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HomeMy WebLinkAboutAG 14-116 - HANWOORI CHURCHRETURN TO: PK ADMIN EXT: 6901 ID #:
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
1. ORIGINATINGDEPT/DIV: PARKS DEPT/ Admin
ORIGINATING STAFF PERSON: Jason Gerwen EXT: 6912 DATE REQ. BY:
TYPE OF DOCUMENT (CHECK ONE:
p 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#): 14-1 16 ❑ INTERLOCAL
0
PROJECTNAME: CHURCH lease at Brooklake
NAME OF CONTRACTOR: New Full Gospel Church f/k/a HANWOORI CHURCH
ADDRESS: 726 S 365TH ST. FEDERAL WAY WA TELEPHONE:253-335-4445
E-MAIL: hanwoorichurch(a7amail.com FAX:
SIGNATURENAME: CHU NAM SONG TITLE: PASTOR
6. EXHIBITS AND ATTACHMENTS: ❑ SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE ❑ ALL OTHER
REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS
CFW LICENSE # BL EXP. 12/31/ UBI # , EXP.
17. TERM: COMMENCEMENT DATE: COMPLETION DATE: 5/30/26
8. TOTAL COMPENSATION: $ THEY PAY US (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: d YES ❑ NO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY
RETAINAGE: RETAINAGE AMOUNT: ❑ RETAINAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDED
❑ PURCHASING: PLEASE CHARGE TO:
9. DOCUMENT / CONTRACT REVIEW
❑ PARKS PROJECT MANAGER
❑ PUBLIC WORKS
DEPUTY DIRECTOR
DIRECTOR
LAW DEPT
COUNCIL APPROVAL (IF APPLICABLE)
CONTRACT SIGNATURE ROUTING
INITIAL / DATE REVIEWED
JHG - 3.5.2025 / JHG - 4.30.2025
APG 3/11/2025/ APG 4.30.2025
SCHEDULED COMMITTEE DATE:
SCHEDULED COUNCIL DATE:
INITIAL / DATE APPROVED
COMMITTEE APPROVAL DATE:
COUNCIL APPROVAL DATE:
❑ 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.)
❑ L W DEPT
SIGNATORY (MAYOR OR DIRECTOR)
❑ CITY CLERK
❑ ASSIGNED AG #
❑ SIGNED COPY RETURNED
Double Thanks for your help on this one!
111LUL-1
CITY HALL
CITY
d e ra I Way Feder l Avenge ,
Federal Wray, WA 98003-6925
,A46 y (253) 835-7000
www.FrderaMvy+w qov
AMENDMENT NO.4
TO
LEASE AGREEMENT
FOR
CHURCH RENTAL AT BROOKLAKE
This Amendment ("Amendment No. 4") is made between the City of Federal Way, a Washington municipal
corporation ("City" or "Landlord"), and New Full Gospel Church f/k/a HANWOORI Church, a Washington non-
profit corporation ("Lessee"). The City and Lessee (together "Parties"), for valuable consideration and by mutual
consent of the Parties, agree to amend the original Agreement for HANWOORI Church Rental at Brooklake
("Agreement") dated effective July 11, 2014, as amended by Amendment Nos. 1, 2, and 3 as follows:
1. AMENDED TERM. The term of the Agreement, as referencedby Section 2 of the Agreement and anyprior
amendments thereto, shall be amended and shall reflect that the Parties agree to extend the Agreement on a month to
month basis. Notwithstanding RCW 59.04.020, either party may terminate this Agreement with One Hundred
Twenty (120) days written notice.
2. AMENDED COMPENSATION. The amount of compensation, as referenced by Section 3 of the
Agreement, shall be amended and reflect that the monthly rent increase of Five Percent (5%) is hereby stricken and
the Lessee will continue to pay $1,500 per month.
3. GENERAL PROVISIONS. All other terms and provisions of the Agreement, together with any prior
amendments thereto, not modified by this Amendment, shall remain in full force and effect. Any and all acts done by
either Party consistent with the authority of the Agreement, together with any prior amendments thereto, after the
previous expiration date and prior to the effective date of this Amendment, are hereby ratified as having been
performed under the Agreement, as modified by any prior amendments, as it existed prior to this Amendment. The
provisions of Section 26 of the Agreement shall apply to and govern this Amendment. The Parties whose names
appear below swear under penalty of perjury that they are authorized to enter into this Amendment, which is binding
on the parties of this contract.
4. NOTICES. For any notices required by the original Agreement contact information has changed as follows:
City of Federal Way
Contact: Jason Gerwen
33325 8" Ave. S
Federal Way, WA 98003
(253) 835-6912 (telephone)
New Full Gospel Church
Contact: Heung Yeol Yoo
726 S 356th St
Federal Way, 98003
E-mail: bobnparkAyahoo.com — Attention Bob Park
[Signature page follows]
AMENDMENT - 1 - 4/2023
MY HALL
CITY Of IMS V" Avenue SsDuttl
Federal Way Fed" Way, wa : _,»
l253l 835-700o
.........rgm
IN WITNESS, the Parties execute this Agreement below, effective the last date written below.
CITY OF FEDERAL WAY:
By:
_ (� Z;,/--
Jim Fe ayor
ATTEST:
R-riA*V- DWw,IMv, C/rG, CfKf clt1m
DATE: > APPROVED AS TO FORM:
Fo Glib
' J. Ryan Call, rney
NEW FULL GOSPEL CHURCH f/k/a HANWOORI CHURCH:
By:
Printed Name: HeunQ Yeol Yoo
Title: Director
Date: S-d-a5
STATE OF WASHINGTON )
ss.
COUNTY OF`
(Alr/r�
On this day personally appeared before me Heung Yeol Yoo, to me known to be the Director of New Full Gospel
Church f/k/a HANWOORI Church that executed the within and foregoing instrument, and acknowledged the said
instrument to be the free and voluntary act and deed of said corporation, for the uses and purposes therein
mentioned, and on oath stated that he or she was authorized to execute said instrument and that the seal affixed, if
any, is the corporate seal of said corporation.
GIVEN under my hand and official seal this ' day of , 2025.
KATHLEEN HOBBS
NOTARY PUBLIC #23031019
STATE OF WASHINGTON
COMMISSION EXPIRES
SEPTEMBER 11, 2027
Notary's signature r�
Notary's printed name ZV> 4-01r-1 "A1p cs
Notary Public in and for the State of Washington.
My commission expires p,
AMENDMENT - 2 - 4/2023
cl-' DATE (MMIDD/YYYY)
Acorzr� CERTIFICATE OF LIABILITY INSURANCE
04/30/2025
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME: Tammy HUSkISSOn
Lightwell Insurance Advisors PHONE (877)224-9255 1 tFa. Nol.- 877 315-8574
222 NE Park Plaza Dr, Ste 101 ADDRIE : THuskisson@Lightwell.com
Vancouver, WA 98684 INSURER(SI AFFORDING COVERAGE NAIC #
INSURED
New Full Gospel Church
726 S 356th St
Federal Way, WA 98003
Rr)VFRA(,FC
(:FRTIFIr'ATF NI IMRFR-
INSURER A: I
INSURER B :
INSURER C :
INSURER D :
INSURER E:
INSURER F :
nnn9i AQi_94ni 3i nQ90Z9
RFVIfiI0N NIIMRFR• A
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.
INSR TYPE OF INSURANCE AD L UBR POLICY NUMBER MM DDNYYY POLICY EFF POLICY
LTR M DDYIYYYY I LIMITS
A
X
I COMMERCIAL GENERAL LIABILITY
Y
46M5A0421679
03/06/2025
03/06/2028
EACH OCCURRENCE
$ 1,000,000
CLAIMS-MADE JxJ OCCUR
DAMAGE TO RENTEU--
PREMISES Ea nee
$ 300 000
MED EXP (Any oneperson)
S 5,000
PERSONAL & ADV INJURY
S 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
S 3,000,000
X POLICY1:1 ECT LOC
PRODUCTS-COMP/OPAGG
$ 3 000000
$
OTHER:
A
AUTOMOBILE
LIABILITY
46M5A0421679
03/06/2025
03/06/2028
EaMaccciden 1 LE u Ir
$ 1.000.000
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
X
Pe�ecci DAMAGE
$
NON-OWN
HIRED
AUTOS ONLY X AUTOS ONELY D
A
I UMBRELLA LAB X
OCCUR
46M5A0421679
03/06/2025
03/06/2028
EACH OCCURRENCE
$ 1,000,000
X
AGGREGATE
$ 1,000,000
EXCESS LIAB
CLAIMS -MADE
DIED RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
YIN ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? r7N
(Mandatory In NH)
N I A
46M5A0421679
03/06/2025
03/06/2028
X PSTAT ER T TH-
Stop Gap
E L EACH ACCIDENT
$ 100,000
E L DISEASE - EA EMPLOYE
$ 100,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E L DISEASE - POLICY LIMIT
$ 500,000
i
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
RE: For On -Going Use Leased Premises at Brook Lake Community Center - 726 S 356th St, Federal Way WA 98003
City of Federal Way is Additional Insured as per attached GL152(1.0) Endorsement and subject to all the terms and conditions
of the policy.
L;tK I It -ILA I t r1ULUtK
City of Federal Way
33325 8th Ave S
Federal Way, WA 98003
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
�n
©1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by TOH on 04/30/2025 at 01:51 PM
This Liability Coverage Endorsement is subject to the terms of the applicable Commercial Liability
Coverage Form (GL-100) and the Liability and Medical Coverage Form (BGL-11). Only one liability
coverage will apply to an occurrence and any related loss. This endorsement is attached to and made
part of the policy.
THIS INSURANCE ENDORSEMENT FORMS PART OF YOUR POLICY CONTRACT.
PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED ENDORSEMENT
ADDITIONAL CONDITION
ViV9191 ft FOP, I I—, 1111111159161111 a] III d Eel 0 1
The following additional condition is added to the
Conditions section of the Liability and Medical
Coverage Form (BGL-11):
Additional Insureds: With respect to any
person or entity shown on the declarations
as an Additional Insured or who is otherwise
designated by the Named Insured and
recognized by us as an Additional Insured,
we will provide Principal Coverage L of the
Commercial Liability Coverage Form (GL-
100) to such Additional Insured (they will be
considered an insured for Principal
Coverage L), but only to the extent that such
person or entity is legally liable for the acts of
you, your leader, your employee, or your
appointed person. Such coverage will be
limited to that which is specifically provided
by Principal Coverage L, and will be strictly
subject to the terms of this policy. No
coverage will apply to any independent acts,
errors, or omissions of an Additional Insured.
OTHER PROVISIONS
All other provisions of the applicable Commercial
Liability Coverage Form (GL-100) and the
Liability and Medical Coverage Form (BGL-11)
remain unchanged
GL-152 (1.0) Copyright, 2013 Brotherhood Mutual Insurance Cc Page 1 of 1
All Rights Reserved
4/30/25, 11:16 AM
Corporations and Charities System
BUSINESS INFORMATION
Business Name:
NEW FULL GOSPEL CHURCH
UBI Number:
605 556 988
Business Type:
WA NONPROFIT CORPORATION
Business Status:
ACTIVE
Principal Office Street Address:
Principal Office Mailing Address:
Expiration Date:
06/30/2025
Jurisdiction:
UNITED STATES, WASHINGTON
Formation/ Registration Date:
06/07/2024
Period of Duration:
PERPETUAL
Inactive Date:
Nature of Business:
Charitable Corporation:
R
Nonprofit EIN:
Most Recent Gross Revenue is less than $500,000:
R
Has Members:
R
Public Benefit Designation:
El
Host Home:
REGISTERED AGENT INFORMATION
Registered Agent Name:
DANIEL KIM
Street Address:
1064 SW 325TH CT, FEDERAL WAY, WA, 98023-4913, UNITED STATES
Mailing Address:
GOVERNORS
Title Governors Type Entity Name First Name Last Name
https://ccfs.sos.wa.gov/#/BusinessSearch/Businessinformation 1/1
4/30/25, 11:15 AM Washington State Department of Revenue
Washington State Department of Revenue
< Business Lookup
License Information: New search Back to results
Entity name:
NEW FULL GOSPEL CHURCH
Business
NEW FULL GOSPEL CHURCH
name:
Entity type:
Nonprofit Corporation
UBI #:
605-556-988
Business ID:
001
Location ID:
0001
Location:
Active
Location address: 726 S 356TH ST
FEDERAL WAY WA 98003-8612
Mailing address: 560 SYLVAN AVE
STE3045
ENGLEWOOD CLIFFS NJ 07632-3181
Excise tax and reseller permit status: Click here
Secretary of State information: Click here
Endorsements
Endorsements held i License # Count Deta Status Expiration d. First issuanu
https://secure.dor.wa.gov/gteunauth/_/#3 1 /2
4/30/25, 11:15 AM Washington State Department of Revenue
Endorsements held; License # Count Deta Status Expiration d, First issuance
Federal Way
General Business
Pending Oct-31-2025
Owners and officers on file with the Department of Revenue
Owners and officers Title
YOO, HEUNG YEOL Director
The Business Lookup information is updated
nightly. Search date and time: 4/30/2025 10:44:36
AM
Contact us
How are we doing?
Take our survey!
Don't see what you expected?
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https://secure.dor.wa.gov/gteunauth/_/#3 2/2
IRETURN TO: EXT:
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
ORIGINATING DEPT./DIV: PARKS
ORIGINATING STAFF PERSON: ROB ETTINGER EXT: 2002 3. DATE REQ. BY:
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
x CONTRACT AMENDMENT (AG#):14-116 ❑ INTERLOCAL
❑ OTHER
5. PROJECT NAME: HANWOORI CHURCH LEASE
6. NAME OF CONTRACTOR: HANWOORI CHURCH
ADDRESS: 726 S. 356TH STREET, FEDERAL WAY, WA 98003 TELEPHONE (253) 335-4445
E-MAIL: HANWOORICHURCH(C�7�,GMAIL.COM FAX:
SIGNATURE NAME: CHU NAM SONG TITLE: PASTOR
7. EXHIBITS AND ATTACHMENTS: ❑ 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: JUNE 1, 2015 COMPLETION DATE: MAY 31, 2025
TOTAL COMPENSATION THEY PAY US (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 ❑ NO IF YES, $
RETAINAGE: RETAINAGE AMOUNT:
❑ PURCHASING: PLEASE CHARGE TO:
10. DOCUMENT/CONTRACT REVIEW
8. PROJECT MANAGER
❑ DIRECTOR
❑ RISK MANAGEMENT (IF APPLICABLE)
❑ LAW
11. COUNCIL APPROVAL (IF APPLICABLE)
PAID BY: ❑ CONTRACTOR ❑ CITY
❑ RETAINAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDEI
INITIAL / DATE REVIEWED
SCHEDULED COMMITTEE DATE
SCHEDULED COUNCIL DATE:
INITIAL / DATEikPPRf)V-PI
COMMITTEE APPROVAL DATE:
COUNCIL APPROVAL DATE:
12. CONTRACT SIGNATURE ROUTING 'q -1
❑ SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D:
❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
❑ CREATE ELECTRONIC REMINDER/NOTIFICATION FOR I 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.)
❑ LAW DEPARTMENT '1lat. a
LL;,-56NATORY (MAYOR OR DIRECTOR) 32)
❑ CITY CLERK
❑ ASSIGNED AG# AG#
❑ SIGNED COPY RETURNED DATE SENT:
141618 uOI11112N .�
` CITY OF CITY HALL
Federal Way Feder l Avenue South
Federal Way, WA 98003-6325
(253) 835-7000
www cayoffederalway corn
AMENDMENT NO.3
TO
LEASE AGREEMENT
FOR
HANWOORI CHURCH RENTAL AT BROOKLAKE
This Amendment ("Amendment No. 3") is made between the City of Federal Way, a Washington municipal
corporation ("City"), and HANWOORI Church, a Washington non-profit corporation ("Lessee"). The City and
Contractor (together "Parties"), for valuable consideration and by mutual consent of the Parties, agree to amend the
original Agreement for leasing of the Brooklake Chapel and office space ("Agreement") dated effective June 1,
2014, as amended by Amendment No. 1 and 2:
1. AMENDED AGREEMENT. The second sentence of paragraph 2. (a) of the Agreement is amended to read
"The City and the Lessee may agree to extend this agreement for additional terms."
2. AMENDED TERM. The term of the Agreement, as referenced by Section 2 of the Agreement and any prior
amendments thereto, shall be amended and shall continue until May 31, 2025 ("Amended Term").
2. ' GENERAL PROVISIONS. All other terms and provisions of the Agreement, together with any prior
amendments thereto, not modified by this Amendment, shall remain in full force and effect. Any and all acts done by
either Party consistent with the authority of the Agreement, together with any prior amendments thereto, after the
previous expiration date and prior to the effective date of this Amendment, are hereby ratified as having been
performed under the Agreement, as modified by any prior amendments, as it existed prior to this Amendment. The
provisions of Section 13 of the Agreement shall apply to and govern this Amendment. The Parties whose names
appear below swear under penalty of perjury that they are authorized to enter into this Amendment, which is binding
on the parties of this contract.
[Signature page follows]
AMENDMENT - 1 - Rev. 3/2017
` CITY OF CITY HALL
8thAvenueSouth
Federal Way. WA 98003-6325
Federal Way
(253) 835-7000
www ci"ffederahvay corn
IN WITNESS, the Parties execute this Agreement below, effective the last date written below.
CITY OF FEDERAL WAY:
U
DATE: 5"
HANWOORI CHURCH
By:
Chu Nam Song, Pastor
Printed Name: C Ll o ''1`t Ck (m M '�
Title: PC r
DATE:
t
STATE OF WASHINGTON )
ss.
COUNTY OF`',,.'L% )
ATTEST:
"ph Courtney, CMC, i y Clerk
APPROVED FORM:
J. Ryan Call, City Attorney
O thi day personally appeared before me_ I � "' � to me known to be the
��( of that executed the foregoing
instrument, and acknowledged the said instrument to be the free and voluntary act and deed of said corporation, for
the uses and purposes therein mentioned, and on oath stated that he/sue was authorized to execute said instrument
and that the seal affixed, if any, is the corporate seal of said corporation.
GIVEN my hand and official seal this day o
MAR.9'Witi4
tARYApta�g i
176 c, s O
�*111" 4* OF W PS`,,
Notary's signature
Notary's printed name
AMENDMENT - 2 - Rev. 3/2017
Brotherhood Mutual®
Insurance Company
MinistryEssentialssm Commercial Multi -Peril
Insurance Coverage Summary
These are your policy's Declarations.
Renewal of 46MAA0421679
Hanwoori Church
726 S 356th St
Federal Way, WA 98003-8612
NAMED INSURED Hanwoori Church
POLICY NUMBER 46MAA0421679
POLICY PERIOD 03/06/2019 to 03/06/2022 at 12:01 a.m.
Key Facts About Your Policy
These Declarations replace your previous ones. Your policy's Declarations contain a summary of the coverage contained in the insurance policy.
Your policy contains a full explanation of your coverage.
AGREEMENT: In return for the payment of the premium and subject to all the terms of the policy, we agree to provide the insurance stated in the policy.
TYPE OF ORGANIZATION: Church Institution
FORM OF ORGANIZATION: Corporation
Policy Overview
COVERAGE DESCRIPTION DETAILS COVERAGE DESCRIPTION DETAILS
Property Coverage Page 2 - 4 Terrorism Coverage See Notice Form MCN6ADXWA 1.0 for Details
Liability Coverage Page 5 - 8 Terrorism Premium $0
Policy Premium Overview
This premium is subject to adjustment at each anniversary.
ANNUAL PREMIUM $1,030.00 PAYMENT SCHEDULE See invoice.
Common Policy Forms
FORM
FORM NAME
FORM
FORM NAME
CLO103 0310
Common Policy Conditions Washington
CL3001.0
Amendatory Endorsement
MCNOI 1.0
.................................._.................
Notice: Policy Change At Renewal
........... ... ..... ......_.......................... .
MCN11A 1.1
............ ........................_..__._....................... ............... ._........._............................ _._................ -.............
Notice Value -Added Benefits
BCL966WA 1.0
Additional Policy Definition
._........._......_
BN1B 1.0
- .................... ............... ........................................... ............. .............................................. .........._......
Notice Of Payment -Related Charges
................................................................................................................................................................................................................................................................
BCL100WA 1.1
Additional Policy Conditions
...... ........................... .................................................
G13210 06
........................................................... ...................................................I ... ............
Notice To Policyholders
.............. ..__............_.
MEN01 1.0
............. ..._.......-........... __..._............... ......_.....- .......... ....._............... ............
Notice Coverage Information
............................. ..........._.._......................
MEN021.0
........_.._..............._.................................. _........................................... _................... .
Notice Mid -Term Changes in Exposure
_....................._..._........_._........................-............................_..............._......_._......................._._.........................._..............I.................
MCN6ADXWA 1.0
Notice Terrorism -Related Loss
_..............._........._..............................._........._.......................................................................
... ....................--_.....
Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I 6400 Brotherhood Way, Fort Wayne, IN 46825
ME DEC WA (12/16) 'Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 1 of 8
NAMED INSURED Hanwoon Church
679
Brotherhood Mutual® POLICY NUMBER 46 06/201 to
POLICY PERIOD 03/06/2019 to 03/06/2022 at 12:01 a.m.
Insurance Company
Property Coverage Summary
MinistryEssentialssm commercial multi -peril policy Declarations continued...
We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according
to the terms of the designated coverage form and any other applicable forms or endorsements.
Property Coverage Details
PROPERTY DEDUCTIBLE $1,000
GLASS DEDUCTIBLE $1,000
Schedule of Locations
LOCATION #
0101
Schedule of Buildings and Personal Property
COVERAGE DESCRIPTION COVERAGE LIMIT
Personal Property $59,500
Schedule of Optional Coverages: All Locations
DESCRIPTION
ADDRESS
Church
726 S 356th St Federal Way, WA 98003-8612
COINSURANCE
VALUATION TYPE PERIL TYPE FORM
Waived
Replacement Cost Special with Theft MEP101WA 2.1
COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM
Ministry Personnel Dishonesty Coverage $5,000 MCP137WA 2.0
Worldwide Personal Property Coverage $5,000 $1,000 MEP101WA 2.1
Schedule of Supplemental Coverages: All Locations
The policy's property deductible applies to each of these coverages. Details are found on the Commercial Property Coverages MEP101WA 2.1
form.
COVERAGE DESCRIPTION
COVERAGE LIMIT
DEDUCTIBLE
FORM
Property Off Premises (180 days or less)
....
$2,500/$25,000 Total
$1,000
MEP101WA 2.1
Within Territorial Limits
$25,000
$1,000
MEP101WA 2.1
.........................................................................................................................................................................................................................................................................
Inter -Continent
.
$2,500/item, $25,000 Total
$1,000
MEP101WA 2.1
.......... .................... ........................................................................................................................ ..........................................................._...............
Owned Personal Property -Parsonage
............................... .........._.............................................. .................................................................
$2,500
........................
$1,000
ME0WA
P112.1
Building & Personal Property - Newly Acquired or Constructed
$500,000
$1,000
MEP101WA 2.1
Outside Objects and Structures
..................................................................................................................................................................
$10,000/category, $15,000 Total
$1,000
MEP101WA 2.1
................. For any one tree, shrub, or plant
................
$500
...............................................................................................................................I..............................
$1,000 ....... .........
MEP101WA 2.1
.............................................
......... .............................................. ......................................... .......................... .......................................................................................................................................
Each loss caused by wind
......................................... ...................................................................
$2,500
................... .......................................... -
$1,000
MEP101WA 2.1
Contents of Other Structures
$10,000
$1,000
MEP101WA 2.1
Dwellings --Private Structures --Personal Property
.
.................................................................................
5%of Building Limit
............................................................................_......................................................................................
$1,000
MEP101WA 2.1
.............................................................................................................................................
Dwellings -Private Structures -Appurtenant Structures
.........................................................................................................................................................................................................
10% of Building
$1,000
MEP101WA 2.1
Contents --Buildings & Structures Described on the Declarations
$10,000
$1,000
MEP101WA 2.1
Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I 6400 Brotherhood Way, Fort Wayne, IN 46825
ME DEC WA (12/16) "Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 2 of 8
NAMED INSURED Hanwoori Church
Brotherhood Mutual® POLICY NUMBER 46 1679
POLICY PERIOD 03/06/20106/2019 to 03/06/2022 at 12:01 a.m.
Insurance Company
Property Coverage Summary
MinistryEssentialssm commercial multi -peril policy Declarations continued...
We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according
to the terms of the designated coverage form and any other applicable forms or endorsements.
Schedule of Additional Coverages: All Locations
The policy's property deductible applies to each of these coverages. Details are found on the Commercial Property Coverages MEP101WA 2.1
form.
COVERAGE DESCRIPTION
Monev and Securities (Other than Theft)
Water Damage (including flood, surface water)
Interior Building Damage
..................... _........................._.....................................
Backup of Sewer and Drain
Schedule of Additional Coverages: All Locations
COVERAGE LIMIT
$5,000
KE
The following coverages have no deductible. Details are found on the Commercial Property Coverages MEP101WA 2.1 form.
Tuition Earnings
........ ................................................................................................................................................................
Extra Expense
. .....................................................................................................................................................................
Papers and Recordings (including electronic data)
.......................................................................................................................................................................
Personal Property of Others (Non-Clergy)
....................................................... ....................... ................. .......................... ..............._....._........... ... ....
........
Personal Property of Clergy
Systems / Equipment Breakdown Coverage
DEDUCTIBLE
$1,000
................................................
$1,000
................. _ ..... _ .................
$1,000
...............................................
$1,000
........................... . ...................
$1,000
MI_P101 WA 2.1
....................................................
MEP101WA 2.1
01 WA 2.1
COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM
Systems / Equipment Breakdown Coverage Building/Personal Property Limit $1,000 MEP100WA 2.0
Additional Property Forms
FORM FORM NAME FORM FORM NAME
BCP0643 0108 Exclusion - War and Military Action CP0171 02 09 Exclusion Water Damage
....................-..................................................................................................................................................... .......... ......... ........................._............................................................. ............................................................................................................................... ................................
MCN021.0 Notice Regarding Building Valuation MEP0465WA 1.0 Amendatory Endorsement Washington
.............._........................._........................................... .......... ......... ......................................................... ................-......................................................._.._..................._.._....................._...................................
MEN2761.0 Flood Insurance Notice BCL060OX 3.0 Cert & Non-Cert Terrorism Loss
............................................................................................................_........................_............................................. ................................................................................._.......................................................................................................................................................................................
EX0651XWA 3.0 NBC Terrorism Exclusion
Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 16400 Brotherhood Way, Fort Wayne, IN 46825
ME DEC WA (12/16) "Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 3 of 8
NAMED INSURED Hanwoori Church
Brotherhood Mutual® POLICY NUMBER 46 1679
POLICY PERIOD 03/06/20106/2019 to 03/06/2022 at 12:01 a.m.
