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AG 13-180RETURN TO: �E' S`�+ Co- EXT: 0- -?CA CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT/DIv: PROS / 2. ORIGINATING STAFF PERSON: D aV G u EXT: (lo`l3 -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 o SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) • ORDINANCE ❑ RESOLUTION • CONTRACT AMENDMENT (AG #): ❑ INTERLOCAL X OTHER (nat�,ni�ic.�: s / IInS�re.NCC Aca . 5. PROJECT NAME: IBC" °t ILsyln; -jax UwLC'S& l ov%s 6. NAME OF CONTRACTOR: '('IntG ADDRESS: 1~W TELEPHONE: 332. (.912 E -MAIL: FAX: SIGNATURENAME: V.JM TITLE: [9u.y►jer 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 CFW LICENSE # BL, EXP. 12/31 / UBI # , EXP. / / 8. TERM: COMMENCEMENT DATE: a 121 113 COMPLETION DATE: 9 12.110 9. TOTAL COMPENSATION: $ N [ A (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 • PROJECT MANAGER • SUPERVISOR • DIRECTOR • RISK MANAGEMENT (IF APPLICABLE) • LAw DEPT 11. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: 12. CONTRACT SIGNATURE ROUTING ❑ SENT TO VENDOR/CONTRACTOR DATE SENT: 10 15 ❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS • LAw DEPT • SIGNATORY (MAYOR OR DIRECTOR) • CITY CLERK • ASSIGNED AG # • SIGNED COPY RETURNED ❑ RETURN ONE ORIGINAL COMMENTS: MEMO • `/ INITIAL / DATE APPROVED COUNCIL APPROVAL DATE: DATE REC'D: -1 116113_ 1/9 INDEMNIFICATION AND INSURANCE AGREEMENT This Indemnification and Insurance Agreement ( "Agreement ") is dated effective this 21"day of September, 2013. The parties ( "Parties ") to this Agreement are the City of Federal Way, a Washington municipal corporation ( "City ") and Kim Daniels, DBA The Ice Cream Lady, a sole proprietor ( "The Ice Cream Lady "). A. The Ice Cream Lady wishes to provide concession services on September 21 't, 2013 ( "K -9 Karnival Event "); and B. The City wishes to cooperate by allowing The Ice Cream Lady to set up a temporary concession stand in conjunction with the K -9 Karnival Event at Steel Lake Park, which is located at 2410 S 312' ST ( "Steel Lake Park "). NOW, THEREFORE, the Parties agree as follows: Indemnification. In consideration of the City authorizing a temporary concession stand in conjunction with the K -9 Karnival Event at Steel Lake Park, The Ice Cream Lady agrees to indemnify and hold the City, its elected officials, officers, employees, agents, and volunteers harmless from any and all claims, demands, losses, actions and liabilities (including costs and all attorney fees) to or by any and all persons or entities, including, without limitation, their respective agents, licensees, or representatives, arising from, resulting from, or connected with this Agreement or the use of the Steel Lake Park Facility or relating to the K -9 Karnival Event to the extent caused by the acts, errors or omissions of The Ice Cream Lady, its partners, shareholders, agents, employees, invitees or by The Ice Cream Lady's breach of this Agreement. 2. Insurance. The Ice Cream Lady agrees to carry as a minimum, commercial general liability insurance with combined single limits of liability not less than $2,000,000.00 for bodily injury, including personal injury or death, products liability and property damage liability for all damage arising out of injury to or destruction of property in such forms and with such carriers as are satisfactory to the City. The City shall be named as additional insured on all such insurance policies. The Ice Cream Lady shall provide a certificate of insurance evidencing such coverage and, at the City's request, furnish the City with copies of all insurance policies and with evidence of payment of premiums or fees of such policies. The Ice Cream Lady's failure to maintain such insurance policies shall be grounds for the City's immediate termination of this Agreement. 3. General Provision. This Agreement contains all of the agreements of the Parties with respect to any matter covered or mentioned in this Agreement. No provision of this Agreement may be amended or modified except by written agreement signed by the Parties. This Agreement shall be binding upon and inure to the benefit of the Parties' successors in interest, heirs and assigns. Any provision of this Agreement which is declared invalid or illegal shall in no way affect or invalidate any other provision. In the event either of the Parties defaults on the performance of any terms of this Agreement or either Party places the enforcement of this Agreement in the hands of -1- an attorney, or files a lawsuit, each