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Home My WebLink AboutAG 23-157 - CONNECTIONS CHURCH OF FEDERAL WAYRETURN TO: EXT: CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEP'T./DIV: CITY OF FEDERAL WAY - PARKS AND RECREATION 2. ORIGINATING STAFF PERSON: ASHRIYA GUPTAR EXT: 6950 3. DATE REQ. BY: 4/21/23 4. TYPE OF DOCUMENT (CHECK ONE): ❑ CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ) ❑ PUBLIC WORKS CONTRACT ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT ❑ PROFESSIONAL SERVICE AGREEMENT ❑ MAINTENANCE AGREEMENT ❑ GOODS AND SERVICE AGREEMENT ❑ HUMAN SERVICES / CDBG ❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) ❑ ORDINANCE ❑ RESOLUTION ❑ CONTRACT AMENDMENT (AG#): ❑ TNTERLOCAL 19 OTHER MOU S. PROJECTNAME: CITY OF FEDERAL WAY AND CONNECTIONS CHURCH -SUMMER SOCCER CAMP 6. NAME OF CONTRACTOR: CONNECTIONS CHURCH OF FEDERAL WAY ADDRESS: 30029 16th Ave S, Federal Way WA 98003 - TELEPHONE 263-545-1280 E-MAIL: rsg2wa@gmail.com FAX: SIGNATURE NAME: Jonathan I ep TITLE owner 7. EXHIBITS AND ATTACHMENTS: It SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE ❑ ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: 7/25/23 COMPLETION DATE: 7/28/23 9. TOTAL COMPENSATION $ (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑ YES ®NO IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED ®YES IDNO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY RETAINAGE: RETAINAGE AMOUNT: ❑ RETAWAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDED ❑ PURCHASING: PLEASE CHARGE TO: 10. DOCUMENT/CONTRACT REVIEW INITIAL / DATE REVIEWED INITIAL / DATE APPROVED N PROJECT MANAGER KH 6/15/23 ❑ DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) 2 LAW JE 6/20/23 11. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: COUNCIL APPROVAL DATE: 12. CONTRACT SIGNATURE ROUTING ❑ SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D: ❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS ❑ CREATE ELECTRONIC REMINDER/NOTIFICATION FOR 1 MONTH PRIOR TO EXPIRATION DATE (Include dept. support staff if necessary and feel free to set notification more than a month in advance if council approval is needed.) INITIAL / DATE SI NED LAW DEPARTMENT ❑ SIGNATORY (MAYOR OR DIRECTOR) ❑ CITY CLERK '� 1 ❑ ASSIGNED AG# ,qG#� -1 COMMENTS: 2/2017 Memorandum of Understanding City of Federal Way and Connections Church THIS MEMORANDUM OF UNDERSTANDING (MOU), dated effective upon mutual execution by all parties, defines the respective responsibilities of the City of Federal Way ("City") and Connections Church of Federal Way (together "Parties"). Background The City of Federal Way Recreation Department will partner with Connections Church of Federal Way (CC) to provide one free soccer camp to children 6-12 years of age from July 25-28, 2023, from 9:00am- 11:00am each day at Steel Lake Park. The Federal Way Community Center will take all registrations. Connections Church will operate the camp, providing coaches and instruction for participants. The Parties anticipate registering a maximum of 80 participants. The summer soccer camp will be a skills -based camp intended to work with youth of all different skill levels. Games will mainly_ be --cooperative. NOW, THEREFORE, the Parties agree as follows: I. City Responsibilities. The City agrees to provide the following: Conduct the registration process and obtain signed waiver forms from registered participants • Provide a soccer ball for every registered participant; • Provide space at Steel Lake Park for the soccer camp; • Ensure appropriate bathrooms and standard goals are available for staff and participants — bathrooms will be in close proximity to the field provided for use and within sight of employees; • Advise participants/parents that they are responsible for snacks, water, proper attire, etc.; and • Provide rosters to Connections Church containing parent contact information for each child for check -in and check-out purposes H. Connections Church of Federal Way (CC) Responsibilities. CC agrees to the following: • Provide cones, goals, and other necessary equipment to run soccer drills and games; ■ Provide coaches and instruction for participants of the soccer camp; • Provide appropriate staffing for camp with a minimum of 1-12 ratio of staff to participants; • Conduct background checks on all volunteers and employees working at the camp; • Take steps to arrange for the safety of participants and ensure all volunteers and employees receive appropriate training for the supervision and care of minors; ■ Facilitate check in and check out process of participants during camp using City provided rosters; and • Support and ensure the sole focus of the camp and all instructors remains on soccer and the development of teamwork, individual skills, and other secular activities and topics throughout the camp due to the partnership with the City in putting on this recreational opportunity. [Signature page follows] IN WITNESS, the Parties execute this MOU below, effective the last date written below. CITY OF FEDERAL WAY: ATTEST: I Hutton, ks 're or C lerk. Stephanie C u ey, CMC DATE: 2'e2z APPROVED AS TO FORM: 3. yan Call, Cit Attorney Connections Church: Signature: _ —.