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AG 11-188RETURN TO: Carol McNeilly EXT: 2540 CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT. /DIV: LAW / CITY CLERK 2. ORIGINATING STAFF PERSON: CAROL MCNEILLY EXT: 2540 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 • CONTRACT AMENDMENT (AG#) 11 -188 ❑ INTERLOCAL • OTHER 5. PROJECT NAME: HEARING EXAMINER SERVICES 6. NAME OF CONTRACTOR: OLBRECTS AND ASSOCIATES, PLLC ADDRESS: 18833 NE 74TH STREET GRANITE FALLS, WA 98252 TELEPHONE 206 - 650 -7268 E -MAIL: OBLRECTSLAWC&,GMAIL.COM FAX: SIGNATURE NAME: PHILA.OLBRECTS TITLE: MEMBER/MANAGER 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: COMPLETION DATE: DECEMBER 31, 2013 9. TOTAL COMPENSATION $ VARIES (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑ YES ❑ NO IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED ❑ YES ❑ NO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY ❑ PURCHASING: PLEASE CHARGE TO: 10. DOCUMENT /CONTRACT REVIEW INITIAL / DATE REVIEWED INITIAL / DATE APPROVED • PROJECT MANAGER • DIRECTOR • RISK MANAGEMENT (IF APPLICABLE) )<LAW 0t, .IS,13 1'1bim 00 1l 2 11. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: COUNCIL APPROVAL DATE: 12. CONTRACT SIGNATURE ROUTING • SENT TO VENDOR/CONTRACTOR DATE SENT: f3.19-15 DATE REC'D: 61.3.15 • ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS INITIAL / DATE SIGNED ❑ LAW DEPARTMENT mg 13 _ iNATORY (MAYOR OR DIRECTOR) TY CLERK '�,�15SIGNED AG# AG# CGNED COPY RETURNED DATE SENT: COMMENTS: 11/9 CITY OF CITY HALL ,.;�. Federal Way 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www cityoffederahvay com AMENDMENT NO.2 TO PROFESSIONAL SERVICE AGREEMENT FOR HEARING EXAMINER SERVICES This Amendment ( "Amendment No. 2 ") is made between the City of Federal Way, a Washington municipal corporation ( "City "), and Olbrects and Associates, PLLC, ( "Contractor "). The City and Contractor (together "Parties "), for valuable consideration and by mutual consent of the parties, agree to amend the original Agreement for Hearing Examiner Services ( "Agreement ") dated effective October 13, 2011, as amended by Amendment 1 dated effective October 10, 2012, 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 12/31/2013 ( "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. IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY ATTEST: B Y 4�. Skip PR&VUayor City tjlA, Carol McNeilly, VMC WMEZOU AP ROVED AS O FORM: A A /-V Ac�- ><ty Att y, Patricia A Ric on AMENDMENT -I- AG 11 -188 CITY OF '�. Federal CITY HALL Way 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www crtyoffederaiway. corn OLBRECTS AND ASSOCIATES, LLC By: PY11 A. Olbrects, Member/Manager DATE: 2c STATE OF WASHINGTON ) ) ss. COUNTY OF6hb k W 5b On this day personally appeared before me Phil A. Olbrects, to me known/proven to be the member / manager of Olbrects and Associates. LLC. that executed the foregoing instrument, and acknowledged the said instrument to be the free and voluntary act and deed of said corporation, for the uses and purposes therein mentioned, and on oath stated tha&h /she was authorized to execute said instrument and that the seal affixed, if any, is the corporate seal of said corporation. Qtf GIVEN my hand and official seal this =aay of} (1��T— , 20 ,$ `� +` ``\� k*, q,���/ Notary's signa �A �� �Notary's printed name i 'p iAi 'OU81- ' X0 �i,'9 4�,1�` � Notary Public in and for the S to of Washington. My commission expires AMENDMENT - 2 - AG 11 -188 RETURN TO: Carol McNeilly EXT: 2540 CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT./DI V: LAW / CITY CLERK 2. ORIGINATING STAFF PERSON: CnROt, McNEt[.LY EXT: 2540 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 o HUMAN SERVICES / CDBG ❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. aorm �LnTED noctrMErrrs) � ORDINANCE O RESOLUTION X CONTRACTAMENDMENT(AG#) 11-188 ❑ INTERLOCAL � OTHER 5. PROJECT NAME: NEARING EXAMINER SERVICES 6. NAME OF CONTRACTOR: OLBRECTS AND ASSOCIATES, PLLC ADDRESS: 18833 NE 74T" SZ'xEET GRANITE FALLS, WA 98252 TELEPHONE 206-650-7268 E-MAIL:OBLRECTSLAW(c�GMAIL.COi4I FAX: SIGNATURENAME: rx�LA.OLBRECTS TITLE: MEMBER/MANAGER 7. EXHIBITS AND ATTACHMENTS: ❑ SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS/CERTIFICATE � ALL OTHER REFERENCED EXHIBITS O PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDMENTS 8. TERM: COMMENCEMENT DATE: COMPLETION DATE: AuGUS'r 31, 2013 9. TOTAL COMPENSATION $ VaRtES (INCLUDE EXPENSES AND SALES TAX, IF ANY� (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: O�S ❑ rro IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED ❑ YES ❑ NO IF YES, $ PAID BY: 0 CONTRACTOR ❑ CITY ❑ PURCHASING: PLEASE CHARGE TO: 10. DOCUMENT/CONTRACT REVIEW ❑ PROJECT MANAGER ❑ DIRECTOR ❑ RISK MANAGEMENT (1F �PLiC�BLE) o LAW INITIAL / DATE REVIEWED 60'l0'i2 INITIAL / DATE APPROVED 11. COUNCILAPPROVAL (cF �PL�C.e,BLE) 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 INI IAL / DATE SIGNED i�LAW DEPARTMENT /!'• . � SIGNATORY (MAYOR OR DIRECTOR� �1' CITY CLERK • Z L�1 ASSIGNED AG# AG# � ❑ SIGNED COPY RETURNED DATE SENT: lO ' lO ' I�L COMMENTS: 11l9 r � �� �;. � ..�..+1: +i'��. AMENDMENT NO. 1 TO Professional Service Agreement FOR Hearing Examiner Services CITY HALL �33c�J �Stl'1 tA4E�'C1U� SOtl��"3 ��Ci£I�r"i� �it�!r'�}i. j+�f� ��Q��-Ei�2�J ���,�} s.��-�€�ao �c�a*�? �ifyoft�ci�r€�tw�y.com This Amendment ("Amendment No. 1") is made between the City of Federal Way, a Washington municipal corporation ("City"), and Olbrects And Associates, PLLC, ("Contractor"). The City and Contractor (together "Parties"), for valuable consideration and by mutual consent of the parties, agree to amend the original Agreement for Hearing Examiner Services ("Agreement") dated effective October 13, 2011, 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 8/31/2013 ("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. IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY B. � � y' � kip Priest, ayor DATE: I O I I D I( 2- ATTEST: ity Clerk, Carol Mc eilly, C C APP OVED AS FORM: �� City Att y, Patricia A Richardson AMENDMENT - 1 - 1/2010 . �, � � � � `+I: +Yi' Olbrect iates, LLC Printed Name: Phil. A Olbrects Title: Member DATE: C� v STATE OF WASHINGTON ) ) ss. COUNTY OF G1TY HALL 33325 8th Avenue Scsufh F�d81'r�I V4!c�'}r,'+���A �SC3(33^Ei32°J (2�3) 835-i �CP(? st�•vw cityc�fle.cier�f�t2ay. cc�rtr W,,�,j� V�'�/ On this day personally appeared before me �,t 1�. ��1��i�� to me �� i to be the �,� of ��1br� a.�c(, �� ra� that executed the foregoing r-�• instrument, and acknowledged the said instrument to be the free and voluntary act and deed of said corporation, for the uses and purposes therein mentioned, and on oath stated tha i's�tc�was authorized to execute said instrument and that the seal affixed, if any, is the corporate seal of said corporation. GIVEN my hand and official seal this �O�day of ����Q%� , 20 I�' ���t� � .. . �~ �1.�' ��,�, r-t0•�'' �lR' w�aM • � .� ..,:��' �" /:� . � ,- � �1��� � ►� Notary Public in and for the State of Washington. My commission expires �_� (U� � � "t� ,� AMENDMENT - 2 - 1/2010 ' � DATE (MM/DD/YYYY) ACOR/� CERTIFICATE OF LIABILITY INSURANCE �� 02/22/2012 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Moranco & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 910 N. Washington, Ste 101 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Spokane, WA 99201 509 324-0640 INSURERS AFFORDING COVERAGE NAIC # wsuReo ,NS�RERA� Twin Citv Fire Insurance Companv Olbrechts & Associates, PLLC 18833 74th St. NE. Granite Falis, WA 98252 INSURER C: INSURER D: INSURER E: COVERAGE3 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MRY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' pOLICY NUMBER POLICY EFFECTVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE 5 COMMERqAL GENERAL LIA8ILITY PREMISES Ea occurence a CLAIMS MADE � OCCUR MEO EXP (My orre person 5 PERSONAL 8 ADV INJURY S GENERAL AC,GREGATE S GEN'L AGOREOATE UMIT APPLIES PER: PRODUCTS - COMP/OP AGG S POUCY PRa LOC AUTOMOBILE LWBILITY COMBINED SINGLE UMIT ANY AUTO (Ee ecGdent) 5 ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS �PefP�O�� a HIRED AUTO5 BODILY INJURY NONAWNEDAUTOS �P������ � PROPERTY DAMAGE i �Per accideM) OARAOE LIABILITY AUTO ONtY - EA ACCIDENT S ANY AUTO OTHER TMAN � ACC S AUTOONLY: A� § EXCESS? UMBREILA LIABILITY EACH OCCURRENCE S OCCUR � CLAIMS MADE AOGREGATE S s DEDUCTIBLE S RETENTION S a WORKERS GOMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABIU7Y ANY PROPRIETOR/PARTNEWEXECU7NE � E.L. EACH ACCIDENT S � OFFICERIMEMBER EXCLUDED7 (Mandatory in NH) E.L. DISEASE - EA EMPIOYE S 1fyes, describe under SPECIAL PROVISIONS balow E.L: OISEASE - POUCY LIMIT S oTr,eR $1,000,000 � PerClaim Lawyers Professional #LT 1616777 10/29/11 10/29/12 $1,000,000 - Aggregate Liability Insurance $2,500. - Deductible DESCRIPTION OF OPERATIONS I LOCATION5/ VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS CERTIFICATE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE FJ(PIRATION DA7E THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL .�� DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE c a�v — 25 (2008l01) Cr1 8-2009 ACO CORPORATI . All r hts reserved. The ACORD name and logo are registered m'�r. c�of ACORD RETURN TO: Carol McNeilly EXT: 2540 CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT./DIV: HuMarr RESOURCES / CcTY CLExx 2. ORIGINATING STAFF PERSON: CAROL MCNEILLY EXT: 2540 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 x PROFESSIONAL SERVICE AGREEMENT o MAINTENANCE AGREEMENT o GOODS AND SERVICE AGREEMENT ❑ HUMAN SERVICES / CDBG o REAL ESTATE DOCLJMENT ❑ SECURITY DOCUMENT �E.G. BOND RELATED DOCUMENTS) ❑ ORDINANCE ❑ RESOLUTION o CONTRACTAMENDMENT(AG#): o INTERLOCAL ❑ OTHER S. PROJECT NAME: HEARING �XAMINER SERVICES 6. NAME OF CONTRACTOR: OLB�c�rs a,�vn AssociATES, PLLC ADDRESS: 18833 NE 74 S'r�ET GRANITE FALLS, WA98252 TELEPHONE 206-650-7268 E-MAIL: oai.�t�ers�.,�«�C�a;; FAX: SIGNATURE NAME: rx�L A. OLBxEC1's TITLE: MEMBER/MANAGER 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: COMPLETION DATE: Aucus'r 23, 2012 9. TOTAL COMPENSATION $ VaiuES (INCLUDE EXPENSES AND SALES TAX, IF ANY� (IF CALCULATED ON HOURLY LABOR CHARGE -ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑ YES ❑ NO IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED ❑ YES O NO IF YES, $ PAID BY: O CONTRACTOR 0 CITY ❑ PURCHASING: PLEASE CHARGE TO: � � ^ �, �" D �-+'� " '�j I �-4' � ��,�=1.� � � 10. DOCUMENT/CONTRACT REVIEW INITIAL/DATEREVIEWED I1�iITIAL/DATEAPPROVED ❑ PROJECT MANAGER ❑ DIRECTOR � ❑ RISK MANAGEMENT (iF ArrLicaBLE) ❑ LAW �� — � 13 l . 11. COUNCILAPPROVAL �IF APPLICABLE� COMMITTEE APPROVAL DATE: COUNCILAPPROVAL DATE: 12. CONTRACT SIGNATURE ROUTING ❑ SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D: ❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS INITIAL / DATE SIGNED ❑ LAW DEPARTMENT ❑ SIGNATORY (MAYOR OR DIRECTOR� � CITY CLERK 0� . � • �� � ASSIGNED AG# AG#,] -- ��g �.41 SIGNED COPY RETURNED DATE SENT: a• �� •�,� � 11/9 CITY OF CITY HALL F � ���� I��� 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www. ciryoflederalwey! com PROFESSIONAL SERVICES AGREEMENT FOR HEARING EXAMINER SERVICES This Professional Services Agreement ("Agreement") is made between the City of Federal Way, a Washington municipal corporation ("City"), and Olbrects and Associates PLLC, ("Contractor"). The City and Contractor (together "Parties") are located and do business at the below addresses which shall be valid for any notice required under this Agreement: CONTRACTOR'5 CO. NAME: Olbrects and Associates, PLLC Phil A. Olbrects 18833 NE 74'� Street Granite Falls, WA 98252 (206) 650-7268 (telephone) olbrectslaw(c�g�nail.com The Parties agree as follows: CITY OF FEDERAL WAY: Carol McNeilly, City Clerk 33325 8�' Ave. S. Federal Way, WA 98003-6325 (253) 835-2540 (telephone) (253) 835-2509 (facsimile) Carol.mcneilly_(a)cityoffederalwa, .� 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 A�u ust 23. 2012 ("Term"). This Agreement may be extended for additional periods of time upon the mutual written agreement of the City and the Contractor. 2. SERVICES. T'he Contractor shall perform the services more specifically described in Eachibit "A", attached hereto and incorporated by this reference ("Services"), in a manner consistent with the accepted professional practices for other similar services within the Puget Sound region in effect at the time those services are performed, performed to the City's satisfaction, within the time period prescribed by the City and pursuant to the direction of the Mayor or his or her designee. The Contractor wanants 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 governmental entities, including but not limited to obtaining a City of Federal Way business registration. Services shall begin immediately upon the effective date of this Agreement. Services shall be subject, at all times, to inspection by and approval of the City, but the making (or failure or delay in making) such inspection or approval shall not relieve Contractor of responsibility for performance of the Services in accordance with this Agreement, notwithstanding the City's knowledge of defective or non-complying performance, its substantiality or the ease of its discovery. 3. TERNIINATION. Either party may terminate this Agreement, with or without cause, upon providing the other party thirty (30) days written notice at its address set forth above. 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 for further City agreements. 4. CONII'ENSATION. 4.1 Amount. In return for the Services, the City shall pay the Contractor an amount not to exceed a maximum amount and according to a rate or method as delineated in Eachibit "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 E�chibit "B", 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. PROFESSIONAL SERVICES AGREEMENT - 1- 4/2011 CITY OF Federal CITY HALL W �� 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www. crtynflederaAvay! cnn► 4.2 Method of Payment. On a monthly basis, the Contractor shall submit a voucher or invoice in the form specified by the City, including a description of what Services have been performed, the name of the personnel performing such Services, and any hourly labor charge rate for such personnel. The Contractor shall also submit a final bill upon completion of all Services. Payment shall be made on a monthly basis by the City only after the Services have been performed and within thirty (30) days after receipt and approval by the appropriate City representative of the voucher or invoice. If the Services do not meet the requirements of this Agreement, the Contractor will correct or modify the work to comply with the Agreement. The City may withhold payment for such work until the work meets the requirements of the Agreement. 4.3 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. 5. INDEIVIl�TIFICATION. 5.1 Contractor Indemnification. The Contractor agrees to release, indemnify, defend, and hold the City, its elected officials, officers, employees, agents, representatives, insurers, attorneys, and volunteers harmless from any and all claims, demands, actions, suits, causes of action, arbitrations, mediations, proceedings, judgments, awards, injuries, damages, liabilities, taxes, losses, fines, fees, penalties expenses, attorney's fees, costs, and/or 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 acts, errors or omissions of the Contractor in performance of this Agreement, except for 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 4.24.115, then, in the event of liability for damages 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 terms 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 grounds to avoid any of these covenants of indemnification. 5.2 Industrial Insurance Act Waiver. It is specifically and expressly understood that the Contractor 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 or benefits payable to or by any third party under workers' compensation acts, disability benefit acts or any other benefits acts or programs. The Parties acknowledge that they have mutually negotiated this waiver. 5.3 City 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 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 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. PROFESSIONAL SERVICES AGREEMENT - 2- 4/2011 ` CITY OP ;�. Federal CIIY HALL W �� 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www. cityntfeder�hva�%com 6. INSURANCE. The Contractor agrees to carry insurance for liability which may arise from or in connection with the performance of the services or work by the Contractor, their agents, representatives, employees or subcontractors for the duration of the Agreement and thereafter with respect to any event occurring prior to such expiration or termination as follows: 6.1. Minimum Limits. The Contractor agrees to carry as a minimum, the following insurance, in such forms and with such carriers who have a rating that is satisfactory to the City: a. Commercial general liability insurance covering liability arising from premises, operations, independent contractors, products-completed opera.tions, stop gap liability, personal injury, bodily injury, death, property damage, products liability, advertising injury, and liability assumed under an insured contract with limits no less than $1,000,000 for each occurrence and $1,000,000 general aggregate. b. Workers' compensation and employer's liability insurance in amounts sufficient pursuant to the laws of the State of Washington; c. Automobile liability insurance covering all owned, non-owned, hired and leased vehicles with a minimum combined single limits in the minimum amounts required to drive under Washington State law per accident for bodily injury, including personal injury or death, and property damage. d. Professional liability insurance with limits no less than $1,000,000 per claim and $1,000,000 policy aggregate for damages sustained by reason of or in the course of operation under this Agreement, whether occurring by reason of acts, errors or omissions of the Contractor. 6.2. No Limit of Liabilitv. Contractor's maintenance of insurance as required by the agreement shall not be construed to limit the liability of the Contractor to the coverage provided by such insurance, or 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 City. 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. 6.3. Additional Insured. Verification. The City shall be named as additional insured on all commercial general liability insurance policies. Concunent with the execution of this Agreement, Contractor shall provide certificates of insurance for all commercial general liability policies attached hereto as Exhibit "C" and incorporated by this reference. At City's request, Contractor shall furnish the City with copies of all insurance policies and with evidence of payment of premiums or fees of such policies. If Contractor's insurance policies are "claims made," 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. 6.4 Survival. The provisions of this Section shall survive the expiration or termination of this Agreement. 7. CONFIDENTIALITY. All information regarding the City obtained by Contractor in performance of this Agreement shall be considered confidential subject to applicable laws. Breach of confidentiality by the Contractor may be grounds for immediate termination. All records submitted by the City to the Contractor will be safeguarded by the Contractor. 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 Contractor while performing the Work 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 work product remaining in the possession of Contractor shall be delivered to the City. 9. BOOKS AND RECORDS. The Contractor agrees to maintain books, records, and documents which sufficiently and 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 PROFESSIONAL SERVICES AGREEMENT - 3- 4/2011 ` CITY OF ;� Federal CITY HALL W �� 333258th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www. cityivtfedera/wey. com 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. 10. INDEPENDENT CONTRACTOR. 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 or other tax which may arise as an incident of employment. Contractor shall take all necessary precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the performance of the contract work and shall utilize all protection necessary for that purpose. 