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AG 15-107 RETURN TO: /� EXT: CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT/DIV: PRCS/ 2. ORIGINATING STAFF PERSON: Kt net beh• i StiC_<<f-ayN EXT: (0c( '2__ 3. DATE REQ.BY: 2/27 /15 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#): ❑ INTERLOCAL VI5THER MO u 5. PROJECT NAME: M( (ks 1"les U w p' MQ,yVLO t1 9....4.4/l1 6. NAME OF CONTRACTOR: I I&Yi& S+e war lila Pat" I,J t{ krvwi.i ADDRESS: J TELEPHONE: E-MAIL: 4 v let Y ma" � ao 1. 1.Ovv\- FAX: SIGNATURE SAME:1)((I ,r+ ()Ad- D i,tI!nt..a.✓A TITLE: 0 9C144(212/1 (212/1 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. / / -7 8. TERM: COMMENCEMENT DATE: ! - ^ �5- COMPLETION DATE: -7"3 6- 1 C 9. TOTAL COMPENSATION:$ (INCLUDE EXPENSES AND SALES TAX,IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE-ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑YES VcIO IF YES,MAXIMUM DOLLAR AMOUNT: $ IS SALES TAX OWED: ❑YES e•NO IF YES,$ PAID BY: ❑CONTRACTOR ❑CITY ❑ PURCHASING: PLEASE CHARGE To: 10. DOCUMENT/CONTRACT REVIEW I REVIEWED INITIAL/DATE APPROVED CT MANAGER ‘` 'AE UPERVISOR �`yllGa N ®11Rr� L�i1. ❑ DIRECTOR AlJJ ❑ RISK MANAGEMENT (IF APPLICABLE) ❑ LAW DEPT • I C/ visits 1-YE(i 'if Z 21(f 11. COUNCIL APPROVAL(IF APPLICABLE) 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 INITIAL/DAT SIGNED ! LAW DEPT .f C, SIGNATORY(MAYOR OR DIREC s e o/S CITY CLERK / ,11 5 -15- ASSIGNED AG# AG# IC110 SIGNED COPY RETURNED DATE SENT: OS I2-' 12 OK ❑RETURN ONE ORIGINAL COMMENTS: W 11 CL act tnsura�nc� �o� once_ �o lkc..s \ace" rto ?ed .■ �∎b19ck. 4 (S. �� woe), PNEAs reAn t".ht vim- S:r , 11/9 MEMORANDUM OF UNDERSTANDING BETWEEN DIANA STEWART & PAT DYHRMAN AND THE CITY OF FEDERAL WAY,WASHINGTON FOR MILES FOR MESO WA MEMORIAL 5K RUN/WALK THIS MEMORANDUM OF UNDERSTANDING ("MOU") is made this 13th day of February 2015 by and between the undersigned representatives of the City of Federal Way ("City"), a Washington Municipal Corporation, and Diana Stewart & Pat Dyhrman, ("Organizers"), the individuals who will be organizing the Miles for Meso WA Memorial 5K Run/Walk("Event"). WHEREAS, the City has desired to host a 5K fun run event in conjunction with the Red White and Blues Festival held annually on the 4th of July; and WHEREAS, the City was approached by the Organizers to operate a 5K fun run event that will be sponsored by Simmons Mesothelioma Foundation, a non-profit foundation dedicated to helping patients and families affected by mesothelioma and would benefit the Mesothelioma Applied Research Foundation located in Puyallup, WA; and WHEREAS, Federal Way residents have benefited from the work of the Simmons Mesothelioma Foundation; and WHEREAS, this event will build awareness through bringing the Federal Way community together to show support for patients and families dealing with mesothelioma; and WHEREAS, this event will promote fitness and generate good public relations for the Federal Way Community Center and its programs; NOW, THEREFORE, in consideration of the mutual agreements and covenants contained herein and for other ood and valuable consideration, the receipt and sufficiency of which hereby P Y are acknowledged, it is mutually agreed and covenanted, by and between the parties to this Agreement, as g Y g � Y p g follows: 1. Event Details. The Event will take place on Saturday, July 4th, 2015 at 9:00am. The Organizers will have access to the Community Wing of the Federal Way Community Center starting at 6:00am. Event registration will open at 7:00am and the entire event will be concluded by 12:00pm. 2. City's Responsibilities: a. The City of Federal Way will collect event registration fees at the Federal Way Community Center and via www.raceroster.com. Once all fees have been collected, a check will be written to the Mesothelioma Applied Research Foundation, 7606 84th Street East, Puyallup, Washington 98371 for the entire balance. b. The City of Federal Way will secure permits to hold the Event. They will also provide one (1) staff person for course set-up and to manage course volunteers, and one (1) staff person to manage volunteers at the event registration table. c. Tables, chairs, garbage service, restrooms and stereo with microphone will be provided for the Event at no charge. 1 3. Organizers' Responsibilities: a. The Organizers shall provide course safety equipment to include: o Police presence on 1St Ave. S. o Barricades and cones on all intersections where runners may come in contact with moving vehicles. o On-call medical support available and alerted to the event in case of emergency. b. The Organizers shall provide marketing posters and flyers, event timing, volunteers, racing bibs, event t-shirts, vendors to provide give-aways for participants, and arrange for either medals or trophies for winners in overall and age categories. c. The Organizers shall ensure that it has appropriate staff and volunteers to provide the highest quality customer service and shall treat all participants with courtesy and respect. d. The Organizers will ensure that all areas of the Community Center used for the Event are cleaned and returned to their original condition by the end of the Event. 