HomeMy WebLinkAboutPK13-179 - Amendment - #2 - Kent East Hill Kids Boxing Club - Amateur Boxing Classes - 01/01/2016 i
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KENT 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: East Hill Boxing Club
Vendor Number:
JD Edwards Number
Contract Number: {73 _ I G) — C0 2
This is assigned by City Clerk's Office
Project Name: East Hill Boxing Club Addendum No. Two
Description: ❑ Interlocal Agreement ❑ Change Order ®Amendment DContract
❑ Other:
Contract Effective Date: 12/31/2015 Termination Date: 12/31/2016
Contract Renewal Notice (Days): one year renewal
Number of days required notice for termination or renewal or amendment
Contract Manager: Lori Hogan Department: Parks Rec
Contract Amount: $ n/a
Approval Authority: (CIRCLE ONE) IDepartment Directo Mayor City Council
Detail: (i.e. address, location, parcel number, tax id, etc.):
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SECOND ADDENDUM TO FACILITIES USE AGREEMENT BETWEEN
THE CITY OF KENT AND KENT EAST HILL BOXING CLUB
This Second Addendum to the Facilities Use Agreement between
and amends of Kent
a d III Kent
East Hill Boxing Club ("Second Addendum ) is effective January 1, een
the Facilities Use Agreement between the City of Kent and Kent East Hill Boxing Club made June 20,
2013, together with its First Addendum dated January 5, 2015 (collectively the "Agreement"),
("Parties").entered into by Kent East Hill Boxing Club and the City of Kent
This Addendum amends the above-referenced contract; all other provisions of the contract
that are not inconsistent with the Addendum shall remain in effect. For valuable consideration and
mutual consent of the parties, the Agreement is modified as follows:
1. The Agreement time for performance provisions of Section III "Term of Program," is
hereby modified as follows:
Original Ex iration Date December 31 2014
Revised Expiration under First December 31, 2015
Addendum:
Revised Expiration under Second December 31, 2016
Addendum:
All acts consistent with the authority of the Agreement, previous Addenda, prior to the
effective date of this Addendum, are hereby ratified and affirmed, and the terms of the Agreement,
previous Addenda, and this Second Addendum shall be deemed to have applied.
In witness, the parties below have executed this Addendum, which will become effect on
January 1, 2016.
This Second Addendum may be signed in counterparts.
Kent East Hill Boxing Club
28026 189t" Avenue S.E.
Covington, WA 98042
(253) 631-3895
(206) 892-8197 ell
Pr nt Name: s e
1 s:
Date: l b
City of Kent
Lori Hogan, Superintendent,
Recreation & Cultural Services
220 Fourth Avenue South
Kent, WA 98032
(253) 856-5050 Telephone
(253) 856-6050 Facsimile
Print. Name: Jeff Watlin =
s: Parks Director
Date:
f Kent Parks, Recreation and Community Services
KENT
r;Mws[avrrs YOUTH SPORTS ORGANIZATION
CONCUSSION AWARENESS STATEMENT
RCW 28A.600.19
Name of Organization street Address Phone,Contact
ka 4fRpresentati a Street Address -Phon Contact
What is the nature and purpose for facility use? i
P r)7 S i. SIJP` L'�/U
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a youth sports organization/team, hereby
verifies II 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 $2,000,000.
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.
Sign: /
I IJ l•tk. c t(� 7cvMiA 1 �1
Representative o Organization Date
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.