HomeMy WebLinkAboutPK12-272 - Original - First Tee of Greater Seattle - Youth/Teen Golf Program at Riverbend - 12/07/2012 ecords Maiwageme-
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KENT Document
W ASHINGTON
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: First Tee of Greater Seattle
Vendor Number:
JD Edwards Number
Contract Number:
This is assigned by City Clerk's Office
Project Name: Youth/Teen Golf Program at Riverbend
Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment ® Contract
❑ Other:
Contract Effective Date: 9/15/2012 Termination Date: 9/15/2013
Contract Renewal Notice (Days): 60
Number of days required notice for termination or renewal or amendment
Contract Manager: Pete Petersen (tp) Department: Riverbend Golf
Complex
Detail: (i.e. address, location, parcel number, tax id, etc.):
S:Public\RecordsManagement\Forms\ContractCover\adcc7832 1 11/08
KENT
WASHINGTON
FACILITIES USE AGREEMENT
between the City of Kent and
FIRST TEE of GREATER SEATTLE
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and First Tee of Greater Seattle, located and doing business at 2340 Broadmoor
Drive East, Seattle, Washington 98112, (866)-858-5678, Contact: Heidi Wills,
heidiw(clthefirstteeseattle.org (hereinafter the "Contractor").
I. RECITALS
The City strives to offer recreation and cultural programs and services to meet the diverse needs of the
Kent community. The City operates the Riverbend Golf Complex located at 2019 West Meeker Street in
Kent. The City's goal is to offer a wide variety of golf related 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 interest in working with the Contractor to teach the basic fundamentals of golf and related
life skills to kids aged 5 - 18 at that location. A basic fundamental of golf and life skills 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 the Contractor limited
use of portions of the Riverbend Golf Complex during non-peak hours will enable that program to move
forward.
II. DESCRIPTION OF WORK.
The Contractor shall perform the following services for the City:
The Contractor will teach the basic fundamentals of golf and related life skills. Through their work with
young people and their families, the Contractor 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: The Superintendent of Golf Operations will determine a schedule during non-
peak hours that will not adversely affect the operation of the golf complex. The Contractor 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: Riverbend Golf Complex, 2019 West Meeker Street, Kent, WA 98032. This Agreement only
governs activity of the Contractor that occurs at the Riverbend Golf Complex; specifically, any offsite
activity by members of the Contractor is not governed by this Agreement.
Program: The Contractor will provide fundamental golf and related life skills to kids aged 5 -18 at the
Riverbend Golf Complex to the youth in the Kent community.
Participation: All girls and boys, ages 5 - 18 will be eligible for participation. Only members of the
Contractor may use the facilities under this program.
Concussion Awareness: The Contractor will sign and adhere to the requirements of the Youth Sports
Organization Concussion Awareness Statement (attached).
PROFESSIONAL SERVICES AGREEMENT - 1
(Under$10,000)
Staffing and volunteers: A minimum of one professionally trained coach will be on-site at all times.
The Contractor'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. The Contractor's Executive Director will be responsible for the behavior and conduct of ail
staff and volunteers while they are on site.
Facility Use: All persons associated with the Contractor, including program staff, volunteers, participants,
and parents will adhere to Kent Parks, Recreation, and Community Services Department and the
Riverbend Golf Complex rules for use of and access to the facility. See attached Exhibit A, Riverbend
Golf Complex Rules for Use and Access.
6Aha u11v)
Evaluation: The Superintendent of Golf Operations will meet tteKTiiy with the Contractor's Executive
Director (more often if deemed necessary by either party) to evaluate performance.
oy ?v45rok►o^ p1we 1.v
Fees and Charges: The Contractor will be responsible for any damages, additional fees, or charges
incurred through their use of the Riverbend Golf Complex. See attached Riverbend Golf Complex Rules for
Use and Access for specific fees and charges.
The 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.
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. 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 has an established and independent business that is eligible for a
business deduction for federal income tax purposes that existed before the City
retained the 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.
C. 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.
D. 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 the
Contractor's business, and has obtained a Unified Business Identifier (UBI) number
from the State of Washington.
E. 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.
PROFESSIONAL SERVICES AGREEMENT - 2
(Under$10,000)
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. The Contractor shall execute the attached City of Kent Equal
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. The 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 solely by the
City's negligence. The City's inspection or acceptance of any of the 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 Contractor shall procure and maintain for the duration of the
Agreement, insurance of the types and in the amounts described in Exhibit B, attached and incorporated
by this reference.
IX. The 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 the Contractor'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 the Contractor's own risk,
and the 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.
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.