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. The Contractor shall pay all income and other taxes due 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 proprietorship or if this Agreement is with an individual, the Contractor agrees to notify the City and complete any required form if the Contractor retired under a State of Washington retirement system and agrees to indemnify any losses the City may sustain through the Contractor's failure to do so. 11. CONFLICT OF INTEREST. It is recognized that Contractor may or will be performing professional 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. EOUAL 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 Contractor 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, 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 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 or 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 oral or written, shall be effective for any purpose. Should any language in any Eachibits 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 Pariy 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. PROFESSIONAL SERVICES AGREEMENT - 4- 4/2011 ` CITY OF �� Federal CITY HALL W �� 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www. cityotieafera/way. cbm 13.2 Assignment and Beneficiaries. 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. 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. Subject 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. T'his 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 or interest in this Agreement based on any provision set forth herein. 133 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 or performance of this Agreement, this A�reement 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 or relinquishment of those covenants, agreements or options, and the same shall be and remain in full force and effect. Failure or delay of the City to declare any breach or 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 or 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 Superior 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 limit the Parties' rights to indemnification under Section 5 of this Agreement. 13.5 Execution. Each individual executing this Agreement on behalf of the City and Contractor represents and warrants that such individual is duly authorized to execute and deliver this Agreement. This Agreement may be executed in any number of counterparts, each of which shall be deemed an original and with the same effect as if all Parties hereto had signed 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 acknowledgment 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 of the Parties have executed a counterpart of this Agreement shall be the "date of mutual execution" hereof. [Signature page follows] PROFESSIONAL SERVICES AGREEMENT - 5- 4/2011 GITY OF Federal CITY HALL W �� 33325 8th Avenue South Federal Way, WA 98003-6325 (253) 835-7000 www. citynfl�derahvay. com IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY � � _.I�i, _ � . ' - : � DATE: I ����� 1 \ OLBRECTS AND ASSOCIATES, PLLC � I' � . _ Printed Name: Phil A. Olbrects Title: Member/Mana�er DATE: � I ?� I I � STATE OF WASHINGTON ) '/ ) ss. COUNTY OF 1�1(1. ATTEST: City Clerk, Carol McNe ly, CMC APPROVED AS TO FORM: %v��� City Attorney, Patricia A Richardson On this day personally appeared before me �h1 � � � t71"l , to me known to be the M2XY1� MAN1QO��Zt' of D���P.�'`a � S�U�a.`�'�5� (�U.C• that executed the foregoing instrument, and acknowledged the said instrument to be the free and voluntary act and deed of said corporation, for the uses and purposes therein mentioned, and on oath stated that he/she was authorized to execute said instrument and that the seal affixed, if any, is the corporate seal of said corporation. � .{:' • •:,,. GIVF��F'i�zy �a��c�official seal this � day of t` �`�,'• �;��''.; '� I t , � ,c �: �` t'� o���o ���Y �� m'' Notary's signature � �-- , .,.....,►► : .{ ``, Notary's printed n� � ��'• �'UBL.�,-, ^ U2\ -^''• ,�r_��,� �� ��� - -�,� .,, € � .• �ti '� r ` �,,�;��''�; ..-: ,�r:J' r ot y Public in and for the My commission expires '� 20 � �. !