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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 Clerks Office.
Vendor Name: Theresa R. Dusek) Vendor Number: JD Edwards Number
Contract Number.
This is assigned by Deputy City Clerk
Description: 2014 Wetland Environmental Consultant Services Agreement
Detail: Wetland / Environmental Consultant Services
Project Name: Wetland / Environmental Consultant Services
Contract Effective Date: 1 1 2014 Termination Date: 12/31/2014
Contract Renewal Notice (Days):
Number of days required notice for termination or renewal or amendment
Contract Manager: Brennan Tavlor Department: ECD
Abstract:
S:Publlc\RecordsManagement\Forms\ConhaciCover\ADCL7832 07/02
CONSULTANT VICE AGREEMENT
between the City of Kent and
Theresa R. Dusek
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation
(hereinafter the "City"), and Theresa R. Dusek organized under the laws of the State of
Washington , located and doing business at 3910 North Defiance, Tacoma, WA 98407, 253 861-
3355 (hereinafter the "Consultant").
I, DESCRIPTION OF WORK.
Consultant shall perform the following services for the City in accordance with the
following described plans and/or specifications:
As attached and described in Exhibit A
Consultant 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 parties agree that work will begin on the tasks
described in Section I above immediately upon the effective date of this Agreement. Upon the
effective date of this Agreement, Consultant shall complete the work described in Section I by
December 31, 2014.
III. COMPENSATION.
A. The City shall pay the Consultant, based on time and materials, an amount not to
.exceed $20,000.00, plus applicable Washington State sales tax, for the services
described in this Agreement. This is the maximum amount to be paid under this
Agreement for the work described in Section I above, and shall not be exceeded
without the prior written authorization of the City in the form of a negotiated and
executed amendment to this agreement. The Consultant agrees that the hourly or
flat rate charged by it for its services contracted for herein shall remain locked at
the negotiated rate(s) for a period of one (1) year from the effective date of this
Agreement. The Consultant's billing rates shall be as delineated in Exhibit A.
B. The Consultant shall submit monthly payment invoices to the City for work
performed, and a final bill upon completion of all services described in this
CONSULTANT SERVICES AGREEMENT - 1
(Over$10,000)
Agreement. The City shall provide payment within forty-five (45) days of receipt of
an invoice. If the City objects to all or any portion of an invoice, it shall notify the
Consultant and reserves the option to only pay that portion of the invoice not in
dispute. In that event, the parties will immediately make every effort to settle the
disputed portion.
IV. INDEPENDENT CONTRACTOR. The parties intend that an Independent
Contractor-Employer Relationship will be created by this Agreement. By their execution of this
Agreement, and in accordance with Ch. 51.08 RCW, the parties make the following
representations:
A. The Consultant has the ability to control and direct the performance and
details of its work, the City being interested only in the results obtained
under this Agreement.
B. The Consultant maintains and pays for its own place of business from which
Consultant's services under this Agreement will be performed.
C. The Consultant has an established and independent business that is eligible
for a business deduction for federal income tax purposes that existed before
the City retained Consultant's services, or the Consultant is engaged in an
independently established trade, occupation, profession, or business of the
same nature as that involved under this Agreement.
D. The Consultant 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 Consultant has registered its business and established an account with
the state Department of Revenue and other state agencies as may be
required by Consultant's business, and has obtained a Unified Business
Identifier (UBI) number from the State of Washington.
F. ' The Consultant 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) days written notice at its address set forth on
the signature block of this Agreement. After termination, the City may take possession of all
records and data within the Consultant's possession pertaining to this project, which may be
used by the City without restriction. If the City's use of Consultant's records or data is not
related to this project, it shall be without liability or legal exposure to the Consultant.
