Coraggio Group Contract#
,V
CITY OF TIGARD, OREGON
PERSONAL SERVICES AGREEMENT
THIS AGREEMENT made and entered into this 19`h day of March, 2008, by and between the
City of Tigard, a municipal corporation of the State of Oregon, hereinafter called City, and
Coraggio Group, hereinafter called Contractor, collectively known as the "Parties".
RECITALS
The City has need for the services of a company with a particular training, ability, knowledge,
and experience possessed by Contractor, and
The City has determined that Contractor is qualified and capable of performing the
professional services as City does hereinafter require, under those terms and conditions set
forth:
Therefore, the Parties agree as follows:
SCOPE OF WORK
Contractor shall initiate services upon receipt of City's notice to proceed together with an
executed copy of this Agreement. Contractor agrees to complete work that is detailed in
Exhibit A - Statement of Work and by this reference made a part hereof.
EFFECTIVE DATE AND DURATION
This Agreement shall become effective upon signature by both parties and shall expire, unless
otherwise terminated or extended, on June 30, 2008. All work under this Agreement shall be
completed prior to the expiration of this Agreement.
COMPENSATION
City agrees to pay Contractor an amount not to exceed One Thousand Five Hundred and
No/100 Dollars ($1,500.00) for the performance of those services described in this Agreement.
Payment will be made based on Contractor's invoice, subject to the approval of the City, and
not more frequently than monthly. Payment shall be payable within thirty (30) days from
the date of the Contractor's invoice. All payments shall be in line with the pricing detailed in
Exhibit A - Statement of Work.
CONTACT INFORMATION
All notices, bills, and payments shall be made in writing and may be given by personal
delivery, mail, or fax. Payments may be delivered by personal delivery, mail, or electronic
transfer. The following addresses and contacts shall be used to transmit notices, bills,
payments, and other information:
2008 PSA-Board and Committee Chairperson Training Page 1
Contract#
CITY OF TIGARD CORAGGIO GROUP
Attn: Bob Roth, Volunteer Prog. Specialist Attn: Linda Lucas
Address: 13125 SW Hall Blvd. Address: 2240 N Interstate Ave, Suite 240
Tigard, Oregon 97223 Portland, Oregon 97227
Phone: (503) 718-2402 Phone: 503) 493-1452
Fax: (503) 684-7297 Fax: (503) 284-1311
Email Address: bob@tigard-or.gov Email Address:
CONTRACTOR AS INDEPENDENT CONTRACTOR
Contractor acknowledges that for all purposes related to this Agreement, Contractor is and shall
be deemed to be an independent contractor as defined by ORS 670.600 and not an employee of
City, shall not be entitled to benefits of any kind to which an employee of City is entitled and
shall be solely responsible for all payments and taxes required by law. Furthermore, in the event
that Contractor is found by a court of law or any administrative agency to be an employee of
City for any purpose, City shall be entitled to offset compensation due, or to demand repayment
of any amounts paid to Contractor under the terms of this Agreement, to the full extent of any
benefits or other remuneration Contractor receives (from City or third party) as a result of said
finding and to the full extent of any payments that City is required to make (to Contractor or to
a third party) as a result of said finding.
Contractor acknowledges that for all purposes related to this Agreement, Contractor is not an
officer, employee, or agent of the City as those terms are used in ORS 30.265.
INDEMNIFICATION
City has relied upon the professional ability and training of Contractor as a material inducement
to enter into this Agreement. Contractor warrants that all its work will be performed in
accordance with generally accepted professional practices and standards as well as the
requirements of applicable federal, state and local laws, it being understood that acceptance of a
contractor's work by City shall not operate as a waiver or release.
Contractor and City agree to indemnify and defend the other, and the other's officers, agents
and employees and hold them harmless from any and all liability, causes of action, claims, losses,
damages, judgments or other costs or expenses including attorney's fees and witness costs and (at
both trial and appeal level, whether or not a trial or appeal ever takes place) incurred by the
party being indemnified resulting from the indemnifying party's acts (or failure to act when
action is appropriate) that may be asserted by any person or entity which in any way arise from
or relate to this Agreement or the performance of obligations under this agreement, except
liability arising out of the sole negligence of the party being indemnified. The indemnification
by Contractor of the City shall also cover claims brought against the City under state or federal
worker's compensation laws. If any aspect of this indemnity shall be found to be illegal or
invalid for any reason whatsoever, such illegality or invalidity shall not affect the validity of the
remainder of this indemnification.
