HomeMy WebLinkAboutPK12-131 - Original - Steve Walters - Tennis Instruction - 05/04/2012 7-37
Records Maa ' A e m n
KENT
NAS„INGTON - Document
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: Steve Walters
Vendor Number:
JD Edwards Number
Contract Number: PK I1- 13 1
This is assigned by City Clerk's Office
Project Name: Tennis Instruction
Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract
❑ Other:
Contract Effective Date: 5/1/2012 Termination Date: 10/31/2012
Contract Renewal Notice (Days):
Number of days required notice for termination or renewal or amendment
Contract Manager: Lori Hogan Department: Recreation
Detail: (i.e. address, location, parcel number, tax id, etc.):
S Public\RecordsManagement\Forms\ContractCover\adcc7832 1 11/08
CAS ccel,�,K �
KENT
WASHINGTON
PROFESSIONAL SERVICES AGREEMENT
between the City of Kent and
Steve Walters
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and Steve Walters (vendor contractor) organized under the laws of the State of
Washington, located and doing business at 240 SW 184th St. Normandy Park, WA 98166 and 253-486-
2220 (hereinafter the "Contractor").
I. DESCRIPTION OF WORK.
Contractor shall perform the following services for the City:
Summer Quarter 2012
• All campers must be registered through Kent Parks, Recreation and
Community Services
• Steve Walters will instruct the skills of tennis in a professional manner
to Youth ages 5-17 in Steve's Summer Tennis Day Camp and Youth & Adults
ages 6-adult in Summer Tennis Lessons.
• Steve Walters will provide a fun and positive atmosphere where all
registrants will participate.
• Steve must be Certified in CPR and First Aid during the time of Steve's
Tennis Camps and Summer Tennis Lessons.
• Steve will hire and pay his own employees for Steve's Summer Tennis
Camp and Summer Tennis Lessons.
• Steve's Summer Tennis Day Camp and Summer Tennis Lessons will
maintain a 1:10 Instructor: Camp Participant Ratio including Steve Walters in
ratio If there are 11 students, then there will be at least 1 instructor and
Steve Walters totaling 2 Instructors present.
• Steve must be present during all hours of Steve's Summer Tennis Day
Camp and Summer Tennis Lessons.
• Steve must have all instructors fill out Washington State Patrol
Background Check prior to them working Summer Tennis Day Camp and
Summer Tennis Lessons (background check forms will be turned into the Kent
Commons, The City of Kent Parks, Recreation and Community Services will
cover the background check expense)
Contractor 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.
II. TIME OF COMPLETION. The 9
parties agree that work will begin on the tasks described in
P
Section I above immediately upon the effective date of this Agreement, and Contractor shall complete the
work by 8/18/2012 for Steve's Summer Tennis Day Camp and 10/31/2012 for Summer Tennis Lessons.
III. COMPENSATION. The City shall pay Contractor a total amount not to exceed $25,000
(See Exhibit B for for Steve's Summer Tennis Day Camp and Exhibit C for Summer Tennis Lessons) for the
services described in this Agreement. The Contractor shall invoice the City monthly based on time and
materials incurred during the preceding month. The hourly rates charged for Contractor's services shall
PROFESSIONAL SERVICES AGREEMENT - 1
(Over$10,000)
be as delineated in the attached and incorporated Exhibit B and Exhibit C. All hourly rates charged shall
remain locked at the negotiated rates throughout the term of this Agreement.
IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent Contractor-
Employer 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. The Contractor 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. The Contractor maintains and pays for its own place of business from which
Contractor's services under this Agreement will be performed.
C. The Contractor has an established and independent business that is eligible for a
business deduction for federal income tax purposes that existed before the City
retained Contractor's services, or the Contractor is engaged in an independently
established trade, occupation, profession, or business of the same nature as that
involved under this Agreement.
D. The Contractor 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.
E. The Contractor has registered its business and established an account with the state
Department of Revenue and other state agencies as may be required by Contractor's
business, and has obtained a Unified Business Identifier (UBI) number from the
State of Washington.
F. The Contractor 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 seven (7) calendar days written notice at its address set forth on the signature
block of this Agreement.
VI. DISCRIMINATION. In the hiring of employees for the performance of work under this
Agreement or any subcontract, the Contractor, its subcontractors, or any person acting on behalf of the
Contractor 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. Contractor 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. Contractor 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 Contractor'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 Contractor'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. The o a or s II procure and maintain for the duration of the
Agreement, insurance of the types n tl e a nts described in Exhibit A attached and incorporated
by this reference. X InJtiJe5 Ak-4 o 475vklice
XII. CONTRACTOR'S WORK AND RISK. The Contractor agrees to comply with all federal,
state, and municipal laws, rules, and regulations that are now effective or in the future become applicable
to Contractor's business, equipment, and personnel engaged in operations covered by this Agreement or
PROFESSIONAL SERVICES AGREEMENT - 2
(Over$10,000)
accruing out of the performance of those services. All work shall be done at Contractor's own risk, and
Contractor 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
I� 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.
