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HomeMy WebLinkAboutPK11-224 - Original - Kent East Hill Kids (PAL) Boxing Club - Kent Kids Boxing Club - 06/30/2011 4100 Records Management 7KENT Document WRSNINGTON CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to City Clerks Office. All portions are to be completed. If you have questions, please contact City Clerk's Office. Vendor Name: Kent East Hill Kids (PAL) Boxing Club Vendor Number: JD Edwards Number Contract Number: 490/- z7 This is assigned by City Clerk's Office Project Name: Kent Kids Boxing Club Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract ❑ Other: Contract Effective Date: 6/30/2011 Termination Date: 6/30/2012 Contract Renewal Notice (Days): 60 days Number of days required notice for termination or renewal or amendment Contract Manager: Lori Hogan Department: Parks Youth/Teen Programs Detail: (i.e. address, location, parcel number, tax id, etc.): Boxing club will be using the fitness room at the Community Center (Phoenix Academy) 5 Public\RecordsManagement\Forms\ContractCover\adcc7832 1 11/08 z FACILITIES USE AGREEMENT between the City of Kent and Kent East Hill Kids (PAL) Boxing Club THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter the "City"), and Kent East Hill Kids (PAL) Boxing Club located and doing business at 28026 189th Avenue S.E., Covington, WA 98042 (hereinafter "Kent Boxing Club"). I. RECITALS The City strives to offer recreation and cultural programs and services to meet the diverse needs of the Kent community. The City currently operates a Teen Community Center at the Phoenix Academy under the terms of a reciprocal use agreement with the Kent School District. The City's goal is to offer a wide breadth of programs to youth and teens at that location. The City has found that collaborative partnerships allow it to expand program offerings and participant access within budget constraints. The City has been approached by the Kent Boxing Club to teach amateur boxing and individual conditioning to kids aged 8 - 18 at that location. A boxing program would be of value and interest to youth in the Kent community, but the City does not have sufficient staff or resources to make that program available. Entering into an agreement that allows Kent Boxing Club to use the Teen Community Center will enable that program to move forward. II. DESCRIPTION OF WORK. Kent Boxing Club shall perform the following services for the City: The Kent Boxing Club will teach amateur boxing and individual conditioning. Through their work with young people and their families, Kent Boxing Club hopes to create in their participants a sense of community involvement and engagement in their neighborhood while strengthening individual skills including leadership, communication, fitness, and positive conflict resolution. Schedule of operations: Monday through Thursday, 5:00pm - 8:00pm, following the Teen Community Center's scheduled days of operation. Boxing staff will be on site at least 30 minutes prior to the start of the program and at least 30 minutes after the conclusion of the program. Changes in scheduling must be approved by the City. Location: Kent Parks Teen Community Center (operating within the weight room of the Kent School District's Phoenix Academy, 11000 SE 264th, Kent, WA 98030). This Agreement only governs activity of the Kent Boxing Club that occurs at the Kent Parks Teen Community Center; specifically, any offsite activity by members of the Kent Boxing Club is not governed by this Agreement. Sanctioning:The program will be sanctioned by USA Boxing and Greater King County Police Activity League (PAL). Individual participants will become members of USA Boxing through payment of fees established by that entity. Kent Boxing Club will provide appropriate certification signifying their affiliation with these sanctioning bodies. Program: Standards for curriculum, safety and health, personal safety equipment, attire, equipment use, and equipment maintenance shall be consistent with those established through USA Boxing Guidelines. The program shall not include competitions with other boxing clubs that occur at the Kent Parks Teen Community Center. Participation: All girls and boys, ages 8 - 18 will be eligible for participation. Prior to participation, they must pass a physical exam and receive clearance established by USA Boxing Guidelines. Only members of the Kent Boxing Club may use the facilities; specifically, this Agreement does not sanction use of the Kent Parks Teen Community Center for competitions with other boxing clubs. Facilities Use Agreement - Kent E. Hill Kids (PAL) Boxing Club Page 1 Concussion Awareness: Kent Boxing Club will sign and adhere to the requirements of the Youth Sports Organization Concussion Awareness Statement (attached). Staffing and volunteers: One professionally trained coach (training consistent with USA Boxing standards and curriculum) and minimally 2 additional adult staff or volunteers will be on-site at all times. Kent Boxing Club's Executive Director