� of Washington. PROFESSIONAL SERVICES AGREEMENT - 6- 4/2011 EXHIBIT "A" SERVICES Federal Wav Revised Code: The Hearing Examiner shall perform all duties described in and pursuant to the jurisdiction, power and authority established in the Federal Way Revised Code (FWRC) Chapter 2.95 for the Hearing Examiner as now existing or hereafter adopted or amended, together with such other or further Hearing Examiner services as may be required by the Federal Way Revised Code. Citv Direction: All duties shall be performed pursuant to the direction of the Mayor or his or her designee. Compliance with Laws: All duties shall be performed in accordance with all applicable federal, state and City laws, including but not limited to King County and the City of Federal Way Land Use laws, State Environmental Act (SEPA), Shoreline Management Act, Open Public Meetings Act, Rules of Evidence, and all City codes, ordinances, resolutions, standards or policies as now existing or hereafter adopted or amended, including the Hearing Examiner Rules of Procedure. Rules of Procedure: The hearing examiner shall establish rules of procedure for the efficient and fair conduct of matters that come before the hearing examiner. These rules must be consistent with sta.te and city law. A copy of these rules of procedure should be made available for inspection and copying in the department of Community Development during regular business hours. Clerical Services: The Hearing Examiner shall furnish clerical services including, but not limited to, the typing of decisions, mailing decisions to parties of record, typing decisions on requests for reconsideration, furnish qualified personnel to mark exhibits, list names and address of parties of record, and record public hearings. Timeliness: Decisions sha11 be rendered within the time period prescribed by the applicable statue or FWRC provision. If the Hearing Examiner is unable to render a decision with the required time period, he shall follow the protocol set forth in the FWRC. Failure to do so will be considered a material breach of contract. Performance Standard: All duties sha11 be performed in a manner consistent with the accepted practices for other similar services, performed to the City's satisfaction, including, but not limited to conducted orderly and impartial hearings, creating a professional and courteous environment for applicants, citizen and staff; and the preparation of findings and conclusions which are understandable and based upon sound reasoning and all applicable laws. When deemed appropriate, the Hearing Examiner will make site visits to familiarize him or herself with the site of the proposed land use and the surrounding azea. Desi�nated Hearin� Examiner: Unless otherwise approved to in writing by the City, the City hereby designates Phil A. Olbrects, as the City's Hearing Examiner; provided however, that in the event Mr. Olbrects is unavailable for any cause deemed reasonable by the City, the City hereby approves a Pro Tem examiner designated by r. Olbrects to act in that capacity. A list of Pro Tem Examiners is attached as Exhibit A 1. Conflict of Interest: The Hearing Examiner shall provide the City with a list of qualified individuals or law firms with which the City can contract for conflict hearing examiner services and shall update the list up to twice per year upon request. PROFESSIONAL SERVICES AGREEMENT - 7- 4/2011 Exhibit A-1 Alternate Examiners Millie Judge Scott Snyder Vicki Orrico Emily Terrel) Olbrechts and Associates will continue to subcontract with and/or employ law students and other qualified individuals to write testimony summaries and assist in the preparation of draft decisions. Exhibit B Compensation Decisions/Recommendations Involvin� Less than a Half-Hour; $800 for all decisions/recommendations except permits subject to Federal Way's Shoreline Master Program, which shall be $950. Decisions/Recommendations Involvin� Hearin�s a Half-Hour to an Hour; $950 for all decisions/recommendations except permits subject to Federal Way's Shoreline Master Program, which shall be $1050. Decisions/Recommendations Involvin� Hearin�s Over an Hour up to Five Hours: $950 plus $175 per hour of hearing over the first hour. Permits subject to Federal Way's Shoreline Master Program shall be a minimum of $1050. Decisions/Recommendations over Five Hours: Hourly at $145 per hour for members and other attorneys working on the decision, $135 for associates; $105 for Emily Terrell (land use planner) and cost plus 10% for up to $65 per hour for contract decision writers. Reconsideration $450 for reconsideration decisions Le�al Research outside the Federal Wav CitY Code• Comqrehensive Plan or Shoreline Master Pro�ram: $145 per hour for members and $135 per hour for associates. Legal research includes any time spent researching legal authority outside the Federal Way Municipal Code, Comprehensive Plan and Shoreline Master Program. The flat rates include travel time and clerical support at the hearing. They do not include administrative expenses (copies, long distance telephone calls, postage, etc.) nor do they include legal research. Corporations: Registration Detail Corporations Division - Registration Data Search Neither the State of Washington nor any agency, officer, or employee of the State of Washington warrants the accuracy, reliability, or timeliness of any information in the Public Access System and shall not be liable for any losses caused by such reliance on the accuracy, reliability, or timeliness of such information. While every effort is made to ensure the accuracy of this information, portions may be incorrect or not current. Any person or entity who relies on information obtained from the System does so at his or her own risk. OLBRECHTS AND ASSOCIATES, PLLC UBI Number Category Profit/Nonprofit Active/Inactive State Of Incorporation WA Filing Date Expiration Date Inactive Date Registered Agent Information Agent Name Address City State ZIP , Special Address Information Address City State 603060102 PLC Profit Active WA 10/31/2010 10/31/2011 PHIL OLBRECHTS 18833 NE 74TH ST GRANITE FALLS WA 98252 Zip Governing Persons Title Member Member Name Olbrechts, Phil Olbrechts, Kristen Purchase Documents for this Carparation » « Return to Search List Address 18833 NE 74th St NE GRANITE FALLS, WA 18833 NE 74th St GRANITE FALLS, WA You can find this information at: http://www.sos.wa.gov/corps/search_detail.aspx?ubi=603 . �'� - ,aco ° � CERTIFICATE OF LIABILITY INSURANCE 12/03120 0 pRpW� THIS CER�{FiCATE IS ISSUED AS A MATTER OF INFORMATION Moranco & Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 7HIS CERTIFiCATE DOES NOT AMENQ, EXTEND OR 910 N. Washingtotl, Ste 10'{ ALTER THE COVERAGE AFFORDEd BY TWE POLICIES BELOW. Sookane. WA 99201 wsw�o Oibrechts & Associates, PLLC 18833 74th S#. NE. Granite Falls, WA 98252 (206} 65U-7268 INSUR6RS AFFORDING COVERAGE NAIC # �r,sur�Ra Twin City Fire Insurance Com an c: COVERAGE3 'fHE POUCfES OF INSURANCE LISTED SEL4W HAVE BEEN 15SUED TOTHE INSURED NAMEO ABOVE FOR TIiE POLiCY PERIOD INAICATED. N0TIMTHSTANDINC ANY REQUIREMENT, TERPII OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VNTH RESPECT TO WHICH THIS CERTIFfCATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE APFORDED BY THE PpUG1ES DESCRIBEd HEREIN 1S SUB.IEC7 TO ALL THE 7ERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR D' pOUCY NUb�ER POLtCY EFFECTIVE POLICY EXpIRAT10N u � $ C GEN�RA� ua80.JTy EACH OCCURRENCE S COMb1ERCU1lGENERAIUABiLfTY ��S E t CLAIMS MADE � OCCl�2 MED FXP (MY one S PERSONALSADVINJURY S GEMERALAGGREGATE S GEN'L AGGREGATE LIMIT APPUES PER: . . PRODUCTS -COMP/OP AGC E � POLICY � LOC AUTOWOBiLE UABILITY COM6INED SINGLE UMiT a {Ea acdderM) ANY AUTO ALLQWNEDAUTQS BO�ILYINJURY a (aer person) SCHEDULEDAUTOS HIRED AUTOS BODILY INJURY E NOWOWNEDAUTOS (Ver eccfdenq � PROPER7Y DAMAGE s (Per accid9nt) GARA6E LIASIIITY � AUTO ONLY - EA ACCIOENT b ANY AUTO OTHER THAN � A � s AUTOONIY: � f pCCE88! UMBRELLA UABILITY EACM OCCURREPICE 8 OCCUR � CLA�MS MADE AGGREGATE S s DEDUCTIBLE f RETENTtaN S S wORKERS COMPEPI3ATION WC S7ATU- OTH- AND �EMPLDYERS' LIABdIIY � ANY PROPRIkTORJPAR7NERlEXECUTNE � E.l. FACH ACGDENT 5 �FICER/MEMBER EXCLUDEO? (Alandatory in NH} E.l. DISEASE - EA EMPLO S ftyes, desalbe under E.L. OISEASE - POLICY LqNIT S SPEGAL PROV�SIONS bebw oTM $1,000,000 - Pef Claim Lawyers Pmfessional LT 1616777 1Q/29/10 10/29/11 $1,Od0,�00 � Aggregate Liabiiity Insurance �$2,500 � Dedudible DESCRIPTION OF OPERATWtiS 1 LOCATIONS 1 VEHICLE51 E%CLUSIONS ADDEU BY ENDOR56MENF 1 SPECIAL PROVISIONS SHOULPA1dY OF THEABOVE DESCRIBEO POLJqE3 BE CANCELLED BEFORE7HE El(PIRATION DATE THEREOf, THE ISSUING iNSUREIt WILL ENDEAVOR TO MAIL 3O DAY8 VYRI'fTEN NOTiCE 70 THE CERTIPICATE HOLDER NAMED 70 THE 4F.FT, BUT FAILURE TO PO80 SHACL IMPOSE NO OBLI(iAT10N OR LIA811.lTY OF ANY KIND UPON THE NISURER,IT8 AOENTS OR AUTNOR¢ED REPRE8ENTA7WE ACORD 25 (2008101} � 9 -2009 ACORD ORPORATIOMr All rights reserved. The ACORD name and logo are registered marks of ACORD