-- - Printed Name:l1 Title: DATE:! .fig a-3 6/20/23, 10:07 AM Corporations and Charities System ,i,n'Ss�fWft�Q nd Charities Filing System BUSINESS INFORMATION CONNECTIONS CHURCH OF FEDERAL WAY 604 899 905 WA NONPROFIT CORPORATION ACTIVE 3002916TH AVE S, FEDERAL WAY, WA, 98003, UNITED STATES. PO BOX 23986, FEDERAL WAY, WA, 98093-0986, UNITED STATES 03/31/2024 UNITED STATES, WASHINGTON 03/30/2022 PERPETUAL RELIGIOUS NONPROFIT CHURCH R https://ccfs.sos.wa.gov/#/BusinessSearch/Businesslnformation Business Name: UBI Number: Business Type Business Status: Principal Office Street Address: Principal Office Mailing Address: Expiration Date: Jurisdiction: Formation/ Registration Date: Period of Duration: Inactive Date: Nature of Business: Charitable Corporation: 1/2 6/20/23, 10:07 AM Corporations and Charities System 88-1520248 R IVI REGISTERED AGENT INFORMATION SUNG YONG LEE Nonprofit EIN: Most Recent Gross Revenue is less than $500,000: 3002916TH AVE S, FEDERAL WAY, WA, 98003, UNITED STATES PO BOX 23986, FEDERAL WAY, WA, 98093-0986, UNITED STATES GOVERNORS Title GOVERNOR GOVERNOR Back Governors Type INDIVIDUAL INDIVIDUAL Entity Name Has Members: Public Benefit Designation: Host Home: Registered Agent Name: Street Address: Mailing Address; First Name Last Name DAVI D GASS SUNG YONG LEE Filing History Name History Print Return to Business Search httpsl/ccfs.sos.wa.gov/#/BusinessSearch/Businessinformation 2/2 6/20/23, 10:06 AM Washington State Department of Revenue Washington State Department of Revenue < Business Lookup License Information: New search Back to results Entity name: CONNECTIONS CHURCH OF FEDERAL WAY Business name: Entity type: Nonprofit Corporation UBI #: 604-899-905 Business ID: Location ID: Location: None Excise tax and reseller permit status: Click here Secretary of State status: Click here Governing People May include governing people not registered with Secretary of State Governing people Title GASS, DAVID LEE, SUNG YONG The Business Lookup information is updated nightly. Search date and time: 6/20/2023 10:06:28 https://secure.dor.wa.gov/gteunauth/_/#3 1 /2 R e CERTIFICATE OF LIABILITY INSURANCE 06n 3/2023 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 WtIlIC210 hO1d0F man ADDITIONAL INSURED. the p c ell) must have ADDITIONAL IN3URED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the farms and conditions of the policy, certain policies may regain an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NAM. CAA $e19Ci CuMCm?T 5ervxm Lincoln Steffens No. En EOC•200.5864 Nei, ADcdlEsa customersorwce croseWLl-cum DIVAI 11(a) AFFORDING COVERAGE NAIL ■ MISNRER A CM Select Insurance Company 16203 MNSURED INlRell!# e CDnnec tows Church DI Federal Way WILONER C PO Box 23986 Federal Way. WA 98093 aSURER o Rr INJIM E SWIL4 I! F 91nurvanN:v rFRTIFIC.ATF NUMBER- REVISION NUMBER: THIS IS I THE POOCIES OF INSLRANCE LOW HAVE N ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REOUIREMENT, 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. r EFF LarTs LTR TYPE OF INSURANCE mm wvo POLICY NRiMIM (Ia�►T IDDYYYf A X CONSMERCIALOENERALUABR.ITY SEL-BOP-OON829 OU2412023 04/2312024 EAcmoccuRRENCE S 2,000.000 cLAR,&NAADE X occuR Y vsa�te sEsiFa occar�czfi f 300,OOC WEE E XP IAry or* pww) f 10,000 PERSONAL JLADV NJURY S 'L AGGREGATE LIMTAPPL ES PEP GENERAL AGGREGATE 00 f 4.0.000 PRODUCTS • COLPIOP ADG f 4,000,000 POU�C LOC MX S OTHER ALIFOUGGIE LLAWLITY !E, a f 2.000.000 BOO LY INJURY IPM Pmw) S ANY AUTO OWNED SChEDUIFD SOCILYIN,AIRYIPara 11 1 S AUTOS PILYNAUTOS AuOEH RED v AUTOSONONLEY Ix f f ta1aRELAALIM OCCUR EACHOCCURRE`kLE S HCLAMS.WACE AGGREGATE S EXCESS LAAS DED I RETENT ON S S woRxxRs AND ENFIOTERS UAGAM YIN ANYPROPRIETORIPARTNER/EXECUTIVE OFF CERMEMBER EXCLUDE D7 `J aand—T inE NIA IM STATUTE ER E L EACH ACCCENT S L DISEASE - EA EPLOYEE f E L D SEASE POLICY LIMIT l yab daaoI u Idw DESCRIPTION OF OPERAT ONS below S DESCRDTION OF OPERATIONS I LOCATIONS I VENICLES (ACORD 101, AddOW" Reawft SeaedMY. m" be aatadrd a mue WAw is FagW1 Sm-cer Camp ADDITIONAL INSURED = Qy of Federal Way r'FRTIFIC.ATE HOLDER City of Federal Way 33325 8Th Ave S Federal Way. WA 98003 253-545-1280 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED N ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED ICEPRES,EIITATIVE D W 1y68-,MD AGl7KY 4VHYUKR I1Un- All rlgn[>b reseFvvu. ACORD 25 (2016f03) The ACORD name and logo are registered marks of ACORD