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 Contractor.
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.
CONTRAC CITY OF KENT:
By: By: <:
Ce(S�g�ture)� . 1a\. S (signature)
Print Name: 3 ` V i2 UJ l Pri Na le S zette Cooke
Its: 'renn,5 In54r%, c_fo1
a or
tlev) I
DATE: q Z A
PROFESSIONAL SERVICES AGREEMENT - 3
(Over$10,000)
DATE:
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
CONTRACTOR: CITY OF KENT:
Steve Walters
lLy1. N ec r k D�D d
240 SW 184" St. City of Kent
Normandy Park, WA 98166 220 Fourth Avenue South
Kent, WA 98032
(2 5 3)&%-50 1,5(te I e p h o n e)
253-486-2220 (telephone) (253)$Sbbpp%facsimile)
(facsimile)
APP OVED A, TO ORM:
Kent Law Departmen
PROFESSIONAL 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 fiverequirements referenced above.
Dated this day of `` , 20
By: IV
A*
For: Clyo-F' rPn'(- PcrfcS Recto oo rvt'ces
Title: lehH +s /r)5+rtAc-�6r
Date: ��Lit rt.--
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.
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.
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 VeueSSuw,Mer Gehn(s PCy comp aid .limer (�e401
Company, hereby acknowledge and declare that the before-mentioned company was the prime
contractor for1he Agreement known as cc40Jlel\ Wi�-A4U5 that was entered into on the_
2 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 �` f i` , 20
ALA
By: i�// //
For: C14y ow F-enT p4rk5, &ree,+, <)v) Comm vmW r0 C4C
Title: l enn'i5 1 vt 5�r k44--6 r
Date: �) �� � � �
EEO COMPLIANCE DOCUMENTS - 3
EXHIBIT A
INSURANCE REQUIREMENTS FOR
SERVICE CONTRACTS
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. Automobile Liability Insurance covering all owned, non-
owned, hired and leased vehicles. Coverage shall be written
on Insurance Services Office (ISO) form CA 00 01 or a
substitute form providing equivalent liability coverage. If
necessary, the policy shall be endorsed to provide
contractual liability coverage.
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. 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 11
85 or a substitute endorsement providing equivalent
coverage.
2. Workers' Compensation coverage as required by the
Industrial Insurance laws of the State of Washington.
B. Minimum Amounts of Insurance
Contractor shall maintain the following insurance limits:
1. Automobile Liability insurance with a minimum combined
single limit for bodily injury and property damage of
$1,000,000 per accident.
1 2. Commercial General Liability 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.
EXHIBIT A (Continued)
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 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 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
respects to 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 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
the Contractor before commencement of the work.
F. Subcontractors
Contractor shall include all subcontractors as insured 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 the Contractor.
BROM 7139787780 WED APR 11 14131103 20_2 PAGE 1 OB 2
CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 04/05/20 2'
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(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,ANDTHE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must he endorsed_ If SUBROGATION IS WAIVED,subject to
the torms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rl ghts to the
certlficato holder in lieu of such endorsamant(s)
PRODUCER CONTACT
NAME
c/o 26 century
B Ewrvic&s of Georgia, Inc. PHONE 877-945-7378 I aAm N 888-467-2378
c/o 26 century Blvd. 4�1L11 l�U
P.O. sox 305191 E MAII
AnnHFRR certificatessvrillie.com
Nashville. TN 37 23 0-5191 _ INS_U_HhK_(S?A. IDkDINb03VL'RAGL NAIGR
INSURERA Philadelphia Yneurenae C®paniee 18058-900
INSURED INSURLRU ACE American Insurance Company 22667-008
United Slates Professional 7ennis Association, Inc. - '--
3535 ariarpark Drive INSURERC.