2008 PSA-Board and Committee Chairperson Training Page 2
Contract#
INSURANCE
Contractor shall maintain insurance acceptable to City in full force and effect throughout the
term of this contract. Such insurance shall cover all risks arising directly or indirectly out of
Contractor's activities or work hereunder.
The policy or policies of insurance maintained by the Contractor shall provide at least the
following limits and coverages:
1. Commercial General Liability Insurance
Contractor shall obtain, at contractor's expense, and keep in effect during the term of
this contract, Comprehensive General Liability Insurance covering Bodily Injury and
Property Damage on an "occurrence" form (1996 ISO or equivalent). This coverage
shall include Contractual Liability insurance for the indemnity provided under this
contract. The following insurance will be carried:
Coverage Limit
General Aggregate 1,000,000
Products-Completed Operations Aggregate 1,000,000
Personal & Advertising Injury 1,000,000
Each Occurrence 1,000,000
Fire Damage (any one fire) 50,000
Medical Expense (any one person) 5,000
2. Business Automobile Liability Insurance
If Contractor will be delivering the goods, Contractor shall provide City a certificate
indicating that Contractor has business automobile liability coverage for all owned, hired,
and non-owned vehicles. The Combined Single Limit per occurrence shall not be less
than $1,000,000. Said insurance shall name City as an additional insured and shall require
written notice to City thirty (30) days in advance of cancellation. If Contractor hires a
carrier to make delivery, Contractor shall ensure that said carrier complies with this
paragraph.
3. Workers' Compensation Insurance
The Contractor and all employers providing work, labor or materials under this
Contract that are either subject employers under the Oregon Workers' Compensation
Law and shall comply with ORS 656.017, which requires them to provide workers'
compensation coverage that satisfies Oregon law for all their subject workers or
employers that are exempt under ORS 656.126. Out-of-state employers must provide
Oregon workers' compensation coverage for their workers who work at a single location
within Oregon for more than 30 days in a calendar year. Contractors who perform
work without the assistance or labor of any employee need not obtain such coverage.
This shall include Employer's Liability Insurance with coverage limits of not less than
$500,000 each accident.
2008 PSA-Board and Committee Chairperson Training Page 3
Contract#
4. Insurance Carrier Rating
Coverages provided by the Contractor must be underwritten by an insurance
company deemed acceptable by the City. The City reserves the right to reject all or
any insurance carrier(s) with an unacceptable financial rating.
5. Certificates of Insurance
As evidence of the insurance coverage required by the contract, the Contractor shall
furnish a Certificate of Insurance to the City. No contract shall be effected until the
required certificates have been received and approved by the City.
The procuring of such required insurance shall not be construed to limit contractor's liability
hereunder. Notwithstanding said insurance, Contractor shall be obligated for the total amount
of any damage, injury, or loss caused by negligence or neglect connected with this contract.
TERMINATION
The parties agree that any decision by either party to terminate this Agreement before either
before the work is completed or the 30`h day of June, 2007 shall be accompanied by thirty (30)
days written notice to the other party prior to the date termination would take effect. There
shall be no penalty for early termination. If City terminates the contract pursuant to this
paragraph, it shall pay Contractor for services rendered prorated to the date of termination.
AGREEMENT MODIFICATIONS
Modifications to this Agreement are valid only if made in writing and signed by all parties.
OWNERSHIP OF WORK PRODUCT
City shall be the owner of and shall be entitled to possession of any and all work products of
Contractor which result from this Agreement, including any computations, plans,
correspondence or pertinent data and information gathered by or computed by Contractor prior
to termination of this Agreement by Contractor or upon completion of the work pursuant to
this Agreement.