Insurance Company
Property Coverage Summary
MinistryEssentialssm commercial multi -peril policy Declarations continued...
We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according
to the terms of the designated coverage form and any other applicable forms or endorsements.
Additional Interests
NAME TYPE LOAN NUMBER INTEREST ADDRESS
None None None None
Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 16400 Brotherhood Way, Fort Wayne, IN 46825
ME DEC WA (12/16) "Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 4 of 8
• NAMED INSURED Hanwoori Church
679
Brotherhood Mutual* POLICY NUMBER 46 06/201 to
POLICY PERIOD 03/06/2019 to 03/06/2022 at 12:01 a.m.
Insurance Company
Liability Coverage Summary
MinistryEssentialssm commercial multi -peril policy Declarations continued...
For application of limits, see For application of limits, see Church Organization Commercial Liability Coverage form form (MEL101CWA 2.0).
Key Liability Coverage Facts: Schedule of Limits
GENERAL OCCURRENCE LIMIT $1,000,000
GENERAL AGGREGATE LIMIT $3,000,000
Principal Liability Coverages
COVERAGE DESCRIPTIONS
COVERAGE LIMIT
COVERAGE AGGREGATE LIMIT
FORM
Bodily Injury/Property Damage Liability (L)
........................................................................................................................................................................................................
$1,000,000*
$3,000,000*
MEL101CWA 2.0
Medical Payments (M)
......................_.........................................................................._..............................................................._....................................................................................
$5,000*+
$3,000,000*
MEL101CWA 2.0
..............................
..........................................................................................................................................................................................................._................................................................................................................................................................................._..............................................................._.........................
Products/Completed Work (N)
$1,000,000*
$3,000,000*
MEL101CWA 2.0
...........................................................................I................... ......................
Fire Legal Liability (0)
.............._............................................................................................................................................_.................................................................................
$300,000*
$900,000*
MEL101CWA 2.0
Supplemental Coverages
COVERAGE DESCRIPTIONS
COVERAGE LIMIT
COVERAGE AGGREGATE LIMIT
FORM
Incidental Contractual Liability
$1,000,000*
$3,000,000*
MEL101CWA 2.0
................................I.........................................................................................................................................._......._...........................................................................
Incidental Medical Malpractice Injury
_............................................................_..........................
$1,000,000*
............ ........................................_..................._..........._.......................................................................
$3,000,000*
MEL101CWA 2.0
....................................................................................................................................................................
Mobile Equipment
.............................................................................................................................................................................................................................................
$1,000,000*
$3,000,000*
MEL101CWA 2.0
Additional Coverages
COVERAGE DESCRIPTIONS
COVERAGE LIMIT
COVERAGE AGGREGATE LIMIT
FORM
Personal Injury Liability
$1,000,000*
$3,000,000*
MEL101CWA 2.0
...................................
Membership Emotional Injury
$1,000,000*
...................................
$3,000,00_0*.._
.2" .......
ME.L1......01CWA 2.0
Nursery Supervision
$1,000,000'
$3,000,000*
MEL101CWA 2.0
.......... .................................. ................................................ .............................................. .......................................................
Nursery Corporal Punishment
..........._.....
$1,000,000*
$3,000,000*
MEL101CWA 2.0
.............................................................................................................................................
Food Preparation Liability
........................................................................................................................................._..................._.........................._.._....................................................
$1,000,000'
$3,000,000*
MEL101CWA 2.0
.................................................................................................................
Damage to Property of Others
.............................................................................................................................................................._...._.._............................................................
MEL101CWA 2.0
Not in Your Control
$1,000*+
$3,000,000*
MEL101CWA 2b
................i........................................._......_......................................-..__.............................................._............_.__........................................._..._.._.._.._...__.....
In Your Control
. ........................................................................................................................................................................
$2,500*+
$3,000,000*
MEL101CWA 2.0
........................................................................................................................................................................
.....................................................................................................................................
Prosthetic Devices
..........................................................................................................................................................................................._......................_......_.
$500*+
$3,000,000*
MEL101CWA 2.6
_...
Incidental Camper *Me'dical
.............................................
$5,000* +
$3,000,000*
..................................................................................................._.__....._._...__........_.......
MEL101CWA 2.0
Nonowned Property Damage Liabilitv
MEL101CWA 2.0
Rea
Property
Defense Coverage
E
Applies in addition to the liability limit unless otherwise specifically stated in an applicable coverage form.
* Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit.
+per person limit
Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 16400 Brotherhood Way, Fort Wayne, IN 46825
ME DEC WA (12/16) "Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 5 of 8
NAMED INSURED Hanwoori Church
679
Brotherhood Mutual* POLICY NUMBER 46 06/201 to
POLICY PERIOD 03/06/2019 to 03/06/2022 at 12:01 a.m.
Insurance Company
Liability Coverage Summary
MinistryEssentialssm commercial multi -peril policy Declarations continued...
For application of limits, see For application of limits, see Church Organization Commercial Liability Coverage form form (MEL101CWA 2.0).
Related Operations Coverage
COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM
None None None None
Sexual Acts Liability Coverage
COVERAGE DESCRIPTIONS
COVERAGE LIMIT
COVERAGE AGGREGATE LIMIT
FORM
Sexual Acts Coverage
$100,000*
$100,000*
MCL611 2.0
Sexual Harassment Liability Coverage (other than your
$100,000*
$10'0,000*
MCL611 2.0
employees)
......................................................................................................................................................................
_..... ...................................................
............................. ......................
Improper Reporting of Sexual Acts Liability Coverage
......................................................................................................................................................................................................
............ .......................... ..................................................
$100,000*
.............................................. .... ....... ........ ......... ........ ...............
$100,000*
MCL611 2.0
Improper Supervision of Convicted Sexual Offenders
$100,000*
$100,000*
MCL611 2.0
Outside Counseling Reimbursement Coverage
............................................................................................................................................................
Sexual Acts Medical Payments Extension
Defense Coverage: Alleged Perpetrator
..............................................................................................................................................................
Image Restoration Extension
(in addition to Limit)
...........................................................
$10,000'
Sexual Harassment Liability Coverage (Employees)
COVERAGE DESCRIPTIONS
Sexual Harassment/Sexual Acts Liability Coverage
(Employment Related)
Counseling Acts Professional Liability Coverage
COVERAGE DESCRIPTIONS
Counseling Acts Liability Cc%
Incidental Counseling Liabilit
................................................................................................
Outside Counseling Reimbur
ent
Religious Freedom Coverage
COVERAGE LIMIT
$100,000*
COVERAGE LIMIT
$500,000*
00,000*
$100,000*
$100,000*
.................................. ........................
addition to Limit)
............................................................
S100.000*
COVERAGE AGGREGATE LIMIT
$100,000*
COVERAGE AGGREGATE LIMIT
$1,500,000*
MCL611 2.0
......................................
MCL611 2.0
FORM
MCL612 2.0
FORM
MCL631 2.0
COVERAGE DESCRIPTIONS
COVERAGE LIMIT
COVERAGE AGGREGATE LIMIT
FORM
Religious Communication Liability Coverage
$500,000*
$1,500,000*
MCL661WA 1.0
Religious Activity Liability Coverage
$500,000*
$1,500,000*
MCL661WA 1.0
Discriminatory Acts Liability Coverage
$500,000*
$1,500,000*
MCL661WA 1.0
.........................................
Tax Exempt Challenge: Reimbursement Coverage
$25,000*
$25,000*
MCL661WA 1.0
Litigation Activity: Legal Defense Reimbursement
See form
See form
MCL661WA 1.0
Coverage
Litigation Activity: Declaratory Action Reimbursement
See form
See form
MCL661WA 1.0
Coverage
* Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit.
+ per person limit
Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333,3735 I 6400 Brotherhood Way, Fort Wayne, IN 46825
ME DEC WA (12/16) "Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 6 of 8
• NAMED INSURED Hanwoori Church
POLICY NUMBER 46 1679
Brotherhood Mutual®
POLICY PERIOD 03/06/20106/2019 to 03/06/2022 at 12:01 a.m.
Insurance Company
Liability Coverage Summary
MinistryEssentialssm commercial multi -peril policy Declarations continued...
For application of limits, see For application of limits, see Church Organization Commercial Liability Coverage form form (MEL101CWA 2.0).
Nonowned Vehicle Coverage
COVERAGE DESCRIPTIONS
COVERAGE LIMIT
COVERAGE AGGREGATE LIMIT
FORM
Nonowned Vehicle Liability Coverage
$500,000*
$1,500,000'
MEL711WA 2.0
.............................................................................................................................
...................................................................................................................................
Defense Coverage: Authorized Operator
(In addition to Limit)
..........................................................................................................................._....................................................................................
Rental Vehicle Physical Damage Coverage
$60,000*
.................................................
$120,000*
MEL711WA 2.0
..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................._..........
Loss of Use Coverage
$2,000*
$6,000*
MEL711WA 2.0
........................................................................................................................................................
Trip Occupant Coverage
$1,000.+
..........................................................................................................................................................................
$10,000*
MEL711WA 2.0
Damage to Property of Others Coverage
$1,000*+
$3,000*
MEL711 WA 2.0
.................................................................................................................................................................................................................$*1'....................................................................................................................................
Nonowned Vehicle Deductible Reimbursement Coverage
$1,000*+
.
$3,000*
MEL711WA 2.0
Directors and Officers Liability Coverage
COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM
Director and Officers Liability Coverage $1,000,000* $3,000,000* MCL811 2.0
Computer -Related Liability Coverage
COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM
Computer Use Liability Coverage $500,000* $1,500,000* MCL8791.0
................................................................................................................................................................................ ................................................................ ......._....._._._....._.... _.._....
Electronic Commerce Liability Coverage $500,000* $1,500,000* MCL8791.0
...................................................._....._._._._...................._._................................................................................................_.._..._.__...._.........__....._............_._.._.........._..._........_....
Comouter Suoervision Liabilitv Coverage %500.000* SI.500.000* MCL8791.0
Worldwide Liability Extension
COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM
Limited Worldwide Kidnap and Extortion Expense See form See form MCL111T 1.0
Reimbursement Coverage
.................................................................................................................................................................._.... ........... ..... ...... ........................... ..................
Expanded Medical Coverage for Short -Term Foreign Trip See form See form MCL111T 1.0
Participants
High Hazard Activities
For details regarding how these coverage limits will apply, see the How Much We Pay section of the High Hazard Activities Coverage Limits Form.
ACTIVITY DESCRIPTION
MEDICAL LIMIT
OCCURRENCE LIMIT
COVERAGE AGGREGATE LIMIT
FORM
Skate Park Operations
$0 per person
$100,000*
$300,000*
MCL121 2.0
........................................................_...............................................................................................................
Fireworks Sales
$0 per person
$100,000*
........................................................................................................................................._...._..._.._....._....._.._......_..
$300,000*
MCL121 2.0
..........................................................................._..............................._.................................
Fireworks Display
............................................................................................................................................
$0 per person
$100,000*
.............................................._....................................................................................
$300,000*
MCL121 2.0
Construction Oversight
$0 per person
$100,000*
............................................._....................................................................................
$300,000*
MCL121 2.0
* Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit.
+ per person limit
Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 16400 Brotherhood Way, Fort Wayne, IN 46825
ME DEC WA (12/16) "Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 7 of 8
NAMED INSURED Hanwoori Church
Brotherhood Mutual® POLICY NUMBER 46 1679
POLICY PERIOD 03/06/20106/2019 to 03/06/2022 at 12:01 a.m.
Insurance Company
Liability Coverage Summary
MinistryEssentialssm commercial multi -peril policy Declarations continued...
For application of limits, see For application of limits, see Church Organization Commercial Liability Coverage form form (MEL101CWA 2.0).
Other Liability and Medical Forms
FORM
FORM NAME
EX9091.0
.................................................................................._.......................................................
Asbestos Exposure Exclusion
GL095012 99
............... .......................................... ..........................._.....
___ ......................................................... ..... .... .......................... ...................
Known Injury or Damage Amendments
........... _.............................-.............
MEL0368CWA 1.0
....................... _..................................................................................
Amendatory Endorsement
.........................................................................._........................................................................................_................................................................................
BGL0250X 3.1
Cert and Non-Cert Terrorism Loss
Additional Insureds
NAME LOAN/REFERENCE NUMBER
Brook Lake Community Center,
Additional Insured
Related Organizations/Operations
The following entities are insured for designated related Coverages.
NAME
None
Schedule of Liability Exposures
FORM
FORM NAME
GLO163 0108
Exclusion War and Military Action ......
.........................................................................................
GL8901.0
_................................................................................... _....... ..................... ........................
Lead Liability Exclusion
MEL0368WA 1.0
Amendatory Endorsement
..........................
EX0281XWA 3.1
.......................... ......_....................................................................................................._....._..................................
NBC Terrorism Exclusion
INTEREST
Other. Brook Lake Community
Center
MINISTRY TYPE
None
ADDRESS
726 S 356th St Federal Way, WA 98003-8612
ADDRESS
None
In issuing this policy, we have relied on material information provided to us by the Named Insured. The following schedule discloses all of the
insured's insurable exposures (as conveyed by the Named Insured) known to exist at the policy inception date. Declared premises must be owned,
occupied, or rented by you or your scheduled related organizations.
EXPOSURE DESCRIPTIONS BI/PD RATE MED RATE
Church 726 S 356th St Federal Way, WA 98003-8612 2.25500 1.05000
.... ................... ..... ... ......... ................... ............_............................._............................ .......... ........
Playgrounds 726 S 356th St Federal Way, WA 98003-8612 47.00700 5.34100
' Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit.
+ per person limit
Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 16400 Brotherhood Way, Fort Wayne, IN 46825
ME DEC WA (12/16) "Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 8 of 8
Brotherhood Mutual*
Insurance Company
Dear Policyholder:
INSURED NAME: Hanwoori Church
POLICY NUMBER: 46MAA0421679
AGENCY NAME: Basin Insurance Associates Inc
AGENCY NUMBER: 4602-006
DATE: 01/29/2019
The purpose of this letter is to inform you that one or more changes will take effect on 03/06/2019, the renewal of your
ministry policy.
In some cases, the effects of these policy changes will mean enhanced coverage, while in other cases, limits, conditions,
exclusions, and limitations may narrow the scope of certain coverages when compared to your prior policy. Following are the
names of the coverage forms that have either been added or removed from your policy.** Please review your declarations
page for changes in the policy values, deductibles, and premium.
NEW FORMS
MCN01 1.0 Notice To Our Policyholders Policy Change At Renewal
MCL111T 1.0 Worldwide Liability and Medical Extension
MCL661WA 1.0 Religious Freedom Protection Coverage
MEL0368WA 1.0 Amendatory Endorsement
REPLACEMENT FORMS
MCP137WA 2.0
Ministry Personnel Dishonesty Coverage
MEP101WA 2.1
Church Organization Commercial Property Coverage Part
MCL121 2.0
Coverage Limits High Hazard Activities
MEP100WA 2.0
Systems / Equipment Breakdown Coverage
MEL101CWA 2.0
Church Organization Commercial Liability Coverage
MCL631 2.0
Counseling Acts Professional Liability Coverage
MEL711WA 2.0
Non -owned Vehicle Coverage
MCL611 2.0
Sexual Acts Liability Coverage
MCL811 2.0
Directors and Officers Liability Coverage
MCL612 2.0
Sexual Acts Liability Coverage Extension
DELETED FORMS
MCL651 1.0
Religious Communication and Religious Activity Liability Coverage
GL0368 0310
Amendatory Endorsement Washington
MCL6671.0
Discriminatory Acts Liability Coverage
Please read your policy carefully.
Your Brotherhood Mutual agent will be pleased to address any questions you may have concerning your policy. You may
contact your agent at 206-801-3401. If you have any questions, you may contact our customer service department at
1-800-333-3735. Thank you for trusting us with your ministry.
**NOTE: No coverage of any kind is provided by this notice. This Summary of Important Changes does not in any way replace any provision of your policy, nor is
every change in your policy listed above. All insurance coverage is subject to conditions, coverage limits, limitations, and exclusions. For precise details ofcoverage,
please refer to your actual policy. While our company's goal is to provide ongoing insurance protection to ministry organizations, changes in company operations,
the regulatory or insurance environment, or significant loss experience can result in policy revision or policy termination.
Administrative Form INCHGI, August 2015 Page 1 of 1
RETURN TO: n 16 2 1, -_-s EXT:
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
1.
ORIGINATING DEPT./DIV: PARKS/BROOKLAKE
2.
ORIGINATING STAFF PERSON: ROB E EXT: 2002 3. DATE REQ. BY:
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
X CONTRACT AMENDMENT (AG#):14-116_ ❑ INTERLOCAL
❑ OTHER
5.
PROJECT NAME: HANWOORI CHURCH LEASE
6.
NAME OF CONTRACTOR: HANWOORI CHURCH
ADDRESS: TELEPHONE
E-MAIL: FAX:
SIGNATURE NAME: CHU NAM SONG TITLE PASTOR
7.
EXHIBITS AND ATTACHMENTS: ❑ 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: _6/l/15 COMPLETION DATE: 5/31/19
9.
TOTAL COMPENSATION $1,5Q&ftW_-N@*I H "d (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 ❑ NO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY
RETAINAGE: RETAINAGE AMOUNT: ❑ RETAINAGE BY (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDED
❑ PURCHASING: PLEASE CHARGE TO: _They pay us
10.
DOCUMENT/CONTRACT REVIEW INITIAL / DATE REVIEWED INITIAL / DATE APPROVED
❑ PROJECT MANAGER
❑ DIRECTOR
❑ RISK MANAGEMENT (IF APPLICABLE)
❑ LAW
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
INITIAL / DATE SIGNED
❑ LAW DEPARTMENT lit..
❑ CHIEF OF STAFF
LI-RGNATORY (MAYOR OR DIRECTOR)
❑ CITY CLERK Z
❑ ASSIGNED AG# AGE#
❑ SIGNED COPY RETURNED DATE SENT:
COMMENTS:
` CITY OF CITY HALL
Fe d e ra I Way Feder 8th Avenue South
Federal Way. WA 98003-6325
(253) 835-7000
www cayoffederalway com
AMENDMENT NO.2
TO
LEASE AGREEMENT
FOR
HANWOORI CHURCH RENTAL AT BROOKLAKE
This Amendment ("Amendment No. 2") is made between the City of Federal Way, a Washington municipal
corporation ("City"), and HANWOORI Church, a Washington non-profit corporation ("Lessee"). The City and
Contractor (together "Parties"), for valuable consideration and by mutual consent of the Parties, agree to amend the
original Agreement for leasing of the Brooklake Chapel and office space ("Agreement") dated effective June 11,
2014, as amended by Amendment No. 1, as follows:
1. AMENDED TERM. Pursuant to Section 2 of the Lease Agreement, the Lease shall be renewed for an
additional three (3) year term commencing on June 1, 2016, and terminating on May 31, 2019.
2. GENERAL PROVISIONS. All other terms and provisions of the Agreement, together with any prior
amendments thereto, not modified by this Amendment, shall remain in full force and effect. Any and all acts done by
either Party consistent with the authority of the Agreement, together with any prior amendments thereto, after the
previous expiration date and prior to the effective date of this Amendment, are hereby ratified as having been
performed under the Agreement, as modified by any prior amendments, as it existed prior to this Amendment. The
provisions of Section 13 of the Agreement shall apply to and govern this Amendment. The Parties whose names
appear below swear under penalty of perjury that they are authorized to enter into this Amendment, which is binding
on the parties of this contract.
[Signature page follows]
AMENDMENT - 1 - 1 /2015
` CITY OF CITY HALL
Federal Way Feder 8th Avenue South
Federal Way. WA 98003-6325
(253) 835-7000
www cayoffederalway com
IN WITNESS, the Parties execute this Agreement below, effective the last date written below.
CITY OF FEDERAL WAY
By:
Ji erre 1, Mayor
DATE:
HANWOORI CH CH
By:
Chu Nidn Song, Pas or
DATE: :,live ZZ �j f / b
STATE OF WASHINGTON )
� ) ss.
COUNTY OF , ,—c
ATTEST:
(ilk dierk, Stephanie Courtnj , C C
APPROVED AS TO FORM:
City Attorney, Amy Jo Pearsall
On this day personally appeared before me Chu Nam Song, to me known to be the Pastor of Hanwoori Church that
executed the foregoing instrument, and acknowledged the said instrument to be the free and voluntary act and deed
of said corporation, for the uses and purposes therein mentioned, and on oath stated that he/she was authorized to
execute said instrument and that the seal affixed, if any, is the corporate seal of said corporation.
GIVEN my hand and official seal this 13 day of - 1Ane 20/K
J U N
�ssion'F
0
: U NOTAR),
PUBLIC
AS
'WN\
Notary's signature
Notary's printed name Tixn , �t
Notary Public in and for the State of Washington.
My commission expires I )
AMENDMENT - 2 - 1/2015
Brotherhood Mutual'
Insurance Company
MinistryEssentials" Commercial Multi -Peril,
Insurance Coverage Summary
These are your policy's Declarations.
Renewal of 46MAA0421679
HANWOORI CHURCH
726 S 356th St
Federal Way, WA 98003-8612
NAMED INSURED
HANWOORI CHURCH
POLICY NUMBER
46MAA0421679
POLICY PERIOD
3/6/2016 to 3/6/2019 at 12:01 a.m.
Key Facts About Your Policy
These Declarations replace your previous ones. Your policy's Declarations contain a summary of the coverage contained in the insurance policy.
Your policy contains a full explanation of your coverage.
AGREEMENT: In return for the payment of the premium and subject to all the terms of the policy, we agree to provide the insurance stated in the policy.
TYPE OF ORGANIZATION Church Institution
FORM OF ORGANIZATION Corporation
6 GROUP PARTICIPATION None
Policy Overview
COVERAGE DESCRIPTION DETAILS
COVERAGE DESCRIPTION
DETAILS
Property Coverage Page 2 - 4
Terrorism Coverage
See Notice Form MCN6ADXWA 1.0 for Details
Liability Coverage Page 5 - 8
Terrorism Premium
$0
Policy Premium Overview
ANNUAL PREMIUM $889.00
PAYMENT SCHEDULE
Annual
This premium is subject to adjustment at each anniversary.
Common Policy Forms
FORM FORM NAME
FORM
FORM NAME
CLO103 0310 Common Policy Conditions Washington CL3001.0
Amendatory Endorsement
.............................................................................................
MCN01 1.0 Notice: PolicyChange At Renewal
.............................................................................................................
MCN11A 1.1
Notice Value -Added Benefits
Y.....................................................
BCL966WA 1.0 Additional Polic Definition
............................................................................................................
BN1B 1.0
Notice Of Payment -Related Charges
BCL100WA 1.1 Additional Policy Conditions
.......................................................................I........................
G13210 06
Notice To Policyholders
g........................................................
MENO11.0 Notice Covera a Information
.............................................................................................................
MEN021.0
Notice Mid .Term Changes in Exposure
.........I............................
MCN6ADXWA 1.0 Notice Terrorism -Related Loss
................. .
Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227
..............................................................................................................................................................................................................................................................................
ME DEC WA (09/11) "Bear ye one another's burdens and so fulfill the law of Christ"— Galatians 6:2 Page 1 of 8
NAMED INSURED HANWOORI CHURCH
Brotherhood Mutual* POLICY NUMBER 3/6/2 16 to 3 6
POLICY PERIOD 3/6/2016 to 3/6/2019
Insurance Company
Property Coverage Summary
MinistryEssentials"" commercial multi -peril policy Declarations continued...
We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according
to the terms of the designated coverage form and any other applicable forms or endorsements.
Property Coverage Details
PROPERTY DEDUC7'3Ls . $1,000
GLASS DEDUCTIBLE $1,000
Schedule of Locations
LOCATION # DESCRIPTION ADDRESS
0101 Church 726 S 356th St Federal Way, WA 98003-8612
Schedule of Buildings and Personal Property
COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE VALUATION TYPE PERIL TYPE FORM
Personal Property $54,500 Waived Replacement Cost Special with Theft MEP101WA 1.2
11
Schedule of Optional Coverages: All Locations
COVERAGE DESCRIPTION
Employee Dishonesty Coverage
Worldwide Personal Property Coverage
COVERAGE LIMIT DEDUCTIBLE FORM
$5,000 MCP137WA 1.1
..............................................................................................................................................
$5,000 $500
Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227
...............................................................................................................................................................................................................................................................................
ME DEC WA (09/11) 'Bear ye one another's burdens and so fulfill the law of Christ"— Galatians 6:2 Page 2 of 8
NAMED INSURED HANWOORI CHURCH
Brotherhood 79
Mutual' POLICY NUMBER 46M2016 to /6
POLICY PERIOD 3/6/2016 to 3/6/2019
Insurance Company
Property Coverage Summary
MinistryEssentialss' commercial multi -peril policy Declarations continued...
We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according
to the terms of the designated coverage form and any other applicable forms or endorsements.
Schedule of Supplemental Coverages: All Locations
The policy's property deductible applies to each of these coverages.
Details are found on the Commercial Property Coverages MEP101WA 1.2 form.
COVERAGE DESCRIPTION
COVERAGE LIMIT
DEDUCTIBLE
FORM
Property Off Premises (180 days or less)
...........................................................................................................................................................................................................................................................
$2,500/$25,000 Total
$1,000
MEP101WA 1.2
Within Territorial Limits
....................................................................................................................................................................................................................................................................
$25,000
$1,000
MEP101WA 1.2
Inte..... inept
...................................................................................................................................................................................................................................
$2,500/item, $25,000 Total
$1,000
MEP101WA 1.2
Owned Personal Property. Parsonage
.....................................................................................................................................................................................................................................................................
$2,500
$1,000
MEP101WA 1.2
Building & Personal Property - Newly Acquired or Constructed
.......................................................................................................................
$500,000
$1,000
MEP101WA Y.
Outside Objects and Structures
.............................................:.....................................................................................................................................................................................................................
.............................................................................................................................................
$10,000/category, $15,000 Total
$1,000
MEP101WA 1.2
For any one tree, shrub, or plant
................................................................................................................................................................................................................................................
$500
$1,000
MEP101WA 1.2
Each loss caused by wind
...............................................................................................................................................................................................................................
$2,500
$1,000
MEP101WA 1.2
Contents of Other Structures
$10 000
$1,000
MEP101WA 1.2
Dwellings Private Structures -Personal Property
5 /o of Building Limit
$1,000
MEP101WA 1.2
Dwellings -Private Structures -Appurtenant Structures
............................................................................................................................................................
.....o....................................................................................................................
10 /o of Building
$1,000
MEP101WA 1.2
Contents Buildings &Structures Described on the Declarations
,...................................................................................................
$10000.....
$1,000
MEP101WA 1.2
hedule of Additional Coverages: All Locations
The policy's property deductible applies to each of these coverages.
Details are found on the Commercial Property Coverages MEP101WA 1.2 form.
COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE
Money and Securities (Other than Theft) $5,000 $1,000
.........................................................................................................
foodSpoilage.........................................................................................................................................................
$5,000 .... $1.00........................................................................................................................................................................................................................
Damage Caused by Animals $2,500 $1,000
..................................................................................................................................................................................................................................................................
Water Damage (including flood, surface water) $2,500 $1,000
.............................................................................................................................................................................................................................................
Interior Building $25,000 $1,000
..........................................................................................................
Backup of Sewer and Drain $5,000 1,000
Brotherhood Mutual Insurance Company I www,brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227
..............................................................................................................................................................................................................................................................................
ME DEC WA (09/11) "Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 3 of 8
NAMED INSURED HANWOORI CHURCH
Brotherhood Mutual79
* POLICY NUMBER 46M2016 to /6
POLICY PERIOD 3/6/2016 to 3/6/2019
Insurance Company
Property Coverage Summary
MinistryEssentials" commercial multi -peril policy Declarations continued...
We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according
to the terms of the designated coverage form and any other applicable forms or endorsements.
Schedule of Additional Coverages: All Locations,
The following coversages have no deductible. Details are found on the Commercial Property Coverages MEP101WA 1.2 form.
COVERAGE DESCRIPTION
COVERAGE LIMIT
FORM
Debris Removal Expense - Partial toss
Remaining Building Limit
MEP101WA 1.2
Debris Removal Expense Total Loss
.......D...........epartment............
..........................................................................................
.. 10,000
MEP101WA 1.2
S.e...rvi...c..e...C........................................................................................................................................................$................................................................
Fire harges
..........................................................................................................................................................................g
25,000
MEP101 WA 1.2
Pollutant Clean Up &Removal
................................................................................................................................................................................................................................................................
....Y.............P..................................................."A"1....
$10,000/loss, $10,000/premises Burin an 12 mth eriod
MEP101WA 1.2
Theft.. Vandalism Reward
.....tall...................................................................................................
Less of $5,000 or the theft/vandalism loss amount
MEP101WA 1.2
Installed Lock Recalibration .
.............................................:......................................................................................................................................................................................................................
.................................................................................................................................
$5,000
MEP101WA 1.2
Arson Reward
..............................................................................................................................................................................................................................................................."...
Lesser of $15,000 or the arson loss amount
MEP101WA 1.2
Tuition Earnings
................................................................................................................................................................................................................................................:...................
$2,500
MEP101WA..2
Extra Expense
....................................................................................................................................................................................................................................................................
$25,000
MEP101WA 1.2
Papers and Recordings (including electronic data)
...........................................................................................
$25,000
MEP101WA 1.2
Personal Pro e
p rty of Others (Non Clergy)
...........................................................................................................................................................................$.........................................................
...............................................................................................................
$1,000 per person,$2,000 a re ate
MEP101WA 1.2
Personal Property of Clergy
$5,000
MEP701WA 1.2
Systems / Equipment Breakdown Coverage
COVERAGE DESCRIPTION
Systems / Equipment Breakdown Coverage
Additional Property Forms
FORM
FORM NAME
BCP0643 0108
........................
Exclusion - War and Military Action
MCN021:0
...............................
Notice Regarding Building Valuation
....................................................
MEN27B 1.0
...................................................................................................
Flood Insurance Notice
BCL0600X 3.0
Cert & Non Cert Terrorism Loss
Additional Interests
ORGANIZATION
None
LOAN #
None
COVERAGE LIMIT
DEDUCTIBLE
FORM,
Building/Personal Property Limit
$1,000
MEP100WA 1.1
FORM
FORM NAME
CP0171 02 09
...... ....... ....
Exclusion Water Damage
..............................................................................................
MEP0465WA 1.0
.....................................................................P..........................................................
Amendatory Endorsement Washington
BN1001.0
Notice Boiler Inspections
....................................................................................................................
EX0651XWA 3.0
NBC Terrorism Exclusion
INTEREST
None
ADDRESS
None
14
Brotherhood Mutual Insurance Company I www.brotherhoodmutuaI.com I 800.333.3735 1 P.O. Box 2227, Fort Wayne, IN 46801-2227
..................................................................................................................................................................................................................................................
NAP r)F(' XA/A ((1Q/11) "Roar — — a +ho: ti—A.— ter,+. E it;n tk- 1,. ..c r .:.11 i _i_.:--- I.-,
NAMED INSURED HANWOORI CHURCH
Brotherhood MON' POLICY NUMBER 46Mto /6
POLICY PERIOD 3/6/2016 2016 to 3/6/2079
Insurance Company
Pability Coverage Summary
MinistryEssentialssm commercial multi peril policy Declarations con't•inued...
The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability
coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifi cally stated within a coverage form or endorsement
represents the most we will pay for the coverage to which such a limit applies. For application of limits, [see Liability and Medical Coverage form (MEL101CWA
1.1)].
Key Liability Coverage Facts: Schedule of Limits,
GENERAL OCCURRENCE. LIMIT $1,000,000
GENERAL AGGREGATE LIMIT $3,000,000
Principle Liability Coverages
COVERAGE DESCRIPTIONS
COVERAGE LIMIT
COVERAGE AGGREGATE LIMIT
FORM
Bodily Injury/Property Damage Liability (L)
$1,000,000*
$3,000,000*
MEL101CWA 1.1
............................................................................
........................................................................................................................................................................."*""'1
Medical Payments (M)
$5,000*+
$3,000,000*
MEL101CWA 1.1
............Products/Completed Work (N)
.......................................................................................................................................................................................................................................................
$1,000,000*
$3,000,000*
MEL101CWA 1.1
Fire Legal Liabi..lity (0)
$300,000*
$900,000*
MEL101CWA 1.1
Supplemental Coverages
COVERAGE DESCRIPTIONS
COVERAGE LIMIT
COVERAGE AGGREGATE LIMIT
FORM
Incidental Contractual Liability
$1,000,000*
$3,000,000*
MEL101CWA 1.1
...............................................................................................................................................................................................................................................................
Incidental Medical Malpractice
$1,000,000*
$3,000,000*
MEL101CWA 1.1
.obil...........................................................................................................................................................................................................................................................
Mobile Equipment
$1,000,000*
$3,000,000*
MEL101CWA 1.1
Additional Coverages
COVERAGE DESCRIPTIONS
Personal Injury Liability
......................................................................................
Membership Emotional Injury
......................................................................................
Nursery Supervision
......................................................................................
Nursery Corporal Punishment
......................................................................................
Food Preparation Liability
......................................................................................
Damage to Property of Others
.......................................................................................
Not Your Control
.................... in ...................................................................
In Your Control
.....................................................................................
Prosthetic Devices
......................................................................................
Incidental Camper Medical
......................................................................................
Nonowned Property Damage Liability
.......................................................................................
Real Property
....................... ...................................... I .....................
,...
Personal Property
Defense Coverage
COVERAGE LIMIT
COVERAGE AGGREGATE LIMIT
FORM
$1,000,000*
.............................................................................................................................................................................
$3,000,000*
MEL101CWA 1.1
$1'000,000*
$3,000,000*
MEE101CWA 1.1
:....................
.......................... ..............................................................................................................................
$1,000,000*
$3,000,000*
MEL101CWA 1.1
.............................................................................................................................................................................
$1,000,000*
$3,000,000*
MEL101CWA 1.1
.............................................................................................................................................................................
$1,000,000*
..............................................................................................................................................................................
$3,000,000*
MEL101CWA .1
.............................................................................................................................................................................
$1,000*+
$3,000,000*
MEL101CWA 1.1
.............................................................................................................................................................................
$2 500*+
$3.000,000*
MEL101CWA 1.1
......................................................................................................
$500*+
$3,000,000*
. .
MEL101CWA 1.1
.............................................................................................................................................................................
$5,000*+
.......................................................................................................................................................................I.....
$3,000,000*
MEL101CWA 1.1
$1,000,000*
.............................................................................................................................................................................
MEL101CWA 1.1
$300,000*
$3,000,000*
MEL101CWA 1.1
...........................................................................................................................................................................
$10,000*
$3,000,000*
MEL101CWA 1.1
Applies in addition to the liability limit unless otherwise specifically stated in an applicable coverage form.
Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit.
per person limit
Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227
..............................................................................................................................................................................................................................................................................
ME DEC WA (09/11) "Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 5 of 8
NAMED INSURED HANWOORI CHURCH
POLICY NUMBER 46MAA0421679
Brotherhood Mutual® POLICY PERIOD 3/6/2016 to 3/6/2019
Insurance company
Liability Coverage Summary
MinistryEssentialssm commercial multi -peril policy Declarations continued...
The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability
coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifi cally stated within a coverage form or endorsement
represents the most we will pay for the coverage to which such a limit applies. For application of limits, [see Liability and Medical Coverage form (MEL101CWA
1.1)].
Related Operations Coverage
i
COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM
None None
None
None
Sexual Acts Liability Coverage
COVERAGE LIMIT
COVERAGE AGGREGATE LIMIT
FORM
COVERAGE DESCRIPTIONS
$100,000*
$100,000*
MCL6111.0
Sexual Acts Coverage.....................................................i...............................................................$100,000t......................MCL6111.0
...............
Sexual Harassment Liability Coverage (other than your
$ 00,000
employees) ..............................................................................................................................................$100A00*.....................................:...
.,
Improper Reporting of Sexual Acts LiabilityCoverage ..............................................
.........................................................................................................MCL6111.0
Improper Supervision of Convicted Sexual Offenders
$
Liability Coverage.................................................................................+...............................................-$100.000'......................MCL6111.0
.....................................................................
Coverage
$5,000*
Outside Counseling Reimbursement ......................................................................................................................................................................................0
............................................................................
$100,000*
MCL6111.0
Sexual Acts Medical Payments Extension
................................................................. .....................................................:...a
(in addition to Limit)
:.........................................................................
(m addition to Limit)
MCL6111.0
Defense Coverage: Alleged Perpetrator
Sexual Harassment Liability Coverage (Employees)
COVERAGE DESCRIPTIONS COVERAGE LIMIT
Sexual Harassment/Sexual Acts Liability Coverage $100,000*
(Employment Related)
Counseling Acts Professional Liability Coverage
COVERAGE DESCRIPTIONS COVERAGE LIMIT
Counseling Acts Liability Coverage (Pastors and Trained $500,000*
Lay Counselors)
Incidental Counseling Liability Coverage (Lay Advisors) $500,000*
............................................................
.................. $5,000*+
Outside Counseling Reimbursement Coverage
Religious Communication and Religious Activity Liability Coverage
COVERAGE DESCRIPTIONS COVERAGE LIMIT
Religious Communications Liability Coverage $500.000*
........................................................................................................ $500,000*
Religious Activity Liability Coverage
Discriminatory Acts Liability Coverage
COVERAGE DESCRIPTIONS
Discriminatory Acts Liability Coverage
COVERAGE AGGREGATE LIMIT
FORM'
$100,000*
MCL6121.0
COVERAGE AGGREGATE LIMIT
FORM
$1,500,000*
MCL6311.0
................................................................................................
$1 S00 000*
MCL63110
.......................................100,000*
MCL6311.0
COVERAGE AGGREGATE LIMIT FORM
................................$1:500,000`..................... MCL651 1.0
$1,500,000* MCL6511.0
COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM
$500,000* $1,500,000* MCL6671.0
* Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit.
+ per person limit
Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227
......................................................................................
NAMED INSURED HANWOORI CHURCH
POLICY NUMBER 46MAA0421679
Brotherhood Mutual* POLICY PERIOD 3/6/2016 to 3/6/2019
12 Insurance Company
iability Coverage Summary
MinistryEssentia/s` Commercial multi -peril policy I Dedarations contibued...
The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability
coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifi cally stated within a coverage form or endorsement
represents the most we will pay for the coverage to which such a limit applies. For application of limits, [see Liability and Medical Coverage form (MEL101CWA
1.1)].
Nonowned Vehicle Coverage
COVERAGE DESCRIPTIONS
Nonowned Vehicle Liability Coverage
COVERAGE LIMIT
COVERAGE AGGREGATE LIMIT
FORM
Ne*Wr;� ... E ................................ .................................... I ..........................................................................
overage: Authorize Operator
$500,000*
$11,56_00u
I ............................... I ...............................................
MEL711WA 1.0
; ..................
............ ...
RentalVe�i'c*i*e***P**h**y**s'i'c'a**I***D"a*'*m*'a,*g**e***C,-*o,*v*e"r"a**g"e ... .......................................................................................................................................................
(in addition to Limit)
...................................................
(in addition to Limit)
MEL711WA 1.0
Loss of Use Coverage ' '...... ...............................
$ - 60 - , - 00 - 0
$12 0, 00 0*
MEL711WA 1.0
................................................................................................................ ....................................................................................................................................................
Trip Occupant overage
$2,000*
$6,000*
MEL711WA 1.0
22MMq.E ...................................................................................................................................
�.��2perty of Others Comm
$.l..,.O ... 0..0..* .........................................................
$.1.0.40_0 ... 0 .....................
M ... E..L.7.1.1 ... W .... A.1 ... 0..
..................................................
Nonowned Ve��i'c'l**e*"D'*e"d'*u**'c*t'i'b*l'*e'**R*'e'imbursement Coverage
$1,000*+
.................... ...................
$3,000*
I .................................. ................
MEL711WA 1.0
.
I
��CE�Tiw;k 1.0
Directors and Officers Liability Coverage
COVERAGE DESCRIPTIONS
Director and Officers Liability Coverage
Computer -Related Liability Coverage
COVERAGE LIMIT COVERAGE AGGREGATE LIMIT I FORM
$1,000,000* $3,000,000* MCL811 1.0
COVERAGE DESCRIPTIONS
Computer Use Liability Coverage
COVERAGE LIMIT
COVERAGE AGGREGATE LIMIT
FORM
'E,*(i��i'*�:***��r.��;���**'E-***�'i*'**,*.*,**-,*,* ... ***** ....... ....................................
.......... 2..!S ................. it Coverage
... y ..................... I ..................................................................................................
$500,000*
. . .
��&5,666; ...............................
$1,500,000*
MCL879 1.0
r
Computer Supervision Liability Coverage
$500,000*
......................................................................................
$1,500,000-
MCL879 1.0
High Hazard Activities
For details regarding how these coverage limits will apply, see the How Much We Pay section of the High Hazard Activities Coverage Limits Form (BGL-21)
ACTIVITY DESCRIPTION
Skate k Operations
MEDICAL LIMIT
OCCURRENCE LIMIT
COVERAGE AGGREGATE LIMIT
FORM
* ............... $0 per person
Firework
..... ............ $100,000*
$300,000*
. ...................
MCL121 1.0
. .. . ....... ................................................................ per person
........ ........................................................................................................................................................................ f�n��s Display $0
..................... RKPam
'h"i
$1.00'.000*
izd, 665;.
$300,.000*
MCL121
Construction i
....................................
$0 per person
�im,6676� .................................................
��66,666 ;� ......................
1.0
. . .
i.6
Other Liability and Medical Forms
FORM
FORM NAME
EX909 1.0 .............
AsbestosExclusion
.Exposure **W11a1s1*h*1i n ...........
Endorsement gt o n
a Liability Exclusion
...............................................
BGL025OX 3.1.............................................
C e r ron s m os s ..........................
FORM FORM NAME
GL0163 0108 Exclusion War and Military Action
...........................................................................................................................
.G.LO.95O..1.2.99 ........... Known Injury or Damage Amendments
.. ... ...... .. .... ...... ......... MEL0368CWA 1.0 Amendatory Endorsement
'ff�0* 2*81**XW** ... A ... J '1' ... * * * * " �b � * f�r' Terrorism sm ... N"c" Exclusion
* o**n' .......
Dnly a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit.
per person limit
Brotherhood Mutual Insurance Company
ME DEC WA (09/11)
www.brotherhoodmutuaI.com 1 800.333.3735 1
P.O. Box 2227, Fort Wayne, IN 46801-2227
"Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2
Page 7 of 8
NAMED INSURED HANWOORI CHURCH
POLICY NUMBER 46MAA0421679
Brotherhood Mutual' POLICY PERIOD 3/6/2016 to 3/6/2019
Insurance Company
Liability Coverage Summary
MinistryEssentialssm commercial multi -peril policy Declarations continued...
The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability
coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifi cally stated within a coverage form or endorsement
represents the most we will pay for the coverage to which such a limit applies. For application of limits, [see 'Liability and Medical Coverage form (MEL101CWA
1.1)].
Additional Insureds
INTEREST ADDRESS
ORGANIZATION
Brook Lake Community Center, Additional Insured F La�e Community Center 726 S 356t : St Federal Way, WA 98003 86
Related Organizations/Operations
The following entities are insured for designated related Coverages.
NAME MINISTRY TYPE ADDRESS
None
None
None
Schedule of Liability Exposures
In issuing this policy, we have relied on material information provided to us by the Named Insured. The following schedule discloses all of the
insured's insurable exposures (as conveyed by the Named Insured) known to exist at the policy inception date. Declared premises must be owned,
occupied, or rented by you or your scheduled related organizations.
EXPOSURE DESCRIPTIONS BVPD RATE MED RATE '
Playgrounds 726 S 356th St Federal Way, WA 98003-8612 42.08700 4.78200
..................................................................................................................................2.02000 .94000
Church 726 S.356th St Federal Way, WA 98003 8612
` Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit.
+ per person limit
Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227
........................................................................................................................
^- -- ^ _r
RETURN TO: RobE EXT:2002
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
1. ORIGINATING DEPT./DIV: PARKSBROOKLAKE
2. ORIGINATING STAFF PERSON: ROB E EXT: 2002 3. DATE REQ. BY: ASAP
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
x CONTRACT AMENDMENT(AG#):AG 14-116 ❑ INTERLOCAL
❑ OTHER
5. PROJECT NAME: HANwooRi CHURCH LEASE
6. NAME OF CONTRACTOR: HANWOORI CHURCH
ADDRESS: 726 S. 356TH STREET, FEDERAL WAY, WA 98003 TELEPHONE (253) 3354445
E-MAIL: HANWOORICHURCH(Cl�,GMAIL.COM FAX:
SIGNATURE NAME: CHU NAM SONG TITLE: PASTOR
7. EXHIBITS AND ATTACHMENTS: ❑ 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: JUNE 1, 2015 COMPLETION DATE: MAY 31, 2016
9. TOTAL COMPENSATION $1,500 MONTH (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 ❑ NO IF YES, $ PAID BY: ❑ CONTRACTOR ❑
CITY
❑ PURCHASING: PLEASE CHARGE TO: They pay us
10. D05ZMENT/CONTRACT REVIEW INITIAL / DATE —REVIEWED INITIAL / DATE APPROVED
CxPROJECT MANAGERS—
❑ DIRECTOR
❑ RISK MANAGEMENT (IF APPLICABLE)
LAW
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
INITIAL / DATE SIGNED
-
❑ LAW DEPARTMENT tolllrc
L CHIEF OF STAFF I J
,)<tGNATORY (MAYOR OR DIRECTOR) CO
A CITY CLERK
SIGNED AG#
IGNED COPY RETURNED DATE SENT:
COMMENTS: I r�
�- �rd� �i►I� �tN1 �cwc� �'1�l
L "rZ�� �_ c (tI I4 Cam �-G 5
-�f��k-
11/9
` CITY OF CITY HAIL
33325
:�..... Fe d e ra I Way Feder 8th Avenue South
edera{ Way, WA 98003-6325
(253) 835-7000
www.ci"ffederaM,ay.com
AMENDMENT NO. 1
TO
LEASE AGREEMENT
FOR
HANWOORI CHURCH RENTAL AT BROOKLAKE
This Amendment ("Amendment No. 1") is made between the City of Federal Way, a Washington municipal
corporation ("City"), and HANWOORI Church, a Washington non-profit corporation ("Lessee"). The City and
Contractor (together "Parties"), for valuable consideration and by mutual consent of the Parties, agree to amend the
original Agreement for leasing of the Brooklake Chapel and office space ("Agreement") dated effective June 11,
2014, as follows:
1. AMENDED TERM. Pursuant to Section 2 of the Lease Agreement, the Lease shall be renewed for an
additional one (1) year term commencing on June 1, 2015, and terminating on May 31, 2016.
2. GENERAL PROVISIONS. All other terms and provisions of the Agreement, together with any prior
amendments thereto, not modified by this Amendment, shall remain in full force and effect. Any and all acts done by
either Party consistent with the authority of the Agreement, together with any prior amendments thereto, after the
previous expiration date and prior to the effective date of this Amendment, are hereby ratified as having been
performed under the Agreement, as modified by any prior amendments, as it existed prior to this Amendment. The
provisions of Section 13 of the Agreement shall apply to and govern this Amendment. The Parties whose names
appear below swear under penalty of perjury that they are authorized to enter into this Amendment, which is binding
on the parties of this contract.
[Signature page follows]
AMENDMENT - 1 - 1/2015
CITY of CITY HALL
.�' Feder 8th Avenue South
Federal Way, WA 98003-fi325
Federal Way
(253) 835-7000
tom.. cityoffederahvay com
IN WITNESS, the Parties execute this Agreement below, effective the last date written below.
CITY OF FEDERAL WAY
By:
errrel , Mayor
Ji
DATE: �y
HANWOORI CHURCH
By:
Chu Nam Song, P or
Printed Name: --, �,IA met "M
Title: pax Y
DATE: /q(A
STATE OF WASHINGTON )
) ss.
COUNTY OF Ot
ATTEST:
Y* IJA IrAk R,
djjeik,- Stephanie Cou e CMC
APPROVED AS TO FORM:
cl'—A
-hW City Attorney, Amy Jo Pearsall
On this day personally appeared before me Chu Nam Song, to me known to be the Pastor of Hanwoori Church that
executed the foregoing instrument, and acknowledged the said instrument to be the free and voluntary act and deed
of said corporation, for the uses and purposes therein mentioned, and on oath stated that he/she was authorized to
execute said instrument and that the seal affixed, if any, is the corporate seal of said corporation.
GIVEN my hand and official seal this ;L 19 �day of //Y!/ (/ , 20 ! 5—
,-'gig° A "'it
NSSIOH 44h,/,9 10
:von �O rq��'�4<<
cn aQ yS
4%L14 s
19;1`602
Notary's signature
Notary's printed name
Notary Public in and for the State of W shington.
My commission expires c� 3111 9 a Oi
AMENDMENT - 2 - 1 /2015
Corporations: Registration Detail Page 1 of 1
HAN WOO RI CHURCH
UBI Number
603266797
Category
REG
Profit/Nonprofit
Nonprofit
Active/Inactive
Active
State Of Incorporation
WA
WA Filing Date
01 /10/2013
Expiration Date
01/31/2016
Inactive Date
Duration
Perpetual
Registered Agent Information
Agent Name
Song Nam
Address
33110 PACIFIC HWY S
#3
City
FEDERAL WAY
State
WA
ZIP
98003
Special Address Information
Address
PO BOX 3677
City
FEDERAL WAY
State
WA
Zip
98063
Governing Persons
Title
Name
Address
President
SONG, CHU NAM
3664 S 378TH ST
AUBURN, WA 98001
Secretary
Song, Chu Nam
3664 S 378th ST
AUBURN, WA 98001
Treasurer
SUNG, SE SOOK
406 SW 336TH CT
FEDERAL WAY, WA 98023
http://www.sos.wa.gov/corps/search_detail.aspx?ubi=603266797 5/20/2015
RETURN TO: EXT:
CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM
1. ORIGINATING DEPT/Div: PettTe-W6RKS /
2. ORIGINATING STAFF PERSON: EXT: \ 3. DATE REQ. BY:
4.
5.
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#): ❑ INTERLOCAL
OTHER
PROJECTT
G. NAME OF
ADDRESS:
TELEPHONE:
E-MAIL: FAX:
SIGNATURE NAME: TITLE:
7. EXHIBITS AND ATTACHMENTS: ❑ SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE ❑ ALL
OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS
CFW LICENSE # (BL,, EXP. 12/31/ UBI # , EXP.
8. TERM: COMMENCEMENT DATE: \ \ �%�1�\� iI d IP. _ �I/� OMPLETION DATE: ZintS
9. TOTAL COMPENSATION: $ \ , ��� �/�� (INCLUDE EXPENSES AND SALES TAX, IF ANY
(IF CALCULATED ON HOURLY LABOR CHARGE - A ACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES
REIMBURSABLE EXPENSE: ❑ YES ❑ NO IF YES, MAXIMUM DOLLAR AMOUNT: $
IS SALES TAX OWED: ❑ YES�❑ N^O, ' IF YES, $ PAID BY: ❑ CONTRACTOR El CITY
❑ PURCHASING: PLEASE CHARGE To -A lX�l� �xw ub
10. DOCUM / CONTRACT REVIEW
R JECT MANAGER
❑ IV ION MANAGER
FEPTY DIRECTOR
TOR
❑ RISK MANAGEMENT (IF APPLICABLE)
❑ LAW DEPT
11. COUNCIL APPROVAL (IF APPLICABLE)
COMMITTEE APPROVAL DATE:
INITIAL / DATE APPROVED
COUNCIL APPROVAL DATE:
12. CONTRACT SIGNATURE ROUTING
❑ SENT TO VENDOR/CONTRACTOR DATE SENT: DATEREC'D:
❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS
AW DEPT
P .
�HIEF OF STAFF
LX SIGNATORY (MAYOR OR DIRECTOR
CITY CLERK
I
ID ASSIGNED AG #
AG#
SIGNED COPY RETURNED
DATE SENT:
❑ RETURN ONE ORIGINAL
COMMENTS:
EXECUTE" "ORIGINALS
11/9
CITY OF CITY HALL
33325 2,th Avenue South
Federal Way Federal Way, OVA 98003-632
(253) 835-7000
'i'ix'Eb.�1�i'f?J`f£:t7L-'fL7fYVtdj!.f.CTr� LEASE AGREEMENT ORIG;!A, AL
This Lease Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal
corporation ("Landlord"), and HANWOORI Church, a Washington non-profit corporation ("Lessee"). The City
and Tenants (together "Parties") are located at the below addresses which shall be valid for any notice required
under this Agreement:
HANWOORI CHURCH:
Chu Nam Song
726 S. 3561h Street
Federal Way, WA 98003
(253) 335-4445 (telephone)
Hanwoorichurch@gmail. com
The Parties agree as follows:
1. Premises.
CITY OF FEDERAL WAY:
City of Federal Way
Contact: Steve Ikerd
33325 Bch Ave. S.
Federal Way, WA 98003-6325
(253) 835-6911 (telephone)
Steve.ikerd(a-),cityoffederalway.com
The City, as fee owner of certain real property described in Exhibit "A", does hereby agree to lease to
the Lessee and the Lessee does hereby agree to lease from the City, the Premises described in Exhibit "A"
attached hereto and incorporated herein by this reference, constituting:
Legal Description:
Certain buildings or portion of buildings as indicated on attached Exhibit "A" located upon King County
Assessor's Parcel No. 242104-9010-07, commonly known as 726 South 356Eh Street, Federal Way, WA 98003.
2. Term.
(a) This Agreement shall be for a term of one (1) year, commencing on the 1 st day of June, 2014,
and shall terminate on the 31 st day of May, 2015. The City and the Lessee may agree to extend this agreement
up to five (5) additional one (1) year terms. Notice of intent to extend this Agreement must be provided to the
City ninety (90) days prior to the expiration of the Term. In addition, the terms and conditions of this lease
shall be in full force and effect as of the date of which the Lessee obtains possession of the Premises pursuant to
section 5 of the Agreement.
(b) Option to Terminate. Lessee shall have the option to terminate this lease agreement prior to the
1 year in case the number of the congregation exceeds the accommodation of the below described premises.
But, such situation to terminate shall be reviewed mutually with the City. The Lessee shall give the City six (6)
months written notice of lease termination. The City shall have the option to terminate this lease upon six (6)
months written notice to the lessee.
3. Rent.
The regular rental rate for this property is $2,300.00. In exchange of a reduced rent, the Lessee will
perform 20 hours a week of maintenance services as described in Exhibit `B". In addition to these services
Initials: Tenant Landlord
LEASE AGREEMENT - 1 - 5/2014
CITY or CITY HALL
33325 8th Avenue South
Federal Way Federal Way, WA 98003-6325
(253) 535-7000
e� 3�ti: c�hfntl�:cit:rf�rvr.�y ce�m
described in Exhibit "B", the Lessee shall pay to the City for the use of the Premises a monthly amount of
$1,500, payable in advance, on the I" day of each month for rent of $1,329.32 and a leasehold excise tax of
$170.68:
(a) Building, known as Space 1, known as Large Hall: Part time for use on each Sunday of the
month.
(b) Building, known as Space 2, known as Small Hall (Service Hall): Full time all week.
(c) Building, known as Space 3, being the upstairs: Full time use as an office with the exception of
one office.
(d) Kitchen and Janitorial Room on the ground floor: Full time all week.
(e) Basement; Full time all week.
Payment shall be made at the City's address specified in section 26 below, or at any other address of
which the City notifies the Lessee in writing. If payments are not made within 15 days of due date a late charge
of Two Hundred Fifty and 00/100 Dollars ($250.00) per month and an additional charge of 1 % per month of the
lease payment for each month that the payment is late.
date.
The monthly rent shall be increased by Five Percent (5%) every year from the lease commencement
4. Utilities.
In addition to the above monthly rent, lessee shall pay utilities as follows:
(a) 50% of the water and sanitary sewer from Lakehaven Utility District, or its successor.
(b) 50% for meter account nos. 287-289-000-5 and 677-289-000-7 serving the Large Hall, Small
Hall, and the Upstairs as listed above.
(c) 50% of the natural gas bills as billed by Puget Sound Energy, or its successor.
(d) 50% of the refuge disposal, if and including when Lessor subscribes to the service offered by
Waste Management, or its successor.
Payment for the above utilities shall be within ten (10) days after Lessor provides to Lessee copies of the
sanitary land receipts and utility bills.
5. Possession.
By taking possession of the Premises, the Lessee shall be deemed to have accepted the Premises as is
subject to the warranty and repair work to be performed pursuant to section 8 of this Agreement. Use of the
Premises shall be exclusive to the Lessee and shall not be shared by others without the written approval of the
City which approval shall not be unreasonably withheld.
6. Business Purpose.
The premises are to be used for the purpose of conducting church and religious services, Christian
Education and office space. The premises shall not be used for living or residential purposes.
7. Repairs and Maintenance.
(a) The L ssee agrees during the term of this Agreement to keep the Premises in a condition and
Initials: Tenant Landlord Vt-N-
LEASE AGREEMENT - 2 - 5/2014
CITY Cad CITY HALL
33325 8th Avenue South
Fedeal Wa
""TAF Federal Way, keVA 98003-6325
(253) €335-7000
mow eihoffede iatvvay corn
state of repair as good as the same shall be on the date of the Lessee's possession of the Premises pursuant to
section 5 above.
(b) The Lessee shall pay the full cost of all repairs and maintenance to the Premises pursuant to the
"Maintenance Schedule" described in Exhibit "B" attached hereto and incorporated by this reference, unless
otherwise agreed upon by the Parties to jointly share the costs or that the repairs are necessary as deemed by the
City to be the responsibility of the City. The City agrees to provide repair and maintenance for major building
systems prior to possession by the Lessee as identified in section 8.
(c) The City shall not be required to make any repairs unless and until written notice of the need for
said repairs shall have first been given by the Lessee to the City in writing at the City's address specified in
section 26 below. The City shall not be called upon to make any improvements, alterations, or repairs of any
kind with respect to the Premises except as specifically provided for in this section.
(d) The Lessee shall provide its own cleaning and custodial services, including waste disposal, at its
expense.
8. Alterations or Improvements.
(a) All alterations or improvements to the Premises undertaken by the Lessee shall be constructed at
the Lessee's expenses, and the Lessee agrees to bear full responsibility for insuring that all construction on the
Premises is undertaken and conducted in a safe and professional manner, and that all alterations or
improvements shall be of high quality construction. The Lessee agrees that it will not allow any liens to attach
to the Premises as a result of any construction preformed on the Premises. However, should a laborer's or
material man's liens be filed per Chapter 60.04 RCW, the City agrees that this will not be considered a breach
of this Agreement. The Lessee further agrees to hold the City harmless from any and all claims, including
costs, attorney's fees, and expenses, arising in any way from any construction on the Premises. Unless
specifically agreed otherwise in writing signed by the City prior to construction or addition of any alterations or
improvements to the Premises, all alterations and improvements shall become the property of the City upon
termination or expiration of this Agreement.
(b) The Lessee shall not perform, or cause to be performed any alterations or improvements to the
Premises without first providing written notice to the City and obtaining the City's review and approval of said
alterations or improvements, including signage on the building, which must comply with the Federal Way City
Code, and all applicable laws. All hours of work in performing alterations or improvements shall also be subject
to the City's prior approval.
(c) If the improvements on said premises shall be rendered untenable by fire or other casualty,
Lessee may, by notice in writing given to Lessor within thirty (30) days after the occurrence of such damage or
destruction, elect to terminate this lease as of the date of the damage or destruction, whereupon Lessor shall be
entitled to all proceeds of insurance, if any, and right or recovery against insurers on the policies covering such
damage or destruction.
(d) At the termination of this Agreement, the Lessee shall ensure that the condition of the Premises
is equal to or better than the condition existing at the commencement of this Agreement, as determined by the
City.
9. Encumbrances.
Initials: Tenant Landlord ki--N
LEASE AGREEMENT - 3 -
5/2014
CITY Of CITY HALL
33325 8th Avenue SOLIth
r dFederal way, wA 98003-6325 eral Way(253) 835-7000
me-,oNvffede:rmvaycara
The Lessee agrees to keep the Premises free and clear of all mortgages, levies, liens, and encumbrances,
whether voluntary or involuntary, and to notify the City in writing within ten (10) days after any such mortgage,
levy, lien, or encumbrance shall attach to the Premises. The City may, in addition to exercising any other right
it may have under this Agreement, and at its sole option, discharge any such mortgage, levy, lien, or
encumbrance, and the Lessee shall, upon demand, reimburse the City for the full amount of any payment for
this purpose, plus interest thereon at the rate of twelve percent (12%) per annum, or such lesser rate as may be
the maximum permitted by applicable law.
10. Taxes.
(a) Personal Property Taxes: the Lessee shall pay, prior to delinquency, all taxes assessed against
and levied upon fixtures, furnishings, equipment, and all other personal property of the Lessee contained in the
Premises.
(b) Tax on Rent: the Lessee shall pay any business and occupation or similar gross receipts tax, but
not including any federal or state income tax or franchise tax.
11. Indemnity/Insurance.
(a) The City shall not be liable for any injury to any person, or for any loss of or damage to any
property (including property of the Lessee), occurring in or about the Premises from any cause whatsoever. The
Lessee shall hold and save the City harmless from any and all losses, damages, liabilities, or expenses
(including attorneys' fees and other expenses of litigation) resulting from any actual or alleged injury to any
person, and/or from any actual or alleged loss of or damage to any property, occurring in or about the Premises
from any cause whatsoever.
(b) The Lessee shall, at its own expense, maintain proper liability insurance with a reputable
insurance company or companies in the minimum amount of One Million and No/100 Dollars ($1,000,000.00)
per incident and in the minimum amount of Three Million and No/100 Dollars ($3,000,000.00) annual
aggregate to indemnify both the City and the Lessee against any such claims, demands, losses, damages,
liabilities, or expenses. The City shall be named as additional insured and shall be furnished with a copy of the
certificate of insurance, which shall bear an endorsement that the same shall not be canceled except upon 30
days prior written notice to the City.
(c) The Lessee agrees that it will not do nor permit to be done in or about the Premises any act or
thing which will invalidate any insurance thereon, or increase the rate of insurance over and above the usual rate
for buildings used for general business purposes, nor will the Lessee permit the Premises to be put, kept, or
maintained in such condition or so occupied that the same will not be insured.
(d) The Lessee hereby releases the City from liability and waives all right of recovery against the
City for any loss of, in or about the Premises, from perils insured against under the Lessee's fire insurance
contacts, including any extended coverage endorsements thereof, whether due to negligence or any other cause;
provided, however, that this section shall be inapplicable if it would have the effect, but only to the extent it
would have the effect, or invalidating any insurance coverage of the City or the Lessee.
12. Fire or Other casualty.
Initials: Tenant Landlord
LEASE AGREEME T - 4 - 5/2014
CITY Of CITY HALL
33325 3th Aveme SOLIth
Federal Way Federal Way, WA 98003-6325
(253) 335-7000
w to Pvofie_9etahva1v cam,
In the event the Premises are damaged and/or destroyed by unavoidable casualty or risks covered by
standard insurance to such an extent as to render any portion of the Premises untenantable, the City shall have
the option to demolish, rebuild or repair the Premises. The City shall have thirty (30) days after the date of
written notification by the Lessee of the happening of any such contingency in which to notify the Lessee of the
City's intention to rebuild or repair the Premises or the parts so damaged. If the City elects to rebuild or repair
said Premises, the City shall prosecute the work of such rebuilding or repairing without unreasonable delay. If
the City fails to give said notice within said period, the Lessee shall have the right to terminate this Agreement
by written notice to the City at any time prior to commencement of reconstruction or repair of the Premises.
13. Eminent Domain.
In the event of a taking of all or any part of the Premises by eminent domain and such taking renders the
Premises unsuitable for the activities of the Lessee, then this Agreement may at the option of either party, be
terminated as of the date when the Lessee is required to vacate the portion of the Premises so taken. Exercise of
said option to terminate shall be made by written notice given to the other party not more than ninety (90) days
after either party has received notice of the taking, and if terminated, all rents shall be paid to the date of
termination. The City reserves and accepts all rights to compensation and damages to the Premises for any
taking by eminent domain, and the Lessee shall make no claim whatsoever against the City for damages for
termination of its leasehold interest in the Premises or for interference with its business. The Lessee may pursue
its own claim against the condemning authority for compensation and damages for loss of its leasehold interest.
14. Bankruptcy.
Neither this Agreement nor any interest therein nor any estate hereby created shall pass to any trustee or
receiver in bankruptcy or to any other receiver or assignee for the benefit of creditors or otherwise by operation
of law. In the event that the Lessee is declared or adjudicated bankrupt, or voluntarily offers to creditors terms
of composition, or in case a receiver is appointed to take charge of and conduct the affairs of the Lessee, the
City may, at is option, declare this Agreement terminated and null and void, and may re-enter the Premises
immediately. Nothing in this section 17 shall be construed to limit the right of the City to prove its claim in any
such bankruptcy or receivership for installments of rent due and unpaid at the time of such bankruptcy or
receivership regardless of whether the City elects to terminate this Agreement as provided in this 17, and
acceptance of any such rent or proceeds shall not impair the City's rights to so terminate this Agreement.
15. Assignment or Sublease.
The Lessee agrees that it will not assign this Agreement, permit, or suffer any assignment hereof by
operation of law, or sublet the Premises or any portion thereof, without the prior written consent of the City. No
consent given by the City or under this section 18 shall have the effect of thereafter rendering inapplicable any
of the restrictions contained in this section 18, but all such restrictions shall remain in full force and effect as to
any subsequent transactions notwithstanding the giving of such consent.
16. The Lessee's Compliance with Laws.
The Lessee shall observe, and be responsible for and bear all expenses of complying with all orders,
ordinances, rules, regulations, requirements, and instructions of all municipal, state, and federal authorities
relative to the Premises. The Lessee will not allow any illegal acts to be conducted on the Premises, will not
overload or permit waste of or damage or injury to the Premises, and will keep all drainage pipes free and open
and will protect water, he ting, and other pipes fromfreezingso that they will not become clogged or broken.
Initials: Tenant z Landlord H-
LEASE AGREEMENT - 5 - 5/2014
4&k CITY •:
Federal Way
17. Suns.
CITY HALL
33325 8th Avenue South
Federal Way, WA 98003-6325
(253) 335-7000
arev v ci4,offedera&V,•�v coo
Lessee may display in or upon the leased premises any signs or symbols of any nature as long as the
signs meet the requirements of the Federal Way Revised Code, State law and the signs are approved by the
City.
18. Inspection.
The City shall have the right to inspect the Premises at all reasonable times and the right to enter the
same whenever it is reasonably necessary for the exercise of any right or privilege of the City under this
Agreement. Provided, however, that except in the case of an emergency, the City shall endeavor to provide the
Lessee with reasonable notice prior to entering the Premises.
