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AG 17-1402/2017 II RETURN TO: Cody Geddes EXT: 6926 CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM I. ORIGINATING 2. ORIGINATING 4. TYPE ❑ CONTRACTOR ❑ PUBLIC ❑ PROFESSIONAL ❑ GOODS ❑ REAL ❑ ORDINANCE ❑ CONTRACT © OTHER 5. PROJECT 6. NAME ADDRESS: E SIGNATURE 7. EXHIBITS OTHER 8. TERM: 9. TOTAL (IF REIMBURSABLE IS SALES RETAINAGE: ❑ PURCHASING: 10. DOCUMENT I PROJECT ❑ DIRECTOR ❑ RISK ❑ LAW 11. COUNCILAPPROVAL(IFAPPLICABLE) 12. CONTRACT ❑ SENT ❑ ATTACH: ❑ CREATE ❑ LAW ❑ SIGNATORY ❑ CITY ❑ ASSIGNED ❑ SIGNED CC\ C\Vk DEPT./DIV: Recreation STAFF PERSON: Cody Geddes EXT: 6926 3. DATE REQ. BY: 8/31/17 OF DOCUMENT (CHECK ONE): SELECTION DOCUMENT (E.G., RFB, RFP, RFQ) WORKS CONTRACT ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT SERVICE AGREEMENT ❑ MAINTENANCE AGREEMENT AND SERVICE AGREEMENT ❑ HUMAN SERVICES / CDBG ESTATE DOCUMENT ❑ SECURITY DOCUMENT (so. BONDRELATEDDOCUMENTS) ❑ RESOLUTION AMENDMENT (AG #): ❑ INTERLOCAL Mou NAME: City of Federal Way, MSM and Mandy Ma OF CONTRACTOR: Multicultural, Self- Sufficiency Movement (MSM) TELEPHONE -MAIL: FAX: NAME: TITLE AND ATTACHMENTS: ❑ SCOPE, WORK OR SERVICES ❑ COMPENSATION ❑ INSURANCE REQUIREMENTS /CERTIFICATE ❑ ALL REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT /AMENDMENTS COMMENCEMENT DATE: upon signature COMPLETION DATE: 12/31/2021 COMPENSATION $ N/A (INCLUDE EXPENSES AND SALES TAX, IF ANY) CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) EXPENSE: OYES ❑ NO IF YES, MAXIMUM DOLLAR AMOUNT: $ TAX OWED OYES ONO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY RETAINAGE AMOUNT: ❑ RETAINAGE AGREEMENT (SEE CONTRACT) OR ❑ RETAINAGE BOND PROVIDED PLEASE CHARGE TO: /CONTRACT REVIEW INITIAL / DATE REVIEWED INITIAL / DATE APPROVED MANAGER Cody Geddes 9/12/17 MANAGEMENT (IF APPLICABLE) 4.9? 12 S'ef 20 I COMMITTEE APPROVAL DATE: N/A COUNCILAPPROVALDATE: N/A SIGNATURE ROUTING TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS ELECTRONIC REMINDER/NOTIFICATION FOR 1 MONTH PRIOR TO EXPIRATION DATE (Include dept. support staff if necessary and feel free to set notification more than a month in advance if council approval is needed.) INITIAL / DATE SIGNED DEPARTMENT i 2-0 Se, 219/T (MAYOR OR DIRECTOR) ',L obi CLERK qJ2.0(�7 AG# AG# 1 110 COPY RETURNED DATE SENT: 041-21-1/— -41— t (3∎ .1' `O`Cit Va't 2/2017 Memorandum of Understanding City of Federal Way and MSM and Mandy Ma THIS MEMORANDUM OF UNDERSTANDING (MOU), dated effective when signed by all parties, defines the respective responsibilities of the City of Federal Way ( "City "), Multicultural Self - Sufficing Movement (MSM) a Washington non -profit corporation, in connection with the senior meal program at the Federal Way Community Center. Background A. The MSM desire to enter an agreement for use of space at the Federal Way Community Center for a twice weekly meal program until December 31, 2021. B. The City of Seattle has provided funding for a congregate meal program to MSM to serve an unmet need in the community. The congregate meal program is donation based and provides warm nutritious meals to low income seniors. C. The City of Federal Way will provide space at the Federal Way Community Center located at 876 S 333rd Street, Federal Way WA. 98003 for the purpose of offering an ethnic low income congregate meal program provided by The Senior Meal Providers. D. MSM has permission to use the community rooms and kitchen or other space designated by the Federal Way Community Center on Tuesdays and continued use on Thursdays. Time of use for MSM is from 8:00 a.m. until 1:00 p.m. both days. E. No party shall be responsible for events that are unforeseeable and beyond its reasonable control, such as acts of God, weather delays or government restrictions. F. This MOU may be terminated by either party with 30 days' notice. NOW, THEREFORE, the parties agree as follows: I. City Responsibilities. The City agrees to provide the following: • Dining areas and kitchen facilities on the days outlined above. • Tables, chairs and appropriate kitchen equipment. • MSM will be notified ten days in advance of any schedule changes or conflicts that may result in canceled or reduced space. • Changes or conflicts that may result in canceled or reduced space will not exceed two dates per month with the exception of holidays and our annual closure week II. Multicultural Self - Sufficiency Movement (MSM) • MSM acknowledge that this agreement is for temporary use of space at the Federal Way Community Center on Tuesdays and will develop an alternative location for continuation of services in 2021. It is understood that a request may be made at the end of this term to continue the meal program at the Federal Way Community Center. • Provide a congregate meal program on Tuesdays and Thursdays at the Federal Way Community Center on the days and times provided above. • MSM is only allowed entrance to facility during designated times on Tuesdays and Thursdays from 8:00 a.m. until 1:00 p.m. including the kitchen and meeting spaces. • Qualified cooks who hold current required permits and training • All food is to be purchased and provided by the MSM at their sole expense. • All paper and plastic products including, but not limited to plates, napkins and utensils are to be purchased and provided by MSM at their sole expense. • MSM is responsible for cleaning the community rooms, kitchen and all equipment after each day of use. This includes emptying all trash in the community rooms and kitchen and placed in the rolling dumpster outside the back door of the kitchen. • MSM is solely responsible for managing it's inventory of food to insure safety and freshness. • MSM is solely responsible for any fines they incur due to violations of health codes. • MSM will provide and maintain a comprehensive general liability insurance policy with limits of Two Million dollars ($2,000,000) per occurrence specifically naming the City of Federal Way additionally insured. This policy shall include personal injury, bodily injury or property claims of MSM services and its agents. • MSM will report any damage or malfunctioning equipment to designated Federal Way Community Center staff upon discovery. • MSM will agree to repair or replace at their expense any damaged equipment caused by misuse by the The Senior Meal Providers. • MSM will only use the designated refrigerator storage space that has been assigned to them and properly store items in non - spill, odor resistant containers. • MSM will assist in paying for quarterly kitchen cleanings, limited to no more than the amount of $500.00 per quarter. • This MOU sets forth the intent of the parties herein. (Signature page follows) MULTICULTURAL SELF - SUFFICIENCY MOVEMENT: By: C C� Printed Name: 1 At\iDy F Title: y\C_ DATE: CO 8" 72D et— STATE OF WASHINGTON ) ) ss. COUNTY OF VkN() ) On this d y personally appeared before me w 1 " 0 , to me known to be the 0 t Vte of ttiliAVNAvta. LI ak0Wt ti1k" 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. GIVEN my hand and official i S 2 • ,► °u ;)9 4:e jf Z _r g; aF tts ATE 0 • \ \ seal this I day of Notary's signatur Notary's printed Notary My com .C� 41,E \PiV ame ubli in.n. ex ®,') �20 . for r the State of Washington. res 0'2,1« I9.0I©1 IN WITNESS WHERE OF, the City, and MSM have executed this Memorandum of Understanding as of the day and year first written above by their duly authorized representatives. CITY OF FEDERAL WAY By Jo ' utton, Parks City of Federal Way 33325 8th Ave S Federal Way, WA 98003 ATTEST: ►11.:�1L )L..L City Clerk, Stephanie Courtn4 CMC APPROVED AS TO FORM: City Attorney, J. Ryan Call AMR INSURANCE LLC /PHS PO BOX 33015 SAN ANTONIO TX 78265 MANDY MA DBA: MULTICULTURAL SELF - SUFFICIENCY MOVEMENT 3820 STEILACOOM BLVD SW LAKEWOOD WA 98499 ACORD 25 (2016/03) ___.