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HomeMy WebLinkAboutPK11-125 - Original - Camp Waskowitz Rental Agreement Highline School District No. 401 Camp Waskowitz Rental Agreement 45505 S E 150"'St,North Bend,WA 98045 Seattle—(425) 277-7195 North Bend—(425) 888-0681 Mailing Address: Camp Waskowitz, 15675 Ambaum Blvd S W ,Burren,WA 98166 (206) 631-7626 Applicant Kent Parks In Charge Julie Stangle Organization At Camp Address 525 Fourth Ave No,Kent,WA 98032 Phone ( 253 ) 856-5030 Age of Est No Est Total Campers Youth Girls Boys Adults M F No Campers 190 Arrival Monday August 8 2011 R,approx 11 00 a in Dinner First Meal(Breakfast 8 00,Lunch 12 00,Dinner 5 30 Departure Fnday August 12 2011 approx 2 00 p m Lunch C 11 00 am Date Time Last meal (Breakfast,Lunch,Dinner) 75-124 people=$224 00 per person, 125-149 people =$216 00 per person Cost Quote on Estimated Total $ 21200 per person for 4 night(s)and 12 meal(s) Additional charges/fees Total Charge S Less Deposit $ Date Certificate of Insurance received Amount Due $ Month/Day/Year CERTIF ICATE OF INSURANCE The lessee,at its own cost, shall maintain public liability insurance for bodily injuries (including sickness or death) and property damages in the nummum amount of$1,000,000 combined single limit per occurrence,and in the nummum amount of$2,000,000 in the aggregate Employers Liability(Washington Stop-Gap)in the amount of no less than $1,000,000 per accident for owned,non-owned and hued automobiles Prior to using the site, the lessee shall furnish the Camp Waskowitz office with a Certificate of Insurance evidencing this coverage and naming the Highlme School District as an additional insured and as the certificate holder HOLD HARMLESS AGREEMENT To the fullest extent perrinued by law,the lessee releases and shall defend,indemnify and hold hat mless the Highlme School District and its directors,agents, employees, successors and assigns from and against all claims, damages, losses and expenses, direct and indirect,or consequential, including but not limited to costs and attorneys' fees incurred on such claims and in proving the right to indemnification, arising out of or resulting from the acts or orrussions of the lessee or its agents and anyone directly or indirectly employed by them or anyone for whose acts they may be liable POOL USE Any rental group using the pool is responsible for fuinishmg a qualified life guard while the pool is in use A qualified life guard shall mean any person over 18 years of age, in good physical condition,having a current registered WSI,Red Cross or other approved lifeguard certification, and having no other duty to perform while in attendance at the pool A copy of the certificate with current date must be submitted prior to pool use Pool use shall be during daylight hours only(8 00 a rr to 8 00 pm) Failure to comply with any of the rules will necessitate the closure of the pool I have read and understand the rules and regulations listed on the back of this application and agree to abide by them HIGHLINTE SCHOOL DISTRICT#401 tihj of1 Organization Organizati i By 6�1� ��M nr� By Signature n II Signa re Date or l I D Da e 3 aA V Please read the back side of this form Rev 8/02 'v APPLICATION PROCEDURES Please Read Carefully 1 Deposit This agreement must be accompanied by a deposit 10%of the estimated total cost or$250 00,whichever is greater,in order to assure the reservation Retain(1)copy for your records 2 Cancellation Policy • Notification of cancellation 60-90 days prior to scheduled date will result in loss of deposit • Notification of cancellation 45-59 days pi for to scheduled date will result in a charge of 25%of estimated cost • Notification of cancellation 30-44 days prior to scheduled date will result in a charge of 50%of estimated cost • Notification of cancellation 14-29 days prior to scheduled date will result in a charge of 75%of estimated cost • Notification of cancellation less than 14 days prior to scheduled date will result in a charge of 100%of estimated cost. 3 Unless the Waskowitz District Office is notified of a decrease in the total number attending at least two work days before the first scheduled meal at Camp, the group will be charged on the basis of"Est Total No Campers"or actual number of Campers, whichever is higher 4 Rates quoted do not include bedding,lmen,recreation equipment, or audio-visual equipment. Provision of these are the responsibility of the renting group Camp equipment or bedding may be provided at an additional charge 5. A statement of charges will be sent to the lessee shortly after the rental period ends Prompt payment should be made to Highlnie School District and sent to Highlme School District, 15675 Ambaum Blvd S W ,Burien,WA 98166 6 The rates quoted by Camp staff are arrived at on the basis that the lessee will leave the Camp in the same order and ur as good condition as they found it on arrival. An added charge will be made if additional work must be done to ready the Camp for the next group 7 The lessee will be held financially accountable for any damage to Camp equipment or facilities done by a member or members of the leasing group 8 Adequate adult supervision must be provided for all youth groups It is suggested that a minimum ratio for a mixed group of youth or teenagers should be 1 to 10 9 Meal menus will be developed by Camp staff. Special requests should be arranged with the Head Cook at least 3 weeks prior to arrival GENERAL RULES AND REGULATIONS It is requested that the"Person in Charge at Camp" go over the following regulations with his/her group before their arrival at Camp. He/she must see that all regulations are adhered to by members of his/her group Further, it is proposed that the following general regulations will be observed 1 Firearms,air rifles,pellet guns,slingshots,look alike weapons,alcoholic beverages,illegal drugs/substances etc,are not allowed on the grounds 2 No smoking is allowed on Camp property 3 No campfires will be set without permission of the Camp staff. 