VI. DISCRIMINATION. In the hiring of employees for the performance of work under
this Agreement or any subcontract, the Consultant, its subcontractors, or any person acting on
behalf of the Consultant or subcontractor shall not, by reason of race, religion, color, sex, age,
sexual orientation, national origin, or the presence of any sensory, mental, or physical disability,
discriminate against any person who is qualified and available to perform the work to which the
employment relates. Consultant shall execute the attached City of Kent Equal Employment
Opportunity Policy Declaration, Comply with City Administrative Policy 1.2, and upon completion
of the contract work, file the attached Compliance Statement.
CONSULTANT SERVICES AGREEMENT - 2
(Over$10,000)
VII. INDEMNIFICATION. Consultant shall defend, indemnify and hold the City, its
officers, officials, employees, agents and volunteers harmless from any and all claims, injuries,
damages, losses or suits, including all legal costs and attorney fees, arising out of or in
connection with the Consultant's performance of this Agreement, except for that portion of the
injuries and damages caused by the City's negligence.
The City's inspection or acceptance of any of Consultant's work when completed shall not
be grounds to avoid any of these covenants of indemnification.
Should a court of competent jurisdiction determine that this Agreement is subject to RCW
4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or
damages to property caused by or resulting from the concurrent negligence of the Consultant
and the City, its officers, officials, employees, agents and volunteers, the Consultant's liability
hereunder shall be only to the extent of the Consultant's negligence.
IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE
INDEMNIFICATION PROVIDED HEREIN CONSTITUTES THE CONSULTANT'S WAIVER OF
IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF
THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY
NEGOTIATED THIS WAIVER.
In the event Consultant refuses tender of defense in any suit or any claim, if that tender
was made pursuant to this indemnification clause, and if that refusal is subsequently determined
by a court having jurisdiction (or other agreed tribunal) to have been a wrongful refusal on the
Consultant's part, then Consultant shall pay all the City's costs for defense, including all
reasonable expert witness fees and reasonable attorneys' fees, plus the City's legal costs and
fees incurred because there was a wrongful refusal on the Consultant's part.
The provisions of this section shall survive the expiration or termination of this
Agreement.
VIII. INSURANCE. The Consultant 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. EXCHANGE OF INFORMATION. The City will provide its best efforts to provide
reasonable accuracy of any information supplied by it to Consultant for the purpose of
completion of the work under this Agreement.
X. OWNERSHIP AND USE OF RECORDS AND DOCUMENTS. Original documents,
drawings, designs, reports, or any other records developed or created under this Agreement
shall belong to and become the property of the City. All records submitted by the City to the
Consultant will be safeguarded by the Consultant. Consultant shall make such data, documents,
and files available to the City upon the City's request. The City's use or reuse of any of the
documents, data and files created by Consultant for this project by anyone other than
Consultant on any other project shall be without liability or legal exposure to Consultant.
XI. CITY'S RIGHT OF INSPECTION. Even though Consultant is an independent
contractor with the authority to control and direct the performance and details of the work
authorized under this Agreement, the work must meet the approval of the City and shall be
subject to the City's general right of inspection to secure satisfactory completion.
CONSULTANT SERVICES AGREEMENT - 3
(Over$10,000)
XII. WORK PERFORMED AT CONSULTANT'S RISK. Consultant shall take all
necessary precautions and shall be responsible for the safety of its employees, agents, and
subcontractors in the performance of the contract work and shall utilize all protection necessary
for that purpose. All work shall be done at Consultant's own risk, and Consultant shall be
responsible for any loss of or damage to materials, tools, or other articles used or held for use in
connection with the work.
XIII. MISCELLANEOUS PROVISIONS.
A. Recyclable Materials. Pursuant to Chapter 3.80 of the Kent City Code, the City
requires its contractors and consultants to use recycled and recyclable products whenever
practicable. A price preference may be available for any designated recycled product.
B. Non-Waiver of Breach. The failure of the City to insist upon strict performance of
any of the covenants and agreements contained in this Agreement, or to exercise any option
conferred by this Agreement in one or more instances shall not be construed to be a waiver or
relinquishment of those covenants, agreements or options, and the same shall be and remain in
full force and effect.
C. Resolution of Disputes and Governing Law. This Agreement shall be governed by
and construed in accordance with the laws of the State of Washington. If the parties are unable
to settle any dispute, difference or claim arising from the parties' performance of this
Agreement, the exclusive means of resolving that dispute, difference or claim, shall only be by
filing suit exclusively under the venue, rules and jurisdiction of the King County Superior Court,
King County, Washington, unless the parties agree in writing to an alternative dispute resolution
process. In any claim or lawsuit for damages arising from the parties' performance of this
Agreement, each party shall pay all its legal costs and attorney's fees incurred in defending or
bringing such claim or lawsuit, 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. If the non-assigning party gives its consent to
any assignment, the terms of this Agreement shall continue in full force and effect and no
further assignment shall be made without additional written consent.
F. Modification. No waiver, alteration, or modification of any of the provisions of this
Agreement shall be binding unless in writing and signed by a duly authorized representative of
the City and Consultant.
G. Entire Agreement. The written provisions and terms of this Agreement, together
with any Exhibits attached hereto, shall supersede all prior verbal statements of any officer or
other representative of the City, and such statements shall not be effective or be construed as
entering into or forming a part of or altering in any manner this Agreement. All of the above
documents are hereby made a part of this Agreement. However, should any language in any of
CONSULTANT SERVICES AGREEMENT - 4
(Over$10,000)
the Exhibits to this Agreement conflict with any language contained in this Agreement, the terms
of this Agreement shall prevail.
H. Compliance with Laws. The Consultant agrees to comply with all federal, state, and
municipal laws, rules, and regulations that are now effective or in the future become applicable
to Consultant's business, equipment, and personnel engaged in operations covered by this
Agreement or accruing out of the performance of those operations.
I. Counterparts. This Agreement may be executed in any number of counterparts,
each of which shall constitute an original, and all of which will together constitute this one
Agreement.
IN WITNESS, the parties below execute this Agreement, which shall become
effective on the last date entered below.
CONSULTANT: CITY OF KENT:
(signature) (signature)
Print Name: Theresw 9D" ek Print Nam -: uzette Cooke
Its awe I1Es Mayor
(title)
DATE: 17rcern�er 5 , w�3 DATE: Wit"
Z
NOTICES TO BE SENT TO: NOTICES TO BE SENT TO:
CONSULTANT: CITY OF KENT:
Theresa R. Dusek [Brennan Taylor, Development Engineering
Manager
3910 North Defiance City of Kent
Tacoma, WA 98407 220 Fourth Avenue South
Kent, WA 98032
253 861-3355 (telephone)
[ (facsimile) (253) 856-5702 (telephone)
(253) 856-6454 (facsimile)
APPROVED AS TO FORM:
Kent Law Department
CONSULTANT SERVICES AGREEMENT - 5
(Over$10,000)
DECLARATION
CITY OF KENT EQUAL EMPLOYMENT OPPORTUNITY POLICY
The City of Kent is committed to conform to Federal and State laws regarding equal opportunity.
As such all contractors, subcontractors and suppliers who perform work with relation to this
Agreement shall comply with the regulations of the City's equal employment opportunity
policies.
The following questions specifically identify the requirements the City deems necessary for any
contractor, subcontractor or supplier on this specific Agreement to adhere to. An affirmative
response is required on all of the following questions for this Agreement to be valid and binding.
If any contractor, subcontractor or supplier willfully misrepresents themselves with regard to the
directives outlines, it will be considered a breach of contract and it will be at the City's sole
determination regarding suspension or termination for all or part of the Agreement;
The questions are as follows:
1. I have read the attached City of Kent administrative policy number 1.2.
2. During the time of this Agreement I will not discriminate in employment on the basis of
sex, race, color, national origin, age, or the presence of all sensory, mental or physical
disability.