PROFESSIONAL SERVICES AGREEMENT - 3
(Under$10,000)
F. Modification. No waiver, alteration, or modification of any of the provisions of this
Agreement shall be binding unless in writing and signed by a duly authorized representative of the City
and Kent Boxing Club.
G. Entire Agreement. The written provisions and terms of this Agreement, together with any
Exhibits attached hereto, shall supersede all prior verbal statements of any officer or other representative
of the City, and such statements shall not be effective or be construed as entering into or forming a part
of or altering in any manner this Agreement. Should any language in any of the exhibits to this
Agreement conflict with any language contained in this Agreement, the terms of this Agreement shall
prevail.
IN WITNESS, the parties below execute this Agreement, which shall become effective on
the last date entered below.
CITY OF KENT:
By: By:
( gnature) (signa e)
Print Name:_ de-;A Wills Pr t N e: Jeff Watling
Its: E$:ec 'A-}--,-4 a 3>ives-4aV Its: Director, Parks, Recreation & ommunity
(title) Services
DATE: to - I - 12
DATE:
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
Heidi Wills CITY OF KENT:
Executive Director
First Tee of Greater Seattle R. D. Pete Petersen, Jr.
Address: 2340 Broadmoor Drive East Supt. of Golf Operations
Seattle, WA 98112
City of Kent
Email: heidiw(abthefirstteeseattle.org 220 Fourth Avenue South
Kent, WA 98032
Telephone: 866-858-5678
rpetersen@kentwa.gov
(253) 856-5190 - Office (253) 709-7411 - Cell
253 856-6190 - Facsimile
P\Clvll\Files\Open Files\0463-Riverbend\Golf Complex Professional services Agreement door
PROFESSIONAL SERVICES AGREEMENT - 4
(Under$10,000)
EXHIBIT A
City of Kent
Parks, Recreation and Community Services Department
Riverbend Golf Complex Facilities Use Agreement
Rules for Limited Use and Access
Under the City of Kent (the "City") Facilities Use Agreement The First Tee of Greater Seattle
('The First Tee") agrees to abide by the following rules for limited use of the Riverbend Golf
Complex (the "Complex") for basic fundamental golf and life skills instruction (the "Program").
1. Limited use of the Complex will be provided by the City to The First Tee during non peak
times of business. Scheduled use of the driving range for Program - associated golf
instruction and the party room for Program - associated classroom instruction will be
determined by the Superintendent of Golf Operations ("Superintendent") on a quarterly
basis.
2. Use of the driving range for golf instruction will be limited to a maximum of six (6) hitting
stalls at any given time. Location of the six (6) stalls may vary depending on driving
range business and other scheduled lessons. When possible, the Program will utilize the
last six (6) stalls available on the driving range tee line.
3. Use of the driving range for golf instruction will be limited to the children participating in
the Program during the scheduled session. Adults, parents or guardians associated with
the children participating in the Program will not be allowed to hit range balls provided for
the Program.
4. The maximum number of Program participates per session on the driving range for golf
instruction will be limited to twelve (12) at any given time and require sharing of the six
(6) stalls provided.
5. The Complex will provide The First Tee access to the driving range and party room for the
following fees; two dollars and fifty cents ($2.50) per participant per session for range
balls/use of the driving range, and fifty cents ($0.50) per participant per session for the
use of the party room. Sessions will be limited to a maximum of one (1) hour and thirty
minutes (30).
6. The Complex will provide The First Tee approximately 3,000 bulk range balls (one
container) for the Program - associated golf instruction.
7. The First Tee will be responsible for providing its own professionals/instructors for giving
golf instruction. These professionals/instructors will be strictly limited to providing
instruction to the Program participants during the scheduled sessions of the Program and
are prohibited from giving independent golf instruction outside the scope of the Program.
S. The First Tee will be responsible for providing the necessary Program support, supplies
and staffing to set up all equipment necessary prior to the beginning of the sessions,
including range balls.
9. The First Tee will be responsible for providing adult supervision of Program participants at
all times.
10. The First Tee will be responsible for providing adult supervision of participants prior to the
beginning of any scheduled session. This requires that an adult associated with the
Program must be present a minimum of thirty (30) minutes prior to the beginning of any
scheduled session to provide supervision prior to the first Program participant arriving.
11. The First Tee will be responsible for providing the necessary support and staffing to clean
up after the end of each session which includes both the driving range and party room.
12.The First Tee will be responsible for providing adult supervision of Program participants
after the end of each session. This requires that an adult associated with the Program
must be present to provide supervision until the last participant has left the facility.
13.Program participants, adults, parents, guardians and instructors associated with The First
Tee will conduct themselves in a positive, polite and courteous manner at all times while
present at the Complex.
14.The Complex will provide The First Tee access on a space available basis one of the
Complex's three (3) practice putting greens. The Superintendent will approve use of the
practice putting greens on a space available basis as part of the quarterly schedule.
15.The Complex will provide The First Tee access to the mini-putt to participants of the
Program for two dollars ($2.00) per round per participant on a space available basis.
16.The Complex will provide The First Tee access to the Par 3 golf course for the participants
of the Program on a space available basis for two dollars ($2.00) per round during the
week and three dollars ($3.00) per round on the weekends. Tee times may be reserved
one week in advance. The Program director is responsible for reserving all tee times.
17.The Complex will provide The First Tee access to the 18-Hole golf course for the
participants of the Program on a space available basis after 12:00 pm for five dollars
($5.00) for nine (9) holes and ten dollars ($10.00) for eighteen (18) holes. Tee times
may be reserved one week in advance. The Program director is responsible for reserving
all tee times.
18.The Program director will be required to check in with the Pro Shop staff twenty (20)
minutes prior to the first scheduled tee time to confirm the number of participants.
Failure to check in may result in Program participants having to wait for the next available
open tee time or in some instance participants may not be able to play that particular day.
Additionally, no-showing for scheduled tee times may result in the Program's loss of
privilege to use the golf courses.
19.Program participants are required to arrive minimum of fifteen (15) minutes prior to their
scheduled tee time and be ready to play. Showing up late for a scheduled tee time may
result in Program participants having to wait for the next available open tee time or in
some instances participants may not be able to play that particular day.
20.Program participants agree to follow and abide by the Complex's "Pace of Play Policy" in
place at both golf courses. The "Pace of Play Policy" is designed to eliminate slow play by
have players play ready golf at all times for the enjoyment of all players. Therefore, it
may be necessary to provide an adult with some groups of participants that are just
learning the game or for those participants that tend to play slower to ensure that the
"Pace of Play Policy" is followed. Failure to abide by the Complex's "Pace of Play Policy"
may result in the Program's loss of privilege to use the golf courses.
21.The First Tee will be responsible for providing a storage unit for all equipment and
supplies necessary for the Program. The Complex will provide space at the driving range
for the storage unit.
22.All Program participants will be required to enter and exit the driving range through the
main entrance. Use of the back doors located at the teaching end of the driving range as
an entrance and exit is prohibited due to the interference with private lessons and for
security reasons. The back doors located at the teaching end of the driving range are to
remain closed at all times.
23.The First Tee will be responsible for submitting to the Complex on a weekly basis the
number of Program participants from the previous weeks sessions.
24.The Complex will invoice The First Tee on a monthly basis for the use of the Complex by
the Program's participants based on the weekly submittals by The First Tee.
25.Payment for the previous month's use of the facility must be received by the tenth of the
following month.
26.The First Tee agrees to pay $ 60, Do per month rent for two parking spaces
located at the west end of the driving range parking lot. The monthly rental rate will be
included on the monthly invoice for the previous month and due on the tenth of the
following month.
EXHIBIT B
INSURANCE & INDEMNITY REQUIREMENTS FOR
LEASE 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.
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 11 85. 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 11 85 or a substitute endorsement providing
equivalent coverage.
a
Minimum Amounts of Insurance
Contractor shall maintain the following insurance limits: "a
9
1. 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.
Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain, the following provisions for
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
2. maintained by the City shall be excess of the Contractor's insurance and shall not contribute
with it.
3. 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.
EXHIBIT B (Continued)
4. 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 coverage's for subcontractors shall be
subject to all of the same insurance requirements as stated herein for the Contractor.
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:
i
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 thefive requirements referenced above.N
Dated this alO day of 4vukx6ey , 20kA.
By: )AZS"
For: `AQ fitS1" Tu X GY#A+w SeA4Ka
Title: bietuA1 v2 bjrEc-toy
—P
Date: it •'f,��/�
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.
a
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.
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.
`E
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.
Dated this AO day of X)oJe1V%LQV , 20 11 .
v
For: Se_Q4{-(_2
Title: !_ ecu}i.Ne �JirzcY
Date: llA0 tom
City of Kent Parks, Recreation and Community Services
YOUTH SPORTS ORGANIZATION
CONCUSSION AWARENESS STATEMENT
RCW 28A.600.190
1 kaFi veal-Tee S A3 o BV-oa► rmby oti- E. 2.CL-b24-1301
Name of Organization Street Address Phone Contact
464 WI11,5 11 ♦1
Name of Representative Street Address Phone Contact
What is the nature and purpose for facility use?
T .ALQni►w LA aVA gol-P fk ,,lks JM 42LJ' 4-t" 5- 18.
.If-Tt%t irst Mv�a'yo th 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 $3,000,000.
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.
Signed:
Repres ntative of Organization pate
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
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.