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Home My WebLink AboutPK13-179 - Amendment - #1 - Kent East Hill Kids Boxing Club - Amateur Boxing Classes - 01/01/2015 Records Mana em fit KENT ,_ Document WASXINGTGN CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to City Clerks Office. All portions are to be completed. If you have questions, please contact City Clerk's Office. Vendor Name: Kent East Hill Boxing Club Vendor Number: JD Edwards Number Contract Number: 1.%'�. 12i - i ' 1- C2 This is assigned by City Clerk's Office Project Name: Addendum One to Facilities Use Agreement with Kent East Hill Boxing Club Description: ❑ Interlocal Agreement El Change Order ❑ Amendment ❑ Contract xOther: Addendum Contract Effective Date: 1/1/2015 Termination Date: 12/31/2015 Contract Renewal Notice (Days): Number of days required notice for termination or renewal or amendment Contract Manager: Lori Hogan Department: Parks Recreation Contract Amount: n/a Approval Authority: (CIRCLE ONE) Department Directo Mayor City Council Detail: i.e. address location parcel number, tax id, etc.)-. As of: 08/27/14 i FIRST ADDENDUM TO FACILITIES USE AGREEMENT BETWEEN THE CITY OF KENT AND KENT EAST HILL BOXING CLUB i This First Addendum to the Facilities Use Agreement between the City of Kent and Kent East Hill Boxing Club ("First Addendum") is effective January 1, 2015, and amends that certain Facilities Use Agreement between the City of Kent and Kent East Hill Boxing Club made June 20, 2013 ("Agreement"), entered into by Kent East Hill Boxing Club and the City of Kent ("Parties"). The Agreement provides for the annual extension of the Agreement through the execution of an addendum. The Parties wish to extend the Agreement for an additional one-year period, on the same terms and conditions, to begin on January 1, 2015, and ending on December 31, 2015, through this First Addendum. This First Addendum may be signed in counterparts. Except as expressly provided herein, all other provisions of the Agreement remain in full force and effect. Kent East Hill Boxing Club 28026 189`h Avenue S.E. Covington, WA 98042 (253) 631-3895 (206) 892-8197 Cel LY 2 ,4 ? JJ P int N e: e54,6 Iq Its: CL tV_e Date: City of Kent Lori Hogan, Superintendent, Recreation & Cultural Services 220 Fourth Avenue South Kent, WA 98032 (253) 856-5050 Telephone (253) 856-6050 Facsimile i Print Name: Jeff Watl'n arks Director Date: It 5:: p:\CINI\Flex\OpeA Nlei\AHLI'1014-Nt9CA.N,,,F,, DENDIIMTO FACH_,ES LINE AG0.EEMEW 6ERYEEN THE CNI OF KENT AND KEW FAIL HILL KIDG FOXING CLVOdm 157533 ` ® DATEIYYYY) A CERTIFICATE OF LIABILITY INSURANCE 115/201t512015 �I 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 policy(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 endorsement(s). PRODUCER _WTP CT Andrea Wright Commercial Lines-(800}332-9256 PHONE f, 800-332-9256 AX No:877-405-9032 Wells Fargo Insurance Services USA,Inc, E'MAJL ADDRESS, andrea.wright@wellsfargo.com 90 S.Cascade Ave,2nd Floor INSURER(S)AFFORDING COVERAGE NAIC11 Colorado Springs,CO 80903 INSURERA: Philadelphia Indemnity Insurance Company 18058 I INSURED INSURER B: USA Boxing,Ina INSURER c: One Olympic Plaza INsuRERD: .- INSURER E: Colorado Springs CO 80909 INSURER F: COVERAGES CERTIFICATE NUMBER: 8603618 REVISION NUMBER: See below 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 VVITH 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. ILTR ADDL SUBR POLICY EFF POLICY EXP LIMITS TYPEOFINSURANCE POLICYNUMBER MMIDDiYYYY MMIDD/YYYY X COMMERCIAL GENERAL LIABILITY PHPK1271 W 171 01/01/2015 01/01/2016 EACH OCCURRENCE $ IPOW A DAMAGE ORIENTED 1000000 $ CLAIMS-MADE 7 OCCUR PREMISES Ea 000u once MED EXP(Any ate erson $ Excluded PERSONALS ADV INJURY $ 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5000000 POLICY❑dECOT LOC PRODUCTS-COMPJOPAGG $ 1000000 OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY Ea aaddenl BODILY INJURY(Per person) $ ANYAUTO ALL OWNE&SCHEDULED BODILY INJURY(Per accident) $ AUTOSUTOS PROPERTY DAMAGE $ HIREDAUT era dent $ A UMBRELLA PHU648397001/01/2015 01/01/2016 EACHOCCURRENCE $ ID00000 EXCESS LIE AGGREGATE $DED PER OTH- WORKERS COMPENSATION STATUTE E AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORfPARTNERIEXECUTIVE E.L.EACH ACCIDENT S NIA OFRCERNEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If' tlescdbe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe affached if more space is required) Named Insured Includes KENT EAST HILL BOXING CLUB The certificate holder is an Additional Insured with respect to liability arising out of the negligence of the Named Insured as per endorsement:Additional Insured-Certificate Holders(Form PI-AM-002).Coverage applies to sanctioned activities and for supervised club approved practice and training of USA Boxing member athletes for USA Boxing sanctioned events. Coverage is excluded for ANY martlal arts or kick-boxing activities,regardless of whether they are part of a USA Boxing sanctioned activity or club activity. CERTIFICATE HOLDER CANCELLATION i City of Kent Parks and Recreation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 220 Fourth Ave South ACCORDANCE WITH THE POLICY PROVISIONS. Kent,WA 98032 ._. AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01)