3. During the time of this Agreement the prime contractor will provide a written statement to
all new employees and subcontractors indicating commitment as an equal opportunity
employer.
4. During the time of the Agreement I, the prime contractor, will actively consider hiring and
promotion of women and minorities.
5. Before acceptance of this Agreement, an adherence statement will be signed by me, the
Prime Contractor, that the Prime Contractor complied with the requirements as set forth
above.
By signing below, I agree to fulfill the five requirements referenced above.
Dated this day of 'fee eMt rf , 20 13 .
l�
By: 1�„(ice
For: 'dw�sa 9 eonsw14-'nIj
Title: vw tt r
Date: Pe c S, 2,' 13
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
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.
By:
For:
Title:
Date:
EEO COMPLIANCE DOCUMENTS - 3
THERESA R. DUSEK
Assessment, Management and Regulatory Permitting 3910 North Defiance
Tacoma,WA,98407
(253) 861-3355
December 5, 2014
Attn: Brennon Taylor
City of Kent
Economic and.Community Development
220 e Avenue South
Kent, Washington 98023-5838
RE: Critical Areas Review Consulting for City of Kent
Dear Brennon,
In response to your request, Theresa R. Dusek, is pleased to submit this scope of services and cost estimate
for services supporting the City of Kent Critical Areas Review. This scope of services and cost estimate is
based on information provided by you.
The following scope of work would be completed as requested by the City of Kent.
I. Review and confirmation of Wetland Delineations. Typically, 8 hours for a five acre or less site at
$100 per hour for an estimated cost or$800.
2. Review of Conceptual and Final Mitigation plans. Typically, 10 to 12 hours at $100 per home for an
estimated cost of$1,000 to$1,200.
3. Inspection of initial plantings. 'typically, 8 hours for a five acre or less site at$100 per hour for an
estimated cost of$800.
4. Inspection,comments and approval of monitoring reports. Typically, 10 to 12 hours at$100.00 per
hour for an estimated cost of$1,000 to $1,200.
5. Other consulting services related to the Critical Areas review and inspection of development pennits.
6. Other consulting services related to environmental code enforcement of violations to KCC 11.06,
Depends on the code enforcement issue but initial review, site visit and memorandum related to the
potential enforcement action would typically require 8 to 10 hours at$100.00 per hour far an
estimated cost of$800 to $1,000. If court time is required the fee would be at$150 per hour.
The above scope of work would be completed by Theresa Dusek at the fee of$100 per hour on a time and
expense basis(except for court time, as noted in Item 6 above). We understand that the City of Kent
contract is on a time and expense,not to exceed $20,000 for 2014, Qualifications for Theresa Dusek are
located in the attached resume. We anticipate that once the City requests a task in writing via letter or email
1 HP-2012-10
(with supporting documents), work would be started within two working days and would be completed within
five working days, depending on the nature of the work.
If you have any questions or would like to discuss this proposal in further detail, please feel free to contact
me. This proposal will be valid if executed within 90 days of the date of this letter. We appreciate the
opportunity to provide our services to you and look forward to working with you on this project.
Tf you have further questions my cell number is 1-253-861-3355.
Sincerely,
THERESA R. DUSEK
Theresa R. Dusek
Natural Resource Ecologist
Enclosures: Agreement for Professional Services rY-12 (7/12)
I accept the above conditions and authorize the work to proceed.
By Signature
(print)
Date
Organization
2 l(P-2012-10
THERESA R. DUSEK
PROFESSIONAL SERVICES AGREEMENT
1. PROFESSIONAL SERVICES
Fees for services arc based on the time expended on the project,including navel. The fee will be computed by multiplying the number of hours
worked by my hourly one of$100. When subconsultants and\or subcontractors are used,the total cost of their services will be marked up 10
percent.