4 Thermostats will be regulated only by Camp personnel 5 Absolutely no tampering with the fire piotection sprinkler system or fire alarm boxes located in each cabin 6 No material(i e towels,clothing,posters, etc,should be hung over or near heaters or lights at any time 7 Fire regulations state"No vehicles shall be parked in or near the vicinity of buildings" Vehicles are to be parked in the Camp parking lot only 8. No Camp equipment, i e beds,gear boxes,mattresses,tables,chalkboards shall be moved without permission of the Camp staff If moved,they are to be returned to the original location piior to departure 9. Swimmers must obey pool regulations(posted at pool entrance) A pool key will be provided to the"Person In Charge" The pool must be kept locked when qualified life guard is not on duty The pool is open June through August 10 Meals are served family style or buffet style in the Dining Hall at 8 00 a m, 12 00 noon, and 5 30 p in Durners after 5 30 p m will result in an additional charge 11 Pets are not allowed on Camp property 12 Guests of members of the lease group may not use the facility or will be charged as part-time users 13 Walk only on established paths or trails 14 No trees,plants or shrubs may be cut 15. The Waskowitz phones are for our business purposes. Please provide your group with a cell phone number to use while at Waskowitz. Rev.6/08 DATE A � CERTIFICATE OF LIABILITY INSURANCE 3,1,MDII ' 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(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 CONTACT NAME Alliant Insurance Services, Inc. PHONE FAX 720 Olive Way, Suite 1700 Alc No EM - - FAX No - - Seattle WA 98101 ADDRESS PRODUCER CUSTOMERID# KE5636C2 INSURER(S)AFFORDING COVERAGE NAIL# INSURED INSURER Princeton Excess 10786 City of Kent 220 Fourth Avenue South INSURERB Kent WA 98032-5895 INSURER INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER 1553739519 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 REOUIREMENT —ERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSJRANCE 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 TYPE OF INSURANCE L POLICY EFF POLICY EXP LIMITS LTR IN SIR POLICY NUMBER MM/DDNYYY MMlDDIYY'IV A GENERAL LIABILITY N--A3-PL-00C0069-00 -/-/20=1 1D/-/2Cli EACH OCCURRENCE $5,CDD,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence S CLAIMS-MADE 1�1 OCCUR MED EXP(Any one person) $ PERSONAL&ADV[NJ URY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LI M IT APPLI ES PER PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ A AUTOMOBILE LIABILITY N1-A3-RL-0000D69-00 1/1/2C11 10/1/2C11 COMBINED SINGLE LIMIT $5,000,000 (Ea accident) X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accidenq $ SCHEDULED AUTOS PROPERTY DAMAGE HIREDAJTOS (Per accident) S Ni AUTOS $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE S RETENTION $ $ WORKERS COMPENSATION 007ATII- OTH- ANDEMPLOYERS'LIABILITY YIN T _. ANY PROPRIETOR/PARTNER/EXECU7IVE E L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDEDI N/A (Mandatory in NH) E L DISEASE-EA EMPLOYE $ If yes,describe uncer DESCRIPTION OF OPERATIONS balm E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE Use of the facilities of Camp Waskowitz the week of August 8th-12th,2011. Camp for 160 children in the 5tn, 6th ar-d 7ta grades in Fall of 2011. Staffed by 38 adult volunteers CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS Highline School District Camp Waskowitz Attn: Ron Meyer 15675 Ambaum Blvd SW AUTHORIZED REPRESENTATIVE Burien WA 98166 i!w� ©t988-2009 ACORD CORPORATION All rights reserved ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD REQUEST FOR MAYOR'S SIGNATURE �� KtNT Please Fill in All Applicable Boxes WASHINa.oe Routing Information (ALL REQUESTS MUST FIRST BE ROUTED THROUGH THE LAW DEPARTMENT) Originator: Julie Stan le Phone (Originator): x5033 Date Sent: 3/9/11 Date Required: 3/23/11 Return Signed Document to: Teri Petrole CONTRACT TERMINATION DATE: 8/12/11 x501 VENDOR NAME: Highline School District DATE OF COUNCIL APPROVAL: #401 Brief Explanation of Document: 2011 contract with Highline School District #401 to rent the Camp Waskowitz facility in North Bend for one week, August 8 - 12, 2011. Children entering 5", 6th and 7" grades in the Fall of 2011 can sign up for this one week summer resident camp. The revenue generated from program fees collected for camp covers the entire rental fee. Can cts Must Be Routed Through The Law Department (This area to be completed by the Law Department) f�`i_ �� MAR 9 2011 , Received: Approva*KbA DEPT. Law Dept. Comments: O f1ce of the kj%jor EDateForwarded to Mayor: Shaded Areas To Be Completed By Administration Staff ; Received: [I `,`/ E. 1 Recommendations and Comments: r Disposition:*W/W'4 � ! CITY OFrTV CI G._k Date Returned: