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AG 07-095RETURN TO: EXT: CITY OF FEDER.AL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT./DIV: 2. ORIGINATING STAFF PERSON: (��� S1ne 1� ov1 EXT: .E��t 3Z 3. DATE REQ. BY: 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. sorm xsi,nrEn nocuMErrrs> ❑ ORDINANCE ❑ RESOLUTION �JCONTRACT AMENDMENT (AG#):�-(�� ❑ INTERLOCAL ❑ OTHER 5. PROJECTNAME: �<<YSo�n a1 TrH�h�v,o serv i �e5 6. NAME OF CONTRACTOR: 'E � a�A y� ADDRESS: 8"16 5 333rA �W 9gpp3 TELEPHONE 253 350 5y'IS E-MAIL: evaera�or � co�nncc.s�. ��} FAX: SIGNATURE NAME: 'E v a Ra Ser TITLE���eN.� �}�i ne r EXHIBITS AND ATTACHMENTS: ❑ SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE �,�4LL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: �J�y� I, 2 D 13 COMPLETION DATE: N� � v �1,► 31 . 2 0 l 3 9. TOTAL COMPENSATION $ 5 D � D O 6. OO (INCLUDE EXPENSES AND SALES TAX, IF ANY� (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TTTLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑ YES ❑ NO IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED ❑ YES ❑ NO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY ❑ PURCHASING: PLEASE CHARGE TO: l l 1_'( ZO D- 3 5! - 5�i �'J' • 51 - yt a 10. OCUMENT/CONTRACT REVIEW IrTITIAL / DATE REVIEWED II�TITIAL / DATE APPROVED � PROJECT MANAGER O DIRECTOR /l/' ( Z (3 ❑ RISKMANAGEMENT (g'.�PL�C.�LE) J� LAW P I Z• • I% i l. COLTNCILAPPROVAL (g'.4rrt,icwsLE) COMMITTEE APPROVAL DATE: ____ COUNCIL APPROVAL DATE: 12. CONTRACT SIGNATURE ROUTING i ❑ SENTTO VENDOR/CONTRACTOR DATE SENT: DATE REC'D: t/Z�I I_� �ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS LAW DEPARTMENT SIGNATORY MAYOR OR DIRECTOR� ;�I CITY CLERK ¢4 ASSIGNED AG# � SIGNED COPY RETURNED I1�IITIAL / DATE SIGNED ��3 - -'L AG# ' DATE SENT: I' - L � . ■ .� � I �A,;, �� � +� +r CITY HA�L ��� 3��25 8th Avenue South Federal Way, WA 98003-6325 (253� 835-70fl0 www c�tyoifederahv�y com AMENDMENT NO. 5 TO RECREATION AGREEMENT FOR PERSONAL TRAINING SERVICES This Amendment ("Amendment No. 5") is made between the City of Federal Way, a Washington municipal corporation ("City"), and Eva Rasor; a 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 Personal Training Services ("Agreement") dated effective May 7, 2007, as amended by all subsequent amendments, as follows: 1. AMENDED TERM. The term of the Agreement, as referenced by Section 2 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 March 31 St, 2013 ("Amended Term"). 2. 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, is 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] AMENDMENT - 1 - 1 /2010 � ���� t�� �;.' "�....r �� � � ��' CITY HP LL ����� 33325 8th Aven€�e St�uth Federai Way, WA 98403-6325 (iv3) 83s-70C1fl �vv�wv: �it�of#eciere�lvv��y.corn IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY ATTEST: By Skip Priest,lVla or City Clerk, Carol McN 'lly, CIYi DATE: ��..� � Z 2t7 I J i ,� EVA RASOR �� r � ` `..� � /�--� <� , ' _� � � / �✓L Title: ���% DATE: � /� APPROVED AS FORM: City Att y, Patricia A Richar son STATE OF WASHINGTON ) ) ss. COUNTY OF � ) On this day personally eazed before me, ��r � GIS�� , to e known to be the individuai described in and w executed the foregoing instrument, and on oath swore that h�they executed the foregoing instrument as hisl e�heir free and voluntary act and deed for the uses and purposes therein mentioned. GIVEN my hand and official seal this �NEL�� M. sr,�� � w�suc DE��? 9. 2�n;� of � �� � , 20� ' (typed/printed name o notary) � Notary Public in ancl for the te of Washington. My commission expires 1 o�i � �1 '( AMENDMENT - 2 - 1 /20l U ACORO° � � FAagwre ��,ranoe agem.y, dx. znoi aoerta � s�t�e �o nn�v�ro.ca9z�- (ST/}438-7459 INSUI�D Eva Rasw 12326 ]8tfi St E E�xraod. WA 98372- COVERAGfS CERTIFtCATE OF LIABILITY INSURANCE ��� THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMMENO, EXTEND OR ALTER THE COVERAGE APFORDED BY THE POUCIES BELOW. 18056 TMe PoucaES oF iNSUw►r� usrm s�.ow �u►ve s� �mronie �r�sweeu � aeovE r�ae � Pouc�r �aeau i�►�u. No�wm�r� nnir �4wRaw�r, �ptM ort toNOmoni oF annr coNrw►cr ort am� oocu�rr wrrH r�cr To wH� TM�s c�RCw►� awr ee �ssu� at MAY PER7AIN, THE INSURANCE AFfORDED BY THE POLICi6 DESCRIBED HEREIN IS SUBIECT TO ALL THE TERMS, EXCWSIOI� AND CONDI'�S OF SUUI POLICIES. A6GRC�aATE UMiTS SHOWN MAY HAVE BEEN REDUGED BY PAID CLAMAS. a�at wot vaua� aamoww►� �m �+u rnEOFa�a� voucr�rt ou►rE o+►�e ts�rrs p x �a.unexm vHwccs��z v!m/miz u/u�/� Eaa+oca�o� S�aoo.000 x oot`neuumcu� �enExa�. un�un r�aES Ea o�e,�os Sioo.aoo C1AIM5 tMADE �X OCCUR MED D� (MY �e P�) � X �ONALW1BILrtY � PERSONN.&AWWNIRT $;{OOq000 6B��A1.1W(i1�6117E $4.000.000 GEN9.A66R�A7EUMRAPPUBPEFC PROWICIS—WMP/bPN66 $4,000000 � X POIKY PRQIECT LOC 1Wip�OBpEt1118p3IY � COMBq1EDS11JGl.EU�Mf ANYAUfO � - (EAaodda�) � . � . ALLONMIDAUIOS � � BOOKYWlUR1f SCHEOIIIEDAUf05 � ��P�) � � � - FpRED AUT�S . � B�ILY MINRtY MOlF�01NWEDAUI05. � (Perao�nNl � � PNO�R11f 011MA6£ � � (P'�aceld�t� 6nrtn�uaexm nuroowir-ea�oc�otr � ANYA!!f0 � OT}�ITHAN EANCC AUIO �LY: � �ICES/UMI�EWtiABIllT7i . EMIOO�ENCE 00."UR � 4AIRA5 MA� . p6�7E DEDUCiiBIE REfED1ilON . . uneiurr r romu�s �n���OemeEx�°ioa.�unm��r°� �. � noc�wr p�n� �1 ea. ws�ese-FaaMaw� s"�diu. �s�o�"'�°`ru a�, e.�. �-vamrta� on�e o�mnoN aF oneu►naaa / wunaNSl veaaFS / oca�s noo� sr emo��tr / svEau. v�wsoxs B is undera000d md a�greed tlnc the fuNowirs �v is addad � an addidonal imred Mrt my with raspeaNs) to the operaHOns of the remed'emaad vzept Nist 5�tv �L from Me ad�tioml F�ned's mk �• ceRnF�cwr� rivwER LDE ���� �zsasnmwes iaderal WaY, WA 9�3- ACORD 25 (2009/01) [�_1; [«��►c111;•];! sti+outo �nnr. oF n� neove o� rauaES eE c�woa2m � n� o�w►n� on� n�ac, n� � a+s�e wiu e�wwa rn � io o+►rs � wan� �ro n� �►tE Ha�e � m n� �r, aur s�wta� m oo so s�uu a�vosE �a aeuwnoN aie � � � 1988-2009 ACORD CORPORATION. All rights reserved. TL� •I�I�ner.��.��_ �.�J f��.� ��� ���'a���J.��_�'_ �t wl�e\r�1� .� ;��, � �- ;i _i � � ; � RETURN TO EXT: `1_..lC�% � CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM i. ORIGINATING DEPT./DIV: ��C S 2. ORIGINATING STAFF PERSON: \m� � �'�'� EXT: �'�� 3� 3. DATE REQ. BY: I 4. TYPE OF DOCUMENT (CHECK ONE): 0 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 ❑ HUN�AN SERVICES / CDBG ❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT �E.G. BOND RELATED DOCUMENTS) O ORDINANCE ❑ RESOLUTION '�( CONTRACT AMENDMENT (AG#): S ❑ INTERLOCAL ❑ OTHER � _ . •. � l' _ + „ 5. PROJECT NAME: 6. NAME OF CONTRACTOR: ADDRESS: _12�2(� E-MAIL:.Qi�/L� erG�s SIGNATURE NAME: TELEPHONE oZS 3 �3"SU-'S�'('T,� FAX: TITLE p� vtisz,� 7. EXHIBITS AND ATTACHMENTS: [� SCOPE WORK OR SERVICES ❑ COMPENSATION �,INSURANCE REQUIREMENTS/CERTIFICATE � ALL OTHER REFERENCED E}Q-IIBITS O PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES � PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: !L� _ COMPLETION DATE: I� t�!� 9. TOTAL COMPENSATION $ ��, U(�(� (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES C7F EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑ Z'ES �lo IF YES� MAXIMUM DOLLAR AMOUN7: $ IS SALES TAX OWED ❑ YES �TIO IF YES, $ PAID BY: ❑ GONTRACTOR O CITY t�; PURCHASING: PLEASE CHARGE TO: ' I, I - � a� ` 3S� ^ �� �� � � ^ � � � 10. D� �UMENT/CONTRACT REVIEW INITIAL / DATE REVIEWED INITIAL / DATE APPROVED [�' PROJECT MANAGER \ l t 1�l ��� DIRECTOR� ��,�i� � ❑ RISK MANAGEMENT (IF APPLICnBLE) �III��,LAW {�{� �1�L ��� -�- 11. COUNCIL APPROVAL (IF APPLICASt,E) COMNIITTEE APPROVAL DATE: COUNCIL APPROVAL DATE: 12. CONTRACT SIGNATURE ROUTING 1 �i SENT TO V ENDOR/CONTRACTOR DATE SENT: I I�1''l t f( DATE REC'D: 1 ❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS �$(/LAW DEPARTMENT � SIGNt�TORY (� M��/' �CITY CLERK ❑ ASSIGNED AG# ❑ SIGNED,.C�.1PY.I�ETURNED ,.R "„-.�,T� _ �'`'c�-�ey ��S. �. Ol'1 �C� � CQ � '�7�1`7 C��^ cw�.�Mac�' �e�.ac�ov� �rocr�) f1�i�� � CITY OF ,:�...., Federal GITY HALL ��� 33325 Sth Avenue South Federai Way, WA 98003-6325 (253) 835-7000 www. ciryoffederelway. com AMENDMENT NO. 4 TO RECREATION AGREEMENT FOR PERSONAL TRAINING SERVICES This Amendment ("Amendment No. 4") is made between the City of Federal Way, a Washington municipal corporation ("City"), and Eva Rasor, a"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 Personal Training Services ("Agreement") dated effective May 7, 2007, as amended by Amendment No. 1 dated effective May 7, 2008 and Amendment No. 2 dated effective June 4, 2009 and Amendment No. 3 dated effective May 17, 2010. 1. AMENDED TERM. The term of the Agreement, as referenced by Section 2 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 1, 2013 ("Amended Term"). 2. 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, is 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 sha11 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] AMENDMENT - 1 - 1 /2010 � CITY OF ,'�.., Federal CITY HALL ��� 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www! cityoffederahvay. com IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY r By: Skip Priest, ayor � ' � .' JI ► ' �/ EVA RASOR / .�— ' � iL�� � /— � � �� "• I � Il ' Title: � � T DATE: �J — � � �- // STATE OF WASHINGTON ) ) ss. COUNTY OF .Zt ) ATTEST: Crty Clerk, Carol Mc eilly C APP OVED AS T ORM: 0 City Attorn Patricia A Richardso On this day personally appeared before me, CV �-1- 2-� , to me known to be the � individual described in and who executed the foregoing instrument, and on oath swore that he/she/they executed the foregoing instrument as his/her/their free and voluntary act and deed for the uses and purposes therein mentioned. GIVEN my hand and official seal this ' I� day of /vOV� �i2 , 201. `_:�.c B. �� �a ° � �"�` �,",�'$�A ^ . � 4 �I+�yy �� ' Z �',� k�pB� �►a�� ofi w►► 5�,'�' 4. �.n��.� � � 0 (`�5��►� � � �c��sg� (typed/printed name of notary) Notary Public in and for the State of Washington. My commission expires �$ - O� � �� AMENDMENT - 2 - 1 /2010 CITY OF ` ���� � Federal Way .������ � � � ��BUSINESS��REGISTRATION ����� � � � �� License'Number 20-0'7-101766-00-BL Business Establishment Registeredz EVA RASOR 30915 ' 18TH AVE S SUITEC FEDERAL WAY, WA 98UO3-490? Exuires:l2/31/2011 � .„� t+��, a��„v : 7230 - Personal Srvc.