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HomeMy WebLinkAboutPK13-179 - Amendment - #3 - Kent East Hill Kids Boxing Club - Amateur Boxing Classes - 01/01/2017 . Records m eM v1�lT Document CONTRACT COVER SHEET This is to be completed by the Contract Manager prior to submission to the City Clerk's 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: N Ili -1-19— 00q This is assigned by City Clerk's Office Project Name: Kent East dill Boxing Club at the Community Center {Phoenix Academy) Description: ❑ Interlocal Agreement ❑ Change Order 0 Amendment QContract ❑ Other: Contract Effective Date: 12/31/16 Termination Date: 12/31/17 Contract Renewal Notice (Days): 60 Number of days required notice for termination or renewal or amendment Contract Manager: Lori Hogan Department: Parks - Recreation Contract Amount: n/a time only Approval Authority: (CIRCLE ONE) Department Directo Mayor City Council Detail: (i.e. address, location, parcel number, tax id, etc.): RavisPd rnn raC termination daYP __...— __...........w.... . As of: 08/27/14 THIRD ADDENDUM TO FACILITIES USE AGREEMENT BETWEEN THE CITY OF KENT AND KENT EAST HILL BOXING CLUB This Third Addendum to the Facilities Use Agreement between the City of Kent and Kent East Hill Boxing Club ("Third Addendum") is effective January 1, 2017, and amends Section III of the Facilities Use Agreement between the City of Kent and Kent East Hill Boxing Club made June 20, 2013, together with its First Addendum with an effective date of January 1, 2015, and its Second Addendum with an effective date of January 1, 2016 (collectively the "Agreement"), entered into by Kent East Hill Boxing Club and the City of Kent ("Parties"). 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: .............- _..._..... 01 Oriqinal Expiration Date December 31, 24 Revised Expiration under First December 31, 2015 Addendum: Revised Expiration under Second December 31, 2016 Addendum: Revised Expiration under Third December 31, 2017 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 Third Addendum shall be deemed to have applied. In witness, the parties below have executed this Addendum, which will become effective on January 1, 2017. This Third Addendum may be signed in counterparts. Kent East Hill Boxing Club 28026 1891h Avenue S.E. Covington, WA 98042 (253) 631-3895 (206) 8 -8197 Cell �S O r G t S w Print ame; Ug 14,4MA0 Its: tanr.` na K +eBL Date: � AlL) 7 � City of K6 t Lori Hogan, Superintendent, Recreation & Cultural Services 220 Fourth Avenue South Kent, WA 98032 (253) 856-5050 Telephone (253) 856-6050 Facsimile NWe; 0 El Its: Parks Director' Date: ✓ > _ cr v'.\CI,I\Rlts\Open Fll IS\200]-Ke,[Esst H I I I I-1,,11u1\20 I I,rl 4e I 1, w1a11-1se PyretnientJoa City of Kent Parks, Recreation and Community Services ~ YOUTH SPORTS ORGANIZATION PAfl KS.RECREPTi Oiu 6 LOMMONIry SEftVILES HB-1824 (Youth Sports-Head Injury Policy) and SB-5083 (Sudden Cardiac Arrest Awareness) COMPLIANCE STATEMENT . ('f�./" ,�✓ _`i`� / �� X.... ,1X,G�' " '*-._,�,t/'✓.) tt Name of Organization Street Address I ,(_. y�rU�, Phone Contact Name of Representative Street Address �'�j w/ Phone Contact What is the nature and purpose for facility use? a youth sports organization/team, hereby verifies all coaches, athletes and their parent/guardians have complied with mandated policies for the Management of Concussions and Head Injuries as prescribed by House Bill-1824, Section 2 and Sudden Cardiac Arrest Awareness as prescribed by State Bill-5083, section 3. 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. Signed: ,�,,��/� rk�a��w7 L Representative of 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. THIS STATEMENT EFFECTIVE FOR 2017 USE YEAR ONLY 15T53S (M GATE MIDDIYYVY) AC+ CERTIFICATE OF LIABILITY INSURANCE va/2017 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION 15 WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not center rights to the certificate holder in lieu of such ondorsormer l s). CONrACT Diana Banks PRODUCER NAME' Commercial Lines-(800)-332-9256 PHONE 303-863 6718 {PA No) 855 669 8729 LArv..Oa h,T.il ....� .,,_ .—... ... 9.,.— Wells Fargo Insurance Services USA,IncEMAILdlana.bartks wBllsiar o com 9 ARD Es9: -..,_._ ..... g—. ....-.. ......... —,..._._.._- 90 S.Cascade Ave,2nd Floor INsuRER( FfU,RpIND CovERAGE _ _..NAlc re Colorado Springs,CO 80903 NSURTRA Philadelphia list Inrnlly Insurance.Company 18058 INSURED -..... WSURERa; _. ,,.. ...�...... ._.... ,.... .._ ...., USA Boxing,Inc. INSURERC; .. ........_— ........ ___...... One Olympic Plaza INSURER O ._._,� ..-... .-._. .— ....-.— INSUPER E' ____ ...-. .............. Colorado Springs CO 80909 INSURER F• - COVERAGES CERTIFICATE NUMBER: 11275482 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. NO ANY REQUIREMENT„ TERM OR CONDITION OF ANY CONTRACT OR OTHER.DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY HE 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 POLICY Eft POLIGG ENP' ' ..., NCE dL EDa. ..... -__. LIMITS rLTH Atb TYPE OF INSURANCE PULIGYNUMBER bYMIDDrYVYM' Iml x COMMERGIALGENERAL LIABILITY PHPKI586554 1/1/2017 1/112018 EACH OrCURRENCE S 1000000 '"viGAMAUEd'O rkLrN1E➢ ...... .— _ too 000 CLAIrAS-MAOE Efl OCCUR PftEIW11Si ra nlxvare Ica). _...§ ..,., ._—. MED EXP�n�(_one ppraPfn) $ PER ___ NALBAU .... rrrS 1000,000 GEN'L AGGREGATE LIMIT APPLIES PER GE. ....AGGREGATE $. .5,000000 I—YPRO. PRODUCTS.COMrVOPAGG $ 1000000 POLICY 6f.AECT El LOC _.— $ AUTOMOBILE E"Rt Club x 01H COMBINED SINGLE LI IT S OMOBILE LIABILITY FES0 WLnnr) „�_,,, ...� ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS "-'--"—'"'""' Als HIRED NON-OWNED PROPEItTV UAMAGL $ AUTOS ONLY AUTOS ONLY IPur Arsid¢glj ._...� :U:MBRELLA LIAR X OCCUR PHUB566079 61161I2017 01ID1/20'3 EACHOCCURRI $, 1.....0 A xCESS LIAR C4ASp,ry"MAL"YL, AGGREGATE.e ....._-..._--...EO RETENTION$ PER U1F7- WORKERS COMPENSATION STATUTE OR ....._�..._... AND EMPLOYERS LIABILITY YIN ANYPROPRIETORPPARTNERXXECURVE rI.EACHACCIDENT. OFFICEPIMEiINEEREx4.LUDEDp ,NIA ( mPlarprp In NH) &;L..DISEASE-EAE".MPLCJYE S „®_......_„ If yyeaa„desub.t'dur E L M$EASE�POLICY LIMIT S I DfSOBIPT10N OF'OPERATIONS bePJW DESCRIPTION OF OPERATIONS!LOCATIONB I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Named Insured Includes City of Kent Parks and Recreation Coverage applies to sanctioned activities and for supervised club approved practice and training of USA Boxing membyr athletes for USA Boxing sanctioned events. Coverage is excluded for ANY martial arts or kick-boxing activities,regardless of whether they are part of a USA Boxing sanctioned activity or club activity CERTIFICATE HOLDER CANCELLATION 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 qe-44 The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016I03) ° ~ ~ FOURTH ADDENDUM TO FACILITIES USE AGREEMENT BETWEEN THE CITY OF KENT AN0KENT EAST HILL BOXING CLU'B, This Fourth Addendum to the Facilities Use Agreement between the City of Kent aind Kent East Hill Boxing Club ("Fourth Addendum") is effective January 1, 2018, and amends Section III of the Facilities Use Agreement between the City of Kent and Kent East Hill Boxing Club made June 20, 2013, together with its First Addendum with an effective date of January 1, 2015, its Second Addendum with an effective date of January 1, 2016, and its Third Addendum with on effective date of January 1, 2017 (collectively the "Agreement"), entered into by Kent East Hill Boxing Club and the City ofKent ("Parties"). 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 Expiration Date December 31, 2014 Revised ixp7iration under First December 31, 2015 Revised Expiration unde,r Second December 31, 2016 Revised Expiration under Third December 31, 2017 Revised Expiration under Fourth riber 31, 2018 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 Fourth Addendum shall be deemed to have applied. In witness, the parties below have executed this Addendum, which will become effective as of January 1, 2018. This Fourth Addendum may besigned in counterparts. Kent East Hill Boxing Club 2802618 9mAvenue S.E. Covington, WY\ 98O42 (253) 631-3�895 (206),892-8197 Cell City mfKent Lori Hogan, Superintendent, Recreation & Cultural Services Z2O Fourth Avenue South Kent, VVA98Q32 (253) 85G-5O5OTelephone (253) 856-6O5OFacsimile Its: Parks D�,rectol: r _ 157533 CERTIFICATE OF LIABILITY INSURANCE DAT2112018YYY) 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 have ADDITIONAL INSURED provisions or 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). PRODUCER CONTACT Rita Nicholson Commercial Lines-(800)-332-9256 NAME:PHONE . 