will be responsible to ensure that all staff and volunteers have passed a Washington State Patrol background check and have received adequate training prior to participation in the program. Kent Boxing Club's Executive Director will be responsible for the behavior and conduct of all staff while they are on site. Facility Use: All persons associated with the Kent Boxing Club including program staff, volunteers, participants, and parents will adhere to Kent School District and Kent Parks, Recreation, and Community Services Department rules for use of and access to the facility. Evaluation: City staff will meet quarterly with Kent Boxing Club's Executive Director (more often if deemed necessary by either party) to evaluate performance. Fees and Charges: Kent Boxing Club will be responsible for any damages, additional fees, or charges incurred through their use of the Phoenix Academy Community Center. Kent Boxing Club further represents that the services furnished under this Agreement will be performed in accordance with generally accepted professional practices within the Puget Sound region in effect at the time those services are performed. III. TERM OF PROGRAM The parties agree that the program will begin as described in Section II above immediately upon the effective date of this Agreement and shall continue for a term of one year, unless the Agreement is terminated prior to that date pursuant to Section V herein. Upon expiration of this Agreement, if it is the desire of both parties to extend this Agreement, the parties may execute an addendum extending the term of this Agreement for an additional year on an annual basis. IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor relationship will be created by this Agreement. By their execution of this Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following representations: A. Kent Boxing Club 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. B. Kent Boxing Club has an established and independent business that is eligible for a business deduction for federal income tax purposes that existed before the City retained Kent Boxing Club's services, or Kent Boxing Club is engaged in an independently established trade, occupation, profession, or business of the same nature as that involved under this Agreement. C. Kent Boxing Club is responsible for filing as they become due all necessary tax documents with appropriate federal and state agencies, including the Internal Revenue Service and the state Department of Revenue. D. Kent Boxing Club has registered its business and established an account with the state Department of Revenue and other state agencies as may be required by Kent Boxing Club's business, and has obtained a Unified Business Identifier (UBI) number from the State of Washington. E. Kent Boxing Club maintains a set of books dedicated to the expenses and earnings of its business. V. TERMINATION. Either party may terminate this Agreement, with or without cause, upon providing the other party thirty (30) calendar days written notice at its address set forth on the signature block of this Agreement. Facilities Use Agreement - Kent E. Hill Kids (PAL) Boxing Club Page 2 VI. DISCRIMINATION. In the hiring of employees for the performance of work under this Agreement or any subcontract, Kent Boxing Club, its subcontractors, or any person acting on behalf of Kent Boxing Club or subcontractor shall not discriminate against any person who is qualified and available to perform the work to which the employment relates as provided for by the City of Kent's Equal Employment Opportunity Policy. Kent Boxing Club shall execute the attached City of Kent Equal 't Employment Opportunity Policy Declaration, Comply with the attached City Administrative Policy 1.2, and upon completion of the contract work, file the attached Compliance Statement. VII. INDEMNIFICATION. Kent Boxing Club 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 Kent Boxing Club's performance of this Agreement, except for that portion of the injuries and damages caused solely by the City's negligence. The City's inspection or acceptance of any of Kent Boxing Club's work when completed shall not be grounds to avoid any of these covenants of indemnification. The provisions of this section shall survive the expiration or termination of this Agreement. VIII. INSURANCE. Kent Boxing Club shall procure and maintain for the duration of the Agreement, insurance of the types and in the amounts described in Exhibit A attached and incorporated by this reference. IX. KENT BOXING CLUB'S WORK AND RISK. Kent Boxing Club agrees to comply with all federal, state, and municipal laws, rules, and regulations that are now effective or in the future become applicable to Kent Boxing Club's business, equipment, and personnel engaged in operations covered by this Agreement or accruing out of the performance of those services. All work shall be done at Kent Boxing Club's own risk, and Kent Boxing Club 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. X. 