- Beauty Shops ` Cornditionsc This license is non-transferable. Please notify the City Clerk's office of any change in your business such as a new location or business name. �,���i�►r,,, ```��� FEDE/� O . � '. ,.. ..,. ; • •, ty i � � :' �oaPORnrE �,�� _ �. _� . � C��P � r��Y����,�'.�- . ._ = SEA1• ; ; � �.,,� ,��o. ` : '� �L ���' �'' � O� � Ci Clerk, Ci of Federai Wa ''�, qSHING�( `��� ty �v Y '��rr u ����� '1'his certifies that the above enrity has beerr issued the registration or license listed. City of Federal Way - Licensing FEDERAL WAY WA 98063-9718, , EVA RASbR 30915 1$TH AVE S SUTTE C FEDERAI; WAY WA 98003 PHILADELPHIA INSURANCE COMPANIES A Member of the Tokio Marine Group One Bala Plaza, Suite 100, Ba1a Cynwyd, Pennsylvania 19004 610.617.7900 • Fax 610.617.7940 • PHL,Y.com � iro�r�o� l Eva Rasor 12326 18th St E Edgewood, WA 98372- Re: PHPK661901-001 Dear Valued Customer: Thank you very much for choosing Philadelphia lnsurance Companies (PHL� for your insurance needs. Our first class customer service, national presence and A+ (Superior) A.M. Best financial strengdi rating have made us the selection by over 150,000 policyholders narionwide. I realize you have a choice in insurance companies and truly appreciate your business. I wish you much success this year and look forward to building a mutually beneficial business partnership which will prosper for years to come. Welcome to PHLY and please v�sit PHLY.com to learn more about our Company! Sincerely, � s ! Cluistopher J. Maguire President and COO Philadelphia lnsurance Companies lu_ ���_ Philadelphia Consolidated Hotding Corp. • Philadelphia lndemnity Insurance Company • Phi(a�lphia lnsurance Company • Maguire Insurance Ageacy, Inc. ,�►�r�rl� � �� Philadelphia lndemnity Insurance Company One Bala Plaza, Suite 100, Bala Cynwyd, Pennsylvania 19004 COMMON POLICY DECLARATIONS Policy Number: PHPK661901-001 Named Insured and Mailing Address: Eva Rasor 12326 18th St E Edgewood, WA 98372- Producer: 6039 Maguire Insurance Agency, Inc. 27101 Puerta Real Suite 200 Mission Viejo, CA 92691- CPD-PIIC (01/07) Policy Period From: 12107J201 To: 12J07/2012 at 12:01 AM. Standard Time at your mailing address shown above Business Descriptio . oga Trainer �� 6,c, � / �S �'i��41( �C� C—� IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY. THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED. THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT. PREMIUM Commercial Property Coverage Part Commercial General Liability Coverage Part Commercial Crime Coverage Part Commercial Inland Marine Coverage Part Commercial Auto Coverage Part Commercial Stop Gap Part Businessowners Workers Compensation Taxes/Fees/Surcharges $75.00 $50.00 Tatal $125.00 FORM (S) AND ENDORSEMENT (S) MADE A PART OF TH1S POLICY AT THE TIME OF ISSUE Refer To Forms Schedule '�Omits applicable Forms and Endorsements if shown in specific Coverage Part/Coverage Form Declarations � � r' ;. , Countersignature Date Authorized Representative Philadelphia lndemnity insurance Company COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS Policy Number:PHPK661901-001 � See Supplemental Schedule Agent #:6039 LIMITS OF INSURANCE $4,000,000 General Aggregate Limit (Other Than Products - Completed Operation) $4,000,000 Products/Completed Operations Aggregate Limit (Any One Person Or Organization) $2,000,000 Personal and Advertising Injury Limit $2,000,�0 Each Occurrence Limit $100,000 Rented To You Limit $2,500 Medical Expense Limit (Any One Person) FORM OF BUSINESS:Individual Business Description:Yoga Trainer Location of All Premises You Own, Rent or Occupy: SEE SCHEDULE ATTACHED AUDIT PERIOD, ANNUAL, UNLESS OTHERISE STATED: ___ Premium Basis Prem Rates ProdJ Advance Premiums Prod./ SEE SCHEDULE ATTACHED TOT PREMIUM FOR THIS COVERAGE PART: $75.00 Included Retroactive Date(CG 00 02 Only) This insurance does not apply to "Bodily Injury", "Property Damage", or "Personal and Advertising Injury" which occurs before the retroactive date, if any, shown below. Retroactive Date: FORM(S) AND ENDORSEMENT (S) APPLICABLE TO THIS COVERAGE PART: Refer To Forms Schedule Countersignature Date Authorized Representative Forms Schedule — General Liability Policy Number: PHPK661901-001 Forms and Endorsements applying to this Coverage Part and made a part of this policy at time of issue: Form/Edition CG00011207 Commercial General Liability Coverage Part Declarations Description Commercial General Liability Coverage Form GL Coverage Part Declarations Page Commercial GL Supplemental Commercial GL Coverage Supplemental Schedule Schedule PI-APG-004 (01/07) PI-APG-WA-1 (01/07) PI-FraudAdd (01/07) PI-FW-001 (01/07) PI-FW 002 (03/09) PI-FW 003 (01/07) PI-FW 005 (01/07) PI-FW-006 (01/07) PI-FW 007 (01/07) PI-FW 008 (01/07) PI-FVV-009 (06/11) Additional Conditions Washington Amendatory-Cancel, Nonrenewal and Cond. Renewal Fraud Notice Coverage C- Athletic Activities Exclusion Deletion Fitness and Wellness Liability Insurance Exclusions Fitness and Wellness Liability Insurance Extension Punitive Damages Exclusion Sexual Abuse Endorsement Specific Claimant Exclusion Violation of Communication or Information Law Exclusion Blanket Additional Insured Page 1 of 1 ACORD TM. C ERTIFICATE OF LIABILITY INSURANCE I DATEO(�MM�p010 RODUCER Phone: (B00) 395-8075 Fax (866) 422-6579 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ITNESS AND WELLNESS ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 0 3TEVEN3 AVENUE, SUITE 206 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR OLANA BEACH CA 92075 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NSURERS AFFORDING COVERAGE NAIC # �ency Licp: 037764 INSURED INSURER A: Philadelphia lndemnity Insuranoe Company 18058 Eva Rasor INSURER B: 1232616th St E INSURER C: Edgewood WA 98372 INSURER D: NSURER E COVERAGES HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDIN NY 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. AGRREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D'L rypE OF INSURANCE POLICY NUMBER �LI EF ECTNE L IX RATION ��� lTR NSR DATE(MMIDD/YY) DATE(MMIDD/YY) ENERAL LIABILI7Y PHPK502161 12I07/2009 12I07I2010 EACH OCCURRENCE 2,000,0 AMAGETOREN'fEDPREMISES ,y'�QQ�OO X OMMERCIAL GENERAL LIABILITY � ���� LAIMS MADE ❑X OCCUR ED. EXP (Any one peraon) SZ�SO A X X PROFESSIONAL LIABILITY ERSONAL S ADV INJURY 2,000,00 ENERAL AGGREGATE 4,000,0 EN'L AGGREGATE LIMIT APPLIES PER: RODUCTS-COMP/OP AGG. 4,000,00 X OLICY PROJ- ECT � UTOMOBILE LIABILITY OMBINED SINGLE LIMIT NY AUTO Ea acadent) OWNED AUTOS ODILY INJURY CHEDULED AUTOS Per person) IRED AUTOS ODILY INJURY ON-OWNED AUTOS Per accident) . ROPERTY DAMAGE Per acadent) ARAGE LIABILITY UTO ONLY - EA ACCIDENT NY AUTO THER THAN EA ACC UTO ONLY: AGG CE88 / UMBRELLA LIABILITY EACH OCCURRENCE CCUR ❑CLAIMS MADE GGREGATE DEDUCTIBLE ETENTION $ c RKERS COMPENSATION AND EMPLOYERS ATU onien inswTr uMRs PROPRIETORIPARTNEWEXECUTNE � � A I N FFICERIMEMBER EXCLUDED? � yes, describe under SPECIAL PROVISION3 below . I EA E-EA EMPL YEE E-P LI Y LIMIT THER: 1 O E I N OCATION H CLE LU ION ADD D BY END RSEMENT/ SP L VI ON Is underotood and agreed that the following entity is added as an additlonal Insured but only as respects the operatlons of the named insured except that Ifability resutting from the ditlonal tnsurcds sole negligence. CERTIFICATE HOLDER CANCELLATION 13325 Sth Ave S XPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 °ederal Way, WA, 98003 AYS WRITTEN NOTICE TO THE CERTIFICATE �HOLDER NAMED TO THE LEFT, BUT AILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON HE INSURER, ITS AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE �"+w� � 1QmtBa1, �1 �tteMion: ACORD 25 (2001l2) Certificate # 84562 ACORD CORPORATION 1988 RETURN TO: �� � �� ��4�� F,XT: CITY OF FEbERAL WAY L�AW DEPARTMENT ROUTING FORM l. ORIGINATING DEPT./DIV: 9 �� � 2. ORIGINATING STAFF PERSON: �t m�� 5�1� L���"1 EXT: �� �Z 3. DATE REQ. BY: ��� / �� 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 � GOODS AND SERVICE AGREEMENT ❑ REAL ESTATE DOCUMENT � ORDINANCE '� CONTRACT AMENDMENT (AG#): 8 7- pq'� � OTHER ❑ MAINTENANCE AGREEMENT ❑ HUMAN SERVICES / CDBG ❑ SECURITY DOCUMENT (E.G. sorm �LarEn Docun�rrTS> ❑ RESOLUTION ❑ INTERLOCAL 5. PROJECT NAME: �E°�$�"7�G� I I CCc ► �(1 I(1 ��Pit"U I G?.O 6. NAME OF CONTRACTOR: � Y� ADDRESS: PiVAG rci5csr �c, E-MAIL: f ? 3'� L �—H� � SIGNATURE NAME: �1(�t Rt TELEPHONE Z53— 3S�S�f7'C' FAX: �' TITLE �v 7. EXHIBITS AND ATTACHMENTS: � SCOPE, WORK OR SERVICES fr� COMPENSATION ❑ INSURANCE REL�UIREME3�ITS/CERTIFICATE �'ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRAC"T/AMENDMENTS 8. TERM: COMMENCEMENT DATE: �l � �1 � [ � COMPLETION DATE: � ` � � 1 2' 9. TOTAL COMPENSATION $ '� � ,� �� v� � (INCLUDE' EXPENSES AND SALES TAX, IF ANY� `(IF CALCULATED ON HOURLY L OR CHARGE - ATTACH SCHEDULES (7F EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: o�s �ro i� �s, tvtAXIMUM DOLt,.a�t �vvtotlta'r: $ IS SALES TAX OWED � YES �NO IF YES, $ PAID BY: O CONTRACTOR ❑ CITY J� PURCHASING: PLEASE CHARGE TO: ���" 1� U J � S �— S 1 S"�� — `�l I� � 10. DOCUMENT/CONTRACT REVIEW INI AL / DATE REVIEWED INITIAL / DATE APPROVED �? PROJECT MANAGER ' 4- � � � ❑ DIRECTOR ❑ RISK MANAGEMENT (iF ArrLlcasLE) S ❑ LAW LI_ "� 0 SLC '1�D U�{�8 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 ❑ LAW DEPARTMENT ❑ SIGNATORY �R DIRECTOR� ❑ CITY CLERK � ASSIGNED AG# O SIGNED COPY RETURNED l� INI' AL / DATE SIGNED 1.- � D . O � AG# y G DATE SENT: • lO _a�) ��� ClTV �s� CITY Hr�LL �� _■�� i.+ �� 33325 8th ,�venue South • PO Box 9718 {!ri Fe�eraf �'4'ay, �rVA 98063-9?18 (253! 835-74fl4 ��vw crfYC�tYt:ci�r3hvay cc�rr3 AMENDMENT NO. 3 TO RECREATION AGREEMENT FOR PERSONAL TRAINING SERVICES This Amendment ("Amendment No. 3") is made between the City of Federal Way, a Washington municipal corporation ("City"), and Eva Rasor, a 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 Personal Training Services ("Agreement") dated effective May 7, 2007, as amended by Amendment No. 1 dated effective May 7, 2008 and Amendment No. 2 dated effective June 4, 2009 as follows: 1. AMENDED TERM. The term of the Agreement, as referenced by Section 1 of the Agreement and any prior arnendments thereto, shall be amended and shall continue until the completion of the Services, but in any event no later than January 1, 2012 ("Amended Term"). - 2. AMENDED SERVICES. The Services or Work, as described in Exhibit "A" and as referenced by Section �, 1 of the Agreement, shaIl be amended to include, in addition to work and terms required under the original � Agreement and any prior amendments thereto, those additional services described in Exhibit "A-2" attached hereto I and incorporated by this reference ("Additional Services"). . 3. AMENDED METHOD OF COMPENSATION. The method of compensation, as referenced by:Secticin' :, 4 of the Agreement, shall be amended to change the method of payment, as delineated in Exhibit �"B-2", attached , hereto and incorporated by this reference. The Contractor agrees that any hourly or flat rate Charged-by:it for its - j services contracted for herein shall remain locked at the negotiated rate(s) for a period of one (1) year �rom� the .�''� effective date of this Agreement. Except as otherwise provided in an attached Exhibit, tke Contractor sha11 �ie solely �, responsible for the payment of any taxes imposed by any lawful jurisdiction as a result of tLie perforn�ance and payment of this Agreement. � � 4. GENERAL PROVISIONS. All other terms a.nd provisions of the Agreement, together with_�n}��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, is 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] AMENDMENT - 1 - 1 /2010 . �I � � ; � " ,rr� � +� a�r GIT°( H.ALL � 33325 8th Avertue S�uth • PQ Bax 9718 Federai bVay. !NA �8�?63-9718 (�5�;� 83�-7�4�t3 kvxsgb �ri.Yr�l`€c:d�r�lwaycnm IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY By: Brian Wilson, 'ty Manager/Police Chief DATE: �/�1 dtOl�7 EVA RASOR DATE: �7' — ��Y� ' �D —� � ATTEST: City Clerk, Carol Mc illy, C A�PROVED AS O FORM: , F ( f City At ey, Patricia A Rich dson STATE OF WASHINGTON ) �I v� > SS. COUNTY OF ) On this day person�lly ap eared before me, Eva Rasor, to me known to be the individual described in and who executed the foregoing instrument, and on oath swore that she executed the foregoing instrument as his/her/their free and voluntary act and deed for the uses and purposes therein mentioned. GI GIVEN my hand and official seal this � day of � r 1 , 20 �� J _ NpEqR M� sr ��� cFs � a�'� w Shi� -'��'Ea ��s � , W'� brQ_ (typed/printed name of notary) Notary Public in and for the State f Washington. �'�"' My commission expires 1 c� _ AMENDMENT - 2 - 1/2010 • a � �r �� .. �"� �� � CITY HAL� 33325 �th Avenue South • PO Box 971 �: Federaf i•b'ay. �@!A 9&063-9?18 �253� 835-7(}00 �anwtiv �;i��cficx�era,°way corr� EXHIBIT "A-2" ADDITIONAL SERVICES 1. The Contractor shall do or provide the following in addition to services in previous Exhibits: Provide personal training services for the City of Federal Way. These services may include, but are not limited to: • Fitness Program Creation • Body Composition Testing and Analysis • Wellness Coaching • Fitness Equipment Instruction • Group Training • Wellness Lectures • Group Fitness Instruction • Marketing and Promotion of Services • Teach Specialty Classes (such as 1Vlaking the Cut and Boot Camp) • Teach Kettle Be11 Classes i AMENDMENT -3- 1/2010 CtTY OF CITY Hi1LL ��� � � �� 303�5 3th 4venua South • PJ Box 971� Federa[ b�,'ay, WA 98�53-??' 8 (253)835-7Q00 �nvav citych`ecic;r�tway eat?r EXHIBIT "B-2" METHOD OF COMPENSATION FOR ADDITIONAL SERVICES 60% of revenue earned by the contractor will be paid upon receipt of invoice. 40% of revenue earned by the contractor stays with the facility Additionally, the contractor may participate in programs requiring personal training (such as the Biggest Loser) and contractor will receive $15 per client per session for these services. The contractor agrees to teach Specialty classes (such as "Making the Cut" or Boot Camp) for $30 per class. For the new Kettle Bell program starting in the Summer/Fall 20I0, the contractor will be paid $3.75 per person for a 25 minute classes, $7.50 per person for 50 minute classes 4 I AMENDMENT -4- 1 /2010 ACORD T� �ERTIFIGATE OF LIABIt�tTY INSURANGE �°��a„�„"°; '^'' fR Phone: (800) 39G9076 Fau (B06) 422�8579 E9S ANG WEUNESS ONLY ANO CONFERS NO RKiNTB UP�I THE CERTIFICATE ST8VEN8 AVENUE. SUffE 298 HOLDER. THIS CER7IFICATE DOES NOT /WENp. EXTENb OR BEACH CA 92073 ALTER TFiE COVERAfi� AFFORDED 8Y TME POLiC1E6 BEt.�M. SURERS AFFORDINd COYERAGE NAIC • u�: osn RED NSURER A PMls�phis Md�fly InwrMpi Compa�ry 1lOb8 6va Rasor N3URER B: 12326 7alh St E NSURER C: Edy�wood WA 80372 NSURER D: SURER E: REOUIftEMENY. TERM OR CONDITI+DN OF ANY CQNTRACT OR OlHER DOCUMENT WI7M RESPECT Td WHICM TH18 CERTIFtCATE MAY BE 198UED OR Y PERTAM. THE MSURANCE AFFOROED BY THE PQUCIE9 DESCPoBED HEREIN IS SUBJECT TO AlL THE TERMS. EXCU1810N3 M� CC�NQITIONS OF SUCM S. Al3RREOATE LIMITS SNOWN MAY HAYE BEEN F�DUCED BY PAID CLANdS. L7R TYPB OF Mt11RANCE lOLICY NUMBFR DA7E OI�I[ �� w►snanr r�+pKSOZ�a� tsro7r�o� taro�riwo a+occuw�ncE �e. x c�N� �u�uTV �.� "� :•oo. Ms MAD� aX occuR . Exr (�r ons venw+) �. �1 X X P ROF ES SIONAL iIAB1LY�Y �ONAL 6 ADV INJURY Z.� ERAIIUiCsREOATE 4 .� ACCREGRTE LlAtlT APPI.IE3 PER: fOP AtaG. 4 � X � T 1►TUMplq,@ LIABNJrY INED SINGI.E IMMT AUTO ' Ea ecddent) p1AMED AUT0.R Y IN,�IRY DULED AtlTOS P�) AUTpg ILY INJURY AUTOS �) PERTY DMIAf�E �) upgR,(iy O O�N.Y - E A ACGDffNT AlliO THERTwW EAJ� • ONLY: A� CEta! UIIBRELIA 41AB11JTY CH OCCURRENCE R ❑CWMSMADE EOATE B4E NS f�M�IfBATION AND ENWIOYERB' TATUaORY HER xarrs vaovwerortm�atwEr�xECUnvE c�R ocaua�n �-�C ye., e.wro. rmaa svECU� v�tov�ons nrow � und�ood �nd apr�ad M�t 1M k�o� �atigi N addeA � en ad0ltlw�N hauwd 6ut oMy �t nsp�aS� tl» op�rNia�s d��nsd Maund ��t p�hiNqr � aom qr kwutwh soM mpMpa�a. CERTIFlCATE HOLQER �A Ave S u way. wa aeoos cavc�iwnav ION OATE TMEREOF. THE 188UIN0 INSURER WIIL Et�E11VOR TO MN. 70 NTTEN NO'MCE TO TME CERTI�TE HOLDER NAMED TO THE LEFT. BUf To 0o so sw►u. u�ose wo oei.�►noN aR �wea.m oF �wr ar� � ���� s�nmes� �i ACORD 25 (2001/2) Certlfic�Ee # 84582 ACORD CORPOFtAT10N 1988 CITY OP �► Wa � Federai y _ BUSINESS REGISTR;ATION Lic�nse Number 20-07-101766-(10-BL Business'Establishment Regis„_,_ tered: EVA RASOR 30915 `18TH AVE S SUITEC FEDERAL WAY, WA 38003-4907 Ea ires:l2/31/2010 Cat� 7230 - Personal Srvc.- Beauty Shops : Con� s: This license is non-transferable. _ Please notify the City Clerk's off'ice of any change in your business such as a new : location or business name. `���,� � � � � �,,,�� ��o� FEDEq i,� � , . ,� ; '.�t: n ; � ���,paPORnik ;' = �...��.ciccr't �' • ' ' 1 G ; Sj : .�..+ ; : _ L ' _ .. • SEA . - _ ` _ %•�•'� ���� � City Clerk, City.of Federal Way i� ' � i � qSN'NG , ` p``�. _ - ' 1'his certities thaithe above entiry has been issued the regisirarioa or license listed. '. � City of Federal Way - Licensing (2S3).835-2506 33325 8th Ave. S., P.O. Box 9718, Federai Way, WA 98063-9718 : EVA RASQR _ 30915 18TH'AVE S: SUITE C . FEDERAL WAY WA 98003 : EVA E RASOR LITTLE SHOP OF NAILS 30915 18TH ST S FEDERAL WAY WA 98003-3878 DETACH BEFORE POSTlNG I _ _ � t���V��� �E+�15�'RATt�P�S A�� L10EN�ES ����� � �������,-��, IInified Business'ID #: 500 606 797 Sale -Proprietorship: Business ID #: 1 ' Locati.on: 1 EUA E RASOR LITTLE SHOP OF'NAILS 30915 18TH ST S FEDEI2AL WAY WA 98D03 TAX REGISTR.�TION '��e #icens�e n�r�ec# abave �tas been issued the busir�ess registrations or � �icenses �isteti. �3�r ac�eptir�c tt�is docurt��nf th� licer�see certifies the 9�afc�rr�tiarr ��r,�� ��� provi��d �a�t #he �pplic�tit�n f4r th�s� ti�enses w�� cor�plete, twue, and accurate y #o ihe bes# o# his or!her k�owletlge, and that''husiness witl 6� conducted in - �__,T_ _�__.�_.____ compiiance vaith ai1 applicat�le Washir�gton state, coiinty, and cii}r regulati�sns. C�drec►or, . partment of �.;censing co~~~~ ~V\ol (?i1J~f 1{\~lJYaV\c( ct+y a~ ~ ks -4 \ CQ--v'-~j .~~J. 5 *" 0..\ \AJ tU, D Ov~c,h '" l 01 L'l)~<l~_.-f ~ C,lV\J.-l~4,-::tO \)J~ VbVD.v-: if\.QMJ~, Ji/'.,* w rOW OY\ ZX A -I nATF TN. DATE IN: 1. 2. 4. 5. 6. 7. 8. 9. 10. 11. 07/05 InATF OT TT' _ 1 / A . _ TO, \/ ~l I I --r- DATE OUT: 0-; CITY OF FEDERAL WAY LA: REQUEST FOR CONTRACT PREPARATIONIDOCUMENT REVIEW/SIGNATURE ROUTING SLIP ORIGINATING DEPT.IDIV: _PP--C5 ORIGINATING STAFF PERSON,JG ""~ -S . TYPE OF DOCUMENT REQUESTED (CHECK ONE) o PROFESSIONAL SERVICE AGREEMENT o MAINTENANCEILABORAGREEMENT o PUBLIC WORKS CONTRACT o SMALL PUBLIC WORKS CONTRACT (LESS THAN $200,000) DPURCHASEAGREEMENn (MATERIALS, SUPPLIES, EQUIPMENT) o REAL ESTATE DOCUMENT sJv l+v-v) EXT: _b'1 ~J-.3. DATE REQ. BY: s-Ig/ '1 o SECURITY DOCUMENT (E.G. AGREEMENT & PERFIMAIN BOND; ASSIGNMENT OF FUNDS IN LIEU OF BOND) ){:CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ) ~CONTRACT AMENDMENT AG#:~ o CDBG o OTHER TELEPHONE c13- 3S-V<'Sl(J ~ TITLE ewV\.~ TOTAL COMPENSATION $ oD OD() (INCLUDE EXPENSESANDSALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR tHARGE - 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 ~OJECT MANAGER ~DIRECTOR o RISK MANAGEMENT o LAW INITIALIDATE APPROVED ~~ 1.~~~~:l, INITIALIDATE APPROVED f()P J:; '(S--o~ ~_~ ~ ~P_\..J-- r INITIALIDATE APPROVED MP Lo-4-D'1 ~~'f!'"G INITIALIDATE APPROVED CONTRACT SIGNATURE ROUTING o LAW DEPARTMENT o CITY MANAGER ~CITY CLERK ]I( SIGN COPY BACK TO ORGINATING DEPT. . o ASSIGNEDAG# A PURCHASING: PLEASE CHARGE TO:' \ II -l&-.DD - ~S-I~ ')7 s-- S-/~ 4/ () frb~ .Svcs. c ~ I ~ ~ e"\ ~JjI(. q ~t16)1 hV\ '1 Jo 112--513 ~ Federal Way CITY HALL 33325 8th Avenue South . PO Box 9718 Federal WBY, WA 98063-9718 (253) 835-7000 wwwcitytlffederalwaycom AMENDMENT NO.2 TO PROFESSIONAL SERVICE AGREEEMNT FOR PERSONAL TRAINING SERVICES This Amendment ("Amendment No.2") is made between the City of Federal Way, a Washington municipal corporation ("City"), and Eva Rasor, a 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 Personal Training Services ("Agreement") dated effective May 7,2007, as amended by First Amendment dated May 7, 2008, as follows: ~ 1. AMENDED TERM. The term of the Agreement, as referenced by Section 1 ofthe 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 by May 7, 2010 ("Amended Term"). (If no new date is included then the Term shall be as provided in the Agreement.) ~ 2. AMENDED SERVICES. The Services or Work, as described in Exhibit "A" and as referenced by Section 2 ofthe Agreement, shall be amended to include, in addition to work and terms required under the original Agreement and any prior amendments thereto, those additional services described in Exhibit "A-1" attached hereto and incorporated by this reference ("Additional Services"). (If no Exhibit "A-1" is attached no amendment of Services is contemplated.) ~ 3. AMENDED COMPENSATION. The amount of compensation, as referenced by Section 4 of the Agreement, shall be amended to change the total compensation the City shall pay the Contractor and the rate or method of payment, as delineated in Exhibit "B-1", attached hereto and incorporated by this reference. The Contractor agrees that any hourly or flat rate charged by it for its services contracted for herein shall remain locked at the negotiated rate( s) for a period of one (1) year from the effective date ofthis Agreement. Except as otherwise provided in an attached Exhibit, the Contractor shall be solely responsible for the payment of any taxes imposed by any lawful jurisdiction as a result of the performance and payment of this Agreement. (If no amount is included then the total compensation shall be as provided in the Agreement and if no Exhibit "B-1" is attached no amendment of compensation is contemplated.) D 4. ADDITONAL AMENDMENTS. The Agreement shall be amended as delineated in Exhibit Z-[ #] attached hereto and incorporated by this reference. (Ifno Exhibit "Z-[#]" is attached no additional amendment is contemplated. ) 5. 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, is 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 14 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] AMENDMENT - 1 - Amd Ind 3/31/09 ,~ Federal Way CITY HALL 33325 8th Avenue South. PO Box 9718 Federal W~, WA 98063-9718 (253) 835-7000 wwwcityoffederalwaycom IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY ATTEST: By: C~M ~ Cary Roe, P.E., ASSIS ant CIty Manager/COO, EM APPROVED AS TO FORM: DATE: 6(4(0; Signature on file, form approved 3/31/2009 by: City Attorney, Patricia A Richardson EVA RASOR L3f~ Printed Name: L=V It Klt-30/C . ../ ...) / /-L By: CA~ Title: C f/T DATE:5-C?9'- Ocr STATE OF WASHINGTON) /J - ) ss. COUNTY OF~A.J/L ruJ ) On this day personally appeared before me, [. cJ a..- rz CL S6 r , to me known to be the individual described in and who executed the foregoing instrument, and on oath swore thaHte/she/~ executed the foregoing instrument as hts/her/thsH:- free and voluntary act and deed for the uses and purposes therein mentioned. BONNIE K. FOX NOTARY PUBLIC STATE OF WASHINGTON COMMISSION EXPIRES APRIL 19. 2012 ,200..1 GIVEN my hand and official seal this ~q tiaay of (typed/printed name of notary) Notary Public in and for the State of Washington. My commission expires r ~ /9 - ;;( (J I;;;J- AMENDMENT - 2 - Amd Ind 3/31/09 411'~ Federal Way CITY HALL 33325 8th Avenue South. PO Box 9718 Federal WB'f, WA 98063-9718 (253) 835-7000 www.dtyotfederalway.com EXHIBIT "A-I" ADDITIONAL SERVICES 1. The Contractor shall do or provide the following in addition to services in previous Exhibits: Provide personal training services for the City of Federal Way. These services may include, but are not limited to: . Fitness Program Creation . Body Composition Testing and Analysis . Wellness Coaching . Fitness Equipment Instruction . Group Training . Wellness Lectures . Group Fitness Instruction . Marketing and Promotion of Services AMENDMENT - 1 - Amend Exh 3/31/09 ~ Federal Way CITY HALL 33325 8th Avenue South. PO Box 9718 Federal Way, WA 98063-9718 (253) 835-7000 w.vw Cityoffederafway com EXHIBIT "B-1" ADDITIONAL COMPENSATION Total Compensation: In return for the Additional Services, the City shall pay the Contractor an amended compensation rate detailed below. The total amount payable to the Contractor pursuant to the original Agreement, all previous Agreements, and this Amendment shall be an amount not to exceed Fifty-Thousand and 00/1 00 Dollars ($50,000.00). Provide personal training services for the City of Federal Way. 60% of revenue earned by the contractor will be paid upon receipt of invoice. 40% of revenue earned by the contractor stays with the facility Additionally, the contractor may participate in programs requiring personal training (such as the Biggest Loser) and contractor will receive $15 per client per session for these services. AMENDMENT - 2 - Amend Exh 3/31/09 ,p ~ CITY OF ,"*"'~~ I:ederal Way "1i;~{""lJll;W~I"",)",,,,d"" '-1 BUSINESS REGISTRATION License Number: 20-07-101766-00-BL Business Establishment Reaistered: EVA RASOR 30915 18TH S SUITE C FEDERAL WAY, WA 98003-4907 Expiration: 12/31/2009 C:1t~q~)lV: 1230 - Persona! Srvc.- Beauty Shops vonditlOd:::;; Tili3 license is n0i",-,I,msfeldUi8 Please notify the City Clerk's office of any change in your business such as a new location or business name. \\1\11111'" ",\ fEDE,9, 11,/ .........0<< ........':'( /"" ~~." ,....~~ ~ #-. :' COP-PORAi I: ". ~ S =0. .--- : = ~ ~ SEAL : = -:. .. 4- ~: ~ ~ "~Q..!>8 "F-,- .::: ", Jf,.... J". ,.' 0'"" "/11 ~SHIN0~ ",,,, 11""'11\\\ CwtBP54. rY)c-~ City Clerk. City of Federal Way This certifies that the above entity has been issued the registration or license listed. City of Federal Way - Licensing (253) 835-2527 - 33325 8th Ave S., PO Box 9718, Federal Way, WA 98063.9718 EVA RASOR ~nn.u: ...OTU ^\/C C ClUTE:: (' ~ :2- ~ "~ :> w "" ~ ... nPHILADELPHIA INSURANCE COMPANIES PI-APG-002 (01107) CERTIFICATE OF INSURANCE-PURCHASING GROUP LIABILITY INSURANCE POLICY This insurance is provided by: Philadelphia Indemnity Insurance Company EVA RASOR ITEM 1. Named Certificate Holder: ITEM 2. Mailing Address: 1232618TH ST. E. EDGEWOOD, WA 98372 Producer Number: Producer Name/Address: Fitness and Wellness Insurance 380 Stevens Ave, # 206 Solana Beach, CA 92075 Master Policy Number: PHPK284105 Certificate Number: 52879 As consideration of the payment of premium and subject to all terms of the master policy, we agree to provide the insurance as stated in this certificate. Item 3: Purchasing Group Name: Fitness and Wellness Purchasing Group Item 4: Mailing Address: 380 stevens Ave, # 206, Solana Beach, CA 92075 Item 5: Business Description: Health and Fitness Item 6: Location of all Premises you own, rent or occupy: Various Item 7: Policy Period: From: December 7,2008 To: December 7, 2009 12:01 A. M. Standard Time at the address shown in Item 2. Item 8: Forms and Endorsements: Forms and Endorsements attached to this certificate - See Schedule of Forms and Endorsements attached to the Master Policy. Copies are available upon request. Item 9: Limits of Insurance: This policy provides for the Limits of Insurance below. General Aggregate Limit (Other than Products Completed-Operations): $ 4,000,000 Products-Completed Operations Aggregate Limit: $ 4,000,000 Personal and Advertising Injury Limit: $ 2,000,000 Each Occurrence Limit: $ 2,000,000 Damages to Premises Rented to You Limit (Any One Premises) $ 100,000 Medical Expense Limit (Any One Person) $ 2,500 Hired and Nonowned Auto Liability: Applies only if a limit is shown $ Not Applicable Uninsured Motorists Coverage (IL and LA) $ Not Applicable Underinsured Motorists Coverage (IL only) $ Not Applicable 6 PHILADELPHIA INSURANCE COMPANIES PI-APG-002 (01107) Item 10: Coverage and Premium: Your policy consists of the following coverage when a premium is indicated. If a premium is not shown, there is no insurance coverage. This premium may be subject to adjustments. COVERAGE PART(S} PREMIUM FOR POLICY PERIOD Hired and Nonowned Auto Liability Coverage $ $ $ 75.00 Commercial General Liability Coverage Stop Gap (OH, NO, WA, WV, WY), if applicable Not Applicable Not Applicable State Tax and/or Surcharge $ TOTAL CERTIFICATE PREMIUM including State Tax, Surcharge $ Countersigned ~/?~ Date: November 24, 2008 THIS CERTIFICATE OF INSURANCE, TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART(S), COVERAGE FORM(S) AND ENDORSEMENT(S) ATTACHED TO THE MASTER POLICY, COMPLETE THE ABOVE NUMBERED POLICY. The following notice is provided pursuant to the Texas Insurance Code Article 21.54. The insurer may not be subject to all insurance laws and regulations of this state. The member benefits described are guaranteed through an insurance contract. The Fitness and Wellness Purchasing Group's insurance policy is underwritten by Philadelphia Indemnity Insurance Company and rated A+ X by the AM. Best Co. in 2006. Fitness and Wellness Insurance A Member of Philadelphia Insurance Companies THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES POLICY CHANGE NUMBER D POLICY NUMBER PHPK284105 POLICY CHANGES EFFECTIVE December 7, 2008 COMPANY Philadelphia Indemnity Insurance Company NAMED INSURED EVA RASOR AUTHORIZED REPRESENTATIVE Jeffrey E. Frick CHANGES THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY EARNED PREMIUM ENDORSEMENT (FULLY EARNED PREMIUM) Premium fully earned at inception: $L75.ool Total Premium: $ 75.00 BY 10 AUTHORIZED REPRESENTATIVE CHGEND Includes copyright malerial oflhe Insurance Services Office, Inc. used with its permission. Fitness and Wellness Insurance Thank you for your business. Below is a recap of your policy information and charges. Named Insured: Eva Rasor Client/Certificate Number: 52879 Policy Number: PHPK284105 Effective Date: December 7, 2008 Breakdown of Charges: IS IS NOT AN INVOICE Premium: Purchasin Grou Total Amount: Insurance Access Fee $ $ $ $ 75.00 50.00 125.00 ** This page is for illustration purposes only; please see your policy and certificate of insurance for exact terms, conditions, limits, coverages and exclusions. Filness and Wellness Insurance. 380 Slevens Avenue, Suite 206 . Solana Beach, CA 92075 .800-395-8075 . Fax: 858-519-0822 Includes copyright malerial oflhe Insurance Services Office, Inc. used with its permission. ACORD CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDIYYYY) TM. 05112/2009 PRODUCER Phone: (800) 395-8075 Fax: (866) 422-6579 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAllON FITNESS AND WELLNESS ONLY AND CONFERS NO RIGHTS UPON THE CERllFICA TE 380 STEVENS AVENUE, SUITE 206 HOLDER. THIS CERllFICATE DOES NOT AMEND, EXTEND OR SOLANA BEACH CA 92075 ALTER THE COVERAGE AFFORDED BY THE POUCIES BEL OW. jlNSURERS AFFORDING COVERAGE NAlC# Agency LiC#: 0377645 INSURED I INSURER A: Philadelphia Indemnity Insurance Company EVA RASOR INSURER B: 12326 18TH ST. E. INSURER C: EDGEWOOD WA 98372 INSURER 0: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAlO ClAIMS. INSR MID' TYPE OF INSURANCE POLICY NUMBER ~~r.:~ PODAU;:,~~ON i LIMITS lTR INSRi i _~NERAL LIABILITY ! PHPK284105 12/07/08 12/07/09 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY I DAMAGE TO RENTEO $ 100,000 PREMISES (Ea occurenee) I ClAIMS MADE [!] OCCUR I MED. EXP (Anyone person) $ 2,500 A i I PERSONAL & ADV INJURY $ 2,000,000 - ----------~ I GEN'L AGGREGATE LIMIT APPLIES PER: I iGENERAlAGGREGATE $ 4,000,000 PRODUCTS-COMPIOP AGG. $ 4,000,000 Xl n PRO- nLOC X POLICY JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT rl ANY AUTO (Ea accident) $ H ALL OWNED AUTOS BODilY INJURY SCHEDULED AUTOS (Per person) $ ------i I HIRED AUTOS BODILY INJURY $ - (Per accident) NON-OWNED AUTOS - I -- I iFROPERTY DAMAGE $ Per accident) GARAGE LIABILITY i I AUTO ONLY - EA ACCIDENT $ i ~ ANY AUTO I OTHER THAN EA ACC $ i I AUTO ONLY: i AGG $ EXCESS I UMBREUA LIABILITY I I EACH OCCURRENCE $ =:=J OCCUR 0 CLAIMS MADE AGGREGATE $ I $ ~ DEDUCTIBLE -- $ I RETENTION $ $ WORKERS COMPENSATION AND I !lYC STATU- . I I OTHER TORY UMITS EMPLOYERS'L1ABILITY E.L. EACH ACCIDENT $ AllY PROPRIETORIPARTNERlEXECUTlVE OFFICERlMEMBER EXCLUDED? E.L. DISEASE-EA EMPLOYEE $ 1f)'W, describe und_ E.L. DISEASE-POLICY LIMIT $ SPECIAL PROVISIONS below OTHER: DESCRIPTION OF OPERATIONS/LOCATtONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS It is understood and agreed that the following entity is added as an additional insured but only as respects the operations of the named insured except that liability resulting from the additional insureds sole negligence. Additionatlnsured Endorsement is Effective: 05107/09 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAlL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE City of federal Way TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF AtoN KIND UPON THE INSURER, 33325 8th Ave SO ITS AGENTS OR REPRESENTATIVES. Federal Way, WA 98003 AUTHORIZED REPRESENTATIVE Attention: Sherry Ramos ACORD 25 (2001/08) Certificate # 91231 @ACORD CORPORATION 1988 DATE IN: 1. 2. 4. 5. 6. DATE OUT: ~ f CITY OF FEDERAL WAY LAW DEPARTMENT REQUEST FOR CONTRACT PREPARATIONIDOCUMENT REVIEW/SIGNATURE ROUTING SLIP ORIGINATING DEPT.IDIV: fees ORIGINATING STAFFPERSON:J<\M~ SheA~ TYPE OF DOCUMENT REQUESTED (CHECK ONE) o PROFESSIONAL SERVICE AGREEMENT o MAINTENANCE/LABOR AGREEMENT o PUBLIC WORKS CONTRACT o SMALL PUBLIC WORKS CONTRACT EXT: lRCf"1'2.. 3. DATEREQ.BY:SJ,/o& (LESS THAN $200,000) o PURCHASE AGREEMENT) (MATERIALS, SUPPLIES, EQUIPMENT) o REAL ESTATE DOCUMENT o SECURITY DOCUMENT (E.G. AGREEMENT & PERFIMAIN BOND; ASSIGNMENT OF FUNDS IN LIEU OF BOND) o CONTRACTOR SELECTION DOCUMENT AG#, D'-lAS-f:) (E.G., RFB, RFP, RFQ) ~ CONTRACT AMENDMENT o CDBG o OTHER PROJECT NAME: PenmoJ -rNllnt~ dv\Pl G-iUNf ~~ NAME OF CONTRACTOR: ev Cl ~ C'~O--( ADDRESS: 1::L ,?'d..IP \<6~ st. eA '?f WDQ) lI\J\A C( x3, ~ SIGNATURE NAME: 13 VrA (.{ Ot~uy '.." ' ~')~-d TELEPHONE a <V3-~ 3-OX'=J\ TITLE () 1.J.1Y\.a ("" 7. ATTACH ALL EXHIBITS AND CHECK BOXES 0 . SCOPE OF SERVICES 0 ALL EXHIBITS REFERENCED IN DOCUMENT o INSURANCE CERTIFICATE 0 DOCUMENT AUTHORIZING SIGNATURE 8. TERM: COMMENCEMENT DATE: ,::; l.JJ 0 <i) COMPLETION DATE: S tIJ oCJ 9. TOTAL COMPENSATION $ 50,000 (INCLUDE EXPENSESANDSALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATIACH 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 SIGNATURE ROUTING o LAW DEPARTMENT o CITY MANAGER o CITY CLERK o SIGN COpy BACK TO ORGINATIN o ASSIGNEDAG# ~ PURCHASING: PLEASE CHARG COMMENTS '~Df ef' IASUriUl\ee ~\~ D.- ilJ'f~ * $ev ~t'b 10. 11. 07/05 CONTRACT REVIEW ,. PROJECT MANAGER o DIRECTOR o RISK MANAGEMENT \ LAW'"?:>..-\l....;D~ INITIALIDATE APPROVED V:~ t~~~~ ~ 5{mO~ INITIALIDATE APPROVED INITIALIDATE APPROVED :.J l \ -l~O- 3S-1 ~S1S- S-l~ 3S'-f ~IA.S. \. CQ,Vtse...- CL~ ~ . \ (\\..l t t \ (\ <,; vr",-~ CR C .L FIRST AMENDMENT TO RECREATION AGREEMENT FOR PERSONAL TRAINING SERVICES AND GROUP EXERCISE CLASSES This First Amendment ("Amendment") is dated effective this 7th day of May, 2008 and is entered into by and between the City of Federal Way, a Washington municipal corporation ("City"), and Eva Rasor, a sole proprietor ("Contractor"). A. The City and Contractor entered into a Professional Services Agreement dated effective May 7, 2007, whereby Contractor agreed to provide personal training services and to teach group exercise classes ("Agreement"). B. Section 13.2 ofthe Agreement provided that the Agreement may only be amended by written agreement signed by the parties. C. The parties desire to amend the Agreement to extend the term of the Agreement. NOW, THEREFORE, the parties agree to the following terms and conditions: 1. Term. Section 2 ofthe Agreement shall be amended to extend the term ofthe Agreement until May 7,2009. 2. Full Force and Effect. All other terms and conditions of the Agreement not modified by this Amendment shall remain in full force and effect. DATED the effective date set forth above. ClTYO~RALWAY By. c:;:-~ /11 ~ Carey M. Roe, P. . Assistant City Manager/Chief Operating Officer Emergency Manager PO Box 9718 Federal Way, WA 98063-9718 - 1 - ATTEST: EVA RASOR BY~~ Eva Rasor, Sole Proprie or . 12326 18th Street East Edgewood, WA 98372 STATE OF WASHINGTON) Q"'" ) ss. COUNTY OF . U)) ~ ) On this day personally appeared before me, Eva Rasor, to me known to be the individual described in and who executed the foregoing instrument, and on oath swore that she executed the foregoing instrument as her free and voluntary act and deed for the uses and purposes therein mentioned. .~ \/l/l /J . _. I. GIVEN my hat.l9-imQ.,~fpcial seal this -3 ( day of I r l..tI./L01'L ....~ 'F" '-ll ~ _-..;'- ...,t-\\i;;, i( f::: '" ~ . .:- 0'" ....... 0" ~ .: <Q .....S\ON ..... 4- " - .: ...~s €:f '.', . ... .~~. ~., 13 .. ---- ; /0 ~OTAFiy ~.~ { l5f\-hl'e t-. /--tJ}C ~ ;() _._ (I): ~ (typed/printed name of notary) .~ <J'l \ PUBUC .: ~ j Notary Public in and for the State of Washington. , :.>. '. .. 0 ... M .. . 2/ ,a '") /\ -g '1,17~.....:t-19-0~..."&.l' Y commISSIon expIres ~{-f'--~6 ". ~ 0 ..........J.,\~ ......- "," f: WASP ~......... \\\\~\. ....'\~,...' ,200Y - 2 - Federal Way Online jsp Template CIi"l'tf FeaeralWay Public Information: C\It Home C\It Register~d Business~~::. > C\It I.s.snedPermits -> , C\It Permit Histo_lY I Status - ,Peo > Registered User Information: C\It Registr.ation for First IiID~_ Users -> C\It Sign-::Dn C\It Log-::.Qff C\It Apply for a Permit -> C\It SchedJ!.le/Cancel an inspection -> C\It StAtus of My Permits -> C\It U12dfi;e Personal Informatiol1..=-~ C\It Re.guest Password -> Citizen Action Requests: C\It S'll.bmjla Citizen Action R~quest -> C\It Ch~~k Status of Citizen Action Reg!l~~L-=2: Address 30915 18TH AVE S Suite C Page 1 of 1 Ci State & Zi FEDERAL WAY, WA 98003-4907 Parcel# 785360 0151 Issue Date A r. 27,2007 Ex iration Date Dec. 31, 2008 Name I Or anization VA RASOR VA RASOR V A RASOR New Search IIfyou have questions or need additional information, please contact the City of Federal IWay at (253) 835-2527. Office hours are from 8:00 am to 5:00 pm, Monday through . I:fIiciay. ...mm m ..mm._m...mmm.m.mmm .........m.mm_. http://epermits.cityoffederalway.com/epermits/registered _business _ details.do 3/12/2008 License Detail Page 1 of 1 License Detail H~lp us imPLQYJ:~ this online service License Information: Entity Name: Firm Name: License Type: Entity~ UBI: Status EVA E RASOR LITTLE SHOP OF NAILS Washington State Business Sole Proprietor 600606797 Business 10:001 Location 10:0001 To check the status of this business, go to Department of Revenue Location Address: 30915 18TH ST S FEDERAL WAY, WA, 98003- 3878 Mailing Address: CONVERSION 30915 18TH ST S FEDERAL WAY, WA, 98003- 3878 Governing People: EVA E RASOR Information Current as of 03/1212008 4:28AM Pacific Time New Search This site is limited to searching for business and professional licenses issued by the Department of Licensing or through the Master License Service. You may wish to click on OTHER LICENSES to check for information on licenses issued by other agencies. Department of Licensing Hom~ Pri'LCl9yPolicy Q!ber Licenses COD!gct Us Use of lists of individuals provided on this site for commercial purposes is prohibited under Chapter 42.56 of the Revised Code of Washington. https:llfortress.wa.gov/do1ldolprod/bpdLicenseQuery /lq sLicenseDetail.aspx ?SessID=2 73 2&RefID=43 7... 3/12/2008 ~~ Federal Wa BUSINESS REGISTRATIO License Number 20-07-101766-00-BL Business Establishment Ree:istered: EVA RASOR 30915 18TH AVE S SuiteC FEDERAL WAY, WA 98003-4907 Expires: 12/31/2008 .. .-C~rv :--7-2JQ..-"P erso-ual Sfvc-.--.-13C<ii.uty Shbps Conditions: This license is non-transferable. Please notify the City Clerk's office of any change in your business such as a new location or business name. \\\111""" "" ~E.DE~ "" ...,' 0<< .,.' - . , . .':'( /// 2~:. ... .. ..~~~ :: t: : CORPORAft '. ~ =: -0: ....--- :. = -;. '. SEAL : ~ ~ -. A. .~: ~ ~ ...t~ 28 ,\~.'~ .::- /... Iz,..... ,.' 