720.543.8803 ac No FAX 610 537-2050 USI Insurance Services National,Inc. noQREss: rita.nicholson@usi.com 90 South Cascade Ave,Ste 940 INSURERS)AFFORDING COVERAGE NAIC Phil is Colorado Springs,CO 60903 INSURERA: adelphia Indemnity Insurance Company 18058 INSURED INSURER B United States Amateur Boxing,Inc.DBA USA Boxing,Inc. INSURER C: One Olympic Plaza INSURER D INSURER E: _ Colorado Springs CO 80909 INSURER F: j COVERAGES CERTIFICATE NUMBER: 12650859 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 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. INSR ADDL SUBR LTR TYPE OF INSURANCE I POLICY NUMBER MMIDCmYY MMIDD/YXYY LIMITS X COMMERCIAL GENERAL LIABILITY A X PHPK1756577 01/01/2018 01/01/2019 EACH OCCU_ToRRENCE S 1,000.000 AMAGCLAIMS-MADE :F OCCUR PREMISES Ea occurrence S 100.000 j—� MED EXP(Any one person) S i I �J PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE_ S 5,000,000 POLICY PRO- JECTu LOC PRODUCTS-COMPLOPAGG S 1,000,000 X OTHER:Club .s AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 Ea accident ANY AUTO BODILY INJURY(Per person) 5 OWNED SCHEDULED BODILY INJURY P AUTOS ONLY AUTOS (Per accident) S HIRED NON-OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE I S Per accident I S A UMBRELLALIAB X OCCUR PHUB612554 01/01/2018 01/01/2019 EACH OCCURRENCE S 1,01D0,000 EXCESS LIAB CLAIMS-MADE AGGREGATE _ $ 1.0W,000 ' DED RETENTION$ S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT S OFFICERIMEMBEREXCLUDED? F-1 1 N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S I l DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Named Insured Includes KENT EAST HILL BOXING CLUB Additional Insured:City of Kent Parks and Recreation 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 martial arts or kick-boxing activities,regardless of whether they are part of a USA Boxing sanctioned activity or club activity. CERTIFICATE HOLDER CANCELLATION City of Kent Parks and Recreation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 220 Fourth Ave South THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. KENT,WA 98032 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) (Thn ce LL Ws roPt c ceWn S 12609185—n!11 1I17r2018) POLICY NUMBER: PHPK1756577 COMMERCIAL GENERAL LIABIUTY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s)Or Organlzation(s): PERSONS OR ORGANIZATION& AS REQUIRED BY WRITTEN CONTRACT EXECUTED PRIOR To LOSS LIMITED TO THE NEGLIGENCE OF THE INSURED Information required to complete this Schedule,if not shown above will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section lit—Limits Of Insurance: with respect to liability for"bodily injury", "property If coverage provided to the additional insured is damage" or personal and advertising injury" required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting on your behalf: amount of insurance: 1. In the performance of your ongoing operations, 1. Required by the contractor agreement:or or 2. Available under the applicable Limits of 2. in connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the I. The insurance afforded to such additional applicable Limits of Insurance shown in the insured only applies to the extent permitted by Declarations, law:and 2. it coverage provided to the additional insured Is required by a contract or agreement, the insurance afforded to such additional Insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured CG 20 26 0413 0 Insurance Services Office,Inc.,2012 Page 5 of 7 City of Kent Parks, Recreation and Community Services ftdiE"T PARKS.RECREATION YOUTH SPORTS ORGANIZATION 6 COMMCNi^r SERVICES HB-1824 (Youth Sports-Head Injury Policy) and SB-5083 (Sudden Cardiac Arrest Awareness) COMPLIANCE STATEMENT � .�� ess r � �/9 7 c �9� ame of Organization G / Street Add ess one Con act Aw, 0 Zm'�eof Re rese t tive Street Address hone toagct What is the nature and purpose for facility use? AnM Ifl)4 0 2�j'WQ f) 00 61JA i i✓tl 'k2� 1�'6 e -, a youth sports organization/team, hereby verifies all coaches, athletes and their parent/guardians have complied with mandated policies for the Management of Concussions and Head Injuries as prescribed by House Bill-1824, Section 2 and Sudden Cardiac Arrest Awareness as prescribed by State Bill-5083, section 3. 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$1,000,000. 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: 411, pr en gani io n Da 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. THIS STATEMENT EFFECTIVE FOR 2018 USE YEAR ONLY