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AG 23-155 - OUTDOORS FOR ALLRETURN TO: EXT: I CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM ORIGINATING DEPT./DIV: City of Federal Way - Federal Way Community Center 2. ORIGINATING STAFF PERSON: Ashriya Guptar EXT: 6950 DATE REQ. BY 6116/23 4. TYPE OF DOCUMENT (CHECK ONE): ❑ CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ) ❑ PUBLIC WORKS CONTRACT ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT ❑ PROFESSIONAL SERVICE AGREEMENT ❑ MAINTENANCE AGREEMENT ❑ GOODS AND SERVICE AGREEMENT ❑ HUMAN SERVICES / CDBG ❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) ❑ ORDINANCE ❑ RESOLUTION ❑ CONTRACT AMENDMENT (AG#): ❑ INTERLOCAL 9 OTHER MOU 5. PROJECTNAME: OUTDOORS FOR ALL- GRAVEL BIKING 6. NAME OF CONTRACTOR: OUTDOORS FOR ALL ADDRESS: 6344 NE 74TH ST, STE 102, SEATTLE WA 98115 TELEPHONE 206-838-6030 E-MAIL: KyleH@outdoorsforall.org FAX: SIGNATURE NAME: KYLE HITZELBERG TITLE PARTNER PROGRAMS MANAGER 7. EXHIBITS AND ATTACHMENTS: ® SCOPE, WORK OR SERVICES ICI COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE ❑ ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: 7/8/23 COMPLETION DATE: 7/8/23 9. TOTAL COMPENSATION $ 0 (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑ YES R NO IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED ®YES ONO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY RETAINAGE: RETAINAGE AMOUNT: ❑ RETAINAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDED ❑ PURCHASING: PLEASE CHARGE TO: 10. DOCUMENT/CONTRACT REVIEW A PROJECT MANAGER ❑ DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) ® LAW 11. COUNCIL APPROVAL (IF APPLICABLE) 12. CONTRACT SIGNATURE ROUTING ❑ SENT TO VENDOR/CONTRACTOR INITIAL / DATE REVIEWED KH 6/13/23 JE 6/15/23 COMMITTEE APPROVAL DATE: DATE SENT: INITIAL / DATE APPROVED COUNCIL APPROVAL DATE: 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.) `VLAW DEPARTMENT ❑ SIGNATORY (MAYOR OR DIRECTOR) ❑ CITY CLERK ❑ ASSIGNED AG# COMMENTS: 2/2017 rovwpnnor Outdoors for All 6344 NE 74th St, Ste 102 Seattle, WA 98115 P 206.838.6030 x 217 EKyleH@outdoorsforall.org Program Memorandum of Name: .com W SL ., Gravel Dates• '-0 Partner Contact Kevin Hutchinson Phene: (253)835-6927 Address: FEDERAL WAY COMMUNITY CENTER 876 5.333RD STREET lwm Details Cost Tax Base Fee Adaptive Bike/Gravel Bike Demo $ 2,500.00 $ Equipment Rental $ $ Vendor Fee $ Transportation Fee $ Additional Fees $ $ - Financial Aid- MSCT 5 Financial Aid - Grant $ 2,500.00 Financial Aid - Outdoors for All $ - Total: $0.00 Detailed Event information — Event Type: Gravel Biking Event Location: Puyallup Riverwalk Trail Liability Link: Event Time: 10am-4pm http5;//www.1fstorMs,cam/497M9Afa 1877=a3N5h0 Transportation Provided: No 00003slY4EAl Schedule: gam - Outdoors for All staff arrive for set-up loam-10:15am - Introductions/Safety Checks/Bike Set-ups 10:15am -12pm - Group Trail Ride 12pm-1pm - Break for Lunch 1pm - 4pm - Finish Trail Ride Event Narrative: Outdoors for All will provide a gravel bike experience day for the partitipants of the City of Federal Way Inclusion Camp at Puyallup Riverwalk Trail. Participants should be able to ride either a standard or adaptive bike independently. All participants must sign the Outdoors for All liability waiver prior to participation. It is recommended that participants bring their own towel, snacks, and water. All participants should wear clothing that is appropriate to be active. Outdoors for All Staff: 2 Partner Staff/VOL: 2 # of Participants: 12 Outdoors for All VOL: 4 to 5 Diagnosis: Diverse Array of Intellectual and Developmental Disabilities Ages: 16-65 Equipment: Adaptive bikes, helmets, adaptive equipment Outdoors for All Contact: Kyle Hitzelberg - KyleH@outdoorsforall.org - 206.838.6030 x217 I outdoors for All agrees to: 1. EQUIPMENT: Provide adaptive and non -adaptive equipment as indicated above. 2. TRANSPORTATION: Provide transportation of equipment and/or participants to event site (as indicated above). 3. STAFF: Provide one or more Outdoors for All staff person/s (as indicated above). Staff will train the partner organization volunteers/staff on equipment operation, choice, and fitting. The Outdoors for All staff person will remain at the base camp to assist, direct, and troubleshoot the volunteers/staff or the Outdoors for All staff will lead the activity. 4. FINANCIAL AID: Outdoors for All is committed to reducing the economic barriers of our partners and participants while financial aid resources are available. Financial aid may not cover vendor fees such as: permits, venue rentals, etc. S. INSURANCE: Provide insurance for the Partnership Program. Outdoors for All maintains an insurance policy with Acordia Northwest. We can provide you with a "certificate of insurance" " naming you "additional insured" if needed. We would also appreciate receiving a "certificate of insurance" from your insurance company. 6. LIABILITY: Each party shall defend, indemnify, and hold the other party, its officers, officials, employees, and volunteers harmless from any and all claims, injuries, damages, losses or suits including reasonable attorney fees, arising out of injuries and/or damages caused by each party's own negligence. Partner Organization agrees to: 1. CANCELLATION/REFUND POLICY: A full refund minus a $100 administrative fee, plus the cost of any vendor fees or reservations, will be given if the partner organization cancels an event by written notice 10 days prior to the scheduled date of the event. The partner organization will be responsible for the full cost of the event if the event is cancelled less than 10 days before the scheduled date or participants drop out less than ten days before the scheduled event. Outdoors for All reserves the right to cancel an event due to unsafe weather. If a partner or participant chooses not to participate due to weather there will be no refund given. If Outdoors for All cancels an event due to dangerous weather or road conditions, a credit for the event will be given and event will be rescheduled on a mutually agreed upon date. No discounted rates will be given due to participant/partner absence or choice of non - participation. 2. VOLUNTEERS/STAFF: If necessary, the partner organization will provide an adequate number of staff and volunteers to assist participants. They will be trained by the Outdoors for All staff person on equipment operation, choice, and fitting. Staff and volunteers will support participants with disabilities as needed, to participate in the activity. The partner organization's staff/volunteers should be dedicated to the needs ofthe participants and group's goals. The Outdoors for All staff person(s) will remain at a base camp to assist, direct, and troubleshoot the volunteers/staff or serve as a lead during the event. 3. Financial Aid & Group Expectations: In order to receive the full financial aid amount listed above, the partner organization must meet its minimum attendance number for eligible participants (as noted in the Detailed Event Information section, "p of participants"). Outdoors for All cannot give away financial aid to have little or no return in participation. All participants, staff, and volunteers must complete digital liability forms prior to joining the event. Each attendee must be capable of appropriately wearing the safety equipment needed for the activity. Individuals who are not able to meet the Essential Eligibility Criteria for a program/sport/activity will be asked to leave the event area. 4. PROMOTION: Promote the event according to the goals of the host organization. With prior written approval by the Partner, the Partner agrees that Outdoors for All may use any photo, video, interviews, and success stories from this event in marketing and outreach . Please return a signed copy of this MOU within 5 business da s of receipt. The Accounting Department will send a final invoice during the first week of the month following the completion of the event. Kyle Digitally signed by Kyle Y Hitzelberg Hitzelberg Date, 2023.06.20 Partner Signature: Outdoors for All Signature: y _09:27�IM-07'p0' Partner Name: [-tv laAtJ,6V6J Outdoors for All Name: Date: 2{ 2 Date: Kyle Hitzelberg 6.20.2023 6/13/23, 1:14 PM Washington State Department of Revenue Washington State Department of Revenue < Business Lookup License Information: Entity name: OUTDOORS FOR ALL FOUNDATION Business OUTDOORS FOR ALL FOUNDATION name: Entity type: UBI #: I Business ID: Location ID: Location: Nonprofit Corporation 600-348-980 001 roll Active Location address: Mailing address: 6344 NE 74TH ST STE 102 SEATTLE WA 98115-8165 6344 NE 74TH ST STE 102 SEATTLE WA 98115-8165 Excise tax and reseller permit status: Click here Secretary of State status: Click here Endorsements