Houston, Tx 77042 INSURCRO
NeLIRERF_
INSURER r
COVERAGES CERTIFICATE NUMBER:17726348 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW I AVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED.NOTWITI(STANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITI I RESPGCT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL I HE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SI IOWN MAY HAVIr BkkN REL)OULD BY PAIL)CLAIMS -
INSR TYPE OF INSURANCE OD' SUB AP WV11 POLICY NUMBER POLICYEFF POLICYEXP LIMITS
A GENERAL LIABILITY y PHPKO01956 12/311201112/31/201 EEAAOMHAOHUGURHENQe $ 11000,000
C014MERLlAL GENERAL LIABILITY PRFM FF onNrTiNnor $ 500,000
6I AIVb-MAU6I �UCLUR MFD FXP( ny one P9rw) f
PERSONALS ADV INJURY s_ 1,OppI Op
AENFRAI AGrREGATE S 2,000,000
GEN'LAGGRECATE LIMIT APPLIES PFR f RODUCTS-COMNOPACO $
PULIGY PRO- LOC $
AUTOMO8ILE LIABILITY Da DcIBIlryry erDiI SINGLE LIMIT $
ANYAUTO OODILY INJURY(Per perms) $
ALLOWNFD SCHEUULLU BODILY INJUHY(Pereedeev) $
AUn)5 AUTOS
IIIREDAUTOS NON-OWNED PROPLRFYLIAMAUL
$
AUTOS (Per N)
j� X UMBRELLA LIAR I Xd OCCUR PHUB396514 12/31/201112/31/203. EACHOCCURRENCE F$ 3,000,000
EXCESS LIAR CLAIM6-MAVF: AGGREGATE UF0 X RETENTION$ 10,00 WORKERS COMPENSATIONAND EMPLUTkRi'LIAHILIfYJMITRANY PROPRIETORJPARTNCRJEXECUTIVE NIAOFFICFRIMFMRFR FXCLUDCD7antory InNH1 EL DISEASE-EA EMPLOYEE lyea,0ea�lbeuntler
DFAGRIPTIQN OF(JPEHAI IONS buluw FI OIBFABF-POI ICY LIMIT
t3 XCQ 0258322PA 12 31 201 12 31 201
EXCeea Liability $5,000,000 Limit
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IAMch Acord 101.Addltenal Remarks Schedule,if more space IS requuadi
Steve Walters 7177
UBPTA Membera are Insureds for General Liability for playing, teaching or Officiating in tennis or
Operating a tennis ball machine for practicing or teaching,
Kent Parks 4 ReCreation 6. Community Services is an Additional Insured ab respecLs General
Liability but only as respects to claims arising Out of the negligence of the !tamed Insured.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEn RFFORr-
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUIHUHIL6UNEPKESt IAINL:
RRnt Parks i Recreation s community Services '�.
525 4th Avp North I ,
Kent, WA 96023 In
Collt369O624 Tpl:1433011 Cert:17726348 @ 1988-2010ACORD CORPORATION.All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
I .
FROM 7139787780 WED APR 11 14r31:41 2012 BAGS 2 OF 2
PI-AS-WO(04/04)
JIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY
ADDITIONAL INSURED: OWNERS AND!OR LESSORS OF PREMISES,
LESSORS OF LEASED EQUIPMENT, SPONSORS OR CO-
PROMOTERS
This endorsement rnodifles insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Thls policy is amended to Include as an additional insured any person or organization of the types
designated below,but orAy with respect to liability arising out of your operations:
1. Owners and/or lessors of the premises leased,rented,or loaned to you,subject to the following
additional exclusions:
a. This Insurance applies only to an"oocurrenao'M*h takes place while you are a tenant In the
premises;
b. Thle Insurance does not apply,to'bodlly Injury"or"property damage"resulting frw structural
alterations,new construction or demolition operations performed by or on behalf of the owner and
/or lessor of the prernkmR;
a. Thls Insurance does not apply to liability of the owners and/or leaeors for'bodlly Injury"or
"pnaparty damage"arising out of any design defect or structural maintenance of the promises or
lobs caused by a premises defect,
With roaperA to any additional Insured Included under this porky,this Insurance does not apply In the
sole negligence of such addltional insured.
2. Lessor of Leased Equipment, but only with reapectto liability for"bociliy Injury ,"property damage'or
`personal and advertising Injury"caused,in whale or In part, by your mendenamo,operation or use of
equipment leased to you by such person(s)or orgenizatlon(s)subject to the following additlonal
exclusions:
a. This Insurance does not apply to any"oocurrenca"which lakes place after the equipment tease
explros.
3. Sponsors
4. Co-Romuleis
Page 1 of 1
FARM E R5
EVIDENCE OF INSURANCE - STATE OF WASHINGTON
Named insured Policy number: 186491155
STEVEN I WALTERS Effectivedate: 01-27-2012
240 SW 184% ST Expiration date: 07-27-2012
NORMARDY PARK WA 98166-3952
NAI(number: 21644
FARMERS INSURANCE COMPANY OF WASHINGTON, MERCER IS, WA ,an authorized Washington
insurer,certifies that it has issued an owners liability insurance policy pursuant to the Mandatory Insurance
Law of Washington Examine the Policy Exclusions carefully This form does not constitute any part of your
insurance policy
Vehicle descnphea Regdered owner
2003 DODGE TRUCK CARAVAN VAN 2WD SE 1D4GP25303B270799 STEVEN Q WALTERS
Agentname NW ServtcePol'nt Phone no. ( )
25-6409 10-10 Keep this certificate in your vehicle at all times. A6409211
' W USA GTON DRIVER LICENSE
WASBjN
4a uctt WALTESJ3B8MQ DONORV ;
WALTERS
r 2 STEVEN JAMES
4a tss 07.29.2010
Doe 07.18.1962
fi ^ u 240 SW 184TH ST `•
NORMANDY PARK WA 98166-3952
F
' 'S( tsSrx M 16 Hyt 600
sfir 174yyt 170 ,e Eyes BLU
I s Class s.End NONE 4a Exp 07-18.2016
' 12 Restrictions C
e
✓ _ 'w .~ s DO WALTESJ388M032102163D1545 R.v 6516 20044
. S
1
`✓ KENT
PARKS RECREATION &
COMMUNITY SERVICES
Exhibit B
2012 Steve's Summer Tennis Day Camp
Steve Walters will receive 60% of the registration fees. The amount received will
be:
$33.00 for each $55.00 registration fee for ages 5-7
$58.80 for each $98.00 registration fee for ages 8-17
Ages 5-7 will have a camp minimum of 4 and maximum of 20
Ages 8-17 will have a camp minimum of 4 and maximum of 50
Ages 5-7
45659 M-Th 9:OOam-10:30am 6/25-6/28
45660 M-Th 9:OOam-10:30am 7/9-7/12
45661 M-Th 9:OOam-10:30am 7/23-7/26
45662 M-Th 9:OOam-10:30am 8/6-8/9
45663 M-Th 9:OOam-10:30am 8/13-8/16
Kent Meridian H.S. S. Walters 4 Sess/$55
Ages 8-17
45664 M-Th 10:30am-1:30pm 6/25-6/28
45665 M-Th 10:30am-1:30pm 7/9-7/12
45666 M-Th 10:30am-1:30pm 7/23-7/26
45667 M-Th 10:30am-1:30pm 8/6-8/19
45668 M-Th 10:30am-1:30am 8/13-8/16
Kent Mendiain H.S. S. Walters 4 Sess/$98
45669 Mon-Fr 9:OOam-12:OOpm 7/2-7/6(No 7/4)
45670 M-Th 9:OOam-12:OOpm 7/16-7/19
45671 M-Th 9:OOam-12:OOpm 7/30-8/2
Kent Meridian H.S. S. Walters 4 Sess/$98
(location subject to change)
`✓ KENT
F+�k4 c_FC:dGf &
COMMA itUTi SERVICES
Exhibit C
2012 Summer Tennis Lessons
Steve Walters will receive 70% of the registration fees. The amount received by
Steve Walters will be:
$42.00 for each $60.00 registration fee.
Summer Tennis Lessons
All lessons have a minimum of 4 and maximum of 20.
BEGINNER (AGES 6-10)
45673 Tu, Th 4:30pm-5:30pm 6/5-6/28
45674 Tu, Th 4:30pm-5:30pm 7/3-7/26
45675 Th, Tu 4:30pm-5:30pm 8/2-8/28
S. Walters 8 sess/$60
BEGINNER (AGES 11-14)
45676 Tu, Th 6:00pm-7:00pm 5/1-5/24
45677 Tu, Th 5:30pm-6:30pm 6/5-6/28
45678 Tu, Th 5:30pm-6:30pm 7/3-7/26
45679 Th, Tu 5:30pm-6:30pm 8/2-8/28
45680 Tu, Th 6:00pm-7:00pm 9/4-9/27
45681 Tu, Th 6:00pm-7:00pm 10/2-10/25
S. Walters 8 sess/$60
BEGINNER/INTERMEDIATE (AGES 15-Adult)
45682 Tu, Th 7:00pm-8:00pm 5/1-5/24
45683 Th, Tu 6:30pm-7:30pm 6/5-6/28
45684 Tu, Th 6:30pm-7:30pm 7/3-7/26
45685 Th, Tu 6:30pm-7:30pm 8/2-8/28
45686 Tu, Th 6:30pm-7:30pm 9/4-9/27
S. Walters 8 sess/$60
All Classes held at Kent Meridian High School
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