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AG 23-242 - MANJIT GREWALRETURN TO: J EXT: CITY OF FE RAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT./DIV: Parks- Recreation 2. ORIGINATING STAFF PERSON: Kevin Hutchinson EXT: 6926 3. DATE REQ. BY: 10/2/2023 4. TYPE OF DOCUMENT (CHECK ONE): A 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#): ❑ 1NTERLOCAL ❑ OTHER 5. PROJECT NAME: Concessionaire Agreement Celebration Park Upper Chase A- Manjit H&S Ice Cream 6. NAME OF CONTRACTOR: Manjit Grewal ADDRESS: 2415 S. 280th Pl., Federal Way, WA 98003 TELEPHONE 425-835-7411 E-MAIL: sukhem@hotmail.com FAX: SIGNATURENAME: Mannit GreWal TITLE 7. EXHIBITS AND ATTACHMENTS: A SCOPE, WORK OR SERVICES m COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE ❑ ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: 8/23/2023 COMPLETION DATE: 1/31/2026 9. TOTAL COMPENSATION $ N-N (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 10YES 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 INITIAL / DATE REVIEWED INITIAL / DATE APPROVED O PROJECT MANAGER KH 9/26/2023 ❑ DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) ❑ LAW TMW - 9/27/23 JE 11/3/23 _ 11. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: COUNCIL APPROVAL DATE: 12. CONTRACT SIGNATURE ROUTING ❑ SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D: ❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS ❑ CREATE ELECTRONIC REMINDER/NOTIFICATION FOR 1 MONTH PRIOR TO EXPIRATION DATE (Include dept. support staff if necessary and feel free to set notification more than a month in advance if council approval is needed.) // INITIAL/ DATE SIGNED VYL AW DEPARTMENT ❑ SIGNATORY ( OR OR DIRECTOR) 0 CITY CLERK u ltb*" ❑ ASSIGNED A09 COMMENTS: 2/2017 CITY OF CITY HALL Federal Way 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www. cltyoffederalway. com AMENDMENT NO. 1 TO CONCESSIONAIRE AGREEMENT FOR CONCESSIONS SERVICES CELEBRATION PARK — UPPER CHASE A This Amendment ("Amendment No. 1") is made between the City of Federal Way, a Washington municipal corporation ("City"), and Manj it Grewal dba H S Ice Cream, a Washington sole proprietor ("Contractor"). The City and Contractor (together "Parties"), for valuable consideration and by mutual consent of the Parties, agree to amend the original Agreement for Concessionaire Agreement for Concessions Services Celebration Park- Upper Chase A ("Agreement") dated effective August 23, 2023, as follows: 1. AMENDED TERM. The term of the Agreement, as referenced by Section 1 of the Agreement and any prior amendments thereto, shall be amended and shall continue until the completion of the Services, but in any event no later than January 31, 2026 ("Amended Term"). 2. AMENDED SERVICES. The Services, as described in Exhibit A and as referenced by Section 2 of the Agreement, shall be amended to include a change to Section 1(c), Hours of Operation, as described in Exhibit A-1 attached hereto and incorporated by this reference ("Amended Services"). 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 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] 1 CITY OF Federal Way CITY HALL 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www. cttyoffederal way. com IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY: MANJIT GREWAL dba H S ICE CREAM: By: Printed Name: Man'it Grewal Title: Owner DATE: STATE OF WASHINGTON ) ss. COUNTY OF ATTEST: 0cpourtney, C , City Clerk APPROVED AS TO FORM: '*all, City Atto ey On this day personally appeared before me, Mari it Grewal dba H S Ice Cream, to me known to be the individual described in and who executed the foregoing instrument, and on oath swore that they executed the foregoing instrument as their free and voluntary act and deed for the uses and purposes therein mentioned. GIVEN my hand and official seal this day of aa�IHA PQ/, off 0 �y `� iljit►u%r��►�'� Notary's signature '—' Notary's printed name 2023. Notary Public in and for the Statejof Washington. My commission expires VA CITY OF CITY HALL Federal Way Feder 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www.ci"ffederalway.com EXHIBIT A-1 AMENDED SERVICES Section 1(c) of Exhibit A to the original Agreement shall be amended as follows: C. Hours of Operation. The Concession Stands shall remain open during the hours of operation set forth in this Exhibit A-1, unless the City notifies the Contractor of other hours of operation, and such hours of operation shall be posted in a conspicuous place on the Concession Stands. i. Through October 31, required to be open through scheduled softball field use as scheduled by the Recreation Manager. A schedule of activities will be provided to the vendor on a monthly basis and is subj ect to change. During all league play the Contractor shall provide the services 15 minutes prior to the scheduled start of the first game until 15 minutes after the scheduled start time of the last game. If the Contractor opens late or closes early for any reason, the Contractor shall notify the Contract Administrator explaining the reason for closure and the hours the concession stand was in operation. ii. On Saturdays, Sundays, and holidays when games are scheduled, the Contractor