2. REIMBURSABLE EXPENSES
Hxpenses other than salary costs that are directly attributable to my professional services will be unvoiced at cost plus 10 percent. Examples ',
include but are not linitedto expenses for out-of-town travel and living information processing equipment,instrumentation and Geld equipment
rental,special fees and permits,premiums for additional insurance where required,local mileage and parking,use of rental vehicles,taxi,
reproduction,local and out-of-town delivery services,express mail, andjob related shipping charges and supplies.
3. PAYMENT TO CONSULTANT
Invoices will be submitted periodically for prior services. Payment will be due upon receipt of invoice. An account will become delinquent 30
days after date of billing. IL is agreed that a late charge will be added to delinquent accounts at the rate of three percent(3%)for each 30 days
from the date of billing(provided the rate of such late charge shall not exceed the maximum allowable by the laws of Washington State,and in
that case,then the highest legal rate). If you fail to make payment within 30 days of receipt,I may,after giving seven days mTittcn notice to you,
suspend services.
4. STANDARD OF CARDABSENCE OF WARRANTIES
Theresa R.Dusck agrees that it will perform its services in a matter consistent with the level of care and skill ordinarily exercised by members
of the profession currently practicing under similar conditions,and in accordance with sound and generally accepted principles consistent with
central consulting practices. Theresa R.Dusck provides professional services,however,and nothing in this contract shall be construed to
constitute an express or implied warranty,including(bat not limited to)any wananty or merchantability or fitness for a particular use.
5. OTHER PROVISIONS
It is agreed that this contract is entered into by partied for the sole benefit of the parties to the contract and that nothing in the contract shall be
construed to create a right or benefit for any third patty.
It is agreed that no action may be commenced by you against the Theresa R.Dusck on any claim arising out of Theresa R.Dusek's services
under this contract,whether based on negligence or breach of contract,more than one year after the date that Theresa R.Dusek has performed
services under this contract. Neither party shall hold the other responsible for damages or delay in performance caused by weather and other
acts of nature,strikes,lockouts,accidents,or other events beyond the control of the other or the others agents.
This agreement shall be construed pursuant to the laws of the state of Washington. If any provision of this agreement is found to be
unenforceable,illegal,or contrary to public policy,the remaining portions of this agreement shall remain in effect and shall be enforceable. One
or more wavers by either party of any provision,term,condition,or covenant shal I not be construed by the other party and a waiver of a
subsequent breach of the same by the other party.
If there is a dispute between'fheresa R.Dusek and you concerning the performance of any provision in this agreement,the losing party shall pay
the prevailing party all reasonable costs incurred in connection with the dispute,including staff time,court costs,attorneys'fees,trod other
dispute-rclated expenses. if any other dispute occurs and rrticresa R.Dusek provides expert or fact witness testimony arising Our of the
performance of any provision in this agreement,whether m your request or that of any other party,you will be responsible and pay for all of our
reasonable related costs,including staff preparation and testimony time,at the rates stated on page 1.
Opinions of probable construction cost prepared by us are made on the basis of our experience and qualifications and represent our best
judgment as an experienced and qualified professional generally familiar with the industry. However,since we have no control over the cost of
labor,materials,equipment,or services furnished by others,or over a contractor's methods of determining prices,or over competitive bidding or
market conditions,we cannot and do notguarantee that proposals,bids,or actual construction cost will not vary for opinions of probable
construction costs prepared by me. If you wish greater assurance as to probable construction cost,you may,employ an independent cost
estimator.
6. TERMINATION
This agreement may be terminated by either party by seven days'written notice. If this agreement is terminated,it is agreed that 1 shod[be paid
for the total charges for labor performed through the termination notice date,plus reimbursable charges,plus reasonable termination expenses to
account for our cost of rescheduling,adjustments,and related costs incurred due to termination.
7. TOTAL AGREEMENT
Our agreement with you,consisting of this Professional Services Agreement,together with our proposal and any exhibits thereto,constitute the
entire agreement between Theresa R.Dusek and you and supersedes all prior written or Ond understandings. This agreement may be amended,
supplemented,modified,or canceled only by a duly executed written instrument
F9 12(7/12)
3 HP-2012-10
EXHIBIT
INSURANCE REQUIREMENTS
CONSULTANT SERVICES AGREEMENTS
Insurance
The Consultant 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 Consultant, their agents, representatives, employees or
subcontractors.
A. Minimum Scope of Insurance
Consultant 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. The City shall be named as
an Additional Insured under the Consultant'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
Consultant 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.
2. Commercial General Liability insurance shall be written with
limits no less than $1,000,000 each occurrence, $2,000,000
general aggregate.
® DATE(MMmDly"
CERTIFICATE OF LIABILITY INSURANCE 1 210 212 01 3
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTERTHE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poltcy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the
certificate holder In lieu of such andorseme s.
PRODUCE NA EACT Shelly Reiten
American Underwriters PHONE F.I. (2e3K73-1415 N 1 253 473-95B2
EDD 9 E shelly®amedcan-underWdters.com
6429 South Tacoma Way A &s
Tacoma,WA 98409 INSURERISI AFFORBING COVERAGE NAIC0
INSURERA: Rockhill.1naurance,Company
INSURED INSURER B:
Theresa Dusek INSURER C:
3910 N Defiance St INSURERD:
Tacoma,WA 98407 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 00005592-0 REVISION NUMBER: 1
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY 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.LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL SUER pOLI NUMBE POLICY EFF POLICY EXP LIMITS
A GENERA-LIABILITY Y ENVP00575601 101012013 1010112014 EACHOCCURNENCE $ 1000000
-tIAMAGE TORE-WE D
$ SO OOO
COMMERCIAL GENERAL LIMLITY
CLAIMS-MADE El OCCUR MEDEICP one n S 5000
PERSONAL&ADV INJURY $ 1000000
GENERAL AGGREGATE S 2 00O 000
GENL AGGREGATE LIMIT APPLIES PER PRODUCTS-COMWOPAGG S 2000000
PoUGT PRO- LOC S
B AUTOMOSILEUABILMY COMBINED SINGLE LIMIT NO CV
ANYAUTO BODILYRLURY(Perpanon) S NO V
AUTOS �'AICIiHO5LE0 BODILY INJURY(PmaoodenU S No v
I NON-OWNED PROPERTY DAMAGE $ O CV
HIREDAUTOS -�AUTOS
S
B X UMBRELLA LIAB OCCUR EACHOCCURRENCE $ No CV
E%CESS LIAB CINMSMADE AGGREGATE $ No CV
DIED RETENTION $
B WORKERS COMPENSATION X I WCSTATU- I IOTH-
IANDEMPLOYES-LIABILITY YIN
ANYPROrOMPRIETORPARTNERIPJ(ECUTIVE❑ NIA E.L EACH ACCIDENT $ NO CV
OFFICEEMBER EXCLUDED?
(Mandctvy In NH) E.L DISEASE•EA EMPLD $ NO CV
D esol uner
' SC d 0he FdOP E R&MON SJ11 I E.L.DISEASE-PoUCY LIMIT S NO CV
A Prof liability ENVP00575601 101012013 101012014 Aggregate 1,000,000
A Pollution Liability ENVP00575601 101012013 1010112014 Aggregate 1,000,000
DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Anach ACORD 101,AddiUonW Remmas Schedule,It more space is required)
City of Kent Economic&Community Development is an additional insured per form CG 20 10 07 04,attached.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Kent THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Economic&Community Development ACCORDANCE WITH THE POLICY PROVISIONS.
220 4th Avenue South
Kent,WA 98032 AUTHOR�OREPRESENTATNE
i
SRR
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
'', Printed by SRR on December 02,2013 at 02:38PM
POLICY NUMBER: ENVP005756-01 COMMERCIAL GENERAL LIABILITY
CG 2010 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED ® OWNERS, LESSEES OR
CONTRACTORS ® SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Or anlzation s : Locatlon s Of Covered Operations
Any person or organization for whom you are performing In respect to any location where the named insured is
operations when you and such person or organization have performing"your worl
agreed in writing in a contract or agreement,effected prior
to the date your operations for that person or organization
commenced,that such person or organization be added as an
additional insured on your policy.
Information requined to complete these Schedule If not shown will be shown In the Declarations.
A. Section 11—Who Is An Insured Is amended to include S. With respect to the insurance afforded to these
as an additional insured the person(s)or additional insureds,the following additional
orgahization(s)shown in the Schedule,but only with exclu-signs apply:
respect to liability for"bodily injury","property damage" This insurance does not apply to"bodily injury"or
or"personal and advertising Injury"caused,In whole or property damage"occurring after:
In part,by: 1. All work,including materials,parts or equip-meet
1. Your acts or omissions;or furnished in connection with such work,on the
project(other than service, maintenance or
2. The acts or omissions of those acting on your repairs)to be performed by or on behalf of the
behalf; additional insured(s)at the location of the covered
in the performance of your ongoing operations for the operations has been completed;or
additional insured(s)at the location(s)designated 2. That portion of"your work"out of which the injury
above. or damage arises has been put to its in-tended
use by any person or organization other than
another contractor or subcontractor en-gaged in
performing operations for a principal as a part of
the same project.
CG 2010 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1
REQUEST FOR MAYOR'S SIGNATURE
KEAT Please fill in All Applicable Boxes
',',ICI IN IT. ,
Routing Information (At, RLQUMS A,IUST FIRST BE ROUTFI) THROU(.--,H THE LAMI DEPARTMENT)
A
' i
Ori-iinatoi: r A, Phoi-ic (On gin,ator):
Date Sent: [-)are Required:
CONTRACT TERMINATION DATE:
Return Signed Document to:
AA'
VENDOR NAME: DATE Of COUNCIL APPROVAL:
-—-------------
Brief Explanation ofDOCUrnent:
WZ/
"74P
&J,
pi E
All Contracts Must Be Routed Through the Law Department
Received:
Approval of Law Dept.:
Law Dept. Comments:'
Date l'orvarded to Mayor:
Shaded Areas to Be Completed by Administration Staff
Received: ary OF KENT
CITY CLERK,
X
Recommendations &,Comments: J;
o
7K,
Disposition'
'14t
chy af
7M 1 1,
Date Returned:
jge,WO . 3!0,
Komoto, Kim
From: Pulliam, Julie
Sent: Wednesday, December 11, 2013 3:09 PM
To: Komoto, Kim
Subject: FW: 2014 Contract
Kim,
Below is Theresa answer.
Julie
From: theresahenson [mailto:theresahenson(&hotmail.com]
Sent: Wednesday, December 11, 2013 2:30 PM
To: Pulliam, Julie
Subject: RE: 2014 Contract
The business is sole proprietorship The state ibid number is 603 225 050. Let me know if there is any
additional information that you need.
--- Original Message ---
From: "Pulliam, Julie" <JPulliamna kentwa.¢oy>
Sent: December 11, 2013 2:24 PM
To: '°theresa dusek"' <theresahensonA_hotmail.com>
Subject: 2014 Contract
Theresa,
We need to how Theresa Dusek is "organized" under the laws of the state of Washington? The
first part of our contracts makes reference to being organized, but I cannot locate you on the
state of Washington Department of Licensing site or through the corporation search.
Thank you
Julie Pulliam, Assistant to the Director
Administration 1 Economic &Community Development
400 West Gowe, Kent, WA 98032
Main 253-856-5454 1 Direct 253-856-5702 -
ioulliam@kentwa.aov
CITY OF KENT,WASHINGTON
KentWA.QOV Faceboak ti t.=r YouTube
PLEASE CONSIDER THE ENVIRCA SENT BEFORE FRIN1TINIc THIS E-MAIL
t