-_1 ® SVY AFRO CERTIFICATE OF LIABILITY INSURANCE R045 DATE (MM/DD/YYYY) 9/20/2017 THIS CERTIFICATEIS 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(ies) must have ADDITIONAL INSURED provisions or 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 AMR INSURANCE LLC /PHS 811642 P: (866) 467 -8730 F: (888) 443 -6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME: (AHNCNo,Ex!): (866) 467 -8730 NC,NoI: (888) 443 -6112 ADDRIESs: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Hartford Casualty Ins Co 29424 INSURED MANDY MA DBA: MULTICULTURAL SELF - SUFFICIENCY MOVEMENT 3820 STEILACOOM BLVD SW LAKEWOOD WA 98499 INSURER B : X INSURERC: INSURERD: 52 SBA GQ0201 INSURERE: 02/12/2018 INSURERF: $ 1,000,000 COVERAGES CERTIFICATE NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF ( MM /DD/YYYV 1 POLICY EXP !MM/OD/YYYYI LIMITS A COMMERCIAL GENERAL -MADE Liab X LIABILITY OCCUR 52 SBA GQ0201 02/12/2017 02/12/2018 EACH OCCURRENCE $ 1,000,000 CLAIMS DAMAGE TO RENTED PREMISES (E a occurrence) $300,000 X General X MED EXP (Any one person) $10,000 PERSONAL 8ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT PRO- JECT APPLIES X PER: LOC GENERAL AGGREGATE $2,000,000 POLICY PRODUCTS - COMP /OP AGG $2,000,000 OTHER: $ AUTOMOBILE UTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ _ PROPERTY DAMAGE (Per accident) S $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE Y/N OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A PER OTH- STATUTE ER E.L. EACH ACCIDENT S E.L. DISEASE- EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ A EMP STOP GAP 52 SBA GQ0201 02/12/2017 02/12/2018 $1,000,000 /$1,000,000 /$1,000,000 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 attached to this policy. DER CANCELLATION City of Federal Way PO BOX 9718 FEDERAL WAY, WA 98063 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 7a--7- - / a-c 'L i ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AMR INSURANCE LLC /PHS PO BOX 33015 SAN ANTONIO TX 78265 City of Federal Way PO BOX 9718 FEDERAL WAY WA 98063 ACORD 25 (2016/03) /..,,, SVY CERTIFICATE OF LIABILITY INSURANCE R045 DATE (MM/DD/YYYY) 9/20/2017 THIS CERTIFICATEIS 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(ies) must have ADDITIONAL INSURED provisions or 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 AMR INSURANCE LLC /PHS 811642 P: (866) 467 -8730 F: (888) 443 -6112 PO BOX 33015 SAN ANTONIO TX 78265 CONTACT NAME. (NC NE No, (866) 467 -8730 FAX (A/C, (888) 443 -6112 ADDRIESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURERA Hartford Casualty Ins Co 29424 INSURED MANDY MA DBA: MULTICULTURAL SELF - SUFFICIENCY MOVEMENT 3820 STEILACOOM BLVD SW LAKEWOOD WA 98499 INSURER B X INSURERC INSURER D: 52 SBA GQ0201 INSURER E: 02/12/2018 INSURER F: $1,000,000 COVERAGES CERTIFICATE NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WV O POLICY NUMBER POLICYEFF (MM/DD/YYYY) POLICY EXP (MMO)D/YYYYI LIMITS A COMMERCIAL GENERAL -MADE Liab X LIABILITY OCCUR 52 SBA GQ0201 02/12/2017 02/12/2018 EACH OCCURRENCE $1,000,000 CLAIMS DAGE S RENTED PREMISES (Ea (Ea occuence) $300,000 X GEN'L General X MED EXP (Any one person) $10, 000 PERSONAL &ADV INJURY $1,000,000 AGGREGATE LIMIT PRO- JECT APPLIES X PER: LOC GENERAL AGGREGATE $2,000,000 POLICY PRODUCTS - COMP /OP AGG $2,000,000 OTHER: $ AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON -OWNED AUTOS ONLY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/ A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE- EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ A EMP STOP GAP 52 SBA GQ0201 02/12/2017 02/12/2018 $1,000,000 /$1,000,000 /$1,000,000 DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION City of Federal PO BOX 9718 FEDERAL WAY, WA Way 98063 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 7a2' -7a.4.-It i ACORD 25 (2016/03) © 1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD