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HomeMy WebLinkAboutAG 20-890 - Stanton Indemnification RETURN TO: EXT: CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT./DIV: l AZ-S tt ,!"[[ _ I 2. ORIGINATING STAFF PERSON: - R S aN • 6 6AW EPJ EXT: ! 3. DATE REQ.BY: SA f 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 ONTRACTAMENDMENT(AG#): ❑ INTERLOCAL OTHER _ 5. PROJECT NAME: 1rJnEMt)!FlC.prGonJ – SI/LJ'rDPJ 6. NAME OF CJQN4RAeT6W- ADDRESS: J11 Q71t AVC SW- 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 8. TERM: COMMENCEMENT DATE: _0P) 51Aa1tJ6 COMPLETION DATE: ra .31 )-I 9. TOTAL COMPENSATION$ (INCLUDE EXPENSES AND SALES TAX,IFANY) (IF CALCULATED ON HOURLY LABOR CHARGE-ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE:❑YES 0 IF YES,MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED ❑YES L7 NO IF YES,$ — PAID BY:❑CONTRACTOR❑CITY RETAINAGE: RETAINAGE AMOUNT: ❑RETAINAGE AGREEMENT(SEE CONTRACT) OR ❑RETAINAGE BOND PROVIDED ❑ PURCHASING: PLEASE CHARGE TO: —_ 10. D�XICUMENT/CONTRACT REVIEW INI f L/DA E I EVIEWED INITIAL/DATE APPROVED [5 PROJECT MANAGER ❑ DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) _ ---_ X1 LAW DK R-21-2U20 •1 __-- 11. COUNCIL APPROVAL(IFAPPLICABLE) IJ/) k) SCHEDULED COMMITTEE DATE: lJ COMMITTEE APPROVAL DATE: SCHEDULED COUNCIL DATE: COUNCIL APPROVAL DATE: 12. CONTRACT SIGNATURE ROUTING ❑ SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D: ❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE,LICENSES,EXHIBITS ❑ CREATE ELECTRONIC REMINDER/NOTIFICATION FOR 1 MONTH PRIOR TO EXPIRATION DATE (Include dept.support staffif necessary and feel free to set notification more than a month in advance ifcouncil approval is needed.) INITIAL/DATE SIGNED ❑ LAW DEPARTMENT ❑ SIGNATORY(MAYOR OR DIRECTOR) ❑ CITYCLERK ❑ ASSIGNED AG# A COMMENTS: DK: recommend adding an insurance requirement 112020 RELEASE AND INDEMNIFICATION THIS RELEASE AND INDEMNIFICATION (the "Release") by Greg Stanton, ("Indemnifier") in favor of the CITY OF FEDERAL WAY, its directors, officers, employees, agents, and volunteers ("City"). Whereas, Indemnifier desires to perform the activity described below ("Activity") on French Lake Off Leash Dog Park (31531 1 st_Aveliue 5otitil. E ederal Way- WA 08003) ("Property"), which is owned by the City; Activity: 1. Mutiially agrCtXd Use of' Skid steer loader or iniju excavator at the French Lake Off Leash Dog Park �?1531 I st AN envie Sowli. F durai Way. WA 98003) 2. Sbelter Construction: anti 3. W eck e rd Clean Up Events. Whereas, the City has granted permission for the Indemnifier to access, enter upon and use the Property for purposes of this Activity throughout the shelter construction process and during weekend volunteer events; Whereas, Indemnifier has agreed to use reasonable care to prevent damage to said Property; Whereas, Indemnifier hereby agrees to minimize obstruction to members of the public that wish to use the recreational facilities on the Property; and Now, therefore, Indemnifier does hereby freely, voluntarily, and without duress execute this Release under the following terms: Release and Indemnification. Indemnifier and Indemnifier' affiliates release and indemnify the City from any and all liability, claims, actions and demands of whatever kind or nature, either in law or equity, by any persons or entities, including without limitation, their respective agents or representatives, including costs and attorney fees, which arise or may hereafter arise from Indemnifier's and Indemnifier's affiliates' acts, errors, or omissions in connection with the use of the Property for the Activity. This release and indemnification includes, without limitation, any claims of injury by anyone arising out of the Activity. Insurance. Indemnifier agrees to maintain adequate insurance coverage to provide indemnification for the Activity. Indemnifier agrees to accept tender of any claims arising out of the activity and will provide the City with proof of insurance. Term. The term of this Agreement shall commence upon the effective date of this Agreement, which shall be the date of mutual execution, and shall continue until the completion of the activity, but in any event no later than December 31, 2021 ("Term"). This Agreement may be extended for additional periods of time upon the mutual written agreement of the City and the Indemnifier. Other. Indemnifier expressly agrees that this Release is intended to be as broad and inclusive as permitted by the laws of the State of Washington, and that this Release shall be governed by and interpreted in accordance with the laws of the State of Washington. Indemnifier agrees that in the event that any clause or provision of this Release shall be held to be invalid by any court of competent jurisdiction, the invalidity of such clause or provision shall not otherwise affect the 1 remaining provisions of this Release which shall continue to be enforceable. Indemnifier has had the opportunity to have this Release reviewed by an attorney and has fully read and understands the terms and provisions of this Release. IN WITNESS WHEREOF, Greg Stanto , Indemnifier DATE: /0 ' & ' 2 0-Z-0 STATE OF WASHINGTON ) ° ) ss. COUNTY OF 1<1 N On this day personally appeared before me, Greg Stanton, to me known to be the individual described in and who executed the foregoing instrument, and on oath swore that he executed the foregoing instrument as his free and voluntary act and deed for the uses and purposes therein mentioned. ,, GIVEN my hand and official seal this day of D`� ` ,2Q20 U01-f1 - fill,, `•�'` ©AEA ........Nes P.G ° e p (typed/printed name of notary) Notary Public in and for the $ tate of Washington. • c OrgA�' D My commission expires .Z p U i 0,, f.::ifnrmsJlZele,i#���Ni�p.��:�e 4;'iSti�•.�,�-`y3` 2 StateFanr State Farm Fire and Casualty Company RENEWAL CERTIFICATE PO Box 853907 POLICY NUMBER 98 CS 3957.4 Richardson,TX 75085-3907 Rental Dwelling Pol•Special Form OCT 22 2020 to OCT 22 2021 H-15- 21 Ai-FACD R F TO BE PAID BY MORTGAGEE STANTON, GREG 30111 8TH AVE SW Coverages and Limits FEDERAL WAY WA 98023-8204 Section I A Dwelling $292,900 Dwelling Extension 29,290 B Personal Property 14,645 C Loss of Rents Actual Loss Deductibles -Section I Basic 1.00% 2,929 5%of Earthquake Endorsement Location: 4235 SW 329TH PL FEDERAL WAY WA 98023-2652 Section II L Business Liab(per occurrence) $300,000 (annual aggregate) 600,000 M Medical Payments to Others 5,000 12 Mortgagee HOMESTREET BANK (each person) ITS SUCCESSORS AND/OR ASSIGNS Loan No:0000448578 Forms,Options,and Endorsements Special Form 3 FP-8103.3 Amendatory Endorsement FE-8247 Annual Premium $961.00 Debris Removal Endorsement FE-7540 Earthquake Premium 267.00 (Included) Special Form 3 Endorsement FE-8320.2 Amendatory Collapse FE-8700.1 Earthquake Excl Masonry Veneer FE-8300.1 Domestic Abuse Endorsement FE-8710 Form 438bfu NS Lndr Loss Pay FE-1313 Mandatory Reportng Endorsement FE-5801 Registered Domestic Partnrship FE-6858 v Rental Dwelling Endorsement FE-2446 Actual Cash Value Endorsemet FE-3650 Inflation Coverage Index: 346.0 Your premium has increased by$71.00 since the last term. Please help us update the data used to determine your premium. Contact your agent with the year each of your home's utilities(heating/cooling, plumbing,or electrical)and roof were last updated. y7_ 9 lov;rr7'a See yeur State Farm agent. /Iwlzo-dz-f cas'St?I`t�e".. See re,erse Par important infbrmation. 2.:1 u nCli Agent KURT KWON INS AND FIN SVCS IN Prepared 01 N A9 Telephone (253)529-4499 REB AUG 31 2020 Your Rental Dwelling coverage amount.... It is up to you to choose the coverages and limits that meet your needs.We recommend that you purchase a coverage limit at least equal to the estimated replacement cost of your rental dwelling. Replacement cost estimates are available from building contractors and replacement cost appraisers, or,your agent can provide an Xactware estimate using information you provide about your rental dwelling. We can accept the type of estimate you choose as long as it provides a reasonable level of detail about your rental dwelling. State Farms does not guarantee that any estimate will be the actual future cost to rebuild your rental dwelling. Higher limits are available at higher premiums. Lower limits are also available, as long as the amount of coverage meets our underwriting requirements. We encourage you to periodically review your coverages and limits with your agent and to notify us of any changes or additions to your rental dwelling. NOTICE TO POLICYHOLDER: For a comprehensive description of coverages and forms,please refer to your policy. Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached to this notice are also effective on the Renewal Date of this policy. Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an endorsement to your policy. Billing for any additional premium for such changes will be mailed at a later date. If,during the past year,you've acquired any valuable property items, made any improvements to insured property,or have any questions about your insurance coverage,contact your State Farm agent. Please keep this with your policy. 300 (olf008gh) 10.11-2010 (olf315b) State Farm State Farm Fire and Casualty Company 2695 98-CS-8957-4 �.v 553-3093 WA Important Information About Damage Caused by Flooding This policy does not cover damage to your property caused by flooding. The federal government offers flood insurance through the National Flood Insurance Program to residents of communities that participate in its program. You can learn more about the National Flood Insurance Program at www.floodsmart.gov or by calling (888)379-9531. If you have any questions,please contact your State Farm@ agent. 553-3093 WA(C) (5/09) Agent: KURT KWON INS AND FIN SVCS IN Telephone:(253)529-4499 70 2695