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, including all appeals, in addition to any other recovery or award provided by law; provided, 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. E. Assignment. Any assignment of this Agreement by either party without the written consent of the non-assigning party shall be void. Facilities Use Agreement - Kent E. Hill Kids (PAL) Boxing Club Page 3 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 Kent Boxing Club. 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. 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. IN WITNESS, the parties below execute this Agreement, which shall become effective on the last date entered below. KENT EAST HILL KIDS (PAL) BOXING CLUB: CITY OF KENT: BY: By: I (Sig tur � l AA (signature) Print Nanjg e fe PrCtNa e: Jeff Watling Its: i' 2/ Itector, Parks, Recreation and Community (title) Services DATE: DATE:�S�Y1� 3fl. I NOTICES TO BE SENT TO: NOTICES TO BE SENT TO: KENT EAST HILL KIDS (PAL) BOXING CLUB: CITY OF KENT: Leslie Kae Hamada, Executive Director Lori Hogan, Supt, Recreation and Cultural Services Kent East Hill Kids (PAL) Boxing Club City of Kent 28026 189th Avenue S.E. 220 Fourth Avenue South Covington, WA 98042 Kent, WA 98032 Leslie.hamada@yahoo.com Ihogan@ci.kent.wa.us 253-631-3895 / 206-892-8197 (cell) (253) 856-5050 (telephone) Facsimile: 253) 856-6050 (facsimile i P\Civil\Files\Open Files\0105-2011-Parks Geneml\BOXING ProfessionalServlcesAgreement dooc Facilities Use Agreement - Kent E. Hill Kids (PAL) Boxing Club Page 4 EXHIBIT A INSURANCE REQUIREMENTS FOR THE FACILITIES USE AGREEMENT Between the City of Kent and Kent East Hill Kids (PAL) Boxing Club Insurance Kent Boxing Club 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 Kent Boxing Club, their agents, representatives, employees or subcontractors. Minimum Scope of Insurance Kent Boxing Club shall obtain insurance of the types described below: 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 City shall be named as an insured under Kent Boxing Club's Commercial General Liability insurance policy with respect to the work performed for the City using ISO additional insured endorsement CG 20 10 11 85 or a substitute endorsement providing equivalent coverage. Minimum Amounts of Insurance Kent Boxing Club shall maintain the following insurance limits: Commercial General Liability insurance shall be written with limits no less than $2,000,000 each occurrence and $3,000,000 general aggregate limit. This coverage may include both a primary layer and an Excess layer in order to achieve the liability limit required under this agreement. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions for Commercial General Liability insurance: 1. Kent Boxing Club'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 Kent Boxing Club's insurance and shall not contribute with it. 2. Kent Boxing Club'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 certified mail, return receipt requested, has been given to the City. 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 Kent Boxing Club 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. Kent Boxing Club'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 respects to the limits of the insurer's liability. EXHIBIT A (Continued) 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 Kent Boxing Club shall furnish 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 Kent Boxing Club before commencement of the work. F. Subcontractors Kent Boxing Club shall include all subcontractors as insureds under its policies or shall furnish 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 Kent Boxing Club. 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 fulfil the five requirements referenced above. Dated this ZI day of �� , 20� By: s-1 ` L ylqz � rx)z For: 7 �c S Title: 6` Date: 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. Any contractor, subcontractor, consultant or supplier who willfully disregards the City's nondiscrimination and equal opportunity requirements shall be considered in breach of contract and subject to suspension or termination for all or part of the Agreement. iI 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 sub]ect 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. 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-mentione6-'cor�6any/owas e prime con ctor 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. Dated this day of r) �, , 20--d By: For: LYS Title: P `!