4. Shared Responsibilities. It is the intention of both parties to do co-promotion of the program through available acquisition channels as agreed upon. Currently this includes advertisement in the quarterly catalog, links on the Federal Way Community Center website and flyers displayed at the community center. 5. Term. The term of this MOU shall commence upon the effective date written above and shall continue until the completion of all obligations under this MOU, but in any event, no later than July 31, 2015. ("Term") 6. Indemnification. The Organizers shall indemnify and hold harmless the City and its officers, boards, commissions, employees, agents, attorneys, and contractors from and against any and all liability, damages, and claims, (including, without limitation, reasonable fees and expenses of attorneys, expert witnesses and consultants), may be asserted by reason of any act or omission of The )� Y y Y Organizers its employees, agents, or contractors, which may arise out of this MOU. The provisions of this section shall survive the expiration or termination of this MOU. 7. Insurance. The Organizers agree 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 with combined single limits of liability not less than $2,000,000 for bodily injury including personal injury or death products liability and property damage; and b. Automobile liability insurance coverage on 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. The Organizers' maintenance of insurance as required by the MOU shall not be construed to limit the liability of the Organizers to the coverage provided by such insurance, or otherwise limit the City's recourse to any remedy available at law or in equity. The Organizers' 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 Organizers' insurance and shall not contribute with it. The City shall be named as additional insured on all commercial general liability insurance policies. Concurrent with the execution of this Agreement, the Organizers shall provide certificates of insurance for all commercial general liability policies attached hereto as Exhibit"A"and incorporated by this reference. At City's request, the Organizers shall furnish the City with copies of all insurance policies and with evidence of payment of premiums or fees of such policies. If the Organizers' 2 insurance policies are "claims made," the Organizers shall be required to maintain tail coverage for a minimum period of three(3)years from the date this MOU is actually terminated. 8. This MOU contains all of the agreements of the City and the Organizers with respect to any matter covered or mentioned in this MOU. IN WITNESS WHEREOF, the City and the Organizers have executed this Memorandum of Understanding as of the day and year first written above by their duly authorized representatives. John Hutton, Director of Parks. CITY OF FEDERAL WAY AT B OIL Lai- /1-7 /Z-49/tf Jo t utt ,Par's Director C© 1.rk, Stephanie Courtney C APPROVED AS TO FORM: ity Attorney, Amy Jo Pearsall ORGANIZERS • Diana Stewart Pat Dyhrman STATE OF WASHINGTON ) STATE OF WASHINGTON ) )ss. )ss. COUNTY OF 01;12-05 ) COUNTY OF 47I ZCE ) On this day personally appeared before me, On this day personally appeared before me, Pat Diana Stewart,to me known to be the individual Dyhrman, to me known to be the individual described in and who executed the foregoing described in and who executed the foregoing instrument, and on oath swore that she executed instrument, and on oath swore that she executed the foregoing instrument as her free and the foregoing instrument as her free and voluntary act and deed for the uses and purposes voluntary act and deed for the uses and purposes therein mentioned. therein mentioned. GIVEN my hand and official seal this ?7( day GIVEN my hand and official seal this SI day of M ,2015. of mots" ,2015. jICA I t o del-Ac i /IW t) (typed/printed name of notary) (typed/printed name of notary) Notary Public in and for the State of Washington Notary Public in and for the State of Washington My commission expires: dklo 20\t My commission expires: au t 19,21)15 - n Notary Public ` State of Washington ( Notary Public JESSICA M.ALONGO 3 State of Washington 4 My Appointment Expires Jul 18,2015 1 JESSICA M.ALONGO 4 My Appointment Expires Jul 