently installed in data electronic equipment or accessories
the covered "auto";and used with this equipment,then for each cov-
b. permanently Installed in the opening of ered "auto" our obligation to pay for, repair,
the dash or console normally used by
CA 71 to 03 07 REpo 5 d e B
••••FtEFRUTEOFROY THE ARCM&TIES TRAmaWlMk#AYadWOEADDMMRL FORMS••«
ratum or roplace damaged or stolen property SECTION Y —DEFINITIONS is amended by adding
will be reduced by a$100 deductible. the following:
4. In the event that there is'more than one ap- ti &Personal effects"
o nt your ytangibbie
plicable deductible, only the highest deduct- p�nY
Me win apply. In no event will more then one cept for tools.Jewelry, money, or securities.
deductible apply. R. 'New vehicle° means any 'auto' of which
you are the original owner and the 'auto"
has not been previously tided and Is less
than 365 days past the purchase date.
rape ado
C" PECORDER Page 1 I 1
LA&I CITY OF C.�99 i Cl�AS H LAN D ''' DATE r:... "PO NUMBERS^, 20 E MAIN ST. 1/20/2012 10642
ASHLAND, OR 97520
(541)488-5300
VENDOR: 003671 SHIP To: Ashland Water Treatment Plant
LIQUIVISION TECHNOLOGY, DIVING SERVICES (541) 488-5345
PO BOX 5277 ASHLAND, OR 97520
KLAMATH FALLS, OR 97601
FOB Point: Req.No.:
Terms: Net Dept.:
Req.Del.Date: Contact: Greg Hunter
Special Inst: Confirming? No
.. .... _ ..,. r .-._. ..
DeScti Uon ;.:.. Und Piicea�. .. ._�.Ext.Price
Contractor to remove accumulated '2,690.00
sediment from the floors of two(2)
connected clearwell reservoirs per
attached contract and proposal.
Contract for Goods and Services
Beginning date:.January 25, 2012
Completion date: February 29, 2012
Insurance required/On file.
SUBTOTAL 2,690.00
BILL TO:Account Payable TAX A0Q!20 EAST MAIN ST FREIGHT 541-552-2028 TOTAL
ASHLAND, OR 97520
. :'Account Number "' •.:.,Projeof Number. - `. .'"Amount '. _.-Account Number ___ := Project Number.?_ ' _ ' :.. :Amount', `-
E 670.08.19.00.704100 2,690.00
Auth6flzed Signature VENDOR COPY
FORM #3 CITY OF
A request for a Purchase C rder ASHLAND
REQUISITION Date of request: t-3-zotz
Required date for delivery:
Vendor Name I InuIVISION TECHNOLOGY DIVING SERVICES
Address,City,State,Zip 711 MARKET STREET KLAMATH FALLS OREGON 97601
Contact Name&Telephone Number BRANDON MCGRAW 541.883-6473
Fax Number FAX # 541.883.1361
SOLICITATION PROCESS
❑ Exempt from Competitive Bidding ❑ Emergency
❑ Written Findings(Fong attached) ❑ Invitation to Bid (Copies on file) ❑ Written findings attached
❑ Quote or Proposal attached Date approved by Council: ❑ Quote or Proposal attached
❑ Small Procurement Cooperative Procurement
Less than$5,000 ❑ Request for Proposal (Copies on file) ❑ State of Oregon
Note:Total contract amount,including any Date approved by Council: Contract#
amendments may not exceed$6,000 ❑ State of Washington
Intermediate Procurement ❑ Sole Source Contract#
GOODS&SERVICES ❑ Written Findings(Form attached) ❑ Other government agency contract
$5,000 to$100,000 ❑ Quote or Proposal attached Agency
® (3)Written quotes attached Contract#
PERSONAL SERVICES ❑ Special Procurement ❑ Intergovernmental Agreement
$5,000 to$75,000 ❑ Written Findings(Form attached) Agency
❑ Less than$35,000,by direct appointment ❑ Quote or Proposal attached Contract#
❑ 3 Wdlten proposals attached Date approved by Council: Date approved by Council:
Description of SERVICES Total Cost
CLEAN DRINKING WATER CLEARWELL FLOOR AT WATER TREATMENT PLANT. $'Z690 00
Item # Quantity Unit Description of MATERIALS Unit Price Total Cost
iiT_OTAL#CO_ Sit '
® Per attached QUOTE
2690 00*
$
Project Number______•___ Account Number___-__-__•__•______ Account Number_670.08.19.00.704100 - -_
Account Number -__-__-__-______ Account Number___-__-__• _
'Expenditure must be charged to the appropriate account numbers for the financials to reflect the actual expenditures accurately. Attach extra pages if needed.
By signing this requisition form,I certify that the inf rmahon pro ided above meets the City's public contracting requirements,and the documentation can be provided
upon request.
Employee Signature: C/ Department Head Signature:' wQ v
Additional signatures(if applicable):
Funds appropriated forcurrent fiscal year.' YES / NO
Finance Director Date
Comments.,
G:FinanceTrocedure'APWormsfform#3-Requisition.doc Updated on:11312012