HomeMy WebLinkAboutPD04-342 - Original - New Connections - Motivational Life Skills Classes for Inmates - 12/27/2004 KENT
WASHINGTON
CONSULTANT SERVICES AGREEMENT
between the City of Kent and
New Connections of South King County
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and New Connections of South King County organized under the laws of the State of
Washington, located and doing business at 412 West Titus Street, Kent, Washington, telephone number 253-
856-9200 (hereinafter the "Consultant").
I. DESCRIPTION OF WORK.
Consultant shall perform the following services for the City in accordance with the following described
plans and/or specifications:
Provide Motivational Life Skills classes and aftercare services to offenders supervised by the
City of Kent Corrections Facility(CKCF) and upon their release from custody as a partner in the
Opening Doors Project. The Opening Doors Project is funded by the Department of Education,
Fund for Improvement of Post Secondary Education grant. See Exhibit A Scope of Work.
Consultant further represents that the services furnished under this Agreement will be performed in
accordance with generally accepted professional practices in effect at the time those services are performed.
II. TIME OF COMPLETION. The parties agree that work will begin on the tasks described in
Section I above immediately upon the effective date of this Agreement. Upon the effective date of this
Agreement, Consultant shall complete the work described in Section I by September 30, 2005, with possible
continuation for two additional years.
III. COMPENSATION.
A. The City shall pay the Consultant, based on time and materials, an amount not to exceed eleven
thousand seven hundred and sixty dollars ($11,760) for the services described in this Agreement.
This is the maximum amount to be paid under this Agreement for the work described in Section I
above, and shall not be exceeded without the prior written authorization of the City in the form
of a negotiated and executed supplemental agreement. The Consultant agrees that the hourly or
flat rate charged by it for its services contracted for herein shall remain locked at the negotiated
rate(s) for a period of one (1) year from the effective date of this Agreement. The Consultant's
billing rates shall be as delineated in Exhibit B.
B. The Consultant shall submit monthly payment invoices to the City for work performed, and a
final bill upon completion of all services described in this Agreement. The City shall provide
payment within forty-five (45) days of receipt of an invoice. If the City objects to all or any
CONSULTANT SERVICES AGREEMENT-1
(Over$10,000)
portion of the invoice not in dispute. I n t hat event,the parties will immediately make every
effort to settle the disputed portion.
IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor-
Employer Relationship will be created by this Agreement and that the Consultant has the ability to control and
direct the performance and details of its work, the City being interested only in the results obtained under this
Agreement.
V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon
providing the other party thirty (30) days written notice at its address set forth on the signature block of this
Agreement. After termination, the City may take possession of all records and data within the Consultant's
possession pertaining to this project, which may be used by the City without restriction. If the City's use of
Consultant's records or data is not related to this project, it shall be without liability or legal exposure to the
Consultant.
VI. DISCRIIVIINATION. In the hiring of employees for the performance of work under this
Agreement or any subcontract, the Consultant, its subcontractors, or any person acting on behalf of the
Consultant or subcontractor shall not, by reason of race, religion, color, sex, age, sexual orientation, national
origin, or the presence of any sensory, mental, or physical disability, discriminate against any person who is
qualified and available to perform the work to which the employment relates. Consultant shall execute the
attached City of Kent Equal Employment Opportunity Policy Declaration, Comply with City Administrative
Policy 1.2, and upon completion of the contract work, file the attached Compliance Statement.
VII. INDEMNIFICATION. Consultant shall defend, indemnify and hold the City, its officers,
officials, employees, agents and volunteers harmless from any and all claims, injuries, damages, losses or suits,
including all legal costs and attorney fees, arising out of or in connection with the Consultant's performance of
this Agreement, except for that portion of the injuries and damages caused by the City's negligence.
The City's inspection or acceptance of any of Consultant's work when completed shall not be grounds to
avoid any of these covenants of indemnification.
Should a court of competent jurisdiction determine that this Agreement i s subject to RCW 4.24.115,
then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused
by or resulting from the concurrent negligence of the Consultant and the City, its officers, officials, employees,
agents and volunteers, the Consultant's liability hereunder shall be only to the extent of the Consultant's
negligence.
IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE
INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONSULTANT'S WAIVER OF
IMMUNITY UNDER INDUSTRIAL INSURANCE TITLE 51 RCW, SOLELY FOR THE PURPOSES OF
THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE
MUTUALLY NEGOTIATED THIS WAIVER.
The provisions of this section shall survive the expiration or termination of this Agreement.
VUL INSURANCE. The Consultant shall procure and maintain for the duration of the Agreement,
insurance of the types and in the amounts described in Exhibit C attached and incorporated by this reference.
CONSULTANT SERVICES AGREEMENT-2
(Over$10,000)
IX. EXCHANGE OF INFORMATION. The City will provide its best efforts to provide
reasonable accuracy of any information supplied by it to Consultant for the purpose of completion of the work
under this Agreement.
X. OWNERSHIP AND USE OF RECORDS AND DOCUMENTS. Original documents,
drawings, designs, reports, or any other records developed or created under this Agreement shall belong to and
become the property of the City. All records submitted by the City to the Consultant will be safeguarded by the
Consultant. Consultant shall make such data,documents,and files available to the City upon the City's request.
The city's use or reuse of any of the documents, data and files created by Consultant for this project by anyone
other than Consultant on any other project shall be without liability or legal exposure to Consultant.
XI. CITY'S RIGHT O F INSPECTION. E ven though Consultant is an independent contractor
with the authority to control and direct the performance and details of the work authorized under this
Agreement,the work must meet the approval of the City ands hall b e subj ect t o the City's general right of
inspection to secure satisfactory completion.
XII. WORK PERFORMED AT CONSULTANT'S RISK Consultant shall take all necessary
precautions and shall be responsible for the safety of its employees, agents, and subcontractors in the
performance of the contract work and shall utilize all protection necessary for that purpose. Al work shall be
done at Consultant's own risk, and Consultant shall be responsible for any loss of or damage to materials, tools,
or other articles used or held for use in connection with the work.
XIII. MISCELLANEOUS PROVISIONS.
A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City requires its
contractors and consultants to use recycled and recyclable products whenever practicable. A price preference
may be available for any designated recycled product.
B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of any of the
covenants and agreements contained in this Agreement, or to exercise any option conferred by this Agreement
in one or more instances shall not be construed to be a waiver or relinquishment of those covenants, agreements
or options, and the same shall be and remain in full force and effect.
C. Resolution of Disputes and Governing Law. This Agreement shall be governed by and
construed in accordance with the laws of the State of Washington. If the parties are unable to settle any dispute,
difference or claim arising from the parties' performance of this Agreement, the exclusive means of resolving
that dispute, difference or claim, shall only be by filing suit exclusively under the venue, rules and jurisdiction
of the King County Superior Court, King County, Washington, unless the parties agree in writing to an
alternative dispute resolution process. In any claim or lawsuit for damages arising from the parties'
performance of this Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending
or bringing such claim or lawsuit, in addition to any other recovery or award provided by law; rop vided•
however, nothing in this paragraph shall be construed to limit the City's right to indemnification under Section
VII of this Agreement.
D. Written Notice. All communications regarding this Agreement shall be sent to the parties at the
addresses listed on the signature page of the Agreement, unless notified to the contrary. Any written notice
hereunder shall become effective three(3)business days after the date of mailing by registered or certified mail,
and shall be deemed sufficiently given if sent to the addressee at the address stated in this Agreement or such
other address as may be hereafter specified in writing.
CONSULTANT SERVICES AGREEMENT-3
(Over$10,000)
E. Assignment. Any assignment of this Agreement by either party without the written consent of
the non-assigning party shall be void. If the non-assigning party gives its consent to any assignment, the terms
of this Agreement shall continue in full force and effect and no further assignment shall be made without
additional written consent.
F. Modification. No waiver, alteration, or modification of any of the provisions of this Agreement
shall be binding unless in writing and signed by a duly authorized representative of the City and Consultant.
G. Entire Agreement. The written provisions and terms of this Agreement, together with any
Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative of the
City, and such statements shall not be effective or be construed as entering into or forming a part of or altering
in any manner this Agreement. All of the above documents are hereby made a part of this Agreement.
However, should any language in any of the Exhibits to this Agreement conflict with any language contained in
this Agreement,the terms of this Agreement shall prevail.
H. Compliance with Laws. The Consultant agrees to comply with all federal, state, and municipal
laws, rules, and regulations that are now effective or in the future become applicable to Consultant's business,
equipment, and personnel engaged in operations covered by this Agreement or accruing out of the performance
of those operations.
IN WITNESS, the parties below execute this Agreement,which shall become effective on the last
date entered below.