0"... //" '1SHING"\ ",,,, """. HI\' d~Kr{/~~ I ---- ._--m_---C\iYClefk~ Ci tyof Feder-aT"Way----------- I I This certifies that the above entity has been issued the registration or license listed. City of Federal Way - Licensing (253) 835.2506 33325 8th Ave. S., P.O. Box 9718. Federal Way, WA 98 63-9718 EVA RASOR 30915 18TH AVE S SUITE C FEDERAL WAY W A 98003 DPmLADELPBIA INSURANCE COMPANIES PI-APG-002 (01/07) CERTIFICATE OF INSURANCe.pURCHASING GROUP LIABILITY INSURANCE POLICY This insurance is provided by: Philadelphia Indemnity Insurance Company EVA RASOR ITEM 1. Named Certificate Holder: ITEM 2. Mailing Address: 1232618TH ST. E. EDGEWOOD, WA 98372 producer Number: producer Name/Address: Fitness and Wellness Insurance 380 Stevens Ave, # 206 Solana Beach, CA 92075 Master Policy Number: PHPK215316 Certificate Number: 52879 As consideration of the payment of premium and subject to all tenns of the master policy. we agree to provide the insurance as stated in this certificate. Item 3: Purchasing Group Name: Item 4: Mailing Address: Item 5: Business Description: Fitness and Weltness purchasing Group 380 Stevens Ave, # 206, Solana Beach, CA 92075 Health and Fitness Item 6: location of all Premises you own, rent or occupy: Various Item 7: Policy Period: from: December 7, 2007 To: December 7, 2008 12:01 A.M. Standard Time at the address shown in Item 2. Item 8: Forms and Endorsements: Forms and Endorsements attached to this certificate - See SChedule c:I Forms and Endorsements attached to the Master Policy. Copies are available upon request. Item 9: LImits of Insurance: This policy provides for the Limits of Insurance below. General Aggregate Limit (Other than Products Completed-OperationS): $ 4.000,000 Products-Completed Operations Aggregate Limit: $ 4,000.000 Personal and Advertising Injury Limit: $ 2,000,000 Each Occurrence Umit: $ 2.000,000 Damages to Premises Rented to You Limit (Any One Premises) $ 100,000 Medical Expense Limit (Any One Person) $ 2,500 Hired and Nonowned Auto Liability: Applies only if a limit is shown $ Not Applicable Uninsured Motorists Coverage (IL and LA) $ Not Applicable Underinsured Motorists Coverage (Il only) $ Not Applicable ijPmLADELPHIA INSURANCE COMPANIES PI_APG-002 (01/07) IteM 10: coverage and Premium: your polICy consists ollt1e following c;oveIB9O when . prem;un is indicated. K · premium is not shown, there is no insurance coverage. This premium may be subject to adjustments. coVERAGE PARriS) PREMIUM FOR POucY pERIOD Stop Gap (OH. NO. WA, WV. WY). if applicable $ $ $ 75.00 Commercial General Uabitity coverage Hired and Nonowned AlA.o UabUity Coverage Not Applicable Not Applicable State Tax and/or Surcharge $ TOT AL CERTIFICATE PREMIUM Including State Tax, surcharge $ Countersigned _~ /7~ Date: February 26, 2008 THIS CERTIFICATE OF INSURANCE, TOGETHER WITH THE COMMON POUCY CONDITIONS, COVERAGE PARfIS), covERAGE FDRM(S) AND ENDORSEMENTIS) ATTACHED TO THE MASTER pOLICY, COMPLETE THE ABOVE NUMBERED pOLICY. lb. tbllowing notice hi provided __ to lb. T_lnsnnm"" Cnde Articl. 21.54. lb. - - nn< be subject to all_"" _ and regu_ nflbls ""'" 1be.......... benefits ~ibed or' _toed tbrongh .. _ee _.1be ....... and Wolin'" ........... GoouP's tnsumn" policy hi undoowrlU'" by Pbi_phia In-.u'Y Insurance Company and rated A+ X by the A.M. Best Co. in 2006. DATE IN: 1. 2. 4. 5. 6. TO: k,mbU SheAWl C& CITY OF FEDERAL WAY LAW DEPARTMENT ~ ~ ~ ~ '" DATE OUT: . . REQUEST FO'R CONTRACT PREPARATIONIDOCUMENT REVIEW/SIGNATURE ROUTING SLIP ~ " ~ , ORIGINATING DEPT.IDIV: Pu:x-k5 aVLct Kec.- reJL1t tn1 ORIGINATING STAFF PERSON:_1-< I m ~ <S'~lM TYPE OF DOCUMENT REQUESTEP (CHECK ONE) )GPROFESSIONAL SERVICE AGREEMENT o MAINTENANCE/LABORAGREEMENT o PUBLIC WORKS CONTRACT o SMALL PUBLIC WORKS CONTRACT EXT: G;li3~ 3. DATEREQ.BY: 5-31-07 o SECURITY DOCUMENT (E.G. AGREEMENT & PERFIMAIN BOND; ASSIGNMENT OF FUNDS IN UEU OF BOND) o CONTRACTOR SELECTION DOCUMENT , i I AG#: /)7 -- If! <;-'" i I , I (LESS THAN $200,000) o PURCHASE AGREEMENT) (MATERIALS, SUPPLIES, EQUIPMENT) o REAL ESTATE DOCUMENT (E.G., RFB, RFP, RFQ) o CONTRACT AMENDMENT o CDBG o OTHER PROJECT NAME: V-0(7)zn1~ -rNllt1/'Vl3 CWLd. (~e.llUp S)(t'ft.L&6 NAME OF CONTRACTOR: Bv &L Rc;tS DY"""' ADDRESS: 12..32-& I '1S -H-i 8+ ,. e-. e4.B~~~oo&.. wA- q ~ 7d. SIGNATURE NAME: l'?Va _ < ROl5 D y" I . TELEPHONE~?,- f?lo.~()X~8 TITLE 0 fAlhe 'v.... .... 7. ATTACH ALL EXHIBITS AND CHECK BOXES ~OPE OF SERVICES 0 ALL EXHIBITS REFERENCED IN DOCUMENT' o INSURANCE CERTIFICATE 0 DOCUMENT AUTHORIZING SIGNATURE 8. 9. 10. 11. TERM: COMMENCEMENT DATE: 5" - '7 -07 COMPLETION DATE: S - f -:- 0 ~ TOTAL COMPENSATION $ 50 000 . (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR C~ARGE -ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: 0 YES ~O IF YES, MAxIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED 0 YES ~IF YES, $ PAID BY: 0 CONTRACTOR 0 CITY ~O!9'RACT REVIEW ~ROJECT MANAGER ~tJ DIRECTOR ~ RISK MANAGEMENT [] LAW l!;'-S S." ~ INITIALIDATE APPROVED ~/g >~( tJo.ten7 tt-((Pl '/fk/' Sffi ( J I INrhALIDATE APPROVED . INITIALIDATE APPROVED fp,t:. 5""1 ~ I D7 J: CONTRACT SIGNATURE ROUTING o LAW DEPARTMENT c;'le o CITY MANAGER o CITY CLERK o SIGN COPY BACK TO ORGINATING DEPT. . o ASSIGNED AG# o PURCHASING: PLEASE CHARGE TO: .111 -I avo -"3 '5'/- 5'7 S- - S-I':'- '3 S'-j COMMENTS 07/05 ~ ~ ~ RECREATION AGREEMENT FOR PERSONAL TRAINING SERVICES AND GROUP EXERCISE CLASSES This Recreation Agreement ("Agreement") is dated effective this 7TH day of May, 2007. The parties ("Parties") to this Agreement are the City of Federal Way, a Washington municipal corporation ("City"), and Eva Rasor, a sole proprietor ("Contractor"). A. The City seeks the temporary services of a skilled independent contractor capable of working without direct supervision, to provide personal training services and to teach group exercise classes and B. The Contractor has the requisite skill and experience necessary to provide such services. NOW, THEREFORE, the Parties agree as follows: 1. Services. Contractor shall provide the services more specifically described in Exhibit "A", attached hereto and incorporated by this reference ("Services"), in a manner consistent with the accepted practices for other similar services, performed to the City's satisfaction, within the time period prescribed by the City and pursuant to the direction of the City Manager or his or her design~e. ' '/1 'i , . "," 2. Term. The term of this Agreement shall commence upon the effective date of this Agreement and shall continue until the completion of the Services, but in any event no later than May 7, 2008 ("Term"). This Agreement maybe extended for additional periods oftime upon the mutual written agreement ofthe City and the Contractor. 3. Termination. Prior to the expiration of the Term, this Agreement may be terminated immediately, with or without cause by the City. 4. Compensation. 4.1 Total Compensation. In consideration of the Contractor performing the Services, the City agrees to pay the Contractor an amount not to exceed Fifty Thousand and NoI100 ($50,000.00), calculated on the basis of paying sixty percent (60%) of each personal training fee paid and not refunded. In addition, the contractor will be paid $30 per group exercise class taught at the Federal Way Community Center. The City makes no representation or warranty regarding participation and nothing in this Agreement obligates the City to pay more than sixty percent (60%) per personal training session fee paid and not refunded. . 4.2 Method ofPavrnent. Payment by the City for the Services will only be made after the Services have been performed, a voucher or invoice is submitted in the form specified by the City, and the appropriate City representative approves the same. Payment shall be made on a monthly basis, thirty (30) days after receipt of such voucher or invoice. 4.3 Contractor Responsible for Taxes. The Contractor shall be solely responsible for the payment of any taxes imposed by any lawful jurisdiction as a result of the performance and payment of this Agreement. 5. Compliance with Laws. Contractor shall comply with and perform the Services in accordance with all applicable federal, state, and City laws including, without limitation, all City codes, ordinances, resolutions, standards and policies, as now existing or hereafter adopted or amended. 6. Warranty. The Contractor warrants that it has the requisite training, skill and experience necessary to provide the Services and is appropriately accredited and licensed by all applicable agencies and govemmentalentities, including but not limited to 'being registered to do business in the City of Federal Way by obtaining a City of Federal Way business registration. 7. Independent Contractor/Conflict of Interest. It is the intention and understanding ofthe Parties that the Contractor shall be an independent contractor and that the City shall be neither liable nor obligated to pay Contractor sick leave, vacation payor any other benefit of employment, nor to pay any social security or other tax which may arise as an incident of employment. The Contractor shall pay all income and other taxes as due. Industrial or any other insurance which is purchased for the benefit of the City, regardless of whether such may provide a secondary or incidental benefit to the Contractor, shall not be deemed to convert this Agreement to an employment contract. It is recognized that Contractor mayor will be performing services during the Term for other parties; provided, however, that such performance of other services shall not conflict with or interfere with Contractor's ability to perform the Services. Contractor agrees to resolve any such conflicts of interest in favor of the City. 8. Indemnification. 8.1 Contractor Indemnification. The Contractor agrees to indemnify, defend and hold the City, its elected officials, officers, employees, agents, and volunteers harmless from any and all claims, demands, losses, actions and liabilities (including costs and all attorney fees) to or by any and all persons or entities, including, without limitation, their respective agents, licensees, or representatives, arising from, resulting from, or connected with this Agreement to the extent caused by the negligent acts, errors or omissions of the Contractor, its partners, shareholders, agents, employees, or. by the Contractor's breach of this Agreement. Contractor waives any immunity that may be granted to it under the Washington State Industrial Insurance Act, Title 51 RCW. Contractor's indemnification shall not be limited in any way by any limitation on the amount of damages, compensation or benefits payable to or by any third party under workers' compensation acts, disability benefit acts or any other benefits acts or programs. 8.2 City Indemnification. The City agrees to indemnify, defend and hold the Contractor, its officers, directors, shareholders, partners, employees, and agents harmless from any and all claims, demands, losses, actions and liabilities (including costs and attorney fees) to or by any and all persons or entities, including without limitation, their respective agents, licensees, or representatives, arising from, resulting from or connected with this Agreement to the extent solely caused by the negligent acts, errors, or omissions ofthe City, its employees or agents. 8.3 Suryival. The provisions of this Section shall survive the expiration or termination of this Agreement with respect to any event occurring prior to such expiration or termination. 9. Equal Opportunity Employer. In all Goatractor services, :prbgrains or. activities, and all Gontractor hiring and employment made possible by or resulting from tms Agreement, there shall be no discrimination by Contractor or by Contractor's employees, agents, subcontractors or representatives against any person because of sex, age (except minimum age and retirement provisions), race; color, creed, national origin, marital status or the presence of any disability, including sensory, mental or physical handicaps, unless based upon a bona fide occupational qualification in relationship to hiring and employment. This requirement shall apply, but not be limited to the following: employment, advertising, layoff or termination, rates of pay or other forms of compensation, and selection for training, including apprenticeship. Contractor shall not violate any ofthe terms of Chapter 49.60 RCW, Title vn ofthe Civil Rights Act of 1964, the Americans With Disabilities Act, Section 504 ofthe Rehabilitation Act of 1973 or any other applicable federal, state or local law or regulation regarding non-discrimination. Any material violation ofthis provision shall be grounds for termination of this Agreement by the City and, in the case of the Contractor's breach, may result in ineligibility for further City agreements. 10. Insurance. The Contractor agrees to carry as a minimum, the following insurance, in such forms and with such carriers who have a rating which is satisfactory to the City: 10.1 Workers' compensation and employer's liability Insurance In amounts sufficient pursuant to the laws ofthe State of Washington; 10.2 Commercial/general liability insurance with combined single limits of liability not less than $1,000,000 for bodily injury, including personal injury or death, products liability and property damage. 10.3 Automobile liability insurance with combined single limits of liability not less than the Washington State minimum for bodily injury, including personal injury or death and property damage. Contractor may be asked to show proof of insurance. The City shall be named as additional insured on all such insurance policies, with the exception of workers' compensation coverages. Contractor shall provide certificates of insurance, concurrent with the execution of this Agreement, evidencing such coverage and, at City's request, furnish the City with copies of all insurance policies and with evidence of payment of premiums or fees of such policies. All insurance policies shall contain a clause of endorsement providing that they may not-be terminated or materially amended during the Term ofthis Agreement, except after thirty (30) days prior written notice to the City. If Contractor's insurance policies are "claims made" or "claims paid" Contractor shall be required to maintain tail coverage for a minimum period of three (3) years from the date this Agreement is actually terminated. Contractor's failure to maintain such insurance policies shall be grounds for the City's immediate termination of this Agreement. The provisions ofthis Section shall survive the expiration or termination ofthis Agreement with respect to any event occurring prior to'suth expiration or termination. 11. Books and Records. , \ The Contractor agrees to maintain books, records;: and documents which sufficiently and properly reflect all direct and indirect costs r~lated to the performance of the Services and. maintain such accounting procedures and practices as may be deemed necessary by the City to assure proper accounting of all funds paid pursuant to this Agreement. These records shall be subject, at all reasonable times, to inspection, review or audit by the City, its authorized representative, the State Auditor, or other governmental officials authorized by law to monitor this Agreement. , " 12. Non-Appropriation of Funds . If sufficient funds are not appropriated or allocated for payment under this Agreement for any future fiscal period, the City will not be obligated to make payments for Services or amounts incurred after the end of the current fiscal period, and this Agreement will terminate upon the completion of all remaining Services for which funds are allocated. No penalty or expense shall accrue to the City in the event this provision applies. 13. General Provisions. 13.1 Entire Agreement. This Agreement contains all of the agreements of the Parties with respect to any matter covered or mentioned in this Agreement and no prior agreements shall be effective for any purpose. 13.2 Modification. No provision ofthis Agreement, including this provision, may be amended or modified except by written agreement signed by the Parties. 13.3 Full Force and Effect. Any provision of this Agreement that is declared invalid or illegal shall in no way affect or invalidate any other provision hereof and such other provisions shall remain in full force and effect. 13.4 Assignment. Neither the Contractor nor the City shall have the right to transfer or assign, in whole or in part, any or all of its obligations and rights hereunder without the prior written consent of the other Party. 13.5 Successors in Interest. Subject to the foregoing Subsection, the rights and obligations of the Parties shall inure to the benefit of and be binding upon their, respective successors in interest, heirs and assigns. 13.6 Attorney Fees. In the event either ofthe Parties defaults on the performance of any terms of this Agreement or either Party places the enforcement of this Agreement in the hands of an attorney, or files a lawsuit, each Party shall pay all its owIi attorneys' fees, costs and expenses. The venue for any dispute related to this Agreement shall be King County, Washington. 13.7 No Waiver. Failure or delay of the City to declare any breach or default immediately upon occurrence shal1.not waive such breach or default. Failure ofthe City to declare one breach of'default does not act as a waiver of the City's right to , , declare another breach or default. 13.8 Governing Law. This Agreement shall be made in and shall be governed by and interpreted in accordance with the laws of the State of Washington. 13.9 Authority. Each individual executing,this Agreement on behalf ofthe City and Contractor represents and warrants that such individuals are duly authorized to execute and deliver this Agreement on behalf of the Contractor or the City. 13.10 Notices. Any notices required to be given by the Parties shall be delivered at the addresses set forth below. Any notices may be delivered personally to the addressee of the notice or may be deposited in the United States mail, postage prepaid, to the address set forth below. Any notice so posted in the United States mail shall be deemed received three (3) days after the date of mailing. 13.11 Captions. The respective captions of the Sections of this Agreement are inserted for convenience of reference only and shall not be deemed to modify or otherwise affect any of the provisions of this Agreement. 13.12 Performance. Time is ofthe essence of this Agreement and each and all of its provisions in which performance is a factor. Adherence to completion dates set forth ,in the description ofthe Services is essential to the Contractor's performance of this Agreement. 13.13 Remedies Cumulative. Any remedies provided for under the terms of this Agreement are not intended to be exclusive, but shall be cumulative with all other remedies available to the City at law, in equity or by statute. 13.14 Counterparts. This Agreement may be executed in any number of counterparts, which counterparts shall collectively constitute the entire Agreement. 13.15 Compliance with Ethics Code. If a violation ofthe City's Ethics Resolution No. 91-54, as amended, occurs as a result ofthe formation and/or performance ofthis Agreement, this Agreement may be rendered null and void, at the City's option. DATED the day and year set forth above. CITY 05JYDERAL WAY By: ~~ /J1 ~ Assistant City anager, Cary Roe 33325 8th Ave S ,P.O. Box9718 Federal Way, WA 98063-9718 APPROVED AS TO FORM: ~ pc:- C~ ~ City Attorney, Patricia A. Richardson EV A RASOR BY:~~ Eva Rasor, Sole Proprieto 12326 18th St. E, Edgewood, WA 98372 STATE OF WASHINGTON) - ) ss. COUNTY OF Pl.../VLt{..; ) On this day personally appeared before me, Eva Rasor, to me known to be the individual described in and who executed the foregoing instrument, and on oath swore that she executed the foregoing instrument as her free and voluntary act and deed for the uses and purposes therein mentioned. GIVEN my hanj..~\~~ficial seal this / G ti...ctay of ~___ , 2002 ......... ..llC l,,- " ~ _---410 O~~~.:7.:', ~"'" 11 ' J'. .: ~.;t.\SSION~',.o+", \.Lr~ ~ f ...."o~ ..'QT.4 ^ +~" '~ B (j Art I .e... It r .cd y , .() \' ..,.,~ "'. ., ~ ~ -._~; i (typed/printed name of notary) ~ ~ \. ,oUSL\C ,.: i Notary Public in and for the State of Washington: ""';'i:'.1."9-0~ .....~~ My commission expIres f/-/7'.-2dtJ j) f"'1.of:"'WAS;\\~~---- ~'\'t.\,...\",,,,,~,......,,,-, EXHIBIT A SCOPE OF SERVICES Contractor shall provide personal training services for the City of Federal Way. She has a 180 day probation period (3/12/07-9/12/07) to enroll a minimum average of 10 hours of personal training weekly. Continued progress will be evaluated on a semi-annual basis. In addition, she will be available to instruct yoga classes on an as needed basis. v '_ ~ CITY OF . . </~/' Federal Way BUSINESS REGISTRATION License Number 20-07-1 01 766-00-BL Business Establishment Reeistered: EVA RASOR 30915 18TH A VB S SuiteC FEDERAL WAY, W A 98003-4907 Expires: 12/31/2007 CateswrV: 7230 - Personal Srvc.