Loading...
AG 14-075RETURN TO: Je-s5ica, EXT: a-101 CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT/DIV: PUBLIC WORKS/ �.: l 2. ORIGINATING STAFF PERSON: /C C Z Ij %� e� � �/'l� EXT: :� -� C' 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) Cl ORDINANCE ❑ RESOLUTION ❑ CONTRACT AMENDMENT(AG #): ❑ INTERLOCAL OTHER Aa�) //69 ► -44:ff AQ Z90AjA&.f,' J"776') 4A§Zl 5Ar 5. PROJECT NAME: S&MbA) Aak-At F-WWT- 6. NAMEOFCONTRACTOR: WOrth Cm 1;-hrn ADDRESS: TELEPHONE: (343-11-R051 E -MAIL: FAX: SIGNATURENAME: 1,�un rtrrera TITLE: 7. EXHIBITS AND ATTACHMENTS: ❑ SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS /CERTIFICATE ❑ ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES Cl PRIOR CONTRACT /AMENDMENTS CFW LICENSE # BL, EXP. 12/31/ UBI # , EXP.' 8. TERM: COMMENCEMENT DATE: �Gt! I!►� COMPLETION DATE: q775) I�T`4 9. TOTAL COMPENSATION: $ -9- (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, $ ❑ PURCHASING: PLEASE CHARGE TO: 10. DOCUMENT/ CONTRACT REVIEW ❑ PROJECT MANAGER X DIVISION MANAGER ❑ DEPUTY DIRECTOR ❑ DIRECTOR RISK MANAGEMENT (IF APPLICABLE) 'XLAW DEPT 11. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: 12. CONTRACT SIGNATURE ROUTING • SENT TO VENDOR/CONTRACTOR DATE SENT: • ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS ❑ LAW DEPT ❑ SIGNATORY (MAYOR OR DIRECTOR) ❑ CITY CLERK A ASSIGNED AG # /SIGNED COPY RETURNED ❑ RETURN ONE ORIGINAL INITIAL/ DATE SIGNED AG #�� i DATE SENT: PAID BY: ❑ CONTRACTOR ❑ CITY INITIAL /DATE APPROVED AG COUNCIL APPROVAL DATE: DATE REC'D: COMMENTS: - • /r b EXECUTE" " ORIGINALS C�LkL! �V� U %Z' _ �VT / �� Y\DeA, WyY,*- 11/9 205 B West Patison Street Port Hadlock, WA 98339 360- 379 -8051 www.nosc.org nerreca@nosc.org NOSC Hold Harmless and Indemnification Agreement I. (�+q c-ot 1 eJtrol W(64_ assumes sole responsibility for the care and safety of FIN, the Migrating Salmon and of all persons engaged in the movement or towing of FIN during the period of time it is outside the control of the North Olympic Salmon Coalition (NOSC) and its employees and agents. 2. C. i 4:!f 4 AQyA I J _ agrees to comply with all relevant provisions of Title 46 RCW as weft as any applicable provisions of local ordinances governing the operation of motor vehicles. 3. Ci i'4 0� C- I �a� hereby releases NOSC, its Board of Directors, employees and agents f om all liability or responsibility occurring as a result of Lft if rw W 's use of FIN the Migrating Salmon. Onj of Fe A etr &L W Cw furthef agrees to indemnify and hold NOSC, its Board of Directors, employees and agents harmless with respect to any and all claims for damage to property or for injuries to persons resulting from the acts of ;41 of IF �4" W o r its employees, agents or guests. c �6 0; �P d a.+ J furtlx r agrees to repair and eplace any NOSC property or equipment that may be damaged during, or as a result of, (., i, gL4 's use of NOSC property or equipment. 4. Prior to b f Ft Aevnl W cu 's use and movement of FIN, the Migrating Salmon, W&Ais required to maintain liability insurance in force and good standing on the driver /vehicleng the trailer, at a minimum liability insurance limits of $2,O�Q,000 aggregate /$1,000000 per occurrence. C' Z.�.ti, f Fe er,� Lo shall furnish a certi ate of insurance to NOSC, evidencing this covera e. tA SiRnatui Mc1,U)M Ja110u,n' Nbt c WovKS Qr-w Date WA Title 46 RCW http: // apps .leg.wa.gov /rew /default.aspx ?Cite =46 N:Wdministrative \FIN's Folder\FIN materials, info, templates, maintenance\Hold Harmless 2014.doc _� �.�n .. ,1