AG 05-007 - LLOYD ENTERPRISES INC
DATE IN:
DATE OUT:
TO:
t~ \\Î)~ CITY OF FEDERAL WAY LAW DEPARTMENT
\\ \D tV ,\ \~\'
REQUEST FOR CONTRACT PREPARATION/DOCUMENT REVIEW/SIGNATURE ROUTING SLIP
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ORIGINATING DEPT.IDIV: Ç~Òe~ \ ~V\. '~)\ \Ge.. SJ~tr \'v^r<? f\
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ORIGINATING STAFF PERSON: ~~'-.Y- V\e Q\. \ EXT: tv ì I 7 3. DATE REQ. BY:
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TYPE OF DOCUMENT REQUESTED (CHECK ONE)
~ROFESSIONAL SERVICE AGREEMENT
-b MAINTENANCE/LABOR AGREEMENT
0 PUBLIC WORKS CONTRACT
0 SMALL PUBLIC WORKS CONTRACT
0 SECURITY DOCUMENT (E.G. AGREEMENT &
PERFIMAIN BOND; ASSIGNMENT OF FUNDS IN LIEU OF BOND)
0 CONTRACTOR SELECTION DOCUMENT
(E.G., RFB, RFP, RFQ)
0 CONTRACT AMENDMENT
0 CDBG
0 OTHER
(LESS THAN $200,000)
0 PURCHASE AGREEMENT)
AG#:
ATTACH ALL EXHIBITS AND CHECK BOXES 0 SCOPE OF SERVICES 0 ALL EXHIBITS REFERENCED IN DOCUMENT
0 INSURANCE CERTIFICATE 0 DOCUMENT AUTHORIZING SIGNATURE
TERM: COMMENCE~ENTDA~E: ,(\~ (\~. ".
D ~tj COMPLETION DATE: ð'(~f.J\ V"\~
TOTAL COMPENSATION $ !' A (INCLUDE EXPENSES AND SALES TAX, IF ANY)
(IF CALCULATED ON HOURLY LABOR C GE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES)
REIMBURSABLE EXPENSE: 0 YES 0 NO IF YES, MAXIMUM DOLLAR AMOUNT: $
IS SALES TAX OWED 0 YES 0 NO IF YES, $
PAID BY: 0 CONTRACTOR 0 CITY
CONTRACT REVIEW
0 PROJECT MANAGER
0 DIRECTOR
0 RISK MANAGEMENT
~LAW
INITIALIDATE APPROVED
INITIALIDATE APPROVED
~
CONTRACT SIGNATURE ROUTING INITIALIDATE APPROVED INITIALIDATE APPROVED
i LAW DEPAAT~m _I
'" CITY MANAGER -,'. ~
TYCLERK ..-' , '=-", W~
~GN COpy BACK TO ORGINATING DEPT: ....~ nJ'
0 ASSIGNED AG# 05' -7
0 PURCHASING: PLEASE CHARGE TO:
COMMENTS
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10/09/02
#
A&. Dr;- 7
Fill Dirt, Gravel
Crushed Rock, Top Soil
Lloyd Enterprises, Inc.
2102 South 341 sl Place
PO Box 3889, Federal Way, W A 98063-3889
FAX: (253) 838-0103
PHONE: (253) 874-6692 / (253) 927-0416
LLOYDI *238 QB
Dump Trucks and Trailers
Loaders and Dozers
HOLD HARMLESS AGREEMENT
THE CITY OF FEDERAL WAY Agrees to defend, indemnify and hold Lloyd Enterprises,
Inc. and its officers harmless from any and all claims, demands, losses and liabilities to or
by third parties arising from, resulting from or connected with services provided or
performed or to be performed under this indemnification agreement to the fullest extent
permitted by law and subject to the limitations thereof.
THE CITY OF FEDERAL WAY's duty to indemnify Lloyd Enterprises Inc. shall not
apply to liability for damages arising out of bodily injury to persons or damage to property
caused by or resulting from the sole negligence of Lloyd Enterprises Inc., or it's
employees.
THE CITY OF FEDERAL WAY's duty to indemnify Lloyd Enterprises and its officers
for liability for damages arising out of bodily injury to persons or damage to property
caused by or resulting from the concurrent negligence of the City of Federal Way.