GOVERNING LAW
Contractor shall comply with all applicable federal, state and local laws; and rules and
regulations on non-discrimination in employment because of race, color, ancestry, national
origin, religion, sex, marital status, age, medical condition or disability. The provisions of this
Agreement shall be construed in accordance with the provisions of the laws of the State of
Oregon. All provisions required by ORS Chapter 279 to be included in a contract of this type
are incorporated into this Agreement as though fully set forth herein. Any action or suits
involving any question arising under this Agreement must be brought in the appropriate court of
the State of Oregon.
2008 PSA-Board and Committee Chairperson Training Page 4
Contract#
CONDITIONS OF SUPPLYING A PUBLIC AGENCY
Where applicable, Contractor must make payment promptly as due to persons supplying
Contractor labor or materials for the execution of the work provided by this order. Contractor
must pay all contributions or amounts due from Contractor to the Industrial Accident Fund
incurred in the performance of this order. Contractor shall not permit any lien or claim to be filed
or prosecuted against Buyer or any subdivision of City on account of any labor or material to be
furnished. Contractor further agrees to pay to the Department of Revenue all sums withheld from
employees pursuant to ORS 316.167.
COMPLETE AGREEMENT
This Agreement and attached exhibit constitutes the entire Agreement between the parties. No
waiver, consent, modification, or change of terms of this Agreement 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 specific instances and for the specific purpose given. There are no
understandings, agreements, or representations, oral or written, not specified herein regarding
this Agreement. Contractor, by the signature of its authorized representative, hereby
acknowledges that he/she has read this Agreement, understands it and agrees to be bound by its
terms and conditions.
IN WITNESS WHEREOF, City has caused this Agreement to be executed by its duly
authorized undersigned officer and Contractor has executed this Agreement on the date
hereinabove first written.
CITY OF T CARD CONTRACTOR
1
By: Auth ized City of Tigard Agent y: Authorize4A�ent of Contractor
314Le'� g17166
Date Date
2008 PSA-Board and Committee Chairperson Training Page 5
Contract#
Exhibit A
Statement of Work
Overview
The Contractor will provide training for the City's Board and Committee Chairpersons,
members, and staff liaisons on better management and facilitation of various meetings.
Currently, "drift" pattern occurs within meetings over the course of several weeks/months,
resulting in inefficient and ineffective outcomes. The training shall occur on May 1, 2008.
The Contractor's training will provide tools and strategies for participants to ensure more
effective meetings. The goal is to provide tools and instill a higher level of confidence in the
participants in leading these meetings. The participants will be better able to identify
potential obstacles in a meeting and isolate the issue behind them. Participants will be
provided tangible tools and specific feedback to ensure an increase in productivity and
participation. The final exercise will involve role-playing to ensure an "experiential" learning
approach that leads to changed behavior.
Approach
The training session will be a highly interactive, facilitated, 2.5-hour program. Group
participation, role-playing and a question/answer session will be used to ensure experiential
learning. The curriculum is designed to provide participants with the knowledge and confidence
to proactively lead meetings and drive for intended results.
Desired Results
1. Clarify role of Chair;
2. Increase Participation;
3. Eliminate "drift" within meetings; and
4. Increase confidence of Chair as a facilitator
Training Keys
1. More effective & efficient meetings;
2. Communication strategies for increased contribution from all participants;
3. Six rules for an effective agenda;
4. Clear understand of how to lead and influence effective meetings;
5. Rules of engagement "do's and don'ts"; and
6. Facilitation tips and role playing activity
Fee
The fee for each 2.5 hour facilitated program is $1,250.00. Workbooks will be provided for each
participant @ $10.00 per person (City of Tigard is welcome to print workbooks at preferred
printer to eliminate any charge for workbooks from the Coraggio Group). A head count for the
event will be needed 1 week prior to the engagement.