CONSULTANT: CITY OF KENT:
\•
By: �v.sn ��n By:
(sr ature) (signature)
Prin Name: K-A�j Print e: Jim White
Its Its Mayor
(title) (nde)
DATE: DATE:
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
CONSULTANT: CITY OF KENT:
May Miller Debra LeRoy
New Connections of South King County City of Kent
412 West Titus Street 220 Fourth Avenue South
Kent, Washington 98032 Kent,WA 98032
(253) 856-9200 (telephone) (253) 856-5856 (telephone)
253 856-9210 (facsimile) (253) 856-6802 (facsimile)
APPROVED AS TO FORM:
t
t
CONSULTANT SERVICES AGREEMENT-4
(Over$10,000)
DECLARATION
CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY
The City of Kent is committed to conform to Federal and State laws regarding equal opportunity. As such all
contractors, subcontractors and suppliers who perform work with relation to this Agreement shall comply with
the regulations of the City's equal employment opportunity policies.
The following questions specifically identify the requirements the City deems necessary for any contractor,
subcontractor or supplier on this specific Agreement to adhere to. An affirmative response is required on all of
the following questions for this Agreement to be valid and binding. If any contractor, subcontractor or supplier
willfully misrepresents themselves with regard to the directives outlines, it will be considered a breach of
contract and it will be at the City's sole determination regarding suspension or termination for all or part of the
Agreement;
The questions are as follows:
1. I have read the attached City of Kent administrative policy number 1.2.
2. During the time of this Agreement I will not discriminate in employment on the basis of sex,race, color,
national origin, age, or the presence of all sensory, mental or physical disability.
3. During the time of this Agreement the prime contractor will provide a written statement to all new
employees and subcontractors indicating commitment as an equal opportunity employer.
4. During the time of the Agreement I, the prime contractor, will actively consider hiring and promotion of
women and minorities.
5. Before acceptance of this Agreement, an adherence statement will be signed by me, the Prime
Contractor, that the Prime Contractor complied with the requirements as set forth above.
By signing below, I agree to fulfill the five requirements referenced above.
Dated this 2 —day of R. � , 200_% .
By: poK
For:
Title: ` GZ-mph
Date:
EEO COMPLIANCE DOCUMENTS- 1
CITY OF KENT
ADMINISTRATIVE POLICY
NUMBER: 1.2 EFFECTIVE DATE: January 1, 1998
SUBJECT: MINORITY AND WOMEN SUPERSEDES: April 1, 1996
CONTRACTORS APPROVED BY Jim White,Mayor
POLICY:
Equal employment opportunity requirements for the City of Kent will conform to federal and state laws. All
contractors, subcontractors, consultants and suppliers of the City must guarantee equal employment opportunity
within their organization and, if holding Agreements with the City amounting to $10,000 or more within any
given year,must take the following affirmative steps:
1. Provide a written statement to all new employees and subcontractors indicating commitment as an equal
opportunity employer.
2. Actively consider for promotion and advancement available minorities and women.
An contractor, subcontractor, consultant or supplier who willfully disregards the City's nondiscrimination and
Y PP Y
equal opportunity requirements shall be considered in breach of contract and subject to suspension or
termination for all or part of the Agreement.
Contract Compliance Officers will be appointed by the Directors of Planning, Parks, and Public Works
Departments to assume the following duties for their respective departments.
1. Ensuring that contractors, subcontractors, consultants, and suppliers subject to these regulations are
familiar with the regulations and the City's equal employment opportunity policy.
2. Monitoring to assure adherence to federal,state and local laws,policies and guidelines.
EEO COMPLIANCE DOCUMENTS-2
CITY OF KENT
EQUAL EMPLOYMENT OPPORTUNITY COMPLIANCE STATEMENT
This form shall be filled out AFTER COMPLETION of this project by the Contractor awarded the
Agreement.
I, the undersigned, a duly represented agent of Company, hereby
acknowledge and declare that the before-mentioned company was the prime contractor for the Agreement
known as that was entered into on the (date)
between the firm I represent and the City of Kent.
I declare that I complied fully with all of the requirements and obligations as outlined in the City of Kent
Administrative Policy 1.2 and the Declaration City of Kent Equal Employment Opportunity Policy that was part
of the before-mentioned Agreement.
a
Dated this day of .200
By:
For:
Title:
Date:
EEO COMPLIANCE DOCUMENTS-3
EXHIBIT A
SCOPE OF WORK
A. The Contractor's responsibilities include:
1. Program Administration
a. Provide We Skills Orientation classes to inmates in the Kent Jail. This
orientation will provide offenders with information covering available
resources and treatment programs in the community. These 90 minute
group classes will be offered as the first week of each six week series of
Life Skills classes separately for each gender. The expected male class
attendance is eight and female class attendance is four.
b. Provide Motivational Life Skills classes to inmates in the Kent Jai two
days per week for five weeks. The Life Skills classes include,but are not
limited to instruction in communications, goal setting,problem solving,
stress and anger management, employment skills and budgeting. These
weekly 90 minute group classes are offered separately for each gender.
