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AG 10-101 II RETURN TO: [V r„ EXT: CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT./DIV: PA 4-5 2. ORIGINATING STAFF PERSON: 4ASD,n.) L�/LGC1I EXT: 6�6 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.BOND RELATED DOCUMENTS) ❑ ORDINANCE ❑ RESOLUTION I-CONTRACT AMENDMENT(AG#): /0 -/°/ ❑ INTERLOCAL ❑ OTHER 5. PROJECT NAME: 514,u S 6. NAME OF CONTRACTOR: )(7-12-4..-4i-- /°)-(/�. ADDRESS: 21/3 )4 2"d e. SL.,rh,r-✓ `1.31 D TELEPHONE 253'-7S0-1^f/6 c E-MAIL: FAX: SIGNATURE NAME: _ n‘.4 I-.... TITLE �j v 7. EXHIBITS AND ATTACHMENTS:❑ SCOPE,WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE ❑ ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: LI/A O/1 D COMPLETION DATE: fd/31 I.of -39 56 5 0 9. TOTAL COMPENSATION$ 1I ' S 1. 50 + boo -1--Zoe. I 1 1 D.ca (INCLUDE EXPENSES AND SALES TAX,IF ANY) (IF CALCULATED ON HOURLY I?ABOR CHARGE-ATTACH SCHEDULES OF EMPLOYEES TITLES 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: 6t,), "14,, -33 1 _ 5-7L 10. DOCUMENT/CONTRACT REVIEW INI .1 L/DATE RE IEWED INITIAL/DATE APPROVED PROJECT MANAGER M ® ZD 1 ❑ DIRECTOR ❑ RISK MANAGEMENT OF APPLICABLE) ❑ LAW d 2 C. 12104 11. COUNCILAPPROVAL OF APPLICABLE) COMMITTEE APPROVAL DATE: COUNCIL APPROVAL DATE: I I 12. CONTRACT SIGNATURE ROUTING L ❑ SENT TO VENDOR/CONTRACTOR DATE SENT: 1'24�Jl DATE REC'D: 11' / 13 ❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE,LIC NSES,EXHIBITS INITIAL/D TE SIGNED ❑ LAW DEPARTMENT I I yf CHIEF OF STAFF 3d�1'.�� 7 SIGNATORY(MAYOR OR DIRECTOR) 'GrP ff/ CITY CLERK ASSIGNED AG# AG# MEE V SIGNED COPY RETURNED DATE SENT: 0 COMMENTS: �+ 1It.�. o-C e u _( 1–... a. • ` -� 11/9 ~— - CITY OF CITY HALL �..,, Federal Way 333258th Avenue South Federal Way,WA 98003-6325 (253) 835-7000 www cityoffederalway corn AMENDMENT NO. 3 TO GOODS AND SERVICES AGREEMENT FOR PARK SIGNS This Amendment ("Amendment No. 3") is made between the City of Federal Way, a Washington municipal corporation("City"), and Jay Crouchet,dba Xtreme Signs&Graphics,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 providing a variety of signs for City parks and facilities ("Agreement")dated effective May 29, 2010, as amended by Amendment No(s). 1 and 2, as follows: 1. AMENDED TERM. The term of the Agreement,as referenced by Section 1 of the Agreement and any prior amendments thereto, shall be amended and shall continue until the completion of the Services,but in any event no later than December 31, 2016 ("Amended Term"). 2. 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-3", 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 the Amended Term. 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. 3. GENERAL PROVISIONS. All other terms and provisions of the Agreement, together with any prior amendments thereto,not modified by this Amendment,shall remain in full force and effect.Any and all acts done by either Party consistent with the authority of the Agreement,together with any prior amendments thereto, after the previous expiration date and prior to the effective date of this Amendment, 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 p arties of this contract. [Signature page follows] AMENDMENT - 1 - 1/2010 CITY OF CITY HALL 33325 8th Avenue South oat,4■....-..., Fe d e ra l Way Federal Way,WA 98003-6325 (253) 835-7000 www cityoffederaiway.corn IN WITNESS,the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY ATTEST: By: i -44- «/_� 1. /ti!i.. ■ Aii..■ Jim Ferre ■ ayor ell ■rk, Stephanie Cou g, CMC DATE: .Y/<0 5 APPROVED AS TO FORM: v �`GL --°(City Attorney, Amy Jo Pearsall XTREME SIG :, G' ' ' ilW B : Y • Printed Name: dAy CRotiCiltr Title: 0W Ir - bp DATE: *g1tf. STATE OF WASHINGTON S IN ON ) ) ss. COUNTY OFQ\�.ccsz ) On this day personally appeared before me, Jcs v\ Q..c-ci che_\-- ,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 15 day of Ve...b , 20 t 5 RUB igr•. '4'f' (typed/printed name of notary) I; � Notary Public in and for the State f Washington. 1'01> p�9 � My commission expires *---\ AMENDMENT - 2 - 1/2010 • CITY OF CITY HALL 33325 8th Avenue South ..... Federal Way Federal Way,WA 98003-6325 (253)835-7000 www cityoffederalway.corn EXHIBIT B-3 ADDITIONAL COMPENSATION 1. Total Compensation: In return for the Services, the City shall pay the Contractor an additional amount not to exceed Eighteen Thousand and No/100 Dollars ($18,000.00), and Washington State sales tax equal to One Thousand Seven Hundred Ten and No/100 Dollars ($1,710.00) for a total of Nineteen Thousand Seven Hundred Ten and No/100 Dollars ($19,710.00). The total amount payable to Contractor pursuant to the original Agreement, all previous Amendments, and this Amendment shall be an amount not to exceed Thirty-nine Thousand Five Hundred Sixty-seven and 50/100 Dollars ($39,567.50). AMENDMENT - 3 - 1/2010 CERTIFICATE OF LIABILITY INSURANCE American Family Insurance Company ❑ American Family Mutual Insurance Company if selection box is not checked. 6000 American Pky Madison,Wisconsin 53783-0001 Insured's Name and Address Agent's Name,Address and Phone Number(Agt./Dist.) Extreme Graphics Foley Insurance Group, Inc. 2913 142nd Ave E 5005 Center St Ste A Sumner,WA 98390 Tacoma,WA 98409 (253)565-0756 (007/354) This certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. This certificate does not amend,extend or alter the coverage afforded by the policies listed below. CQVERAGL$ "; This is to certify that 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. POLICY DATE TYPE OF INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS OF LIABILITY (Mo,Day,Yr) (Mo,Day,Yr) Homeowners/ Bodily Injury and Property Damage Mobilehomeowners Liability Each Occurrence $ ,000 Bodily Injury and Property Damage Boatowners Liability Each Occurrence $ ,000 Bodily Injury and Property Damage Personal Umbrella Liability Each Occurrence $ ,000 Farm Liability&Personal Liability Each Occurrence $ ,000 Farm/Ranch Liability Farm Employer's Liability Each Occurrence $ ,000 Statutory »•_»•_»•• Workers Compensation and Each Accident $ ,000 Employers Liability t Disease-Each Employee $ ,000 Disease-Policy Limit $ ,000 General Liability General Aggregate $ ,000 ❑ Commercial General Products-Completed Operations Aggregate $ ,000 Liability(occurrence) Personal and Advertising Injury $ ,000 ❑ Each Occurrence $ ,000 ❑ Damage to Premises Rented to You $ ,000 Medical Expense(Any One Person) $ ,000 Each Occurrencett $ 2,000,000 Businessowners Liability 46-X04928-01 06/01/2014 06/01/2015 Aggregatett $ 2,000,000 Common Cause Limit $ ,000 Liquor Liability Aggregate Limit $ ,000 Automobile Liability Bodily Injury-Each Person $ ,000 ❑Any Auto Bodily Injury-Each Accident $ ,000 ❑All Owned Autos ❑ Scheduled Autos Property Damage $ ,000 ❑ Hired Auto ❑ Nonowned Autos Bodily Injury and Property Damage Combined $ ,000 0 Excess Liability ❑ Commercial Blanket Excess Each Occurrence/Aggregate $ ,000 Other(Miscellaneous Coverages) DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS tThe individual or partners ❑Have shown as insured elected to be covered under this policy. ❑Have not ttProducts-Completed Operations aggregate is equal to each occurrence limit and is included in policy aggregate. : . Ct' iCA'f ;t#QL#}E!x*fi+yAlMANb A#?LiRES ❑ Should any of the above described policies be cancelled before the expiration date thereof,the company will endeavor to mail=( days)written notice to the Certificate Holder named,but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives.*10 days unless different number of days shown. U This certifies coverage on the date of issue only. The above described policies are subject to cancellation in conformity with their terms and by the laws of the state of issue. DATE ISSUED AUTHORIZED REPRESENTATIVE 03/09/2015 Jenny Daft U-201 Ed.5/00 Stock No.06668 Rev.7/02 RETURN TO: s� ������ ,� / EXT: �� � � l� CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM l. ORIGINATING DEPT./DIV: C I�GS 2. ORIGINATING STAFF PERSON: ST�� I�'�1�� EXT: ��_ 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 �❑ O INANCE ONTRACT AMENDMENT (AG#): 1(� - lp1 ❑ OTHER 5. PROJECT NAME: 6. NAME OF CONTRACTOR: aDn�ss: Z9t3 lu E-MAIL: �1 W �; SIGNATURE NAME: � MAINTENANCE AGREEMENT ❑ HUMAN SERVICES / CDBG ❑ SECURITY DOCUMENT (E.G. sorm �LnTED Docun�NTS> ❑ RESOLUTION ❑ INTERLOCAL FAX: TITLE Pju,9lRrcC 7. EXHIBITS AND ATTACHMENTS:�p ScOpE, WORK OR SERVICES "� COMPENSATION f�INSURANCE REQUIREMENTS/CERTIFICATE ❑ ALL OTHER REFERENCED EXHIBITS 'L�PROOF OF AUTHORITY TO S1GN � REQUIRED LICENSES � PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: ��, I. Z0�3 COMPLETION DATE: �.L �jI , ZO 1� 9. TOTALCOMPENSATION$ I� �I�Z'S� '�' $��03�'�� 'r $�'� �'� = 19�$�'.5�0 � ( NCLUDE EXPENSES AND SALES TAX, IF ANY� (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: � YES �10 IF YES, MAXIMUM DOLL,4R AMOUNT: $ [S SALES TAX OWED �'4ES ❑ NO IF YES, $ PAID BY: 0'�ONTRACTOR � CITY nct-Ti�o•33g•�'1(0• pfo•490 H`�b� � aa ❑ PURCHASING: PLEASE CHARGE TO: p� t-"'�lOO •'33 l• 5'lfo • g�y �o �.-�' 50 55 '��SS • 10. DOCUMENT/CONTRACT REVIEW INITIAL / DATE REVIEWED INITIAL / DATE APPROVED ,�'PROJECT MANAGER � • � �( DIRECTOR ❑ RISK MANAGEMENT (iF arPLtCasLE) � LAW P , ,� • � � � 11. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: COUNCIL APPROVAL DATE: 12. CONTRACT SIGNATURE ROUTING ��'"`# `� �% 13 ❑ SENT TO VENDOR/CONTRACTOR DATE SENT: ��/� Z DATE REC'D: ❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS �LAW DEPARTMENT `'( SIGNATORY (CM OR DIRECTOR I3�j 13 �] CITYCLERK ��$I�j� � " •4 �ASSIGNEDAG# AG# j�- 1 �] SIGNED COPY RETURNED DATE SENT: _\ COMMENTS: 11/9 � CITY 4f CITY NA�L �� � � ��' ���� 33325 8th Avenue Sauth Federai Way, WA 98003-6325 (253) 835-7000 www crryoifederahvay cam AMENDMENT NO. 2 TO GOODS AND SERVICES AGREEMENT FOR PARK 5IGNS This Amendment ("Amendment No. 2") is made between the City of Federal Way, a Washington municipal corporation ("City"), and Jay Crouchet, dba Xtreme Signs & Graphics, 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 providing a variety of signs for City parks and facilities ("Agreement") dat�l effective April 1, 2010 as amended by Amendment No(s). 1, as follows: 1. AMENDED TERM. The term of the Agreement, as referenced by Section 1 of the Agreement and any prior amendments thereto, shall be amended and shall continue until the completion of the Services, but in any event no later than December 31, 2014 ("Amended Term"). 2. 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-2", 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 the Amended Term. Except as otherwise provided in an attached Exhibit, the Contractor shall be solely responsible for the payment of any ta�ces imposed by any lawful jurisdiction as a result of the performance and payment of this Agreement. 3�, GENERAL PROVISIONS. All other terms and provisions of the Agreement, together with any prior amendments thereto, not modified by this Amendment, shall remain in full force and effect. Any and all acts done by either Party consistent with the authority of the Agreement, together with any prior amendments thereto, after the previous expiration date and prior to the effective date of this Amendment, 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 a��� �� � �;- � , ,� ..��` CiT'� HA` � .�`.J'�J�' �i�� M f+nfi;U2 .`�.�GU:l1 F�C��t� Ftday +,�}A 98C103-6i2S j253; �;��-70£}� �yn x �.- i�.{tiv!fec7ereait��z3;•: c� �; r � I�i WITNESS, the Parties execute this Akgeement below, effecti�e ttze last date written below. CITi' OF FEDERAL WAi� By: �� Cary M. R.o�,L A aE., Directar, Parks, Public Works & Emergeney Management DATE: �'' I �TRBME SIG�VS & GRAFHICS By: Printed Name: f .�.3'�y ���u�tJf�"�'� Title: �jc..>.,v�"/�.. D,ATE; J/3l%�vi � �--�T_. _._._......_.._� STATE �F WAS�-IINGTOAi ) ) ss. COU�iTY OF�'.�_ } ATTEST: [ C�ST�C �2S41 iV1GP(�i ' Ci1/�� �Y , Y= AP OVED AS FORI'+�I: � .ity Atto , Patrieia A Richardson On #his day personally appeared be€ore me, �� y �-. t` rav�e...�u`v�,�-. to me known to bs the individuai described in and wha executed the fareg�ing instrument, anei on oath svuore that helshelthey executed the faregaing instrument as his/hetltheir free and voi�tary act and deed for the uses and purpases there�in mentioned. GNEN rny hand and official seal this �� day of �ut�, , 20 t�. ����� T � ��,. ���..�,,.�.�,. _�U�__�__`�c�, c��,c��mmQ.�'�-'�— (typetifprinted name of notary) Notary Public in and for the State of Washington. My commission expires � � '�. �� AMEC�iDMENT - 2 - ll201 d . � � � _ 1;,�,,,, �. • GITY HALL '��� 33325 8th Avenue Sauth Federal Way, WA 980Q3-6325 (253) 835-7000 wrvw cifyoffederahvay cvm EXHIBIT B-2 ADDITIONAL COMPENSATION 1. Total Compensation: In return for the Services, the City shall pay the Contractor an additional amount not to exceed Eight Thousand Six Hundred Thirty Four and 70/100 Dollars ($8,634.70), and Washington State sales tax equal to Eight Hundred Twenty and 30/100 Dollars ($820.30) for a total of Nine Thousand Four Hundred Fifty Five and No/100 Dollars ($9,455.00). The total amount payable to Contractor pursuant to the original Agreement, all previous Amendments, and this Amendment shall be an amount not to exceed Nineteen Thousand Eight Hundred Fifty Seven and 50/100 Dollars ($19,857.50). AMENDMENT - 3 - 1/2010 Business Licensing Service:License Query Search • Contact us • Forms • About us • Home • Start your business • Chanae or uodate vour business information • How to renew vour license Search Business Licenses License InPormation: Entity Name: ]AY ALBERT CROUCHET Business Name: XTREME GRAPHIX License Type: Washi�gton State Business Enti Ty�e�. Sole Proprietor UBI: 602214829 Business ID:001 Location ID:0001 Status: To check the status of this business, go to Deoartment of Revenue. Loeation Address: 19208 78TH ST E BONNEY LAKE, WA, 98390 View Additional Locations Registered Trade Names: NWAUTOWRAPS.COM XTREME GRAPHIX Governing People: JAY ALBERT CROUCHEf Mailinp Addreas: 19208 78TH ST E BONNEY LAKE, WA, 98390 Status Active Active Expires N/A N/A Information Current as of Ol/11/2013 5:43AM Pacific Time This site is limited to searching for business licenses issued through the Washington State Business �icensing Service. • Contact us • Forms . About us • PrivaCy �02011 Washin ton State Department of Revenue and its licensors. All rights reserved. http://bls.dor.wa.gov/LicenseSearch/1qsLicenseDetail.aspx?RefID=1704513 First Isaued 08/25/2008 04/11/2003 Page 1 of 1 1/14/2013 CERTlFICATE OF LIABILITY iNSURANCE DATE(MM1DOlYYVY) 04/0412013 THIS CERTfFICATE IS ISSUED AS A MATTER OF INFORMATlON ONLY AND CONFERS NO RIGNTS UPON THE CERTIFICATE HOLDER. THIS CERTIp{CATE OUE5 fVOT AFFIRMATIVELY OR NEGATfVELY AMEND, FX7END OR AtTER THE COVERAGE AFFORDE� BY THE POLICIES BELaW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODIJCER, ANp THE CERTIFICATE HOLDER. IMPORTANT: It the certiflcate holder is an ApQITIONAL INSURED, the poticy(ies) must be endorsed. If SUBROGATION fS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate dces not confer righfs to the certificate holder in lieu of such endorsementtsf. PR�UCER INSURED Mandarr Foley Agency 5005 Center St Suite A Tacoma, WA 98409 Xtreme Slgns � Graphix 19208 78th St E Bonney Lake, WA 98391 COVERAGE$ CERTIFICATE NUMBER: REViS10N NUMBER: THIS IS TO CERTIFY THAT THE POUCIES OF INSURAP�[CE LISTEp BELOW HAVE BEEN ISSUED TO T1iE INSURED NAMEQ ABOVE FOR THE POIICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDfT10N OF ANY CON7RACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURAIdCE AFFORDED BY THE PbLIGIES DESCRIBE� FiERElN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CQNDITIONS OF SUCN POLICfES. LIMITS SIiOWN MAY HAVE BEEN REDUCEQ BY PAIp CLAIMS. ��R TYPE OF (NSURANCE � POLlGYNUII�ER � � FF � L Y V� GENERAL LIABILITY FACH OCCURRENCE S Z AO X COMMERCIAL GENERhL LIIIBILITY pREMI E a 50 000 CLAIMS-MADE � OCCUR MED EXP ane S � OOQ �O 46X0492801 06101/2012 06/01/2013 PERSONPL 8 ADV 1NJURY s GBNERAL AGGREGATE S 2r�O�OOO GEML AGCiREGATE UMIT APPLlES PER: PRODUCT3 - COMPIOP AGG E (K) � x POUCY PR4 �� s '�`��� ��� MB ED S1NG lM1T ent AidY AU70 BO�fLY (NJl1RY (Per person) E �O NEU ��ULED BODILY INJURY (Per acctden� S HfRED AUTOS p�pg�� PROPER7Y OAMAGE s r S UMBRELUI LIAB OCCUR EqCN OCCURRENCE a ��� ��� CLAIMS-MADE ACaGREGATE S DED RETENTIOM s WORKER8 CONpENSASfON � �A� ��y, AND EMPLOYER8' LIRBILfTY ANY PROPRIETQSVPqRTNER(EXECUTIVE Y! N E.L. EACH ACCIDEMT S OFFICERlM1EMBER D(CLUDED? ❑ N! q (M�daMry In Nlf) E.L. DISEASE - EA EMPLOYE 3 Hyes� aeser]he uM19r DESCRIPTION OF �RATlONS bebw EL. OfSEASE - POLICY LIMIT 5 OEBGImpTIpN OF OPERqT1pN8 ) LOCATIONS J VEHICLE$ (pt4oh qCORD 1Q1. AddRionel RemaAts Schequb, if more spaos is requi�ed) . City of Federel Way s��s �, av� s Fede�i wey, wa seoo� ACORD 25 {2010105) SHOULD ANY OF THE A80VE DESCRiBED POLICIES BE CANCELLED BEPORE THE EXPERATfON DATE TFfEREdF, NOTiCE WIlL 8E DELNERED IN ACCORDANCE WITH THE POLiCY PROVISIONS. AU'ItipRRED REPRESENTATIVE �� 198$/1010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are istered marks of ACORD RETURN 'I'O: EXT: CITY OF FEDERAL WAY LAW DEPARTMENT �ROUTING FORM 1. ORIGINATING DEPT./DIV: �'��S 2. ORIGINATING STAFF PERSON: ��� I��-'�-�� � EXT: �i l 1 3. DATE REQ. BY: 4. TYPE OF DOCUMENT (CHECK ONE): ❑ CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ) ❑ PUBLIC WORKS CONTRACT O 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. aorrD xELnrED DocuMErrTS> ❑ O INANCE ❑ RESOLUTION CONTRACTAMENDMENT(AG#): ��'�O� ❑ INTERLOCAL ❑ OTHER 5. PROJECT NAME: 6. NAME OF CONTRACTOR: ADDRESS: Z 1� E-MAIL: W W W� N W SIGNATURE NAME: �� q�5 1 �C-5 . TELEPHONE Z'S3� FAX: TITLE (��nM�" _ 7. EXHIBITS AND ATTACHMENTS: ❑ scoPE WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE ❑ ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES � PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: ��' l3� ZO l0 N' S�� COMPLETION DATE: �G �� I Z'�� Z 9. TOTAL COMPENSATION $�� Z � � yO � 5 UO �� aD �� � (INCLUDE EXP�EN ES ND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: O YES ❑ NO IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED � YES ❑ NO IF YES, $ PAID BY: � CONTRACTOR B'CITY 3o3- •�?(o• 3l2 ^- �i$o7�5� c�S�I�U•oo�w ❑ PURCHASING: PLEASE CHARGE TO: ap �- � pa .��l -'S''I(p' $U - 3� Z�^— l b�JZ' SU 10. DO UMENT/CONTRACT REVIEW �OJECT MANAGER � ❑ DIRECTOR � � �RISK MANAGEMENT (iF aPrLicaBLE)'y� 0 LAW . , � � ATE REVIEWED 1Z l(7 � �T�l�a ' .. �-/ -� INITIAL / DATE APPROVED 11. COUNCI�LA��R��GGAI.(IF�PLICABLE EAPPROVALDATE: COUNCILAPPROVALDATE: 12. CONTRACT SIGNATURE ROUTING ) '�1 J �SENT TO VENDOR/CONTRACTOR DATE SENT: � Z �Z�� / �� DATE REC'D: �( �� ❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS �LAW DEPARTMENT �I l� � SIGNATORY (� D��C'rox) t� I �� CITY CLERK � ASSIGNED AG# � SIGNED COPY RETURNED AG# - DATE SENT: �S t�r�v.� d�rE.SS _ �'�' :_ r � ;������ C�t,-� � �D- IG - �C�I�'�� -�. �� �C'�-�l� J��� i S o ✓ � s "�Y U� �v� u�s� � `�-cE� �� ��' � c � 'n , ��-�' � � 1�-.� 1��--n +�-- �; t t i� �ra.E.�— r,�,�,,c�.� ,� u► c,-1 �5 � e,��. rc,� J� 1 1 �.�.. (�('� °� i �'1l�1 �i:1^�L�i:c� • � �` �� T► ill-�— v� �j.•ih Jr° � ���� �� � � � �'Y �€kLL :� z.i �.�5 ��t`'E MJ?3 73i� GLi E�'T '�"` �.rCSC �,f'i i� FE;�"ri�l'+l�ic�Sr t^•Id .'-'.��i#�:;-3?`�.�. {���; F4w�->'��k �'l �i'c�b. Clt`Yi:;if.'lf°I87 :•�.'34! Gi''f"`'3 AMENDMENT NO. 1 TO GOODS AND SERVICES AGREEMENT FOR PARK SIGNS This Amendment ("Amendment No: 1") is made between the City of Federal Way, a Washington municipal corporation ("City"), and Jay Crouchet, dba Xtreme Signs & Graphics, a sole proprietor ("Contractar"). The City and Contractor (together "Parties"), for valuable consideration and by mutual consent of the parties, agree to amend the original Agreement for providing a variety of signs for City parks and facilities ("Agreement") dated effective April l, 2010, as follows: 1. AMENDED TERM. The term of the Agreement, as referenced by Section 1 of the Agreement and any prior amendments thereto, shall be amended and shall continue until the completion of the Services, but in any event no later than December 31, 2012 ("Amended Term"). 2. AMENDED COMPENSATION. �'he amount of compensation, as r�,ferenced 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 E�ibit "�- i", attached hereta anci inc�rporated by this reference. The Contractor agrees that any hourly or flat rate charged by it for its services contracted. for herein sha11 remain locked at the negotiated rate(s) for the [Amend�d] T���cn. Except as otherwise provided in an attac;hed Exhibit, the �,onh•actor shall be solely responsiUle for the payment of any taxes imposed by any lawful jurisdiction as a result of the performance and payment af this Agreerrient. 3. GENERAL PROVI5IONS. All uthei• tern�s and provisions of the Agreement, together with any prior amendments thereto, not modified by this Ainendment, shall remain in full force and effect. Any arid 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 sv�Tear under penalt y of perjury that they are authorized to enter into this Amendment, which is binding on the parties of this contract. [Signature page follows] AMEI�IDMEN"C � - 1�- I!?�?1G � ��"f'� &�� �'�'`f Fif+€.L �°' � � :� , a ��s v�i^ .��ff_t�yi.�� �LifE� ° �'`+.3 �iG< <3;i : � F���€ �1+,+�3y, '�r^•It� d��i�''-a:�°�7� a ���,z; uw:�-'�C£� :v�s�;a: cr<i�'��etzs���i;•h3t� ttirrn IN WITNESS, the Parties execute this Agreem�nt below, effective the last date written below. CITY OF FEDERAL WAY B y� � -- Cary M. Roe .E., Director, Parks, Public Works, & Emergency Management DaTE: 2� l( ATTEST: --�� - Cit Clerk Carol� , CMC " Y � Y A.PF O�'ED AS TO FORM: _ _:------ ---- -- �'�- !Crty �tt ey, Patricia A Kichardson XTREI�I� S B� Printec� i�arne: �' ,� �aov_��_�__.__.— Title' ___,(,��%� _�—____ _- DATE: .-_. �����L STATE C1F WASHINGTON ) ) ss. COUNTY OF Q � �,� �,.,_) On this rl.ay �ersonally appeared before me, Jay Crouchet, to me knewrr �o be the inc�ividual described in arad who executec3 the f�oregoing instrument, and on oath swore that he execu�ed t:�he roregoing instrument as his/her/their free and voluntary act and deed for the uses and pur therein mer.tio�ed. C1VEN my hand an.d�official seal this _\__ day of __�e�c�qcv�____, 2�__�1 �� N� V,� ���°\ ..� - _. ------ ----- ---------- -- --- NOTqR � � _..�_��__� t c-��—m��- �----_ _ _---- ' (typed/prz,l_ec.� name of r�ota�y) P UBL�C Notaiy Public ;n unci �or the State of Washir��toi�. Y �, �� .,,,_ _ . �✓Iy cornmissic7n expires_ 1 - `'1 - l5 Aluf_ENI=)MF�I�1T - 2 - �I/21i10 4 ' ����+ �� � �€'Y #-€�LL ; � � �. �3 +` � +'1�f'�'!L� GL;{�'j ' �.} '�i' ���� s � . � � ��'��''�'i�� 4 �� + �Sr L W . ... . . � �c"',..7�`` �i �t � iY'o':',L`: �R�/i;t:E:C1Sfs2rsK3t! C?:+7?? EXHIBIT B-1 ADDITIONAL COMPENSATION L Total Compensation: In return for the Services, the City shall pay the Contractor an additional amount not to exceed Five Thousand and No/lU0 Dollars ($5,000.00), and Washington State sales tax equal to Four Hundred Seventy Five and No/100 Dollars ($475.00) for a total of Five Thousand Four Hundred Seventy Five and No/100 Dollars ($5,475.00). The total amount payable to Contractor pursuant to the original Agreement, al1 previous Ameridments, and this Amendment sha]1 Ue an amount not to exceed Ten Thousand Four Hundred Two and 50/100 Dollals ($10,402.50). AMF�t):�-1�:NT - 3 - 1/201Q APR-13-2011 09:50 From: To:12532356909 Pa9e:2�4 C�RTIFICATE OF LIABILiTIf INSURANCE American Family Insurance Company ❑ American Family nrtutual Insurance Cornpany IF selection box is not checked. 6000 Amertcan Pky M0.tlison, Wisconsin 53783•�001 Insuretl's Name �nd Address Agent's Nam�, Address anci Pnpne Number (AgtJDist.) Jay Crouchef db� Extreme Graphics Mandon Foley (253) 565 19208 78th St E 7305 40th Si W 6onney Lafce, WA 98391 University Place, WA 98466 (do7/354) This certiflcate is issued as a matter of inforrnation only ane confers no rights upon th� Certifica2e Holder. This cartificate dnes not Amend, extend or alter the co�erage afforded by the polici�s listed belpw. Thi9 �s to ceRtfy tnat Dolicfes of insuranc0 tisl9tl hglow ha�9 bee� �s5u90 to tna insUt9d nametl atlovg far the policy pe�od ind�c9te0, notWittistanCing any requirfiment, tglm or wndition a! qny cont�act or otner Qocumenl wifh raEDBC1 t0 WhiC� tllis c�niticpte may 6g issued or may peR81n,1ha inaurance aROrtl¢d by �he policies descr,bs0 nere�� ia auD�ect to all i�e larms, ezclusfong, a�d condiiions ol such pollc�es, TYPE OF INSURANCE ROLICY NUMBER EFFECTIVE EXPIRA710N LIMITS OF LIABILITY Mo Da Yr Mo D Yr Homsownsrs/ Bodi y m�ury an Prope�iy Oamage Mobil�homeowners Llebiliry �scnocc��r�nce $ ,000 Boatowners Liability . . . . . . . . . 90tlily lnjury gnd Prapgrty Dam�9e Each Occurrence $ ,900 Personal Umbrella Liability Bodily In�vry a�d PropeM �amage � Eacn occurrenca $ ,000 Farrn/Ranch Liabilhy Workers Compensation and Employers Liabiliry {� General lf8bility D Commercial General Liabiliiy (occurrence) ❑ � 9u9inessawners Liahility 46 Liquor Liabllity Automvbile Liybility � Any Auto � All Own�d Autos � SChgduled Autos ❑ Hired Auto ❑ Nonowned Autos ❑ Excess Lianility ❑ COmmercial Blankec Excess ❑ Oth�r (Miscellsneous Coveraa CERTfFICATE HOLQER'S IdAME AN . Fgrm Wab��ily & PB�S0�8f LiSbiliry E,�ch_OQC�rrence � Fartn �mploYer'e Liahllt�y Each OCCUr�nc $ 3tatutory Eac� Accident $ Dieaase - Each Empfoy�e $ plaease - Po��cy Um�t $ Cienerai AQgregale $ Protlucte - Compleretl OOarationa Aggregate $ Pefaonal an� AQVenlsln� InIuN � Edch Occvrrgncg $ Each OGCUrrgnCBt j' $ 6/1/2010 6/1/2011 Aggregatett $ COmmOn CdUSB �m�� $ n re ate �tm�� $ Bodpy InJury - �ach Person $ Bodily Injury • Esck� Accitlenl $ ProAerty Damag� $ Bodtly tnjury and Craperry Da�&ge CombineC $ x�,ex�sxxxr*x ,000 ,000 ,000 2,��� .000 z,aoo ,000 OQb ,�Q� 50 .000 t ,—��..� ,��0 ,000 ,000 ,000 ,040 ,000 ,000 ,000 Eacb Occurrgnc�/Aggregale $ ,OOQ t Tne Ina�;CUaf or Parfi6�a sn� a3 �nyved ❑ Ngve � HaYe abc4ed to bo cova�od aa empfoyee6 under U6s Do��cY. �RoGUC�Lomplgtad Oparationa aggrvgala la oquel lo auh occulrgneq am�t ana IglncWaee In po9q a99rngata. +caNCeL�anoN Should any of the above described policies b� cancelled before th expiration date th�reot the company w+l! endeavor fo mail *( day; wntten notice tn the G�ertificate Holder named, but failure to mail suc notice shall impose no obiigation or iiabiliN of any kind upon th company, its agents or representatives. 'ia days unless differer num of days s hown. � This certifies coverage on the tlate of issue only. The_ abo described policies are suble�t to cancellation in conformiiy uvith th� terms and by th� laws of the state ot issue. 4/1 �/2011 U-2D1 Etl. 5/OD SiocK No. 06868 R�v. 7/62 APR-13-2011 09:50 From: 530 Page:3�4 46X0492801 02 002 CAM093 THIS ENDORSEMENT CHANGES 7HE POL{CY. PLEASE REAa IT CAREFULLY, POLICY CHANGES POLICY NUMBER EFFEC7IVE DATE 46x0492801 02-14�2011 ISSUED TO ,TAY CROtTCHE°T' AGENT 007-354 MA.�il70IV FOLEY The fallowing item(s): � Additional Interested PaRies ❑ Covered PropertylLocation DeSCription ❑ Insured"S Name ❑ Insured's Mailing Address ❑ Insured's �egai Stalus/Business of Insured ❑ Underlying Insurance ❑ Policy Number is (are) changed as follows: ADD'L PREMIUM RETURN PREMIUM POLICY CHANGE N0, ooz CUSTOMER BILLING ACCOU►vT oi5-912-4ss 4� ❑ Classification/Class Codes 0 Coverage Forms and Endorsements ❑ Deductibles ❑ LimitslExposures ❑ Premium Determination ❑ Rates St7S2NESSOwNEt�5 �OL�CX TI-IE FOLLOWI�TG CHANGES k.PPLY TO .ti�LL PREMISES: TI-I� k'OLLOWZ�7G IS AATJED: LIABILITY FORMS AND ENDORSEMEI3T5 APPLYIIVG TO ALL PRES�TISES : SP 04 �8 O1 06 .�J3DIT�0�7A� INSUR�D — AESIGNATED PERSON OR OFtGANT �,�TI O�T All other terms remafn unchanged. Paqe o� ot oi qMERICAN FAMILY MUTUAL INSURANCE COMPANY MADISON, W15CONSIN AUTHORl2ED � ��e � GOIiM�RS�GN�6 REPRESEPfTATIVE Preamc�l � ;.,,�i �CENSEO RESIDENT AGEM IL 75 37 09 09 YNSVRED Sfock No,18020 To:12538356909 APR-13-z011 09:50 From: To:12538356909 Page:4�4 530 POLICY NUMBER: 46X�49�80�. THIS ENDORSEMENT CNANG�S THE POLICY. PLEASE FtEAD IT CAR�FULLY. ADDITfONAL INSURED — DESIGNATED PEFtSON OR ORGANIZATION This endorsement modiTies Insurance provided underthe following: BUSINESSOWNERS COVERAGE FORM a6X049�8p� 02 002 CArt693 BUSINESSOWNERS �P 04 48 01 06 BP 04 48 01 O6 � ISO Properties, Inc., 20�4 Stock No, 13799 The following is added to Paragraph C. Who Is An Insured in Section II — Liability: 3. Any person(s) or organization(s) shown in lhe 5chedule is aiso an additional insured, but oniy with respec# to liability for "bodily injury", "property damage" ar "pe►sonal and adverfising injury" caused, in whflle or in par1, by your acis or omissions or the aCls or amissions o� those aciing on your beh�lf in the performance of your ongoing operations or in connectian with your premises owned by or rented to you, RETiJRN Tn: EXT: CITY OF F�`�ERAL WAY LAW DEPA�TMENT ROUTING FORM 1. ORIGINATING DEPT./DN: 2. ORIGINATING STAFF PERSON: �i�� I I`.Ut,� EXT: (� l( 3. DATE REQ. BY: 4. TYPE OF DOCUMENT (CHECK ONE): O 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.�. soND �LaTED DocuMEUrs> ❑ ORDINANCE ❑ RESOLUTION ❑ CONTRACT AMENDMENT (AG#): ❑ INTERLOCAL ❑ OTHER 5. PROJECT NAME: 6. NAME OF CONTRACTOR: ADDRESS: 19Z� E-MAIL: �-►�q� , SIGNATURE NAME: � C�r� TELEPHONE Z-Fj 3• Z3 Z•`j d'I3 FAX: NA TITLE (�, i �y� 7. EXHIBITS AND ATTACHMENTS: ❑ SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICACE ❑ ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: A�1�� � �,?,04 (� COMPLETION DATE: IV�,aY �j � � 'ZU � � 9. TOTAL COMPENSATION $ �'�`� ��� �� 2 � �� (INCLUDE EXPENSES AND SALES TAX, IF ANY� (IF CALCULATED ON HOURLY LABO CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: � YES ❑ NO [F YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED . �YES ❑ NO IF YES, $ PAID BY: � CONTRACTOR ❑ CITY 3o3-��csr�-t2�-��{-�b-312 -�- �3,00b• ❑ PURCHASING: PLEASE CHARGE TO: pnt -1�vu -�i2• '�'�(s- C� •'S�Z a- � I f 860' aO 10. DO UMENT/CONTRACT REVIEW �� PROJECT MANAGER ❑ DIRECTOR ❑ RISK MANAGEMENT (1F APPLICABLE) ❑ LAW 11. COUNCIL APPROVAL (� APrLicaBLE) INITIAL / DATE REVIEWED 1NITIAL / DATE APPROVED _ �j�- �'li'LO � s/2�1c� �P `�1 Scc_ Op. 1�'1 COMMITTEEAPPROVALDATE:� COUNCILAPPROVALDATE: N/ t 12. CONTRACT SIGNATURE ROUTING ❑ SENT TO VENDOR/CONTRACTOR DATE SENT: N,� �I 1 � DATE REC'D: /�S�j'� ❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS ❑ LAW DEPARTMENT ❑ SIGNATORY (cM ox Di�CTOx) �" CITY CLERK B^ASSIGNED AG# qsSIGNED COPY RETURNED INITIAL / DATE SIGNED �Q J � — �0 �0' � ' I�L� aG# 11�1 D I DATE SENT: jp - �� � COMMENTS: �,�;� �.�,. 3-���� �..�e-,';� L �,a- `��-E R: � ���9 � � ra � r . +r. �' wr ar CITY HALL �� 33325 8th Avenue Stx�ttt • PU �ox 971 � Federai Way, �!A 98C}63-9718 (253j 835-7�3fl uo�a��r� crtyof€�dertzPway carra GOODS AND SERVICES AGREEMENT FOR PARK SI(GNS This Goods and Services Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal corporation ("City"), Jay Crouchet, dba Xtreme Signs & Graphics, a sole proprietor ("Contractor"). The City and Contractor (together "Parties"} are located and do business at the below adclresses which shall be valid far any notice required under this Agreement: XTREME SIGNS & GRAPHICS: CITY OF FEDERAL WAY: Jay Crouchet, Owner H. Stephen Ikerd, Parks & Facilities Nlanager 19208 78 Street East 33325 8 Ave. S. Bonney Lake, WA 98391 P.O. Box 9718 Federal Way, WA 98063-9718 (253) 835-6911 (telephone) 253-232-9873 (telephone) (253) 835-6909 (facsimile) stickerja msn.com Steve.ikerd cityoffederalway.com The Parties agree as follows: 1. TERM. The term of this Agreement shall commence upon the effective date of this Agreement, which shall be the date of mutual execution, and shall continue until the completion of the Work, but in any event no later than Mareh 31, 2011 ("Term"). This Agreement may be extended for additional periods of time upon the mutual written agreement of the City and the Contractor. 2. WORK. 2.1 Work. The Contractor shall provide goods, materials or services and otherwise perform the work mare specifically described in Exhibit "A", attached hereto and incorporated by this reference ("Work"), 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 ar her designee. 2.2 Warranties. The Contractar warrants that it has the requisite training, skill, and experience necessary to provide the Work and is appropriately accredited and licensed by all applicable agencies and governmental entities, including but not limited to obtaining a City of Federal Way business registration. The Contractor warrants it will provide services in a manner consistent with the accepted practices for other similar services within the Puget Sound region in effect at the time those services are performed. The Contractor warrants goods are merchantable, are fit for the particular purpose for which they were obtained, and will perform in accordance with their specifications and Contractor's representations to City. The Contractor shall, at its sole cost and expense, correct all Work performed which the City deems to have defects in worlananship and material discovered within one (1) year after the City's final acceptance of the Work. This Agreement is subject to all warranty provisions established under the Uniform Commercial Code, Title 62A RCW. In the event any part of the goods are repaired, only original replacement parts shall be used; rebuilt or used parts are not acceptable. When defects are corrected, the warranty for that portion of the work shall extend for one (1) year from the date such correction is completed and accepted by the City. The Contractor shall begin to correct any defects within seven (7) calendar days of its receipt of notice from the City of the defect. If the Contractor does not accomplish the corrections within a reasonable time as determined by the City, the City may complete the corrections and the Contractor shall pay all costs incurred by the City in order to accomplish the correction. 2.3 Time, Documentation, and Inspection. Work shall begin immediately upon the effective date of this Agreement. Work shall be subject, at all times, to observation and inspection by and with approval of the City, but the making GOODS AND SERVICES AGREEMENT - 1- 1/2010 • ■ � � ,, �.� � �ww� ; �! GfTY HALL r� � 333zs 8m avenue scx.rth • Pt� �c�x 979s � �ederal Way �lA 98t763-9718 {253) 835-7(}Ofl irsv�avcifyof�def�lway c.arrr (or failure or delay in making) such inspection or approval shall not relie��e Contractor of responsibility for performance of the Work in accordance witl� th is Agreemet�t, notwithstanding the City's knowledge of defective or non-complying performance, its substantiality or the ease of its discovery. 2.4 Clean Up. At any time ordered by the City and immediately after completion of the Work, the Contractor shall, at its own expense, clean up and remove all refuse and unused materials of any kind resulting from the Work. In the event the Contractor fails to perform the necessary clean up, the City may, but in no event is it obligated to, perform the necessary clean up and the costs thereof shall be immediately paid by the Contractar to the City and/or the City may deduct its costs from any remaining payrnents due to the Contractor. 3. TERMINATION. Either party may terminate this Agreement, with or without cause, upon providing the other pariy thirty (30) days written notice at its address set forth on the signature block of this Agreement. The City may terminate this Agreement immediately if the Contractor fails to maintain required insurance policies, breaches confidentiality, or materially violates Section 12 and such may result in ineligibility far further City agreements. 4. COMPENSATION. 4.1 Amount. In return for the Work, the City shall pay the Contractar an amount not to exceed a maximum amount and according to a rate or method as delineated in Exhibit "B", 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 the Term. Except as otherwise provided in Exhibit "B", the Contractor shall be solely responsible far the payment of any taxes imposed by any lawful jurisdiction as a result of the performance and payment of this Agreement. 4.2 Method of Payment. On a monthly basis, the Contractar shall submit a voucher or invoice in the form specified by the City, including a description of what Work have been performed, the name of the personnel performing such Work, and any hourly labor charge rate for such personnel. The Contractor shall also submit a final bill upon completion of all Work. Payment shall be made on a monthly basis by the City only after the Work have been performed and within thirty (30) days after receipt and approval by the appropriate City representative of the voucher or invoice. If the Work do not meet the requirements of this Agreement, the Contractar will correct or modify the wark to comply with the Agreement. The City may withhold payment for such work until the work meets the requirements of the Agreement. 4.3 Defective or Unauthorized Work. If any goods, materials, or services provided under this Agreement are either defective, unauthorized, or otherwise do not meet the requirements of this Agreement, the Contractor will correct or modify the work to comply with the Agreement and the City reserves the right to withhold payrnent from the Contractor until the goods, materials, ar services are acceptable to the City. If Contractor is unable, for any reason, to complete any part of this Agreement, the City may obtain the goods, materials or services from other sources, and Contractor shall be liable to the City for any additional costs incurred by the City. "Additional costs" shall mean all reasonable costs, including legal costs and attorney fees, incurred by the City beyond the maximum Agreement price specified above. The City further reserves its right to deduct these additional costs incurred to complete this Agreement with other sources, from any and all amounts due or to become due the Contractor. 4.4 Non-A�propriation 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 payrnents for Work or amounts incurred after the end of the current fiscal period, and this Agreement will terminate upon the completion of all remaining Work for which funds are allocated. No penalty ar expense shall accrue to the City in the event this provision applies. 4.5 Final Payment: Waiver of Claims. Contractor's acceptance of final payment shall constitute a waiver of any and all claims, except those previously and properly made and identified by Contractor as unsettled at the time request for final payment is made. GOODS AND SERVICES AGREEMENT - 2- 1/2010 +�fv�t t�F ��r�ri�� 5. INDEMNIFICATION. ClTY HALL 33325 8th Avenue Stsuth • PC3 Box 9 718 �BdeCa( Wr1y.1�'A 9$�3-9? 1$ f25�� &35-74(}fl r� �.sv cnynf�cterat�ay c:cx� 5.1 � Contractor Indemnification. The Contractor agrees to reiease indemnify, defend, and hold the City, its elected officials, officers, employees, agents, representatives, insurers, attomeys, and volunteers harmless from any and all claims, demands, actions, suits, causes of action, arbitrations, rnediations, proceedings, judgments, awards, injuries, damages, liabilities, taxes, losses, fines, fees, penalties eYpenses, attorney's fees, costs, andior litigation expenses to or by any and all persons or entities, including, without limitation, their respective agents, licensees, or representatives, arising from, resulting from, or in connection with this Agreement or the performance of this Agreement, except far that portion of the claims caused by the City's sole negligence. Should a court of competent jurisdiction determine that this Agreement is subject to RCW 424.115, then, in the event of liability for darnages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the Contractor and the City, the Contractor's liability hereunder shall be only to the extent of the Contractor's negligence. Contractor shall ensure that each sub-contractor shall agree to defend and indemnify the City, its elected officials, officers, employees, agents, representatives, insurers, attorneys, and volunteers to the extent and on the same teims and conditions as the Contractor pursuant to this paragraph. The City's inspection or acceptance of any of Contractor's work when completed shall not be grotmds to avoid any of these covenants of indemnification. 5.2 Industrial Insurance Act Waiver. It is specifically and expressly understood that the Contractar waives any immunity that may be granted to it under the Washington State industrial insurance act, Title 51 RCW, solely for the purposes of this indemnification. Contractor's indemnification shall not be limited in any way by any limitation on the amount of damages, compensation ar benefits payable to or by any third party under warkers' compensation acts, disability benefit acts or any other benefits acts or programs. The Parties further acknowledge that they have mutually negotiated this waiver. 5.3 Citv Indemnification. The City agrees to release, indemnify, defend and hold the Contractor, its officers, directors, shareholders, partners, employees, agents, representatives, and sub- contractors harmless from any and all claims, demands, actions, suits, causes of action, arbitrations, mediations, proceedings, judgments, awards, injuries, damages, liabilities, losses, fines, fees, penalties expenses, attorney's fees, costs, and/or litigation expenses to or by any and all persons ar entities, including without limitation, their respective agents, licensees, ar representatives, arising from, resulting from or connected with this Agreement to the extent solely caused by the negligent acts, errors, or omissions of the City. 5.4 Survival. 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. 6. INSiJRANCE. The Contractor agrees to carry insurance for liability which may arise from or in connection with the performance of the services or wark by the Contractar, their agents, representatives, employees or subcontractors, as provided in Exhibit "C" , attached hereto and incorporated by this reference, for the duration of the Ageement and thereafter with respect to any event occurring prior to such expiration or termination. The provisions of this Section shall survive the expiration or termination of this Agreement. 7. CONFIDENTIALITY. All information regarding the City obtained by Contractar in performance of this Agreement shall be considered confidential subject to applicable laws. Breach of confidentiality by the Contractar may be grounds for immediate termination. All records submitted by the City to the Contractor will be safeguarded by the Contractar. The Contractor will fully cooperate with the City in identifying, assembling, and providing records in case of any public records disclosure request. 8. WORK PRODUCT. All originals and copies of work product, including plans, sketches, layouts, designs, design specifications, records, files, computer disks, magnetic media or material which may be produced or modified by Contractar while performing the Wark shall belong to the City upon delivery. The Contractor shall make such data, documents, and files available to the City and shall deliver all needed or contracted for work product upon the City's request. At the expiration or termination of this Agreement, all originals and copies of any such wark product remaining in the possession of Conh shall be delivered to the City. BOOKS AND RECORDS. The Contractor agrees to maintain books, records, and documents which sufficiently and GOODS AND SERVICES AGREEMENT - 3- 1/2010 . � ,w ,a , w� rrr � rrw • c�T� Ha�� 33325 stn Avenue saa�ti, � Po aux �7is FedBCal Warf, !NA 98t}£'i3-971$ (2�3) 835-7C)Q4 �r�au r�tycaffeder�thut�.V cnm, properly reflect all direct and indirect costs related to the performance of the Work 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 ar audit by the City, its authorized representative, the State Auditor, or other governmental officials authorized by 1aw to monitor this Agreement. 10. INDEPENDENT CONTRACTOR / EMPLOYEE CONDITIONS 10.1 Independence. The Parties intend that the Contractor shall be an independent contractor and that the Contractor has the ability to control and direct the performance and details of its work the City being interested only in the results obtained under this Agreement. The City shall be neither liable nor obligated to pay Contractor sick leave, vacation pay or any other benefit of employment, nor to pay any social security, income, or other tax which may arise as an incident of employment, except as specifically provided in Section 4. Industrial or any other insurance that 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. If the Contractor is a sole proprietarship or if this Agreement is with an individual, the Contractar agrees to notify the City and complete any required form if the Contractor retired under a State of Washington retirement system and agees to indemnify any losses the City may sustain through the Contractor's failure to do so. 10.2 Safe . Contractor shall take all necessary precautions and shall be responsible for the safety of its employees, agents, and subcontractors at the work site and in the performance of the contract work and shall utilize all protection necessary for that putpose. Contractor shall comply with all applicable provisions of federal, state and municipal safety and health laws and codes, including without limitation, all OSHA/WISHA requirements, Safety and Health Standards far Construction Work (Chapter 296-155 WAC), General Safety and Health Standards (Chapter 296-24 WAC), and General Occupational Health Standards (Chapter 296-62 WAC). Contractor shall erect and properly maintain, at all times, all necessary guards, barricades, signals and other safeguards at all unsafe places at or near the site for the protection of its employees and the public, safe passageways at all road crossings, crosswalks, street intersections, post danger signs waming against lrnown or unusual hazards and do all other things necessary to prevent accident or loss of any kind. Contractor shall protect from damage all water, sewer, gas, steam or other pipes or conduits, and all hydrants and all other property that is likely to become displaced or damaged by the performance of the Work. The Contractor shall, at its own expense, secure and maintain a safe storage place for its materials and equipment and is solely responsible for the same 10.3 Risk of Work All work shall be done at Contractor's own risk, and Contractor shall be responsible for any loss of or damage to materials, tools, or other articles used or held for use in connection with the work. Industrial or any other insurance that 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. Even though Contractor is an independent contractor, the work must meet the approval of the City and shall be subj ect to the City's general right of inspection to secure satisfactory completion 11. CONFLICT OF INTEREST. It is recognized that Contractor may or will be performing professiona] services during the Term for other parties; however, 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. Contractor confirms that Contractor does not have a business interest or a close family relationship with any City officer or employee who was, is, or will be involved in the Contractor's selection, negotiation, drafting, signing, administration, or evaluating the Contractor's performance. 12. EQUAL OPPORTUNITY EMPLOYER. In all services, programs, activities, hiring, and employment made possible by or resulting from this Agreement or any subcontract; there shall be no discrimination by Contractar or its subcontractors of any level, or any of those entities' employees, agents, subcontractors, or representatives against any person because of sex, age (except minimum age and retirement provisions), race, color, religion, 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 to, 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 comply with and shall not violate any of the terms of Chapter 49.60 RCW, Title VI of the Civil GOODS AND SERVICES AGREEMENT - 4- 1/2010 .: 111 � ,�, � ew �r �' +wr �rr CITY NALL ����� 33325 8th f�venue .�.outh » PC7 Bc�x 9718 � Federat �iVa+/, �R 98t�63-9718 (2�3} F335-7C#�HI s�nv�vcaFt�ffe�}er�h�za�. c,�xr; Rights Act of 1964, the Americans With Disabilities Act, Section 504 of the Rehabilitation Act of 1973, 49 CFR Part 21, 21.5 and 26, or any other applicable federal, state, or local law ar regulation regarding non-discrimination. 