19. Default.
(a) Time is of the essence hereof. If the Lessee shall neglect or fail to perform or observe any of the
covenants or conditions contained herein on its part to be observed and performed and continue to be in default
for a period of ten (10) days or, if the default be other than one due to non-payment of any sums due by the
Lessee under this Agreement ten (10) days (if more than ten (10) days are required to cure any such default, the
Lessee shall commence to cure such default with said days and shall faithfully pursue completion thereof as
expeditiously as possible) after written notice by the City of such breach, then the City may, at its option,
perform such duties or obligations for the Lessee and upon completion thereof bill the Lessee for the cost of
said performance (payable immediately), and bearing interest at twelve percent (12%) per annum, or such lesser
rate as may be permitted by applicable law) or at its option the City may, without notice and immediately upon
such breach, enter into and upon the Premises, or any part thereof, and repossess the same, and upon entry, as
aforesaid, this Agreement, at the option of the City shall terminate and wholly expire, and the Lessee covenants
and agrees that upon such termination it will indemnify the City of the cost of renovation the Premises for a new
tenant and against all loss of rent which the City may incur by reason of such termination during the residue of
the term of this Agreement.
(b) Upon any termination of this Agreement, whether by lapse of time or otherwise, or upon
termination of the Lessee's right to possession without termination of this Agreement, the Lessee shall
surrender possession and vacate the Premises immediately and deliver possession thereof to the City. The
Lessee hereby specifically grants to the City full and free license to enter into and upon the Premises in such
event with or without process of law and to repossess itself of the Premises as of the City's former estate and to
expel or remove the Lessee and any others who may be occupying or within the Premises and, at the City's
option, to remove any and all property therefrom using such force as may be necessary. The Lessee hereby
grants said license to enter as aforesaid to the City and/or its designated agents, who in the exercise of which
shall not be deemed in any manner guilty of trespass, eviction, or forcible entry or detainer, and without
relinquishment of the City's rights to rent or any other right given to the City hereunder or by operation of law.
The Lessee expressly waives the service of any demand for the payment of rent or for possession and, except
for notice provided in section 22(a), the Lessee expressly waives service of any notice of the City's elections to
terminate this Agreement or to re-enter the Premises, including any statute or other law, and agrees that the
simple breach of any covenant or provision of this Agreement by the Lessee shall, of itself, without the service
of any notice of deman whatsoever, constitute a forcible and/or unlawful detainer on the Premises by the
Initials: Tenant Landlord VNN
LEASE AGREEMENT - 6 - 5/2014
Lessee
CITY OF
Federal
20. No Waiver.
CITY HALL
33325 8th Avenue South
Wa Federal %Nay, VIVA 98003-6325
(253)835-7000
No failure by either of the Parties to exercise any of the remedies available to it by the terms of this
Agreement, or by operation of law, upon any breach of this Agreement by the Lessee or upon any default
hereunder by the Lessee shall constitute a waiver by the City of any other breach or default by the Lessee, or
any subsequent like breach or default; and the acceptance of rent hereunder by the City shall in no event
constitute a waiver by the City of any breach or default unless the City specifically intends it is so to do advises
of such fact in writing.
21. Attorney. Fees.
In the event either of the Parties defaults on the performance of any terms of this Agreement or either
Party places the enforcement of this Agreement in the hands of an attorney, or files a lawsuit, each Party shall
pay all its own attorneys' fees, costs and expenses. The venue for any dispute related to this Agreement shall be
King County, Washington.
22. Holding Over.
Any holding over and continued occupancy by the Lessee after the expiration of the term herein created
shall be on a tenancy from month to month, and either party hereto shall have the right to terminate the same by
giving twenty (20) days' written notice of its intention to terminate said tenancy.
23. Notices.
All notices herein provided or permitted to be given by either the City or the Lessee to the other may be
given by enclosing the same in a sealed envelope properly addressed to the other and depositing the same,
registered with postage prepaid thereon, in the United States Post Office, and service shall be deemed complete
at the time of such deposit. For the purpose of this section, the address of the Lessee shall be 726 South 356tn,
Federal Way, WA 98003, and the address of the City shall be 33325 8th Ave. South, Federal Way, WA 95003,
subject to the right of either party to designate by notice in writing to the other a new address to which said
notice shall be sent.
24. Successors and Assigns.
This Agreement shall be binding upon and for the benefit of the City and the Lessee, and their respective
successors and assigns; provided that no assignment by the Lessee, or by operation of law, which violates any
of the terms of this Agreement shall vest any rights in the assignee.
25. Signature Authority.
It is hereby acknowledged that the Lessee's signatory of this Agreement has the authority to so sign and
bind the Lessee in its entirety.
26. General Provisions.
Initials: Tenant Landlord
LEASE AGREEMENT - 7 - 5/2014
city Of
Federal Way
CITY HALL
33325 8th Avenue South
Federai Way, "A 98003-6325
(253) 835-7000
a^.�t;-w:,,rti ftec7t:rtr#4tfc s'.amn
This Agreement contains all of the Agreements between the City and the Lessee with respect to any
matter covered or mentioned in this Agreement. No provision of this Agreement, including this provision, may
be amended or modified except by written agreement signed by the Parties.
27. Headings.
The headings herein contained are inserted only as a matter of convenience and for reference and in no
way define, limit, or describe the scope of intent of this Agreement or in any way affect the terms and
provisions hereof.
28. No commission.
The City and the Lessee agree that there is no commission due to any broker upon execution of this
Agreement.
29. Severability.
If any provision of this Agreement is held invalid for any reason whatsoever, such invalidity shall not
affect any other provision which can be given effect without the invalid provision, and to that end, provisions of
this Agreement are declared to be severable.
Initials: Tenant -J�/
LEASE AGREEMENT
[Signature page follows]
Landlord
-8-
5/2014
CITY OF
Federal Way
CITY HALL
33325 Sth Avenue South
Federal Way, WA 98003-6325
(253)835-7600
IN WITNESS, the Parties execute this Agreement below, effective the last date written below.
CITY OF FEDERAL WAY
Jim F ell, ayor
DATE:
HANWOORI RCH
By:ti--
Chu Nam Song, astor
DATE:
STATE OF WASHINGTON )
) ss.
COUNTY OF lel&e2j
ATTEST:
C"
City Clerk, Carol McNeill , CMC
APPROVED AS TO FORM:
Interim CiVy jkttomey, Amy Jo Pearsall
On this day personally appeared before me Chu Nam Song, to me known to be the Pastor of Hanwoori Church
that executed the foregoing instrument, and acknowledged the said instrument to be the free and voluntary act
and deed of said corporation, for the uses and purposes therein mentioned, and on oath stated that he/she was
authorized to execute said instrument and that the seal affixed, if any, is the corporate seal of said corporation.
GIVEN my hand and official seal this ''°'Pday of , 2014.
1 �
!� i�✓�0
►� G !/
(typed/printed name of notary)
Notary Public in and for the State of Washington.
My commission expires (j 3 -/ 9 ,Zoi
Initials: Tenant Landlord - '
LEASE AGREEMENT - 9 -
5/2014
AIL
CITY OF
Federal Wa
=■ .
EXHIBIT "A"
PREMISES AREA
S ��F v sir
PEF�►aSG
g2\ A� �-
N bT - (-b C5, ,s
CITY HALL
33325 8th Avenue SOuth
Federal Way, WA 98003-6325
(253) 835-7000
DWilb'coer
Cm
Z,
4- .
�I
cNT2-�n,.N L�
1'
6-N -cam C-6
X
Initials: Tenant Landlord
RESIDENTIAL LEASE AGREEMENT - 10 -
5/2014
CITY Of CITY HALL
Feder' 33325 8th Avenue South
WayFederal Way, VVA 98003-6325
(253) 835-7000
EXHIBIT `B"
SCOPE OF SERVICES
The Caretaker position is a non -paid, non -benefited position that provides maintenance and security services at
Brooklake. The Caretaker will be required to perform an average of twenty (20) hours per week of maintenance
and security services during the course of the year. It is anticipated that the majority of the work will occur
during the summer and less in the winter.
The following Maintenance services are representative of services to be performed. Specific work orders will be
assigned as needed by Park Supervisors or their designee.
Park Lawns and Grounds
A. Mow with push and riding mower
B. Edge with line trimmer
C. Re -seed as necessary
D. Pick up trash
Park Gardens
A. Prune and trim as needed to maintain proper appearance
B. Remove weeds
C. "Dead Head" flowers
D. Rodent Control, (joint with City)
Park Grounds
A. Clean signs
B. Maintain buildings; plumbing, electrical, interior, as mutually agreed upon with the City
C. Pick up trash and litter
D. Prune back brush
Security Duties:
A. Clean up and repair vandalism, and report suspicious activity to the City
B. Unlock and Lock Hall at designated times for parties and events
C. Monitor park for after hour activity
D. Contact emergency services personnel (police and fire) as needed
Parking Lot
A. Weed, prune and trim landscape beds
B. Fall clean up
Buildings
A. Monitor buildings (lock doors, close windows)
B. Turn off lights and heat when building is not being used
C. Provide minor maintenance on bathrooms, kitchen, etc.
D. Paint and repair structure as mutually agreed upon with City
E. Clean up after parties and events, remove and dispose of garbage, clean
hall, and put away all chairs and tables
kitchen, all rooms, bathrooms,
Initials: Tenant Landlord 0A
RESIDENTIAL LEASE AGREEMENT
5/2014
F�herhood Mutual°
ce Company
NAMEDINSURED
POLICY NUMBER
POLICY PERIOD
461V
HANWOORI CHURCH
46MAA0421679
03/06/2013 - 03/06/2016
Lia ility Coverage Summary
Mini tryEssentials"commercial multi -peril policy Declarations continuEd
1679
The Co�rages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsemnts.Only one liability
covera and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage f rm or endorsement
represei s the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage for (MEL101CWA 1.1).
Liab I ty Coverage Details: Schedule of Limits
GEN. . AL OCCURRENCE LIMIT $1,000,000
GEN AL AGGREGATE LIMIT $3,000,000
Principal
Liability Coverages
COVERAGE
DESCRIPTIONS
Bodily
Injury/Property Damage Liability (L)
Medical
Payments (M)
Prod
is/Completed Work (N)
Fire L
al Liability (0)
Supp
emental Coverages
COVE
AGE DESCRIPTIONS
Incid
r tal Contractual Liability
Incid
tal Medical Malpractice
MobilHEquipment
COVERAGE LIMIT
$1,000,000*
$ 5,000*+
$1,000,000*
$300,000*
COVERAGE LIMIT
$1,000,000*
$1,000,000*
$1,000,000*
COVERAGE AGGREGATE LIP
$3,000,01
COVERAGE AGGREGATE LIMIT
$ 3,000,000*
$ 3,000,000*
$ 3.000.000*
* Only single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits (ire subject to the general
+per z}son limit
FORM
MEL101CWA 1.1
MEL101CWA 1.1
MEL101CWA 1.1
MEL101CWA 1.1
FORM
MEL101CWA 1.1
MEL101CWA 1.1
MEL101CWA 1.1
Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1 800-333-3735 1 P.O. Box 2227, Fort Wayne, IN 4 801-2227
............................ ......... ........ ............. I. .................. .............................. _ _ ME DEC 09/11) 'Bear ye one another's burdens and so fulfill the law of Christ." ---- Galatians 6:2 Page 5 of 9
46MAA04 679
RDherhood Mutual' NAMED INSURED HANWOORI CHURCH
Insu ra Co Cum pany
POLICY NUMBER 46MAA0421679
POLICY PERIOD 03/06/2013 - 03/06/2016
Liabili y Coverage Summary
Ministry --ssentia/ssmcommercial multi -peril policy Declarations continued
The Coverages li ied here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. On one liability
coverage and on medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form ore ors
ement
represents them -st we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (MEL 1CWA 1.1).
Additional Coverages
COVERAGE DI SCRIPTIONS
Personal Injury _lability
Membership Ei iotional Injury
Nursery Supen sion
Nursery Corpoi sl Punishment
Food Preparati n Liability
Damage to Pro aerty of Others
Not in Your C �ntrol
In Your Contr 4
Prosthetic De ices
Incidental Cam er Medical
Nonowned Pro erty Damage liability
Real Property
nal PersoPro arty
COVERAGE LIMIT
COVERAGE AGGREGATE LIMIT
FORM
$1,000,000*
$3,000,000*
M--101CWA
1.1
$1,000,000*
$3,000,000*
M
101CWA 1.1
$1,000,000*
$3,000,000*
M
- 101CWA 1.1
$1,000,000*
$3,000,000*
M"
101CWA 1.1
$1,000,000*
$3,000,000*
M
101CWA 1.1
$1,000*+
$3,000,000*
M
101CWA 1.1
$2,500*+
$3,000,000*
M
101CWA 1.1
$500*+
$3,000,000*
M1.1
101CWA 1.1
$5,000*+
$3,000,000*
ME1
101CWA 1.1
$1,000,000*
M
l 101CWA 1.1
$300,000*
$3,000,000*
M11
101CWA 1.1
$10,000*
$3,000,000*
MI1d10ICWA
1.1
Defense C verage
Applies in a dition to the liability limit unless otherwise specifically stated in an applicable coverage form.
Related Op
COVERAGE DE
None
!rations Coverage
CRIPTIONS
COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM
None None None
' Only a single lim applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregatelirnit.
+ perpersonlirnit
Brotherl clod Mutual Insurance Company I www.brotherhoodmutual.com 1 800-333-3735 1 P.O. Box 2227, Fort Wayne, IN 46801-2227
............................................................................................. ...........
ME DEC (09/1 1) 'Bear ye one anot her's burdens and so fulfill the law of Christ." --- Galatians 6:2 Pwae 6 of 9