2008 PSA-Board and Committee Chairperson Training Page 6
u�
City of Tigard, Oregon • 13125 SW Hall Blvd. • Tigard, OR 97223
April 2, 2008
Coraggio Group
Attn: Linda Lucas
2240 N Interstate Avenue, Suite 240
Portland, Oregon 97227
Dear Ms. Lucas,
Enclosed you will find two copies of a proposed agreement between the City of Tigard and the
Coraggio Group for services related to an Board and Committee Chairperson Training. Please
review the agreement and, if you are comfortable, sign both copies and return them, along with a
copy of your firm's federal Tax ID form, to my attention at:
City of Tigard
Attn: Joe Barrett, Contract/Budget Analyst
13125 SW Hall Blvd.
Tigard, Oregon 97223.
Once I've received the signed copies, I'll assign a contract number for future reference and return a
fully executed copy to you.
Thank you for your prompt attention to this matter. The City is truly looking forward to this
opportunity to work with your company. If you have any questions please feel free to contact me at
either (503) 718-2477 or at josephQatigard-or.gov.
Sincerely,
Joseph Barrett
Contracts/Budget Analyst
Phone: 503.639.4171 . Fax: 503.684.7297 . www.tigard-or.gov . TTY Relay: 503.684.2772
CITY OF TIGARD
CONTRACT SUMMARY FORM
FO-1- FORM MUST ACCOMPANY EACH CONTRACT FOR AUTHORIZATION)
Title of Contract: Board and Committee Chairperson Training Contract #: (As&rrejxecution) 9-11441
Contractor: Coraggio Group Total: $1,500.00 (nte)
Brief Overview: Contractor will provide meeting management and facilitation training to the City's various
Boards and Committees chairpersons, members, and staff liaisons.
Changes Made To No significant changes to the template short PSA.
Boilerplate
Contract
Type of Contract: ❑ Purchase A reement ® Personal Service ❑ Construction ❑ Other
Start Date: March 19, 2008 End Date:June 30, 2008 LCRB Award Date: N/A
Contract Manager: Bob Roth Extension: 2402 Department: City Administration
Quotes/Bids/Proposals: COMPANY AMOUNT /SCORE
Direct Appointment under PCR 70.015 C 1 a
Department Comments:
Department Signature Date:
Purchasing Comments:
Purchasing Signa 4 Date: (( c,,o,
Administration: Date:
Certificate of Insurance Rec ed? ❑ Yes ® No ❑ Self-Insured Form Received)
Business Tax Current? M Yes ❑ No Contractor License Current? ❑ Yes ❑ No
Federal TIN/1099 #: 20-2833669 Bonds Required: ❑ Yes ® No
Accounting String: Fund Division Account Total
600 3120 601000 $1,500.00
CNA
CNA Connect
Renewal Declaration
<;:gx
h::
1+
J.fr�'}
f.
::r%>:'i:%:i�iiii}Yi:i?::i?iii}?iii:C�i?'rii:!%ii>
.r{+i {•: 4 ?i::�-i?}:{[•:}};4}i}is•Y.•?:{4i}';:,{h;{{Ji:4:{;'y?:•
�:..n..nr:i r•:{:•}viv:r +: ...............v.y:::::4v:::::;:..::r:.�:.�:..::: .yf:. ?i• :..............:::::::.�.�::::::r.:::.�::v:; ::::: :::::;:::.:�::::•:{:.:::::.....?}??::::::.::.......
..::v•.:..n....f -.��`'r/..... n::::v.:::.�:v::::::: .r. :::.�:::::::::::::::v::::::.:.::::i:_F{....:::::v:}i:•ii::.
.r •rw:v}}}}}}:• r.v:::::nv::.v +/.-}:} :::::v:::::::::::v::..vvn�:::.W::.?w.�:::::::::::::::::}
-:v:•:.�:::::.�::::.:v.v •fes .+.�+%:::w:::::::::x::.::::::::::::::::::::::::::::.�: v v..
.�..}..:. /..Y.�..r7:[if{................................................ fi..ff /.•Y-{-..�iY.v:r:{h}?:v.�.y::::::::r.?::::.�:::}}:... -� :.:•:i::::
POLICY NUMBER COVERAGE PROVIDED BY FROM - POLICY PERIOD - TO
B 2067254149 CONTINENTAL CASUALTY COMPANY 04/01/2008 04/01/2009
333 S. WABASH
CHICAGO, IL. 60604
INSURED NAME AND ADDRESS
THE CORAGGIO GROUP, INC .
