HomeMy WebLinkAboutPK16-049 - Original - Highline School District No 401 - Camp Waskowitz - 08/01/2016 Records 4. ,n4iemetx
KENO" Document
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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 Clerk's Office.
Vendor Name: Highline School District No. 401
Vendor Number: 37911
JD Edwards Number
Contract Number:
This is assigned by City Clerk's Office
Project Name: Camp Waskowitz
Description: ❑ Interlocal Agreement ❑ Change Order ❑ Amendment [X]Contract
❑ Other:
Contract Effective Date: 8/1/2016 Termination Date: 8/5/2016
Contract Renewal Notice (Days): 0
Number of days required notice for termination or renewal or amendment
Contract Manager: Julie Stangle Department: Parks Youth and Teen
Contract Amount: $40 280 00
Approval Authority: (CIRCLE ONE) Department Director Ma or City Council
Detail: (i.e. address, location, parcel number, tax id, etc.):
Annual rental_agreement with Hi hg line School District for Camp Waskowitz
As of: 08/27/14
16-050 1/4/2016
Highline School District No. 401
Camp Waskowitz Rental Agreement
45505 S.E. 150"St.,North Bend,WA 98045 Seattle—(425)277-7195 North Bend—(425)888-0681
Mailing Address: Camp Waskowitz, 15675 Ambaum Blvd. S.W.,Burien,WA 98166 (206)631-7626
Applicant Kent Parks In Charge Julie Stangle/ Camp Leaders
Organization At Camp
Address 525 Fourth Ave N., Kent WA 98032 phone ( 2531856-5030
Email Address:lstangle@kentwa.gov
Age of YOUtfI Est.Total Est. 190
Campers Girls Boys Adults:M F No.Campers:
Arrival: Monday, August 1 , 2016 @ Approx. 11 :00 AM Lunch
Date Time First Meal(Breakfast 8:00,Lunch 12:00,Dinner 5:30
Departure. Friday, August 5, 2016 @ approx. 2:00 PM Lunch Ali
75 124 = $224.00 Per person 125-149 = 4216.00 PP Last meal (Breakfast,Lunch,Dinner)
Cost Quote on Estimated Total: $212.00 per person 4 night(s) and 12 meal(s)
Additional charges/fees:
Total Charee $
Less Deposit $ 250.00
Date Certificate of Insurance received / / Amount Due $
Month/Day/Year
CERTIFICATE OF INSURANCE: The lessee,at its own cost,shall maintain public liability insurance for bodily injuries
(including sickness or death)and property damages in the minimum amount of$1,000,000 combined single limit per occurrence,and
in the minimum amount of$2,000,000 in the aggregate Employers Liability(Washington Stop-Gap)in the amount of no less than
$1,000,000 per accident for owned,non-owned and hired automobiles. Prior to using the site,the lessee shall furnish the
Camp Waskowitz office with a Certificate of Insurance evidencing this coverage and naming the Highline School District as an
additional insured and as the certificate holder. SEE ATTACHED CHECELIST FOR INSURANCE REQUIREMENT
DEFFINITION
HOLD HARMLESS AGREEMENT: To the fullest extent permitted by law,the lessee releases and shall defend,indemnify and
hold harmless the Highline School District and its directors,agents,employees,successors and assigns fi•om and against all claims,
damages,losses and expenses,direct and indirect,or consequential,including but not limited to costs and attorneys' fees incurred on
such claims and in proving the right to indemnification,arising out of or resulting from the acts or omissions of the lessee or its agents
and anyone directly or indirectly employed by them or anyone for whose acts they may be liable.
POOL USE Any rental group using the pool is responsible for furnishing a qualified life guard while the pool is in use. A qualified
life guard shall mean any person over 18 years of age,in good physical condition,having a current registered WSI,Red Cross or other
approved lifeguard certification,and having no other duty to perform while in attendance
at the pool. A copy of the certificate with current date must be submitted prior to pool use. Pool use shall be during daylight hours
only(8:00 a.m.to 8:00 p.m.) Failure to comply with any of the rules will necessitate the closure of the pool.
I have read and understand the rules and regulations listed on the back of this application and agree to abide by them.
Waskowitz Outdoor School/Highline Public Schools
Kent Parks Department/City of Kent
Organization _ Organizations
By By
Signature Signature yy
( P f
Date Date—'` �•._ ,-.' 4
Please read the back side of this form
APPLICATION PROCEDURES
Please Read Carefully
1. Deposit
This agreement must be accompanied by a deposit 10%of the estimated total cost or$250.00,whichever is greater,in order
to assure the reservation. Retain(1) copy for your records
2. Cancellation Policy
• Notification of cancellation 60.90 days prior to scheduled date will result in loss of deposit.
• Notification of cancellation 45.59 days prior to scheduled date will result in a charge of 25%of estimated cost. !!
• Notification of cancellation 30-44 days prior to scheduled date will result in a charge of 50%of estimated cost.
• Notification of cancellation 14-29 days prior to scheduled date will result in a charge of 75%of estimated cost.
• Notification of cancellation less than 14 days prior to scheduled date will result in a charge of 100%of estimated cost.
3. Unless the Waskowitz District Office is notified of a decrease in the total number attending at least two work days before the
first scheduled meal at Camp,the group will be charged on the basis of"Est.Total No.Campers"or actual number of
Campers,whichever is higher.
4. Rates quoted do not include bedding,linen,recreation equipment,or audio-visual equipment. Provision of these are the
responsibility of the renting group. Camp equipment or bedding may be provided at an additional charge,
5. A statement of charges will be sent to the lessee shortly after the rental period ends. Prompt payment should be made to
Highline School District and sent to Highline School District 15675 Ambaum Blvd S.W.,Burien,WA 98166.
6. The rates quoted by Camp staff are arrived at on the basis that the lessee will leave the Camp in the same order and in as
good condition as they found it on arrival. An added charge will be made if additional work must be done to ready the Camp
for the next group.
7. The lessee will be held financially accountable for any damage to Camp equipment or facilities done by a member or
members of the leasing group. -
8. Adequate adult supervision must be provided for all youth groups. It is suggested that a minimum ratio for a mixed group of
youth or teenagers should be 1 to 10,
9. Meal menus will be developed by Camp staff. Special requests should be arranged with the Head Cook at least 3 weeks prior !
to arrival.
GENERAL RULES AND REGULATIONS I
It is requested that the"Person in Charge at Camp"go over the following regulations with his/her group before their arrival at Camp. t
He/she must see that all regulations are adhered to by members of his/her group. Further,it is proposed that the following general
regulations will be observed:
1. Firearms,air rifles,pellet guns,slingshots,look alike weapons,alcoholic beverages,illegal drugs/substances etc, are not
allowed on the grounds.
2. No smoking is allowed on Camp property.
3. No campfires will be set without permission of the Camp staff.
4. Thermostats will be regulated only by Camp personnel.
5. Absolutely no tampering with the fire protection sprinkler system or fire alarm boxes located in each cabin.
6. Nonmaterial(i.e.towels, clothing,posters,etc.,should be hung over or near heaters or lights at any time.
7. Fire regulations state"No vehicles shall be parked in or near the vicinity of buildings". Vehicles are to be parked in the
Camp parking lot only.
8. No Camp equipment,i.e.beds,gear boxes,mattresses,tables,chalkboards shalt be moved without permission of the Camp
staff. If moved,they are to be returned to the original location prior to departure.
9. Swimmers must obey pool regulations(posted at pool entrance). A pool key will be provided to the"Person In Charge
The pool must be kept locked when qualified life guard is not mr duty. The pool is open June through August.
10. Meals are served family style or buffet style in the Dining Hall at 8:00 a.m., 12:00 noon,and 5:30 p.m. Dinners after 5:30
P.M.will result in an additional charge.
it. Pets are not allowed on Camp property.
12. Guests of members of the lease group may not use the facility or will be charged as part-time users.
13. Walk only on established paths or trails.
14. No trees,plants or shrubs may be cut.
15. The Waskowitz phones are for our business purposes. Please provide your group with a cell phone number,to use
while.at Waskowitz.
Rev.6/08
AC®® CERTIFICATE OF LIABILITY INSURANCE GATE tMM DDIYYYY)
� . 2/9/2016
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,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les) must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this Certificate does not confer rights to the
certificate holder in lieu of such endorsements .
CON
PRODUCER NAMEACT Conn! E.Scott _
Seattle-Alliant Insurance Services, Inc. PHONE FAX
1.206-204-9140 FA(AX N,p 206-204-9205
1420 Fifth Avenue, Suite 1500 E-MAIL
Seattle WA 98101 -ADDRESS.cscott@alliant.com
INSURERS)AFFORDING COVERAGE NAIC W
INSURER A:Princeton Excess&Surplus Lines In 10786
INSURED KE583802 INSURERB:Safety National Casualty Corporatio 15105
Cityy of Kent INSURERC:
220 Fourth Avenue South
Kent WA98032-5895 INSURERD:
INSURER E: ._.
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1510647807 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
AOOL POLICY EFF POLICY EXP
INSR TYPE OF INSURANCE LIMITS
LTR INSR D POLICY NUMBER MMIDOIYYYY MMIDDI
A X COMMERCIAL GENERAL LIABILITY Y Y N1A3RL000006905 111/2016 1/1/2017 EACH OCCURRENCE $5,000,000
-- DAMAGE T R E
CLAIMS-MADE Fx_1 OCCUR PREMISES Ea occurrence $
MED EXP Any one person) $ _
PERSONAL&ADVINJURY $
GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ __
POLICY❑ jEOT LOD PRODUCTS-COMP/OP AEG S
OTHER: ISIR $250,000
A AUTOMOBILE LIABILITY N1A3RL000006905 111/2016 1/1/2017 Ea acccidennt $5,000,000
X ANY AUTO BODILY INJURY(Par person) $
ALL OOWNED SCHEDULED BODILYINJURY(Heracciden0 $
HIREDAUTOS S AUTOS
NON-OWNED Peraccde t)DAMAGE $
Deductible I SIR $250,000
UMBRELLA LIAR OCCUR EACHOCCURRENCE S
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DED RETENTIONS S
B WORKERS COMPENSATION SP4062264 111/2016 1/1/2017 x PER OT H-
STATUTE ER
AND EMPLOYERS'LIABILITY
ANYPROPRIETOR/PARTNEREEXECUTIVE YIN E.L.EACH ACCIDENT 51,0 00,000'
OFFICERIMEMBER EXCLUDED? �N NIA
(Mandatory In NH) E.L.DISEASE-EAEMPLOYE $1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICV LIMIT $1,000,000
A Stop Gap N1A3RL000006905 1/112016 1/1/2017 Each Occurrence $5,000,000
Aggregate $5,000,000
Deductible $250,000
DESCRIPTION OF OPERATIONS/LOCATIONS IVEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached 'more space is required)
Work Comp has a$500,000 SIR
RE: Renting Camp Waskowitz facility the week of August 1 -August 5, 2016,
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Highline School District#401 ACCORDANCE WITH THE POLICY PROVISIONS.
Attn: Carey Gannaw
15675Ambaum Blvd SW AUTHORIZED REPRESENTATIVE
Burien WA 98166 f
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
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