Party shall pay all its own attorneys' fees, costs and expenses. The venue for any dispute related to this Agreement shall be King County, Washington. Failure of the City to declare any breach or default immediately upon the occurrence thereof, or delay in taking any action in connection with, shall not waive such breach or default. Time is of the essence of this Agreement and each and all of its provisions in which performance is a factor. DATED the day and year set forth above. CITY OF FEDERAL WAY By: _ K -'2c: a 7 P P A V eo-' - Cary M. Roe, PE, D' ector of Parks Public Works & Emergency Management Date: 7 /Z4, 13 ATTEST: QLCAIerk, Carol McNeilly, MC APPROVED AS TO FORM: 440W.-.2:1 City Attorney, Pafricia A. Richardson THE ICE C AM LADY By: � Kim Daniels, Daniels, Owner 1�7 3 q z (Address (Phone) ,:�il'Gl. � MV , STATE OF WASHINGTON ) ss. COUNTY OF On this day personally appeared before me, Kim Daniels, 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 han. oorkR .Pjoq� this day of , 2013. Q� OT At A'�i�0 /'i r (typed/printed name of notary) 9' '�r, ,, _ 2 = Notary Public in and for the State of Washington. 1$_16 O �,��...��`` G� My commission expires �4 F WABH�� -2- !%01, --1411 THEIC -1 OP ID: EA .44 v D /1 YI - %CER1FICATE OF LIABILITY INSURANCE 4 0919/3 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE- ISSUING INSURER(SI, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the oolicy(ies) must be endorsed. If SUBkOGAInON IS WAIVED, subject to the terms and conditions of the pollcy, certain pollcl•a may require an endorsement A statement on this c•rtlficato does not confer rIgms to the certificate holder In lieu of such •ndorsemen • . PROOUCER 360 -746 -0051 141uF. Emily E. Russ Virgil R. Lee & Son PII FAX Looted Worthington LLC 560. 748.3941 360,748.0_051 _ LY Ia C, No)' 360 -748 -3941 P -O. Box 1226 eibuslsClovitelitW orthington.com Chehalis WA 98532 David J. Isaacson INSURERISI Af FORDING COVERAGE NAIL Ir IN SURF A: The Charter Oat( Fire Ins. Co. IN SWUM The Ice Cream Lady INSUNI N it Kim Daniels, dba 30858 22nd Avenue $. INeURf.R r Federal Way. WA 98003 INSURER o: INSURER E INSURER F ........ -... ..�.. wir•nwrl.uin aAelueurn. cCtA atA/J M / /laalarle• + IHI` Ii Ir/ 1,x:14 Tit Y THAI 111E iJ+` IIr.mRAWA L1'(IID lit ttFW NAVE. BC1 :N 1'1:,01 U IIJ 11,11, uisu Nt(y IJAMPa.M Aill 1 t1R 1111 HliLit:Y HLRIIILI m()1CATF11 NOT:VITHSTAIiDIfJr3 AIIY RCUUIRt1.TENI TtRfA OR CONQITICTtt OF ANY CONTRACT OR OTHER r1OCtiMFI1T WITH kFiPF(*,Y TO WHl(,H THIS C:ERTFTCATF MAY BE ISSUED OR MAY PERTAIN THE INSURAtICE AFFORrIFC) BY THE POAiCIES r)FS(:RIBFD HFRF.Ifi IS SUR.IF(':T 1`0 All, THE TFRh1S E?:+_ LUS IpIJ3AtlDCQNOITIrJ (4:iUF8Ul;HVVIIC;+f;ti IiNt(I$ SHOWN MAY HAVE BEE NREDUCEDBY PAID CLAIMS NSN A001 SU9R 1><)I nfY 11 pUl 'Y lIIV LY(>f (If INS(1RAIH:! N k'Y IAIMUEH rY LIMITS GENERAL LIABILITY F ;,Im Ct:CURRENCE 4 1.000,00 A X rt;,llrll.rr:Iat,,t: +Ef�LU•HIU *r X 6908363W977COF•13 06101113 06101114 pREId F, +ER1Et Pyn5p; S 300,00 L'LhIL1:•t.1AUE X IVY:I iii' 1.ILV LnI(4m (rIN Ga,f0,1. 6,00 PERSOrIAL& Aft, IWURY S 1,000,0 5,FtIFR,1I yCGRF r.ATF 1 2,000,00 t;b,l il, 41r VFrk!,4tE UI.111 4PFUES PER 2,000,00 X POLICY IF ?i l'7C 3 "AUFOMOSKF L1ARIt ITV ��. 1 Il wv - 3 Ally 4UY'J 1. 801>10 It IAJM .PY 041501V :11 'hWiF0 `CHEVULEC 8CJrJ1L?' RIJVRY IV'N acad"t: S gLl�'O,i .i11r'JS 'IJFrb - ,PERly C.41,15GE HIM-0 l!1 `J5 .I! t py ,Ph r,vuenl • T UhSRELLAL6" U(:(:VR I E A CH Ora:URREPACE S. FXCF.SSLIAB r; {4tW', IA-Pr; f1 RV rl"fillorl$ WORNERSCOMPENSATION TORYLIUITS ER AND EMPL DYERS' LI481LITY Y I N •Marc PRCd�RIL-rr/Rlrl- riTllrFVr CrXTI',E N A It.tklMI•II0FRF•(4 l"l-17 E L EA �H 11:IJCiHT i 411 IL/xa4IiHY In HHI EL D14C4:E •C4 CUPL0YLC 3 rt es.aesulaeunoe, lbrroF']P,, tTJ,4tt 0, l iiLSEw$E •jL,iCY V11111 i OE Sr RIPTIOI OF OPf RATION S I LOCATION 5' VEHIC LE5 IAeach ACORD 101. Additional aeNMAl9 S00dale, It Moro apace N reoa Neal City of Federal Way and K9 Karniva.1 erw nomad as Additional Inured as required by arittan oentrant, per per CG T4 91 11 /08- : K9 Karnival at Steel Yaks Park Saturday, Sept. 21, 2013 GCK Ilr'II.A IC r/VILLFCR VISA VG4V� ,.v.� CITYFED SHOULD ANY OF THE A9OVS 9ESCRI§6D POLICIES e6 CANCELLED GSFORE CI of Federal Way THE EXPIRATION DATE THEREOF, NOTICE WILL YE OaLNiRED IN City y ACCORDANCE WITH THE POLICY PROVISIONS. RE: K9 Karn(vat AUTHORIZED RE PRE SEN VAT Nt ACORD26 (2010106) 101906 -2010 ACORO CORPORATION. All fldhts reserved, The ACORD name and logo am registered marks of ACORO Z /Z ,asva WV 65 =80 CT0Z -60'0Z