2240 N Interstate #240
PORTLAND, OR 97217
AGENCY NUMBER AGENCY NAME AND ADDRESS
026862 CS&S/FULLERTON
2701 NW VAUGHN STREE
SUITE 340
PORTLAND, OR 97210
Phone Number : (866)337-6532
BRANCH NUMBER BRANCH NAME AND ADDRESS
050 SEATTLE BRANCH
999 THIRD AVENUE, STE 2500
SEATTLE, WA 98104
Phone Number : (206 )587-2600
> :;
This policy becomes effective and expires at 12 :01 A.M. standard time at your mailing
address on the dates shown above .
The Named Insured is a Corporation .
Your policy is composed of this Declarations , with the attached Common Policy Conditions ,
Coverage Forms, and Endorsements , if any . The Policy Forms and Endorsement Schedule shows
all forms applicable to this policy at the time of policy issuance .
The Estimated Policy Premium Is $508 .00
Terrorism Risk Insurance Act Premium $10.00
Audit Period is Not Auditable
...............................................:..........v..:v v:::x,...r.vv:vxv:•:::.•. vxvq:t:b:,:}}Xi{:?i-:v'•:v'n}'}:-}}}i}'v:C•}}:•:y}'•}ir: •
....:..•.v.......v....................... ......n............,........... .v'v r .::.v ..-......•t....h,\- 5 :.m.......v...:•vv.•:}:::::•:?}r f..
.................... .....................................::.�:.v.•...n..:.............................:....:.v:v::::::::.v:T.-x.v :.:.•. :tQ 4}.x:u:-.:}n.A}:v!}:viti vv,:v:::.:x:::,.......:.....J:::+fb:::nr/. +:::F:'•i�•'.i,...v::.v:}}:::::..,:•::i.i:•i}:?•}'l.'
.:-.}.:::..,::•:::::::::.:.:::::•::v:::::::.::::v.v:::::::::::4?'.}'.}!i}}.J:.v::.l.:::::::::......,.....:n....:.�:<v1:?:i iiii::n......... ......,.......v..........:4....:....:......................•..,%v.
POLICY NUMBER INSURED NAME AND ADDRESS
B 2067254149 THE CORAGGIO GROUP, INC.
2240 N Interstate #240
PORTLAND, OR 97217
f ... ..
.......:r............: r.. ........rf...............r.. .n......r. r.....................................:n..... ....
v.... ..........r.............r...............::. .. fi .... ...xwn.,•:::::::::w:.�:::::.�:n;:::.�::un.......::: v:.::::•awn;w::nv.�:.::::::n.:
...:............::v:::.{rf.r:+ir?r�r:+ ....r.........................r.r..........r..... br 4 ..
...........r ... f ... ....,.,,r .... f.................... .J.
f...
1. '^.-.
...:. :{.. .....�.f .... ::.... .r.v v/.:? {.r:v.v: v Yny;{?n:?�::r�:tiv}•}i}}}}})}:?............ .......... ..........
..........././r ....r..r�� 4:.vi.. r....{...{... .. ....%�i'.� ..r...........::::r::.{:•:;........:.v::�.:�::::. : •r p 4:}i::::......... ,......:: :...........:n•::::.........,.....:•-::-:::•i:-:i-}}:•:
�h4.�Yl.^v'.+�� .......:::::::::.......................
...�{.y:::;;v:v:".:'•:r}:f.•.rn••::.:vr:.'.:•:..::.:...v..... v�{•. �:.r..:::::::::::. -
PROPERTY COVERAGE LIMIT OF INSURANCE
The following deductible applies unless a separate deductible is shown on the Schedule of
Locations and Coverage .