shall provide services 15 minutes before the scheduled start time of the first game until 15 minutes after the schedule start time of the last game. 3 11/3/23, 10:40 AM Washington State Department of Revenue Washington State Department of Re < Business Lookup License Information: Entity name: GREWAL, MANJIT K Business name: H S ICE CREAM Entity type: Sole Proprietor UBI #: 601-477-510 Business ID: 002 Location ID: 0001 Location: Active Location address: 2415 S 284TH PL FEDERAL WAY WA 98003 Mailing address: 2415 S 284TH PL FEDERAL WAY WA 98003 Excise tax and reseller permit status: 1 Endorsements Endorsements held at this locatie License # Federal Way Home 01-101702-00-1 i Occupation Business Click here Count Details Status Expiration date Active Apr-30-2024 Governing People May include governing people not registered with Secretory o/State Governing people Title GREWAL, MANJIT K Registered Trade Names Registered trade names Status H S ICE CREAM Active New search Back to results First issuance date May-11-2001 First issued Apr-23-2001 The Business Lookup information is updated nightly. Search date and time: 11/3/2023 10:39:55 AM v https://secure.dor.wa.gov/gteunauth/_/#4 1/2 1113/23, 10:40 AM Washington State Department of Revenue Contact us How are we doing? Take our survey! Don't see what you expected? Check if your browser is supported https://secure.dor.wa.gov/gteunauth/_/#4 2/2 '4C;1lR '© CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 9/6/2023 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 NAM✓•:=. SUKHWINDER SIDHU Agency IInsurance PHONE FAX C No. Exf : ( 253)236-4123 AIC. Nc): 10120 SE 260TH ST. ADDRESS: Agency insurance@gmail.com SUITE # 210 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : OIIIO SECURITY INS CO 24082 KENT WA 98030 INSURED INSURER B : INSURER C : Manjit Kaur Grewal INSURER D : 2415 S 284th PI INSURER E : INSURERF: Federal Way WA 98003 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY MM/DD/YYYY) LIMITS A K COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR SPC Y Y BLS62838394 I 03/01/2023 03/01/2024 EACH OCCURRENCE $ 1,000,000 PREMISES (Ea occurrence) $ 1,000,000 h MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 L AGGREGATE LIMIT APPLIES PER: POLICY J@�LOC M'OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 S AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Ea aecidonl $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ Per accident) $ UMBRELLA LIAB EXCESS LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) Ifyes, describe under DESCRIPTION OF OPERATIONS below N I A STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) LOC #1 -1095 S 324TH PL FEDERAL WAY WA 98003 LOC # 2- 2410 S 312TH ST FEDERAL WAY WA 98003 f'FRTIF[r:ATF Hni nPR CANCELLATION 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 5. 51Cf4U U 1988-2015 ACURD GUKPUKA I IUN. All rlgnts reserves. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD yet STATE OF WASHINGTON Sole Proprietor MANJIT K GREWAL H S ICE CREAM 2415 S 284TH PL FEDERAL WAY WA 98003 BUSINESS LICENSE TAX REGISTRATION #600-662-906 - ACTIVE W Issue Date: Mar 17, 2023 Unified Business ID #: 601477510 Business ID #: 002 Location: 0001 Expires: Apr 30, 2024 CITY ENDORSEMENTS: FEDERAL WAY HOME OCCUPATION BUSINESS #01-101702-00-BL - ACTIVE REGISTERED TRADE NAMES: H S ICE CREAM This document lists the registrations, endorsements, and licenses authorized for the business named above. By accepting this document, the licensee certifiesthe information on the applicadou was complete, true, and accurate to the best of his or her knowledge, and that business will be conducted in compliancewith all applicable %Mwdiinfton state, county, and city regulations. �i� r sa y.�aC:.��ie 4 .�:i'r- �.i� i��� - -......:� �_.,.::a=�'...�Y_r.:...Sr ••k.:� STATE OF WASHINGTON UBI: 601477510 002 0001 MANJIT K GREWAL TAX REGISTRATION #600=662-906 - H S ICE CREAM ACTIVE 2415 S 284TH PL FEDERAL WAY HOME OCCUPATION FEDERAL WAY WA 98003 BUSINESS #01-101702-00-BL - ACTIVE I C►irsrtwr, QryrTrlmm� �� ftevenur Expires: Apr 30, 2024 IMPORTANT! PLEASE READ THE FOLLOWING INFORMATION CAREFULLY BEFORE POSTING THIS LICENSE General Information Endorsements Post this Business License in a visible location at your All endorsements should be renewed by the expiration place of business. date that appears on the front of this license to avoid any late fees. If you were issued a Business License previously, destroy the old one and post this one in its place. Login to My DOR at dor.wa.gov if you need to make changes to your business name, location, mailing address, telephone number, or business ownership. Telephone: 360-705-6741 If there is no expiration date, the endorsements remain active as long as you continue required reporting. Tax Registration, Unemployment Insurance, and Industrial Insurance endorsements require you to submit periodic reports. Each agency will send you the necessary reporting forms and instructions. For assistance or to request this document in an alternate format, visit http://business.wa.gov/BLS or call (360) 705-6741. Teletype (TTY) users may use the Washington Relay Service by calling 711. BLS-700-107 (07/27/20)