THE CITY OF FEDERAL WAY specifically and expressly waives any immunity that
may be granted it under the Washington State Industrial Insurance Act, Title 51 RCW.
Further, the indemnification obligation under this agreement shall not be limited in any
way by any limitation on the amount or type of damages, compensation or benefits
payable to or for any third party under workers compensation acts, disability benefits acts,
or other employee benefits acts.
THE CITY OF FEDERAL WAY's duty to defend, indemnify and hold Lloyd Enterprises
Inc. and its officer harmless shall include, as to all claims, demands, losses and liability to
which it applies to personnel-related costs, reasonable attorneys fees, court costs and all
other claim related expenses.
THE UNDERSIGNED HEREBY CERTIFY THAT THIS AGREEMENT WAS MUTUALLY NEGOTIATED.
DATED:
/-.;l/ -0:;
:~mc v'
N~r~~
TITLE: Mý~U'ßX ,
DATED:
t!IY/Oj-
CITY OF FEDERAL WAY
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BY: U{J-1 '
~ David H. Moseley, City Manager
PO Box 9718
Federal Way, WA 98063-9718
(~
APPROVED AS TO FORM:
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?t ~ '-1.. '. /(/<-êf"jj'~~.o.-
Patricia A. Richardson, City Attorney
K:\Agreements\Lloyd Hold Harmless - Bomb Training
LLCIJID
ENTERPRISES
EARTH MOVERS
Seattle (206) 521-9709 / Tacoma (206) 922-0822 P.D.Box 3889 Federal Way, WA 98003
INC.
SITE SPECIFIC HAZARD AWARENESS
TRAININ G RECD RD/CERTIFI CA TE
(Please Print)
NAME S7Efflf/1/ -L < ß¿r:-1Lc('/(
MINENAME&ID#....................................... MILTON PIT B220 #45-03069
LOCATION:..................................................80 Sth ave. Milton. WA983S4
CUSTOMER/VENDOR OR OTHER... Cust. #
LENGTH OF TRAINING...... ........................ ... ... .......5 minutes to 1 hour
DATE....r<:.L....¥:...-?c.o.~..........................
/
COMPETENT PERSON PROVIDING TRAINING... ... .C~¿Z:--5' ,¿:::f"'/2él~/1/
HAZARDS DO EXIST IN THE MINE! THE FOLLOWING RULES AND REGULATIONS
WERE DESIGHNED FOR YOUR SAFETY AND THE SAFETY OF OTHERS
TRAFFIC CONTROL
.
Seatbelts shall be worn at all times
Follow all signs and any verbal instructions
Onsite haul trucks and loaders have the Right of Way
Safety equipment (such as back up alarms) must be in working order
Communication; use channel #4 on CB for loader operator or scale house
Unless Directed stay in vehicle at all times
.
.
.
.
.
PERSONAL PROTECTION EQUIPMENT (PPE)
. Hard Hats
. Safety glasses
. Steel-toed boots
. Use hearing protection when applicable
. Safety Vests
(pPE is required for anyone who must exit his or her vehicle)
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LLC8D
ENTERPRISES
EARTH MOVERS
Seattle (206) 521-9709 / Tacoma (206) 922-0822 P,O.Box 3889 Federal Way, WA 98003
I N C ,
SITE SPECIFIC HAZARD AWARENESS
TRAININ G RECD RD/CERTIFI CA TE
(Please Print)
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CUSTOMERIVENDOR OR OTHER. . . Cust. #
NAME 'LA",\~,",j )(, ij,,') ~ ~
MINENAME&ID#................,..,...,....,.......... MILTON PIT B220 #45-03069
LOCATION:....................,.............................80 5th ave. Milton. WA98354
LENGTH OF TRAINING...... .....................................5 minutes to 1 hour
DATE....:ç...,.~.~.\..o..~?.~............................."""""""
COMPETENT PERSON PROVIDING TRAINING............ c.. ~r,::a
f) /" ð v.J V\
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(Date)
HAZARDS DO EXIST IN THE MINE! THE FOLLOWING RULES AND REGULATIONS
WERE DESIGHNED FOR YOUR SAFETY AND THE SAFETY OF OTHERS
TRAFFIC CONTROL
.
Seatbelts shall be worn at all times
Follow all signs and any verbal instructions
Onsite haul trucks and loaders have the Right of Way
Safety equipment (such as back up alarms) must be in working order
Communication; use channel #4 on CB for loader operator or scale house
Unless Directed stay in vehicle at all times
.
.
.
.
.
PERSONAL PROTECTION EQUIPMENT (PPE)
. Hard Hats
. Safety glasses
. Steel-toed boots
. Use hearing protection when applicable
. Safety Vests
(pPE is required for anyone who must exit his or her vehicle)
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Date
Signature
Time
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L LCØlD
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ENTERPRISES
EARTHMOVERS
Seattle (206) 521-9709 / Tacoma (206) 922-0822 P.D.Box 3889 Federal Way, WA 98003
INC.
SITE SPECIFIC HAZARD AWARENESS
TRAININ G RECD RD/CERTIFI CA TE
(Please Print)
CUSTOMERIVENDOR OR OTHER... Cust. #
NAME ~\f'\j<-
(\ ~CÀ \
MINE NAME & ID#.................. ... .., ......... ... ... MILTON PIT B220 #45-03069
LOCATION:... ...... ..................... ...... ... ...... .....80 5th ave. Milton. WA 98354
LENGTH OF TRAINING...... ... ... ... ......... ............... ....5 minutes to 1 hour
DATE................................................................... Od' 0 '--{. oS--
COMPETENTPERSONPROVIDINGTRAINING............C~'í\ ~ ß<ð~(\
HAZARDS DO EXIST IN THE MINE! THE FOLLOWING RULES AND REGULATIONS
WERE DESIGHNED FOR YOUR SAFETY AND THE SAFETY OF OTHERS
TRAFFIC CONTROL
.
Seatbelts shall be worn at all times
Follow all signs and any verbal instructions
Onsite haul trucks and loaders have the Right of Way
Safety equipment (such as back up alarms) must be in working order
Communication; use channel #4 on CB for loader operator or scale house
Unless Directed stay in vehicle at all times
.
.
.
.
.
PERSONAL PROTECTION EQUIPMENT (PPE)
. Hard Hats
. Safety glasses
. Steel-toed boots
. Use hearing protection when applicable
. Safety Vests .
(pPE is required for anyone who must exit his or her vehicle)
St~ v!J~
Signature
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Time Date .
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ENTERPRISES
EARTHMOVERS
Seattle (206) 521-9709 / Tacoma (206) 922-0822 P.D.Box 3889 Federal Way, WA 98003
INC.
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LLCØlD
SITE SPECIFIC HAZARD AWARENESS
TRAININ G RECD RD/CERTIFI CA TE
(Please Print)
CUSTOMERIVENDOR OR OTHER... Cust. #
NAME !tv I L (.... I ..q ""'-1 C. <;. 1-1 Dc. k L. E r
MINENAME&ID#....................................... MILTON PIT B220 #45-03069
LOCATION:..................................................80 5th ave. Milton. WA98354
LENGTH OF TRAINING...... """,.""",.., ...... ... ...... ....5 minutes to 1 hour
DATE................................................................... FE13- t../, 7DO":;-
COMPETENT PERSON PROVIDING TRAINING... ... ... '"
CHef":,
ï5QD......... ,v
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(Date)
HAZARDS DO EXIST IN THE MINE! THE FOLLOWING RULES AND REGULATIONS
WERE DESIGHNED FOR YOUR SAFETY AND THE SAFETY OF OTHERS
TRAFFIC CONTROL
.
Seatbelts shall be worn at all times
Follow all signs and any verbal instructions
Onsite haul trucks and loaders have the Right of Way
Safety equipment (such as back up alarms) must be in working order
Communication; use channel #4 on CB for loader operator or scale house
Unless Directed stay in vehicle at all times
.
.
.
.
.
PERSONAL PROTECTION EQUIPMENT (PPE)
.
Hard Hats
Safety glasses
Steel-toed boots
Use hearing protection when applicable
Safety Vests
(pPE is required for anyone who must exit his or her vehicle)
.
.
.
.
(SÅL
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Signature
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Time
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Date