13. GENERAL PROVISIONS. 13.1 Interpretation and Modification. This Agreement, together with any attached Exhibits, contains all of the agreements of the Parties with respect to any matter covered or mentioned in this Agreement and no prior statements or agreements, whether aral or written, shall be effective for any purpose. Should any language in any Exhibits to this Agreement conflict with any language in this Agreement, the terms of this Agreement shall prevail. 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. Any provision of this Agreement that is declared invalid, inoperative, null and void, or illegal shall in no way affect or invalidate any other provision hereof and such other provisions shall remain in full force and effect. Any act done by either Party prior to the effective date of the Agreement that is consistent with the authority of the Agreement and compliant with the terms of the Agreement, is hereby ratified as having been performed under the Agreement. No provision of this Agreement, including this provision, may be amended, waived, or modified except by written agreement signed by duly authorized representatives of the Parties. 13.2 Assignment and Beneficiaries. Neither the Contractor nor the City shall have the right to transfer or assign, in whole ar in part, any or all of its obligations and rights hereunder without the prior written consent of the other Party. If the non- assigning party gives its consent to any assignment, the terms of this Agreement shall continue in full force and effect and no further assignment shall be made without additional written consent. Subj ect to the foregoing, 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. This Agreement is made and entered into for the sole protection and benefit of the Parties hereto. No other person or entity shall have any right of action ar interest in this Agreement based on any provision set forth herein. 13.3 Compliance with Laws. The Contractor shall comply with and perform the Services in accordance with all applicable federal, state, local, and city laws including, without limitation, all City codes, ordinances, resolutions, regulations, rules, standards and policies, as now existing or hereafter amended, adopted, or made effective. If a violation of the City's Ethics Resolution No. 91-54, as amended, occurs as a result of the formation ar performance of this Agreement, this Agreement may be rendered null and void, at the City's option. 13.4 Enforcement. Time is of the 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 of the Services is essential to the Contractor's performance of this Agreement. Any notices required to be given by the Parties shall be delivered at the addresses set forth at the beginning of this Agreement. 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 above. Any notice so posted in the United States mail shall be deemed received three (3) days after the date of mailing. 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. The failure of the City to insist upon strict performance of any of the covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement in one or more instances shall not be construed to be a waiver ar relinquishment of those covenants, agreements ar options, and the same shall be and remain in full force and effect. Failure or delay of the City to declare any breach ar default immediately upon occurrence shall not waive such breach or default. Failure of the City to declare one breach or default does not act as a waiver of the City's right to declare another breach ar default. This Agreement shall be made in, governed by, and interpreted in accordance with the laws of the State of Washington. If the Parties are unable to settle any dispute, difference or claim arising from this Agreement, the exclusive means of resolving that dispute, difference, or claim, shall be by filing suit under the venue, rules and jurisdiction of the King County Superior Court, King County, Washington, unless the parties agree in writing to an alternative process. If the King County Superiar Court does not have jurisdiction over such a suit, then suit may be filed in any other appropriate court in King County, Washington. Each party consents to the personal jurisdiction of the state and federal courts in King County, Washington and waives any objection that such courts are an inconvenient forum. If either Party brings any claim or lawsuit arising from this Agreement, each Party shall pay all its legal costs and attorney's fees and expenses incurred in defending or bringing such claim or lawsuit, including all appeals, in addition to any other recovery or award provided by law; provided, however, however nothing in this paragraph shall be construed to GOODS AND SERVICES AGREEMENT - 5- 1/2010 � a r � rrr �' ^rrr • ci�� H�.�;.. ��� 33325 8th kve�,.�e South � PO �ox 9718 Feder�d V�ta�. s�`.� 9��3-9718 {�53) 8�5 r�t3�? �s�vwcstu��ff�.�1F xrnarap��_;,r; limit the Parties' rights to indemnification under Section 5 of this Agreement. 13.5 Execution. Each individual executing this Agreement on behalf of the C'ity and Contractor represents and warrants that such individual is duly authorized to execute and deliver this Agreement This Agreement maybe executed in an} number of counterparts, each of which shall be deemed an original and with the same effect as i f all Parties hereto had sign�d the same document. All such counterparts shall be construed together and shall constitute one instrument, but in making proof hereof it shall only be necessary to produce one such counterpart. The signature and acl:nowledgment pages from such counterparts may be assembled together to form a single instrument comprised of all pages of this Agreement and a complete set of all signature and acknowledgment pages. The date upon which the last of all ofthe Parties have executed a counterpart ofthis Agreement shall be the "date of muhial exectrtion" hereof. [Signature page follows] GOODS AND SERVICES AGREEMENT - 6- 1/2010 a� �, s w: rww ' � �r , yr CIT`f H.A�.L ���� 33325 8th �G�r�u� �au#h - PC) Bc�x 8718 Fede1'al V�, �a^JA �$(3�3-971$ (2�31 $3� fCt.�`i� `s�fb3�bYCf7'S��?�t <!c'+�i' r:i3r�i IN WITNESS, the Parties execute this Agreemer�t below, effective the last date �ritten below. CITY OF FEDERAL WAY ATTEST: / " � ��-' f ------ -- -- ------ . Cary M. Roe, P.E., rector of Parks, Public Works City Clerk, Carol McNeilly, CMC and Emergency Management DATE: ---- ���� �� XTREME SIGNS & GRAPHICS B y� --- — __ Jay Crouchet, Owner DATE: _�G�, �� Z� I �J --- � 2� STATE OF WASH GTON ) � ) ss. COUNTY OF _ ) APPROVED AS I'O FORM: � City Atto , Patricia A Richardson On this day personally appeared before me, Jay Crouchet, 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 free and voluntary act and deed for the uses and purposes therein mentioned. y � � GNEN m hand and official seal this da of , 20 �. r q3 � :; � V �IV 1'� (� j' � , 5a �� �<p j�� (typed/printed name of notary) ,, ,.4 ; • �,,`�' �� �.� �, , Notary Public in and for th St te of Washington. "°� �fltaRy w' �� My commission expires �� U �._- �:, �d�El1G � � ��'� "�'.'l!F28.?��o'�,� �F����°�`����' � .'r4f>'.R4ii GOODS AND SERVICES AGREEMENT - 7- 1/2010 L'iTV 0!� i:-E � 4�9A�' .? 332� Ei�h ,�V�(tU2 SL}LPt11 • f t} BQX �7 9 h �edera( .��ay. t�dR �8063-9�18 �`` ; ��3, �35 7C30fl ��{ �� i�rrc��,u�ty c��rrz EXHIBIT "A" SFRVICES ���'rie C�'�antractor shall do or �ro��ide �he fc�llowing: Re-do layuat w�,rk of an existing 24" x 3i)"' �tules sign and miscell�n:;o�.�s other signs in City approvec� coio:s_ Provid� di�ital �proofs of all signs pnar to order. Provide maniifac�turer �warc of vinyl. Strip old �c� ies vinyl and install new approved vinyl sign on same City ahuninum �blank. New vinyl is to be cornpat�h��r� �, backing and have exter�d�d u�ear �properties for ��iltr=� ��+r,�ie�k �ind adverse weather conditio�r�s Supply t�F���v RL�les signs on vendor provided die-bond backing. Supply 4«' x 72" monument signs on vend�r provided die-bond backing. Supply I:1� ��� x t 8" miscellaneous sign messages on vendar provided die-bond backing. Suppl�y �� "_'.�" x%4" emphasis signs on vendor provided die-bond backing. Slappl;� �! K�>�_ �Z4" rniscellaneous sign messages on vendor provided die-borid backing. GOi7DS ��NT� SERVICES AGRF,EME��"C� - 8- 1/2010 �! s'+Y fi�t �l� r �-7�i. � 33.�''� 3ft Avs€��_�e S�ut� ° f�G Box 9718 F �etler� 'N�;.�. t�4t� 98��-97�8 (2�'�; z33� %�i�� �+,^ .F t ,:ftc:7f.' , r,::�; ifi (' GGDfI LiA[.1117A1 D t "�I)f+,!iPEi�1SATION l. �ota� '':?rs���� ;.-�sation: In retiu fo�r th� �e��vices, �the C�ity shall pay thr ��:c�rztractor an amount not t� exceed Fu�rr ����c�i�sand Five Hundred and T�ic,' 1 C>Q l�oilars ($4,SOO.GO) and ��.�s�i.n��on State sales tax equal tr� Four Hundxe� �I����enty Seven and 50/lOG Uo;iar� {�42i.50) for a total of�:F�o��Er �I'housand Nine Hundred �'went;� Seven arid 5U,� �� C�C? Dollars ($4,927.50 j. 2. '� ��; �73��c;ing schedule 2010-20I i— tax not included Recotrer =�* 'lea5� >i:� �°xisting 24" x 30'' Paxk Ftule�, ,signs: $22.50 each New die bond ?4" x 30" Park rules signs: $40.00 each New die barid 44" x 72" Monument signs: $200.00 each New die borid � 2' x 18" miscellaneous signs: $12..00 each New die bond 1�" �?4" miscellaneous signs $ I 5.00 each New die borid i 8" x?_4" miscellaneous signs: $23.50 each GOUI7S A�TL� <<Ek_VICES AGREEMEl��I� - 9- 1/2010 .� �,� - ,� - ti�! ,.� '�1M .; !i GETY �t.�i_�� i � + � 3332w 8th f��✓�enu� `-}�utt � , �s�x � j � � s=edeE'�I V1�3y 'etVA_ �£tt?�? 97 , R q��3j 835-7� §ti�t�,�� ctivi�frt ���'�aha`�✓...3� ��.:'?..RIUI l. GG�''99 A I. tl � �.: Li.�`11, ��L� TnE ('ont� agrees �c carry as a r?1in�nl��ll , the• �c�iiow•.ing insuraa�c:e. ;n suc,h fc�rrr3s ana with such carriers who have a�ratirr� �r'r�a�� �s satisfactory �to the ('ity: a. Commerci�l general liabiiity insurance covenng liability arising �fron�� premises, operations_ indepe�ndent contracto_rs, products-completed operations, stop gap liability, personal injt�y, bodily injury, death, property darriage, produets liability, advertisir�g injury, and liability assumed under an. insured contract with limits no less than �61,000,000 for each occurrence and $1,000,000 general aggregate. �b Wo_r.kers' compensatiori and �m�ployer's tia�bility i.risurance in arxi��unts su:f�icient pursuant to the laws of the State of Was�ungton; c. Automobile liability insurance covering all owned, non-owned, hired and leased vehicles with a minimum corribined single limits in the minimum amounts required to drive undex Washington State law per accident for bodily injury, including personal injury or death, and property damage. 2. �;ontractor':5 maintenance of insurance as required by the agreement shall not be construed to limit the liabilit�� L>f the Coritractor to the coverage provided by such insurance, ar otherwise limit the City's recourse to any remedy available at law or in equity. The Contractor's insurance coverage shall be primary insurance as respect the C'ity. Any insurance, self-insurance, or insurance pool coverage maintained by the City shall be excess of the Contractor's insurance and shall not contribute with it. 3. The City shall be named as additional insured on all such insurance policies, with the exception of any professional liabi?ity insurance and any �vorkers' compensation coverage(s) if Contractor participates in a state- run workers' co�npensation program. t:ontractor shall provide certificates of insurance, concurrent with the execution of this Ag�eement, 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 inate:rially amended during the Term of this Agreement, except after khirty (30) days prior written notice to the City. If Contractor's insurance policies are "claims �nade," Contractor shall be required to maintain tail coverage for a minimum period of three (3) years from the date this Agreement is actually terminated or upon project completion and acceptance by the City. GOODS AND SERVICES AGREEMENT - �1G - ' %ZOiO CERTIFICATE OF LIABILITY INSURANCE American Family Insurance Company ❑ American Family Mutual Insurance Company if selection box is not checked. 6000 American Pky Madison, Wisconsin 53783-0001 Insured's Name and Address AgenYs Name, Address and Phone Number (Agt./Dist.) Jay Crouchet DBA Xtreme Signs Graphics Mandon Foley (253) 565-0756 3290 B Street Northwest 7305 40th St W Auburn, WA 98001-1723 University Place, WA 98466-4316 (007/354) This certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. This certificate does not amend, extend or alter the coverage afforded by the policies listed below. COVERAGES This is to certify that policies of insurance listed below have been issued to the insured named above for the policy period indicated, nolwithstanding any requirement, term or condition of any conUact or other document with respect to which this certificate may be issued or may pertain, the insurance afforded by lhe policias described herein is subject to all the terms, exclusions, and conditions of such policies. I Y T TYPE OF INSURANCE POLICY NUMBER EFFECTIVE EXPIRATION LIMITS OF LIABILITY Mo Da Yr Mo Da Yr Homeowners/ Bodily Injury and Property Damage Mobilehomeowners Liability �acn occurren� $ ,000 Boatowners Liability Bodily Injury and Property Damage Each Occurrence $ ,��0 Personal Umbrella Liability Farm/Ranch Liability Workers Compensation and Employers Liability t General Liability � Commercial General Liability (occurrence) ❑ ❑ Businessowners Liability Liquor Liability Automobile Liability ❑ Any Auto ❑ All Owned Autos ❑ Scheduled Autos — ❑ Hired Auto ❑ Nonowned Autos ❑ Excess Liability ❑ Commercial Blanket Excess ❑ Other (Miscellaneous Coveraqes) CERTIFICATE 0 AND ADDRESS CANCELLAI'10N Should any of the above described policies be cancelled before the expiration date thereof, the company will endeavor to mail *( days) wntten notice to the Certificate Holder named, but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. *f0 days unless different number of days shown. � This certifies coverage on the date of issue only. The abov< described policies are subject to cancellation in conformity with thei terms and by the laws of the state of issue. Bodily Injury and Property Damage Each Occurrence Farm Employer's Liability Each Occurrence Statutory Each Accident Disease - Ea ch Employee Disease - Policy Limit General Aggregate Products - Camoleted Ooe Each Occurrence Damaae to Premises Rented to You Each Occunencet t Ass�eyacett Common Cause Limit Aggregate Limit Bodily Injury- Each Person Bodily Injury- Each Accident Property Damage $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Bodily Injury and Property Damage Combined $ Each Occurrence//\qgregate $ ,000 ,000 ,0�� ,t*�st***e*�t�r* ,000 ,000 ,000 1000000 ,000 2000000 .000 1000000 ,000 50000 ,000 1000000 ,000 1000000 ,000 2000000 ,000 ,000 ,000 ,��� ,0�� ,0�� ,��0 t The individual a paMers shovm as insured U Have U Have not elected to be covered as empbyees under this policy. �ProductsLompleted Operatims aggegate is equai to exh occwrence limit and is induded in policy aggrega�. 5/3/2010 46-X04928-01-00 I 6/1 /2009 I 6/1/2010 U-201 Ed. 5/00 Stock No. 06668 Rev. 7/02 License Detail License Information: Entity Name: Firm Name: License Type: Entity Type. UBI: Status Location Address: 3290 B ST NW STE B AUBURN, WA, 98001-1723 View A ddi t ional Locatio Governing Peopl_e: JAY ALBERT CROUCHET Registered Trade Nam_es:. NWAUTOWRAPS.COM XTREME GRAPHIX JAY ALBERT CROUCHET XTREME GRAPHICS Washington State Business Sole Proprietor 602214829 Business ID:001 Location ID:0002 To check the status of this business, go to D_epartment__o_f Revenue Mailing Address: 19208 78TH ST E BONNEY LAKE, WA, 98391- 7103 ,� s r t � � t � . � . Page 1 of 1 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 af l.icensi� Home Privacy Policv Other Licenses Contact 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: //fortress. wa. gov/dol/dolprod/bpdLicenseQuery/1qsLicenseDetail. aspx?SessID=53 83 &... 4/7/2010 � . .