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AG 14-086RETURN TO: Mary J EXT: 2702 CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT./DIV: PARKS, RECREATION & CULTURAL SERVICES 2. ORIGINATING STAFF PERSON: CODY GEDDES EXT: 6926 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 ❑ CONTRACTAMENDMENT(AG #): ❑ INTERLOCAL ® OTHER l@L,ArorA-cAv --io ► .r lAjW,4 N fa/e.Ce 44ErI4— 5. PROJECT NAME: TOUCH A TRUCK VENDOR 6. NAME OF CONTRACTOR: LISA PARKER ADDRESS: 5527 95TH ST NE, MARYSVILLE WA 98270 TELEPHONE 206.713.9898 E -MAIL: TAZZETC@YAHOO.COM FAX: SIGNATURE NAME: LISAPARKER TITLE OWNER 7. EXHIBITS AND ATTACHMENTS: ❑ SCOPE, WORK OR SERVICES ❑ COMPENSATION l3 INSURANCE REQUIREMENTS /CERTIFICATE ❑ ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN Q REQUIRED LICENSES ❑ PRIOR CONTRACT /AMENDMENTS 8. TERM: COMMENCEMENT DATE: MAY 17TH 2014 COMPLETION DATE: MAY 17TH 2014 9. TOTAL COMPENSATION $_0 (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑ YES GCVO IF YES, MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED ❑ YES 6�V0 IF YES, $ PAID BY. ❑ CONTRACTOR ❑ CITY ❑ PURCHASING: PLEASE CHARGE TO: 10. DOCUMENT /CONTRACT REVIEW WPROJECT MANAGER )4 DIRECTOR ❑ RISK MANAGEMENT (IF APPLICABLE) LAW 11. COUNCIL APPROVAL (IF APPLICABLE) INITIAL / DATE REVIEWED L=6 A3 '1.22 -11 Ste ,*s 1�- COMMITTEE APPROVAL DATE: INITIAL / DATE APPROVED N /gyp /i�/ COUNCIL APPROVAL DATE: 12. CONTRACT SIGNATURE ROUTING • SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D: • ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS • LAW DEPARTMENT • SIGNATORY (MAYOR OR DIRECTOR) XCITY CLERK B(ASSIGNEDAG# 5QSIGNED COPY RETURNED COMMENTS: Ytud INITIAL / DATE SIGNED I AG# ► oojn DATE SENT: raj- iS • 1a 11/9 INDEMNIFICATION AND INSURANCE AGREEMENT This Indemnification and Insurance Agreement ( "Agreement ") is dated effective this 17'' day of May, 2014. The parties ( "Parties ") to this Agreement are the City of Federal Way, a Washington municipal corporation ( "City ") and Lisa Parker, Busy Bean Espresso, a Mis pagwgmr ( "Busy Bean Espresso "). L4-C- A. Busy Bean Espresso wishes to provide concession services on May 17, 2014 ( "Touch a Truck "); and B. The City wishes to cooperate by allowing Busy Bean Espresso to set up a temporary concession stand in conjunction with the Touch a Truck Event at the old Toys R Us parking lot, which is located at 31510 20'b Ave S. NOW, THEREFORE, the Parties agree as follows: Indemnification. In consideration of the City authorizing a temporary concession stand in conjunction with the Touch A Truck Event at Toys R Us parking lot, Busy Bean Espresso 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 Toys R Us facility or relating to the Touch a Truck Event to the extent caused by the acts, errors or omissions of Busy Bean Espresso, its partners, shareholders, agents, employees, invitees or by Busy Bean Espresso's breach of this Agreement. 2. Insurance. Busy Bean Espresso 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. Busy Bean Espresso 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 feesof such policies. Busy Bean Espresso 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 an attorney, -1- 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: Ken Miller, Interim Director of Parks Date: S� \ \ & M. presso `?0la —1 1 (Phone) STATE OF WASHINGTON ) ) ss. COUNTY OF ATTEST: --u I ra City Clerk, Carol McNeiliy, MC APPROVED AS TO FORM: Amy Jo P (*all, Interim City Attorney G62:"1 06"-' M40 -00UE. a cam- 9'?JI (Address) On this day personally appeared before me, Lisa Parker, 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 instruM MSt as his/her /their free and voluntary act and deed for the uses and purposes therein mentioned. GIVEN my hand and official seal this day of AIV, 2014. 411111811'r0 ERRIO k., , (typed/printed name of notary) s a Notary Public in and for the State o Washington. n= S My commission expires no :.o� z Nam 1111141% -2- A� °e CERTIFICATE OF LIABILITY INSURANCE /14/ 014 5/14/2014 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(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER C Don Filer Agency 518 North Olympic Avenue Arlington WA 98223 -1247 CaMEACT Jennifer Savage PHONE . (360) 435 -5565 FAX . (340) 43S -5927 ADDIS .jsavage @filerinsurance.com INSURER (S) AFFORDING COVERAGE NAIL 0 INSURERA:Contractors Bonding & Ins Co. 37206 INSURED Busy Bean Espresso 5527 95th St NE Marysville VIA 98270 INSURERS: /8/2014 INSURERC: EACH OCCURRENCE INSURER D: DAMAGE Ta now PREMMES WA aceLymcei INSURER E• MEO EXP one INsuRN P• PERSONA L_& ADV INJURY CAVFRAQES CERTIFICATE NUMBER--2014 -2015 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR R TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Federal Way N POLICY F EXP LIM178 A GENERAL LIABILITY X COMMERCIAL GENERAL L mBIITY CLAMS -MADE © OCCUR X B31A=147 /8/2014 /8/2015 EACH OCCURRENCE S 1,000,000 DAMAGE Ta now PREMMES WA aceLymcei S 51000 MEO EXP one S 101000 PERSONA L_& ADV INJURY S 1,000,000 GENERAL AGGREGATE a 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: X POLX:Y PR LOC PRODUCTS - COMPIOP AGO S 2,000,000 S AUTONOSILE L IABWTY ANY AUTO ALL AUTOS° AAUTOESS D HIRED AUTOS AUTO ED 5MMME3 SIAM 001T ODDLY NJURY (Per pawn) a eoaLY IwuaY (Pa as a OPERTY a a UMBRELLA LIAR EXCESS LIAR x EACH OCCURRENCE S HCLcAcm,,-MAOE AGGREGATE a D NIORKERBCONIMSATION AND ENFOLOYERIP LIABILITY ANY PROPIdETORIP� a OFFICERALEMSER EXCLUDED? I In NN) wym Sesame under I DESCRIPTION OF OPERAMONS bebr NIA I WC A EL EACH ACCIDENT $ EL DISEASE - EA EMPLOM a E.L. DISEASE - POLICY LSYST a DEBCRIP110N OF OPERATMB I LOCATIONS / VMCLB8 (ACaeh ACORD 101. Add&W Remaly Sdwduf% H mm spwo b eaub► Certificate Holder is named as an additional insured CERTIFICATE WALDER P�NP_FI I ATInN ACORD 25 (2010108) 0 1989M ACORD CORPORATION. All Lights reserved. INS025 (woo4m The ACORD name and logo are r6&tered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Federal Way ACCORDANCE WITH THE POLICY PROVISION 876 S. 333rd Street A Federal Way, WA 98003 ACORD 25 (2010108) 0 1989M ACORD CORPORATION. All Lights reserved. INS025 (woo4m The ACORD name and logo are r6&tered marks of ACORD