Deductible: $500
Business Income and Extra Expense Coverage
Business Income and Extra Expense 12 Month Loss Sustained
Business Income and Extra Expense - Dependent Properties $10,000
Employee Dishonesty $25,000
Forgery and Alteration $25 ,000
LIABILITY COVERAGE 'LIMIT OF INSURANCE
Each Occurrence Limit $1,000,000
Medical Expense Limit $10,000
Personal and Advertising Injury $1 ,000,000
Products/Completed Operations Aggregate $2 ,000,000
General Aggregate $2 ,000,000
Damage To Premises Rented To You $300,000
Employee Benefits Liability
Each Employee Deductible $1,000
Each Employee $1 ,000,000
Aggregate $2 ,000,000
Employment Practices/Fiduciary Liability Retroactive Date : $10,000
EPLI Deductible : $0
Hired Auto Liability $1 ,000 ,000
Nonowned Auto Liability $1 ,000,000
POLICY NUMBER INSURED NAME AND ADDRESS
B 2067254149 THE CORAGGIO GROUP, INC.
2240 N Interstate #240
PORTLAND OR 97217
..r.:........................................:.. ......... .........:.....x:::::::.�:v:::•;.................. ...� f.............:�.::F%•:.:'4i�4:^:4}}^}}i}}}i:{•v}'r:ii•}}::f:ri:4}:hi}?%......... F r
......... ........... ........ :...n.,.....:. ......... .r...................::::•::r:::::n:•.•... :...
%.i...:�.i:.rf..4..�...,...:.......:..f...:..:...v..;...:..:..:..:..::.:r.:.:r...:..:..•.:..::.:...:..vr..,..,nf,...r..:..�..:...r..:..:..::.:..:...n�.......................:..r...........r..........r........r.r:Jffl:.ri.:.rl.r..x.::.�•:%:::.:.:r:.::r-.v:.:..:�.:...:.:::.:..•.�.:.:.:.::..:.:.:.v....r........r.../........:.................:f.?..v..:..:.i..^n::r.....:. � r•
.}:n,. • y ? ? + .0.;::r..}'�.i..4}.:.:i..i:.:��.:'':{.i•.:.y'.i't•}•}}}:•}%::r:�}}:r}ir-i�'}:•}:F•r•:}:}:}:-{::::.i}}::{inf'.i}i:r:v.'f}.rff"r�`t{��.rf�rvr•:.
............................
SCHEDULE OF LOCATIONS AND COVERAGE
LOCATION 1 BUILDING 1
2240 N INTERSTATE #240
PORTLAND, OR 97217
Construction: Joisted Masonry
Class description: Advertising Agencies
Building Glass Deductible : $100
PROPERTY COVERAGE LIMIT OF INSURANCE
Accounts Receivable $25,000
Business Personal Property $25,000
Electronic Data Processing $50,000
Equipment Breakdown $25,000
Fine Arts $25,000
Ordinance or Law $25,000
Seasonal Increase: 25%
Sewer or Drain Back Up $25 ,000
Valuable Papers & Records $25 ,000
�..�-...........:.r-.-:-:::�:::::::..::::. .. .. - :ar-+ -f• .Hca:}:•}:_:r-:�::?•s.,,33:=.:{•}•.•:: ..........,.r:..
,..v..n,.........,. .r....:............ .. ....-.-.k{•: :•y.}'?•:-+{r-. :;.s:•::?{?•ss:;•:{:.::•:3:->:-ss:->:-:{{-s:-:3:+-r:�:-yi:s:{••:•• �..,.n:: •r..n.......:.:.......n•..:...::.
................. a. ...........;,.:s:C�'f! :'bi�.'+:9k,•n?;:• : £ :•::..::,•:::rt n...r- :...:.::. n...:,::...- :.v.....:....... .,st ..:..:::}.:
n?L4
alt",:rhr i��: ♦:G+r.. ..k.- ..s.. ••{•n :
......... , :v... :.r.--'.Sz}iY.J... ................,.::}:1::::-:::.....:•::.f••:•:•i}n-.,:•:n::.:::-:::::::-}::•::::::.:::::.v:}i:-i--is{{::?ti.:::.- , ' .$r�ir•..... ....
.. .. :{...rr............x.a,^LC: :.. : . -..... .::. :...................... .....................:.:::.:.:. ... - P... .r.,...,.y:.::::n:,•.•}::.;.,•.;.,,•:
....,,.. ,•4. ..} ....n}..............n..... .... Mrn X.... .. .....,.,. ::v::::-:::. :v.:::::•rY. .. •:r;•yvv'
..... ... ... ......r..........n......:n.... .... ... :..r£r..:v:•.v:r::::: •v:;.{.y•n}'l:-:'•::: . .-....lr•}:3}}'?.:.....-.. lw::::�?' .. fl• ::•:t:?:::i:•}i'1.•.�}:v3'•:ri3f.�r:�:?.:.3 $::•::.
r :{�. w}}.. .,, Jr,Ji}•.-,::w::::.w::::::.v...wntr.n:
{U.. fr•:.{ft•:{+.:.i:?.i}}:v/..:i.{{1,.;1:::w.}:}:v}}:L:%F•£�'rn3::.r... r
POLICY NUMBER INSURED NAME AND ADDRESS
B' 2067254149 THE CORAGGIO GROUP, INC.
2240 N Interstate #240
PORTLAND, OR 97.217
.iy{:yp•.iv,?•;n}�:r:rr}+}3:•3}:•}:•i:{.}::v}}3:{.3:?{.}:.}:.:.}:-}::-}y-}}:.}}:
}i:{{+:{x:.•:?::.:::{.}y:-::{{?.J '•A}yI.?•}'4}:.}::3':•.y}:•}vi•}'{.3'f'}:}}Y.. y}:{, n•.F'r::n;.vyny:•.'i ♦ }:{ry•'f.•}:{{:yr/. ,f.rr
..3iM.J.£n r... J/.... {}?,}r{n}:f:fv.p}l-..;�.,:.,{•i :+l n•:1::•... ...f::n••`..:::::fi v :vF,..}+r:.,;{n.
:::::.v.nv:....,:+:Y•i'} :n:v:{4i::r•: , v::l.•:r - ...:..f,. r::... ..
l f.•ygn. \. .fv:•::r r. r�:3.•:4 :3::::4'i.'-'i ../.... ..{.....n.YJlfJ•.+•"•.v:f/,..{{..;;..;..;Y.;{?fi:{?{{•�•ir•}::?Q}}}}3:{{4:....
...............r f.:. 1::......:!.. £ ^',"^ .G:hf lv+.•f •r /....r.% n{......• r.n
...............r..r. .,f.. i� {n....... ........ r n .n. .. : .f.. ....y,,...-.,.:jj:: ...:::v::::x::.v:r:::::fi:::%. nr{.,{{•::: •Y•\9::::?•}::-}..,}}}"r'-3:i�:
..,{.?fxl.�...rr£v.:n•i.+.$'f,,•,� f } :f'/ / f -i}Y::}}n{{:;'r::y;ry}?{;}:;{:::{}j:�:....r...r..9....:...
?+r� •i•f /.r, f. /�:::n•::l r£n, •Jf ♦r:r:.f .f:: rr ff�C .r£ :::.n. ••r�::�:.,+r:r::n.::.>:•�s:-:�s:�s:-:::{•sy:..:. .:.r:•:::•::%�...........:. ..f:.;+,.
.:..r:::::::� .r},�{{;{{ff.•:r'r.•r.•laY.•£.{:furl.•r:�st/.,+.G:{r:,?f..,:.,::•:::.� 1C4:�♦f�jl,,:r.:,G,:+/,,.rr//::'trr-`/..:{•::.�1.•::.�{ :`.�::::., ....::.�::::. , : : r
ADDITIONAL INTEREST SCHEDULE
LOCATION N/A BUILDING N/A
Types Manager, Lessor
Additional Interest Name and Address:
NORTH INTERSTATE LLC
P 0 Box 490
BEAVERCREEK OR 97004
LOSS PAYEE SCHEDULE
All loss payees as their interests may appear in the Covered Property.
The following provisions apply in accordance with the insurable interest of the loss
payee:
Description of Property: Any Covered Property in which a loss payee, creditor or lender
holds an interest, including any person or organization you have entered a contract with
for the sale of Covered Property.