18,2015 DATE: 4/23/2015 CERTIFICATE OF INSURANCE CERTIFICATE NUMBER: 20150217315517 AGENCY: ESIX 3 LLC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND d/b/a Entertainment&Sports Insurance eXperts(ESIX) CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES d/b/a Entertainment and Sports Insurance Agency(California) NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 2727 Paces Ferry Road,Building Two,Suite 1500 BELOW. Atlanta,GA 30339 678-324-3300(Telephone) 678-324-3303(Facsimile) NAMED INSURED: INSURERS AFFORDING COVERAGE: USA Track&Field,Inc. Miles for Meso INSURER A. Philadelphia Indemnity Ins.Co. 132 East Washington Street,Suite 800 Indianapolis IN 46204 INSURER B: Philadelphia Indemnity Ins.Co. EVENT INFORMATION: Miles for Meso Washington Memorial 5K/Run Walk(7/4/2015-7/5/2015) POLICY/COVERAGE INFORMATION: ON: 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS TYPE OF INSURANCE: POLICY NUMBER(S): EFFECTIVE: EXPIRES: LIMITS: A GENERAL LIABILITY X Occurrence PHPK1241556 11/1/2014 11/1/2015 GENERAL AGGREGATE(Applies Per Event) $3,000,000 12:01 AM 12:01 AM X Participant Legal Liability EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES(Each Occ.) $1,000,000 MEDICAL EXPENSE(Any one person) EXCLUDED PERSONAL&ADV INJURY $1,000,000 PRODUCTS-COMP/OP AGG $3,000,000 B .UMBRELLA/EXCESS LIABILITY X Occurrence PHUB476653 11/1/2014 1111/2015 AGGREGATE(Applies Per Event) $10,000,000 ;12:01 AM ,12:01 AM EACH OCCURRENCE $10,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: Coverage applies to USA Track & Field sanctioned events and registered practices, including any directly related activities, such as event set-up and tear-down, participant check-in and award ceremonies. The certificate holder is an additional insured as required by written contract or written agreement, but only for liability arising out of the negligence of the Named Insureds per the following endorsement:Additional Insured-Certificate Holders(Form PI-AM-002) The General Liability policy is primary and non-contributory with respect to the negligence of the Named Insureds(Form CG 00 01). The General Liability policy contains a blanket Waiver of Subrogation as required by contract per Waiver of Transfer of Rights of Recovery Against Others(Form CG 24 04). CERTIFICATE HOLDER: NOTICE OF CANCELLATION: City of Federal Way Should any of the above described policies be cancelled before the expiration date thereof, 876 333rd St. notice will be delivered in accordance with the policy provisions. Federal Way WA 98003 AUTHORIZED REPRESENTATIVE: t DATE: 5/12/2015 1 CERTIFICATE OF INSURANCE CERTIFICATE NUMBER: 20150217315408 AGENCY: 1 ESIX 3 LLC [THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND d/b/a Entertainment&Sports Insurance eXperts(ESIX) CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES d/b/a Entertainment and Sports Insurance Agency(California) NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 2727 Paces Ferry Road,Building Two,Suite 1500 BELOW. Atlanta,GA 30339 678-324-3300(Telephone) 678-324-3303(Facsimile) NAMED INSURED: `INSURERS AFFORDING COVERAGE: USA Track&Field,Inc. Miles for Meso 132 East Washington Street,Suite 800 INSURER A: Philadelphia Indemnity Ins.Co. Indianapolis IN 46204 INSURER B: Philadelphia Indemnity Ins.Co. i `EVENT INFORMATION: Miles for Meso Washington Memorial 5K/Run Walk(7/4/2015-7/5/2015) POLICY/COVERAGE INFORMATION: t 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.AGGREGATE E LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ;INS:TYPE OF INSURANCE: POLICY NUMBER(S):1 EFFECTIVE: EXPIRES: )LIMITS: A `GENERAL LIABILITY X Occurrence E PHPK1241556 11/1/2014 11/1/2015 ` GENERAL AGGREGATE(Applies Per Event) $3,000,000 112:01 AM 12:01 AM X Participant Legal Liability 1 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES(Each Occ) $1,000,000 MEDICAL EXPENSE(Any one person) EXCLUDED t PERSONAL&ADV INJURY $1,000,000 PRODUCTS-COMP/OP AGG $3,000,000 B UMBRELLA/EXCESS LIABILITY I X Occurrence =PHUB476653 111/1/2014 11/1/2015 ( AGGREGATE(Applies Per Event) $10,000,000 ? -,-,- 112:01 AM /12:01 AM ( EACH OCCURRENCE $10,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: Coverage applies to USA Track& Field sanctioned events and registered practices, including any directly related activities, such as event set-up and tear-down, participant check-in and award ceremonies. Evidence of coverage only CERTIFICATE HOLDER: NOTICE OF CANCELLATION: Miles for Meso : Should any of the above described policies be cancelled before the expiration date thereof, Attn:Diana Stewart and Pat Dyhrman 1 notice will be delivered in accordance with the policy provisions. 2120 Overview Drive North East I AUTHORIZED REPRESENTATIVE: Tacoma WA 98422 i e I