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AG 05-007 DATE IN: DATE OUT: TO: t~ \\Î)~ CITY OF FEDERAL WAY LAW DEPARTMENT \\ \D tV ,\ \~\' REQUEST FOR CONTRACT PREPARATION/DOCUMENT REVIEW/SIGNATURE ROUTING SLIP 1. 2. 4. 5. 6. 7. 8. 9. 10. 11. ORIGINATING DEPT.IDIV: Ç~Òe~ \ ~V\. '~)\ \Ge.. SJ~tr \'v^r<? f\ . \ ORIGINATING STAFF PERSON: ~~'-.Y- V\e Q\. \ EXT: tv ì I 7 3. DATE REQ. BY: . 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 .., r'.., ~!C(, 2 2 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 fI, ^-j¡ BY: U{J-1 ' ~ David H. Moseley, City Manager PO Box 9718 Federal Way, WA 98063-9718 (~ APPROVED AS TO FORM: -1, - -1/ ~_. (r -4"/ ? ?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) /' ~.. /' ----/«, ,0" L//'/-<: -,-/"'.., /' /,'/ ./'"' ,00'./'" (/ //1 L " "- ,./,00' ~ .. '- Signature // .. 4' .: r-'/o /;1 , / .-'> ,/ ...- Time / C /.d': ¥ j' ....-,-- ç- , ( ¿ Da~ \, ".;', ""T,, ,\, - , J 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) .. . '. . 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\ :;;- V-i)? (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) ,~-----7 , -,," ,.---.. . /-- .-', ---. I ) \/ S-- L.. '-( C ~- Date Signature Time ____0 -",-------,- ..---,--,,-"',-- ---- -_o--~-,----,,-,------------~--- ------- -------,---_.J L LCØlD J ¡ 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 /.. 4ç--~rvr\ OJ. 0<--/' OS- Time Date . .nO__._~-----_..._..._-' ....,,-., ._..._,-,------------~ ------------_J ~ ENTERPRISES EARTHMOVERS Seattle (206) 521-9709 / Tacoma (206) 922-0822 P.D.Box 3889 Federal Way, WA 98003 INC. ~ I i I I i I I I I 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 d - Cj-úS- (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 <.--' / Signature I I I I ------ -_._-_.,.----,,-------,-----,---_. -,.----" I', 'IS- p......... Time ). . 't . or::; Date