- Beauty Shops Conditions: This license is non-transferable. Please notify the City Clerk's office of any change in your business such as a new location or business na.tne. \\\""",;, ",\ fl~DEJi "'" ~'o<< ...-....~( "",. ~~.. ..~~ 2,- :' cORPORAlt: ".?c. ~ =0. .......... : = ; ~ SEAL : ~ ~ e. ~f:::):.... ~ ,:~ H ~~.'~ ~ ",. 'v. . ~.V/. ~O , """.~.sHING \", , "'tllll\\\\ This certifies that the above entity has been issued the registration or license listed. .. City of Federal Way - Licensing (253) 835-2506 33325 8th Ave. S., P.O. Box 9718, Federal Way, WA 98063-9718 d {lUtL k r{/dkw""(j City Clerk, City of Federal Way . ..:,/0 ....-; -\:!"'. ~~. .~; ...... -i' -: '1- EVA RASOR 30915 18TH AVE S SUlTEC' FEDERAL WAYWA 98003 I FWBL#20-~- -BL I BUSINESS LICENSE APPLICATION Please type or print clearly in dark ink. RECEIVED ONew Application OUpdate Application/Address ChUfIg& 3 2007 DFederal Way Business DOutside Contractor DHome Occupation O.GEMENTSERVICES ()FFEDERAl \A'II~ .... .. SECTION A - Business Information - Please complete all information. Business Na e WA State UBI # (1-800-647-7706) . SO e CJ 6 Business Address (StreeUSuite# - Physical Location) Are you currently occupying this address?aVes aNo (50 Y S- I S' 6f . . rz; C- City State ZiP... Business Phone #: h {;:7JZt'tZ- W iu r..r rr (5 0 3 d( 5-3 ..s-o s- Y 7 Mailing Address. City State Zip Business Fax #: . SA. & Is this a Non-Profit Organization established for educational, reli ious, or charitable ur oses? DYes SNo Is there Liquor served on the premise? aVes lSNo If yes. State Liquor License # Numb r of persons employed in Federal Way: # 'Full Time # 0 Part Time Is there Gambling activities? aVes If yes, State License # o SECTION B - Description of Business - describe in detail your business activities -including which category - retail, wholesale, or services. /IJ /J / L- S ~L!-c) /lJ y[ O~ F/ (J ~ F o~ P C1<soN Jf-4 7ft! A-I tV I {It...! b 8 /"~/ /U e:s-" - SECTION C - Business Ownership - Attach additional pages if necessary. OPartnershi aNon-Profit aOther Title: ,.-:7 o u.J IlJ CJ"- Date Business began or will be in in FW: Driver License#/State: Home Address (Street/PO Box, City, State, Zip) % Owned: Name of Emergency Notification/Contact: e fi!. SECTION D - Business Location - Some improvements to your business may require separate ermits. Please contact the Communit Develo ment ermit counter at 253 835-2607 for more information. King County Parcel #: Are you making tenant improvements? aYes No i Building: OSingle Tenant I SMultiT enant Does building/premise have a securit alarm s stem? SECTION E - Hazardous Materials - Required by th.e City of Federal Way and Fire Department. Does your facility currently report to the Federal Way Fire Department under Sara Title III? DYes No Does your facility currently use or store flammable materials? Yes DNo If es, lease list. What types of hazardous materials and lor waste are used, stored, handled, processed, or generated by your busines..S? If additional_space is needed, please attach a separate sheet(s) of paper. /L 'CJelStt CMO()C:: eYe- - What quantity (in gallons) of the above subs ance is stored on site at any given time? cR G/f-L. (Excluding consumer commodities for household use packaged in quantities of less than five (5) gallons) SECTION F - Home Occupation - If you are applying for an Adult Famify Home or In-Home Da care lease contact Communit Develo ment De artment at 253-835-2607 for additional re uiremen ts. Name all family members who reside at the home and work in the business, include yourself: Name of Apartmentffownhouse Complex:(lf applicable) Complete Floor Space of Residence: Will there be any outside storage of goods, display of materials or outside activity? DYes DNo If Yes, lease ex lain: Will the business require the use of heavy equipment, power tools or power sources not common to a residence? DYes DNo, If Yes, lease ex lain: Will there be any pick up or delivery by commercial vehicles? DYes DNo If Yes, lease ex lain t e and fre uenc : Will there be any visits to the home by clients, employees, or delivery services? DYes DNo If Yes, lease ex lain the number of deliveries ex ected: er week er month Are there any conditions produced by the home occupation such as 'noise, vibration, smoke, dust, odor, heat, or glare which would exceed that normally produced by a single residence, or which could create a disturbing or objectionable condition in a neighborhood? DYes DNo If Yes, please explain type and frequency: SECTION G- Temporary Business Activity - Temporary licenses are granted for a specific . d d tt d90d' I d peno ,an are no o excee avs In a ca en ar year. Description of Temporary Business/Activity: Specific Dates of Temporary Activity: Is site layout of area/structures provided? DYes DNo I Signed Consent of Property Owner must be attached for (including ingress and egress of area) approval. Copy of lease agreement is acceptable. SECTION H - SIGNATURES I (we) the undersigned, declare under the penalties of perjury and the denial of a license or revocation of any license granted, that I (we) am (are) the applicant(s) or authorized representative(s) of the firm making this application and that the answers contained, including any accompanying information have been examined by me (us) and that the information set forth is true, correct, and complete. I also understand that I am responsible for notifying the City Clerk, in writing, of any change in location or mailing address within thirty da~. All licenses are nontransferable. I understand my place of busines t comp- 'th all federal, state, and local codes and ordinances. OCU/lJe Title --1,3, () Date Application prepared by (please print) Title Phone Number Amount Received: 7 s. For office use only Check NO(~'~-- Date Received: t+-:? ....67 Receipt No.: 0 \ - Ct V 3D ( . Business license #: SIC CODE: Date License Issued: ~ A (.,UKU TM. PRODUCER Phone: (800) 595-5075 Fax: (858) 519-0822 FITNESS AND WELLNESS INSURANCE AGENCY 380 STEVENS AVENUE, SUITE 206 SOLANA BEACH CA 92075 CERTIFICATE OF LIABILITY INSURANCE U.A.l ~ \nUVl/UUlT t II} 0411312007 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE INSURERS AFFORDING COVERAGE NAlC# A ene LiC#' 0028716 INSURED EVA RASOR 1232618TH ST. E. PUYALLUP WA 98372 INSURER A:. Zurich American Insurance Com n INSURER B: INSURER C: INSURER 0: INSURER E: COVERAGES (lHE POLICIES OF INSI.JRMICE L1SlED BELOW HAVE BEEN ISSUED TO'THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITI-lSTMlDING p.m REQUIREMENT. lERM OR CONDITION OF !'Ny CONTRACT OR OTHER DOCU1vi"ENf WITH RESPECT TOVI/MlCH THIS CERTlFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POliCIES DESCRIBED HEREIN IS SUBJECT TO AlL THE TERMS. EXClUSIONS !'NO CONDITIONS OF SUCH POliCIES. AGGREGATE lIMIlS SHOWN MAY HAVE BEEN REDUCED BY PAID ClAIMS. ,NSR ADD\. TYPE OF INSURANCE POUCY NUMBER P~~:~ P~'g~ LIMITS LlR INSRll GENERAL LIABIlITY EOL9012327 -02 12107/06 12107/07 E.A.cH OCCURRENCE ~ 2,ooO,OOC I-- DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PRei!lSES (Ea~CUf1iJl'ICS) $ 100,000 I ClAIMS MADE W OCCUR MED EXP (All)/ one person) $ 2,500 A PERSONAl & /lDV INJURY $ 2,000,000 - GENERAl AGGREGATE $ 4,000,000 - GENL AGGREGATE LIMIT APPLIES PER' PRODLlCTS-COMP/OP AGG $ 4.000.000 )(l POliCY n P~ nLOC AUTOMOBilE LIABIlITY COMBINED SINGLE LIMIT - $ !'NY AUTO (Ea accident) - AlL OWNED AUTOS BODILY INJURY - (Per per5Oti) $ SCHEDULED AUTOS - HIRED AUTOS BODILY INJURY - $ NON-OWNED AlJI"OS (Par accident) - - PROPERTY DAMAGE $ (Per accident) GARAGE UABIlITY AUTO ONLY - EA ACCIOENT $ ~ !'NY AUTO OTHER TH/lN EA ACC $ AUTO ONLY: AGG $ EXceSS I UMBRaLA LlABtLITY EACH OCCURRENC= $ ::::J OCCUR 0 ClAIMS M'IDE AGGREGATE $ $ ~ DEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION AND I~r~~ I 10lliER EMPLOYERS' LIABIlITY E,L, EACH ACCIDENT $ Ill<< PROI'RIETORIPARTIIBlIEXKUTlV OFflCERlllEtllIER EXClUDED? EL DISEASE-EA EWoPLOYEE $ rr wes. desafbe under E.L. DISEASE-POLICY LIMIT $ SPECIAL PROVJSIOIIS ltoloW' OlHER: DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS It is understood and agread that the following entity is added as an additional insured but only as respects the operations of the named ir except that liability resulting from the additional insureds sole negligence. Additional Insured Endorsement is Effective: 04/09/07 CE~T1I=1C4 TJ: Hnt nJ:R CANCELLATION SHOUlD mv OF THE ABOVE DESCRISED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUiNG INSURER WILL ENDEAVOR TO MAIL 10 City of Federal Way DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO so SHAlL IMPOSE NO OBliGATION OR LIABILITY OF !'NV KIND UPON THE 33325 8th Ave S INSURER. rrs AGENTS OR REPRESENTATlIlES Federal Way WA 98063 AlJIHORIZED REPRESENTATIVE ~~~ Attention: Jeffrey E. Frick, CEO ured ACORD 25 (2oo1ros) Certificate # 54302 @)ACORD CORPORATION 1988 Page 1 of 1 Kimberly Shelton - Re: Personal Training Contacts From: To: Date: Subject: Iwen Wang Kimberly Shelton 4/3/2007 3:40 PM Re: Personal Training Contacts Okay to lower the liability insurance coverage for personal training contracts to $1 million. Iwen Wang Management Services Director (253) 835-2510 iwenw@cityoffederalway.com >>> Kimberly Shelton 4/3/07 3:26 PM >>> Iwen, I am working on getting some Personal Training contracts approved through legal, and they said that I need to contact you in order to get a 1,000,000 Commercial/General Liability insurance amount approved instead of 2,000,000. As I am sure you know, 1,000,000 is pretty standard for the fitness industry - and it would be very challenging to find personal trainers who would be willing to increase their insurance to 2,000,000. Please let me know if there is additional information you need from me and/or what my next step is once this is approved. Thanks so much for your help. Kimberly Shelton Fitness/Athletic Coordinator x6932 file://C :\Documents%20and%20Settings\default\Local%20Settings\ Temp\GW} 0000 1.HTM 4/3/2007