The expected class capacity including both genders is 12 clients per week.
C. Contractor will perform and document individual assessments through pre
and post testing. Compile results from pre and post testing and submit
report to police department project director monthly. Provide project
evaluator with access to raw data as necessary.
d. Provide certificate of completion to inmates completing Life Skills classes.
e. Provide two hours of follow-up support contacts each week with
individual clients in the Kent Jail.
f. Provide aftercare support to Kent Jail clients to include,but not limited to:
• Driver license reinstatement assistance
• Housing referrals
• Voice Mail
• Postal Address
• Drug, alcohol,domestic violence referrals
• Support groups
• Clothing vouchers
• Ignition Interlock Program
• Community service referrals
EXHIBIT A
SCOPE OF WORK
PAGE 1 OF 3
2. Records
a Contractor staff will maintain all class attendance records.
b. The Department of Education reserves the right to reproduce, publish or
otherwise use and to authorize the use of any work developed under this
grant.
o The consultant must grant access to all data,documents and records relating
to this grant project to the City,the Department ofEducation,the Comptroller
General of the United States or any other authorized representatives.
d. The consultant must retain all records relating to this grant project for three
years following the final grant payment to the grantee and sub grantees.
e. Contractor staff will transport records to and from the class site,maintaining
inmate client confidentiality.
f. Contractor shall provide inmate client class and service registration forms
including release of information language for program evaluation purposes.
Kent Police Department(KPD) staff or research intern hired by KPD shall
have access to all inmate client records at the Contractor's business address
for program research and evaluation purposes only.
3. Quarterly Meetings
The Contractor's representative will meet quarterly with the CKCF Administrator or
designee to review the Life Skills instruction program.
4. Semi-annual and Annual Reports
The Contractorwill provide semi-annual and annual statistical reports on the CKCF
Opening Doors Project to the police department project director. These reports are
due May 31,2005 and September 30,2005. These reports will include,but may not
be limited to:
a. Number of Kent Jail inmates contacted in orientation classes.
b. Number of Kent Jail inmates enrolled in Life Skills classes.
C. Number of Kent Jail inmates completing Life Skills classes.
d. Number of Kent Jail inmates who dropped out of Life Skills classes.
e. Number of Kent Jail inmates released from custody prior to
completing Life Skills classes.
EXHIBIT A
SCOPE OF WORK
PAGE 2 OF 3
f. Number ofKent Jail inmate clients removed from Life Skills Classes
due to disciplinary actions.
g. Number of Kent Jail inmate clients referred to drug, alcohol and
domestic violence treatment or classes.
h. Number of Kent Jail inmate clients contacted in jail individual
sessions.
i. Number of Kent Jail inmate clients contacted at New Connections
office upon their release from jail.
j. Number and names ofpeople utilizing New Connections foraftercare
once released from CKCF.
5. Contractor employees
Contractor will run background checks on all employees and volunteers with access
to inmates or their records in order to protect their confidentiality. All contractor
employees or volunteers entering CKCF will provide picture identificationto CKCF
staff and be subject to a criminal history background check prior to entering the
facility.
B. The City's responsibilities include:
1. Provide a classroom with furnishings and security for group classes. A room will
also be provided for individual follow-up support contacts.
2. The CKCF Administrator, or designee, will meet quarterly with the Contractor's
representative to review the Life Skills instruction program.
3. Coordinate group class and individual follow-up support contact schedules with
Contractor.
EXHIBIT A
SCOPE OF WORK
PAGE 3 OF 3
r '
Exhibit B
Consultant Services Agreement
between the City of Kent and
New Connections of South King County
Fee Schedule
Hourly Contract
Fee Hours Total
Instruction preparation(8 hm max ea.Series) $30.00 40 $1,200.00
Ufe Skills Orientation Gass $30.00 i5 $450.00
Motivational Ufa Skills Gass $30.00 90 2,700.00
Inmate follow-up support contact $30.00 70 2,100.00
Aftercare:
Client assistance at New Connections office $30.00 117 3,510.00
Office costs and supplies-client assistance/forms 350.00
Instructional Aids 250.00
Grant Administration Data collection/Reporting $30.00 40 1,200.00
Contract Total $11,760.00
The above schedule lists the maximum hourly rate for services provided by this contract.
Individual services and costs may be adjusted during the contract period. The Contractor ney
not bill for fees or costs exceeding the total contract amount of$11,760.
EXHIBIT C
INSURANCE REQUIREMENTS FOR
CONSULTANT SERVICES AGREEMENTS
Insurance
The Contractor shall procure and maintain for the duration of the Agreement, insurance
against claims for injuries to persons or damage to property which may arise from or in
connection with the performance of the work hereunder by the Contractor,their agents,
representatives, employees or subcontractors.
A. Minimum Scope of Insurance
Contractor shall obtain insurance of the types described below:
1. Commercial General Liability insurance shall be written on ISO
occurrence form CG 00 01 and shall cover liability arising from
premises,operations, independent contractors,products-completed
operations,personal injury and advertising injury, and liability
assumed under an insured contract. The Commercial General Liability
insurance shall be endorsed to provide the Aggregate Per Project
Endorsement ISO form CG 25 03 1185. There shall be no
endorsement or modification of the Commercial General Liability
insurance for liability arising from explosion,collapse or underground
property damage. The City shall be named as an insured under the
Contractor's Commercial General Liability insurance policy with
respect to the work performed for the City using ISO additional
insured endorsement CG 20 10 1185 or a substitute endorsement
providing equivalent coverage.
B. Minimum Amounts of Insurance
Contractor shall maintain the following insurance limits:
1. Commercial General Liabilitv insurance shall be written with limits no
less than$1,000,000 each occurrence,$1,000,000 general aggregate
and a$1,000,000 products-completed operations aggregate limit.
C. Other Insurance Provisions
The insurance policies are to contain,or be endorsed to contain, the following provisions
for Automobile Liability and Commercial General Liability insurance:
1. The Contractor's 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 Contractor's insurance and shall not contribute with it.
2. The Contractor's insurance shall be endorsed to state that coverage shall not be
cancelled by either party,except after thirty(30)days prior written notice by cerflfied
mail,return receipt requested,has been given to the City.
S
EXHIBIT C (Continued)
3. The City of Kent shall be named as an additional insured on all policies (except
Professional Liability) as respects work performed by or on behalf of the contractor
and a copy of the endorsement naming the City as additional insured shall be attached
to the Certificate of Insurance. The City reserves the right to receive a certified copy
of all required insurance policies. The Contractor's Commercial General Liability
insurance shall also contain a clause stating that coverage shall apply separately to
each insured against whom claim is made or suit is brought,except with respectsto
the limits of the insurer's liability.
D. Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M.Best rating of not less than
ANII.
E. Verification of Coverage
Contractor shall finish the City with original certificates and a copy of the amendatory
endorsements, including but not necessarily limited to the additional insured
endorsement, evidencing the insurance requirements of the Contractor before
commencement of the work.
F. Subcontractors
Contractor shall include all subcontractors as insureds under its policies or shall finish
separate certificates and endorsements for each subcontractor. All coverages for
subcontractors shall be subject to all of the same insurance requirements as stated herein
for the Contractor.
FES-0 0-04 11:42AM FROM-BELL ANDERSON T-243 P 01/03 F-667
'ACOW. CERTIFICATE OF LIABILITY INSUKANUtz 62rua04
PRODUCF9 THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION
Belt-Anderson ins. -Kent C/L ONLY AND CONFERS NO RICrHTS UPON THE CERTIFICATE