Endorsements held i License # Count Details Minor Work Permit hftps:Usecure.dor.wa.gov/gteunauth/_/#2 New search Back to results Status Expiration First issua Active Jan-31-2C May-10-2 '3 6/13/23, 1.14 PM Washington State Department of Revenue Endorsements held i License # Count Details Status Expiratior First issua Governing People May include governing people not registered with Secretary of State Governing people BRONSDON, ED EFROYMSON, AMY ESTEP, TOM INSLEE, CONNOR REYNOLD$, ROGER ZYLSTRA, TH ERA Registered Trade Names Registered trade names Status OUTDOORS FOR ALL Active FOUNDATION Title First issued Dec-16-2019 View Additional Locations The Business Lookup information is updated nightly. Search date and time: 6/13/2023 1:13:53 PM https:gsecure.dor.wa.gov/gteunauth/_/#2 2/3 6/13/23, 1:14 PM Corporations and Charities System BUSINESS INFORMATION Business Name: OUTDOORS FOR ALL FOUNDATION UBI Number: 600 348 980 Business Type: WA NONPROFIT CORPORATION Business Status: ACTIVE Principal Office Street Address: 6344 NE 74TH ST STE 102, SEATTLE, WA, 98115-8165, UNITED STATES Principal Office Mailing Address: 6344 NE 74TH ST STE 102, SEATTLE, WA, 98115-8165, UNITED STATES Expiration Date: 01/31/2024 Jurisdiction: UNITED STATES, WASHINGTON Formation/ Registration Date: 01/23/1979 Period of Duration: PERPETUAL Inactive Date: Nature of Business: CHARITABLE Charitable Corporation: R Nonprofit EIN: 91-1085999 Most Recent Gross Revenue is less than $500,000: Has Members: Public Benefit Designation: R Host Home: REGISTERED AGENT INFORMATION Registered Agent Name: OUTDOORS FOR ALL FOUNDATION Street Address: 6344 NE 74TH ST STE 102, SEATTLE, WA, 98115-8165, UNITED STATES Mailing Address: https://ccfs.sos.wa.gov/#/BusinessSearch/Businessinformation 1/2 6/13/23, 1:14 PM Corporations and Charities System GOVERNORS Title Governors Type Entity Name First Name Last Name GOVERNOR INDIVIDUAL ED BRONSDON GOVERNOR INDIVIDUAL ROGER REYNOLDS GOVERNOR INDIVIDUAL TOM ESTEP GOVERNOR INDIVIDUAL AMY EFROYMSON GOVERNOR INDIVIDUAL CONNOR INSLEE GOVERNOR INDIVIDUAL THERA ZYLSTRA https://ccfs.sos.wa.gov/#/BusinessSearch/Businessinformation 2/2 SK143613 1 0 i LVLJ_/7, CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 6/20/2020/2023 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 Safehold Special Risk, Inc. (877) 281-5690 CONTACT NAME: PHONe FAX AIC No): Safehold Special Risk, Inc. (CA DOI # OG13561) E4WAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# 601 Union St, Suite 1000 Seattle, WA 98101 : NOVA Casualty Company 42552 INSURED : Outdoors For All Foundation LINSURER: D: 6344 NE 74th Street, Suite 102 : Seattle, WA 98115 INSURER F : COVERAGES CERTIFICATE NUMBER: 15738131 REVISION NUMBER: See below 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 LTR TYPE OF INSURANCE ADDL INS aUBR POLICYNUMBER POLICY EFF MMIDDJYYYY POLICY EXP MMIDDIYYYY LIMITS A )( COMMERCIAL GENERAL LIABILITY X WFR-GL-10000044-05 10/01/22 10/01/23 EACH OCCURRENCE S 1,000,000 CLAIMS -MADE � OCCUR PREMISES Ea uiccurrencel S 1,000,000 X MED EXP (Any one person) $ Not Covered WA Stop Gap Employers Liability X $1,000,000 Limit PERSONAL & ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE I $ None POLICY JECOT- LOC PRODUCTS - COMP/OP AGG 1 $ 2,000,000 SEXUAL MISCONDUCT S 1,000,000 OTHER_ AUTOMOBILE LIABILITY COMBINED SINGLE LIMTT accident) $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) S PROPERTY DAMAGE Per ac idenl S HIRED NON -OWNED AUTOS ONLY AUTOS ONLY $ A UMBRELLALIAB X OCCUR X WFR-XS-10000041-05 10/1/22 10/1/23 EACH OCCURRENCE S 4,000,000 AGGREGATE S 8,000,000 X EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ S 'WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N FR c7ATUTE ERA ANYPROPRIETOR/PARTNER/EXECUTIVE E. L. EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE S If yes, describe under DESGRIPTIONOFOPERAT10NSheiow E.LDISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) The Certificate Holder is an Additional Insured when required by written contract, agreement, lease, or permit, as respects liability arising from the operations of the Named Insured. CERTIFICATE HOLDER CANCELLATION City of Federal Way SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Kevin Hutchinson ACCORDANCE WITH THE POLICY PROVISIONS. 876 S 33rd St. Federal Way, WA 98003 AUTHORIZED REPRESENTATIVE a - The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103)