82 (Policy Provisions: WC 00 00 00 A)
81
PS INFORMATION PAGE
WEG WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY
INSURER:
HARTFORD ACCIDENT AND INDEMNITY COMPANY
.100 HARTFORD PLAZA, HARTFORD, CONNECTICUT 06115
NCCI Company Number: 10448 THE
Company Code: 5
HARTFORD
0
Suffix
LARS RENEWAL
POLICY NUMBER: 176 WEG PS8182 02
CD N Previous Policy Number: 76 WEG PS8182
00 HOUSING CODE: 76
°D 1. Named Insured and Mailing Address: THE CORRAGIO GROUP, INC.
w (No., Street, Town, State, Zip Code)
N
CD 2240 N INTERSTATE AVE #240
CD
Ln FEIN Number: 202833669 PORTLAND, OR 97227
r,
State Identification Number(s):
UIN:
The Named Insured is: CORPORATION
Business of Named Insured: CONSULTANT - MANAGEMENT
Other workplaces not shown above: 2240 N INTERSTATE AVE #2
PORTLAND OR 97227
2. Policy Period: From 12/01/07 To 12/01/08
12:01 a.m., Standard time at the insured's mailing address.
Producer's Name: PAYCHEX AGENCY INC
308 FARMINGTON AVE
FARMINGTON, CT 06032
Producer's Code: 210705
Issuing Office: THE HARTFORD
308 FARMINGTON AVE
FARMINGTON CT 06032
(877) 287-1312
Total Estimated Annual Premium: $634
Deposit Premium:
Policy Minimum Premium: $350 OR (INCLUDES INCREASED LIMIT MIN. PREM. )
Audit Period: ANNUAL Installment Term:
The policy is not binding unless countersigned by our authorized representative.
Countersigned by b 12/01/07
Authorized Representative Date
Form WC 00 00 01 A (1) Printed in U.S.A. Page 1 (Continued on next page)
NFORMATION PAGE (Continued) Policy Number: 76 WEG PS8182
3.A. Workers Compensation Insurance: Part one of the policy applies to the Workers Compensation Law of the
states listed here: OR
B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A.
The limits of our liability under Part Two are:
Bodily injury by Accident $500, 000 each accident
Bodily injury by Disease $500, 000 policy limit
Bodily injury by Disease $500, 000 each employee
m C. Other States Insurance: Part Three of the policy applies to the states, if any , listed here:
d+
C) ALL STATES EXCEPT ND, OH, WA, WV, WY, AND
STATES DESIGNATED IN ITEM 3 .A. OF THE INFORMATION PAGE.
H
� D. This policy includes these endorsements and schedule:
N WC 00 01 13 WC 00 03 08 WC 00 04 21A WC 00 04 22 WC 36 04 01
co SEE ENDT
m
U) 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating
r- Plans. All information required below is subject to verification and change by audit.
CN Premium Basis
Ln Classifications Total Estimated Rates Per Estimated
Code Number and Annual $100 of Annual
_ Description Remuneration Remuneration Premium
8810 150, 000 .26 390
DRAFTING EMPLOYEES
TOTAL PREMIUM SUBJECT TO EXPERIENCE MODIFICATION 390
OR - MERIT RATING CREDIT (9885) .900
PREMIUM ADJUSTED BY APPLICATION OF EXPERIENCE MODIFICATION 351
TOTAL ESTIMATED ANNUAL STANDARD PREMIUM 351
EXPENSE CONSTANT (0900) 180
OR WC ADMINISTRATIVE FUND 4.6000 PERCENT 28
FOREIGN TERRORISM (9740) 150, 000 . 030 45
DTEC (9741) 150, 000 . 020 30
TOTAL ESTIMATED ANNUAL PREMIUM 634
Total Estimated Annual Premium: $634
Deposit Premium:
Policy Minimum Premium: $350 OR (INCLUDES INCREASED LIMIT MIN. PREM. )
Interstate/Intrastate Identification Number:
NAILS:
Labor Contractors Policy Number: SIC: 8742
UIN:
NO. OF EMP: 1
C..—\A/!' nn nn n4 A 14% 0.-:.-.4-,4 :.. I 1 0 A n..,.,, O