� 2 Date: ZS l City of Kent Parks, Recreation and Community Services ENT R,rvSFa ,F= YOUTH SPORTS ORGANIZATION CONCUSSION AWARENESS STATEMENT RCW 28A.600.19 me of Orbanizatioo Street Addre Phone Contact A Na a of Reprtgntitik Street Address �`�p`��� Phone Contact CCJJ'.' I What is the nature and purpose for facility use? Kent Boxing Club, a youth sports organization/team, hereby verifies all coaches, athletes and their parent/guardian have complied with mandated policies for the management of concussions and head injuries as prescribed by RCW 28A.600.190. A copy of the text of this statute is provided on the back of this form. All community organizations/teams requesting use of City of Kent Park facilities must also submit a Certificate of Insurance and Endorsement naming the City of Kent as an additional insured for the amount of $2,000,000. The undersigned representative certifies that the information above is true and correct and hereby certifies this statement on behalf of the identified organization including all teams, players, coaches and parents/guardians affiliated with such organization. Signe : I Representative of Organization Date i Note: Access to City of Kent facilities may not be granted until all requirements of this application are complete and approved by the Kent Parks Department and/or designee. i -see reverse side- RCW 28A.600.190 Youth sports — Concussion and head injury guidelines — Injured athlete restrictions — Short title. (1)(a) Concussions are one of the most commonly reported injuries in children and adolescents who participate in sports and recreational activities. The centers for disease control and prevention estimates that as many as three million nine hundred thousand sports-related and recreation-related concussions occur in the United States each year. A concussion is caused by a blow or motion to the head or body that causes the brain to move rapidly inside the skull. The risk of catastrophic injuries or death are significant when a concussion or head injury is not properly evaluated and managed. (b) Concussions are a type of brain injury that can range from mild to severe and can disrupt the way the brain normally works. Concussions can occur in any organized or unorganized sport or recreational activity and can result from a fall or from players colliding with each other, the ground, or with obstacles. Concussions occur with or without loss of consciousness, but the vast majority occurs without loss of consciousness. (c) Continuing to play with a concussion or symptoms of head injury leaves the young athlete especially vulnerable to greater injury and even death The legislature recognizes that, despite having generally recognized return to play standards for concussion and head injury, some affected youth athletes are prematurely returned to play resulting in actual or potential physical injury or death to youth athletes in the state of Washington. (2) Each school district's board of directors shall work in concert with the Washington interscholastic activities association to develop the guidelines and other pertinent information and forms to inform and educate coaches, youth athletes, and their parents and/or guardians of the nature and risk of concussion and head injury including continuing to play after concussion or head injury. On a yearly basis, a concussion and head injury information sheet shall be signed and returned by the youth athlete and the athlete's parent and/or guardian prior to the youth athlete's initiating practice or competition. (3) A youth athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be removed from competition at that time. (4) A youth athlete who has been removed from play may not return to play until the athlete is evaluated by a licensed health care provider trained in the evaluation and management of concussion and receives written clearance to return to play from that health care provider. The health care provider may be a volunteer. A volunteer who authorizes a youth athlete to return to play is not liable for civil damages resulting from any act or omission in the rendering of such care, other than acts or omissions constituting gross negligence or willful or wanton misconduct. (5) This section may be known and cited as the Zackery Lystedt law. DATE 6111 0/2011 CERTIFICATE OF INSURANCE --- CERTIFICATE NUMBER 120110610046265 AGENCY: rEntertainment&Sports Insurance eXperts(ESIX) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS 5660 New Northside Drive,Suite 640 NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Atlanta,Georgia 30328 Phone 678-324-3300 Fax 678-324-3303 i NAMED INSURED�a — I INSURERS AFFORDING COVERAGE USA Boxing The Kent East Hill Kids(PAL)Boxing INSURER A Philadelphia Insurance Company One Olympic Plaza Phonenix Academy High School Weight Room INSURER B Philadelphia Insurance Company Colorado Springs,Colorado 80909 Kent,Washington 98030 EVENT INFORMATION Training 2010-2011 (-) -- I POLICYICOVERAGE 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 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS l INS l TYPE OF INSURANCE l POLICY NUMBERS) EFFECTIVE EXPIRES: LIMITS i A (GENERAL LIABILITY-_-- ------ __ - --�--- ----- —-�� PHPK630702 10/1/2010 10/1/2011 GENERAL AGGREGATE $5,000,000 X Occurrence 12 01 AM ,12 01 AM -------------- X Participant Legal Liability EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES(Each Odd) $300,000 MEDICAL EXPENSE(Any one person) EXCLUDED PERSONAL&ADV INJURY $1,000,000 -- PRODUCTS-COMP/OPAGG $1,000,000 B IUMBRELLAIEXCESSLIABILITY _ _ _ 1 __ r -- -- --- -- _PHU6322830 10/1/2010---_ -110/1/2011 I X Occurrence AGGREGATE $1,000,000 I n 12 01 AM 112 01 AM ------- - - EACH OCCURRENCE - — $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY EN DO RSEMENTISPECIAL PROVISIONS -—_ r- The certificate holder is an Additional Insured with repect to liability arising out of the negligence of the Named Insured as per the following endorsement Additional Insured-Certificate Holders(Form PI-AM-002) Coverage is excluded for ANY martial arts or kick-boxing activities,regardless of whether they are part of a USA Boxing sanctioned activity or club activity it CERTIFICATE HOLDER NOTICE OF CANCELLATION: City of Kent Parks Department Should any of the above described policies be cancelled before the expiration date thereof, 220 4th Ave,South notice will be delivered in accordance with the policy provisions Kent,Washington 98032 AUTHORIZED REPRESENTATIVE PI-MANU-1 (01/00) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY PI-AM-002 (08/06) ADDITIONAL INSURED - CERTIFICATE HOLDERS ADDITIONAL INSURED - CERTIFICATE HOLDERS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY PART SECTION II - WHO IS AN INSURED is amended to include any Certificate Holder, identified as an additional insured, on a Certificate of Insurance issued ESIX 3 LLC dba Entertainment & Sports Insurance Experts (ESIX) or Philadelphia Indemnity Insurance Company, but only for liability arising out of the negligence of the named insured. The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement. These limits are inclusive of and not in addition to the limits of insurance shown in the declarations. All other terms and conditions of this Policy remain unchanged. Page 1 of 1 A� CERTIFICATE OF LIABILITY INSURANCE 3/22/20 1" PRODUCER (661)327-3111 FAX: (661)327-1262 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Thomas B. Mestmaker Ins Associates ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR c/o Wilson Paves & Associates ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW 2300 Bahamas Drive i Bakersfield CA 93309 _ _ _ INSURERS AFFORDING COVERAGE INAIC# INSURED _ i INSURERA Lexington Insurance Company '14437 Greater King County Police Activities League INSURERB Natl Un_Fire Ins CO/Pittsburg 19445 800 5th Ave. #101-216 INSURERc -m— INSURER D Seattle I WA 98124 I INSURERE COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTVNTHSTAN DING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT NTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OFSUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS POLICY EFFECTIVE POLICY EXPIRATION ILTR IMM TYPE FIN NCE PODGY NUMBER DATE MMIDDIYYYY ? M DI LIMITS GENERAL LIABILITY I EACH OCCURRENCE OAMAC�,El�RE�Tc�D---- Xj COMMERCIAL GENERAL LIABILITY -PREMISES fEa occurrencel $ 300,000 A X r CLAIMS MADE Fi OCCLR 9471733 7/1/1010 7/1/21111 MED EXP(Any on a Pem I $ 5 OD0 — — r exual Abuse PERSONAL&ADV INJURY $ 1,000'D D 0 IL LGENERAL AGGREGATE $ 3,000,000 �AGGREGA-E LIMIT APPLIES PER (PRODUCTS-COMP/OPAGG I$ 1,000,000 PRO- OLICY T LOC I AUTOMOBILE LIABILITY 'I COMBINED SINGLE LIMIT I$ ANY AUTO (Ea scndent) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS tP_Pe son) -- $ ---- HIRED AUTOS i !BODILY INJURY $ i (Per ecudent) i NON-OWNED AUTOS I PROPERTY DAMAGE {Per acadent) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ I ANY AUTO AOTHER UTOOTHAN FA ACC($ —j AUTO ONLY pGG $ i I j EXCESS/UMBRELLA UABILnY EACH OCCURRENCE $ j OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ I WORKERS COMPENSATION WC STATU- 07H- ANDEMPLOYERS'LIABILTTY YIN S ANY PROPRIETOR/PART,NERIEXECUTNE EL EACH ACCIDENT OFFICER/MEMSER EXCLUDED (Masdatcry in NHj E L DISEASE-EA EMPLOYEE E It yes,de be urdff EL DIS EASE-POLICY LIMB I S SPECIAL PROVISIONS be'mv B OTHERACC ident/Medical ROOD09101551 17/1/2010 7/l/2011 (Limit $50,000 Deductible $50.00 A Directors k Officers 28182305 ,7 1 2010 I 7 1 2011 1 000 1 0DO DESCRIPTION OF OPERATIONS I LOCATION'S/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Re: Kent Eill Boxing Club. City of Kent is included as additional insured as required by written contract per attached Form CG2026 1185 with respects to the general liability and only with regards to the operations of the named insured e10 day cancellation for nonpayment as per the disclaimer shown below. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRI BED POLICIES BE CANCELLED BEFORE THE EXPIRATION City Of Kent DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MA L *30 DAYS WRITTEN 220 Fourth Ave S. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Kent, WA 98032 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES AUTHORIZED REPRESENTATIVE Mike Wilson/AM ACORD 25(2009101) ©1988.2009 ACORD CORPORATION AH rights reserved INS025(20o99t) The ACORD name and logo are registered marks of ACORD POLICY NUMBER- 9471733 POLICY PERIOD: 7/l/2010-7/l/2011 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 Kent 220 Fourth Ave S. Kent,NVA 98032 (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 26 1185 Copyright,Insurance Services Office,Inc., 1984 Page 1 of 1