P. 0. Box 887 HOLDER.THIS CERTIFICATE FOES NOT AMEND,EXTEND OR
724 West Smith 5t. ALTER THE COVERAGE AFFORDED BY THE POLICIES 13ELOW
Kent, WA 98030-0037 INSURIrRS AFFORDING COVERAGE NAIC A
INSURERA Mount Vernon Fife Insuran
Now Connections of SelJtn fling Coynty INSURERS
412 W Titus INSURERS
Kent,WA a8D32-120$ INSURER D
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LlSTEp BELOW HZF BEEN ISSUED TO THE INSURED NAMPO ABOVE FO)2 THE POC-ICY PERIOD INOtCATEP NOTWITHSTANDING
ANY REOUIREMENT 7BRM OR CON0ITION OF ANY CONTRACT OR OTHER DOCumENT wiTH RESPECT TO WHICH TRIS CERTIFICATE MAY sE ISSUEP OR
MAY PERTAIN Tmg rNSURANCE AFFORDED BY ThE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EACLQSIONS AND CONDITIONS OF SUCH
POLICIES AGGR9cxATF LIMITS SHOWn MAY HAVE BEEN REDUCED BY PAID CLAIMS
LTR NNE TYPE OF J"URANCE POLICY MUMBER Pp UCT�fFTF 013 IWTE r P ON UNITS
A QFKAA),LIAWTY CP200772713 01/26104 01/26105 EACnOCCURRENCE $1000000
X CQMImAPRCIAL GENERAF LIAPILITY On AGE TO RENTED $1 OO q00
CLAIMS MADE OCCUR MEP P(Any WS person) SS 000
PERSONAL S ADV INJuRY $1 000 000
GEHBRAL AGGREGATE 12 000 000
GEN L AGGREGATE LIMIT APPLI€S PER PRODUCTS•COMPICP AGG S2,000,000
POLICY jE O- LOC
AUTOMOBILE LIApiu'Y COMBINED SINGLE=LIMIT S
ANY AuTO CEO wzcIent)
ALL O WNED AUTO.i
NOOILY InjURY $
SCT+€DV L€A AuTOS tPer w4cr;
MIR£DAUTDS BODILY IN4uRY ;
NON-O WNED AUTOS CPer acnaenU
PROPERTY DAMAGE $
(Peraeelgc*II)
GARAGE LJABIUTY AUTO ONLY•EA ACCIDENT S
ANT AUTO EA ACC E
OTHER T1u+N
NUTO ONLY AGG 5
EXCEISfUMBRELW LiA&u_Y EACH OCCURRENCE E
OCCUR CLAIMS MADE AGGREGATE S
f
DEDUCTIBLE S
TION S 1 Is
WORKERS COMPENSATION AND LAC STATU. OTM•
EMPLOYERS LIABILITY
ANY PROPRIF!'OR+PARTNERiFxECuTIVE EL EACH ACCIDENT S
OFFICERIMEMBER FACLUDEOT E L DISEASE•EA EMPLOY0 S
Ryes,umcTee wnaer
SPECIAL PROVISrOr19 aelgr EL DISEASE-POLICY LIMrT S
DTMER
DESCRIPnON OF OPERATIONS I LOCATIONS T VEHICLES I EXCLUSIONS ADDED aY ENDORSEMENT/SPECIAL PROVISIONS
CITY OF KENT IS NAMED AS ADDITIONAL INSURED RE: LEASE OF 220 4TH AVE S,
KENT WA- FOrM CG2026 is attached.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLIOIES BE CANCELLED BEFORE THE EXPIRATION
CITY OF KENT DATE THEREOF,THE WIWI INSURER WILL ENDEAVOR TO MAA- --ILL PAYS WRITTEN
220 FOURTH AVE S NOTICE TO THE CERTIACATE HOLDER NAMED TO THE LEFT.BUT FAILPRE TO 00 SO SMALL
Kent, WA 98032 IMPOSE NOOPPGATION OR UA&U`rr OF AAY KIND UPON THE POURER,ITS AGENTS OR
REPRESENTATIVES
AUTHOR"O REPRESENTATIVE
ACORD 25(2001tes) 1 of 2 #73648 CJL 0 ACORD CORPORATION 198E
- FEB-K-04 II:42AM FROM-BELL ANDERSON T-243 P 02/03 F-667
IMPORTANT
It the certificate holder is an ADDITIONAl- INSURED.the pohcy(ies)must De endorsed A statement
an this certificate does not confer rights to the certificate holder In lieu of such endorsement(s)
If SUBROGATION IS WAIVED, suptoct 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 ruch engorsement(s)
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract notween
the issuing insurer(s), authorizea representative or producer, and the certificate holder, nor aoes it
affirmatively or negatively amena, extend or alter the coverage afforded Dy the poilcies listed thereon
A>~eRn zs,Z t2031;Da) 2 of 2 073648
JAN-2q-2004 02:15PM FRDM-SELL ANDERSON INSURANCE 253 852 7572 T-983 P 003/003 F-768
. x
POLICY NUMBER: CP2007727B
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT
CAREFULLY.
ADDITIONAL INSURED—DESIGNATED PERSON
OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
NAME OF PERSON OR ORGANIZATION: City of Dent, its officers, officials,
agents and employees.
(If no entry appears above, information required to complete this endorsement will
be shown in the Declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person
or organization shown in the Schedule as an Insured, but only with respect to
liability arising out of your operations or premises owned by or rented to you.
CG 20 2611.85 Copyright,Insurance Services Office, Inc., 1984