HomeMy WebLinkAboutCAG2021-350 - Original - Carolyn Rosenfield - Senior Center Yoga Class Instructor - 08/12/2021ApprovalOriginator:Department:
Date Sent:Date Required:
Authorized to Sign:
Director or Designee
Date of Council Approval:
Grant? Yes No
Type:Review/Signatures/RoutingComments:
Date Routed to the City Clerk’s Office:Agreement InformationVendor Name:Category:
Vendor Number:Sub-Category:
Project Name:
Project Details:
Agreement Amount:
Start Date:
Basis for Selection of Contractor:
Termination Date:
Local Business? Yes No*
Business License Verification: Yes In-Process Exempt (KCC 5.01.045)
If meets requirements per KCC 3.70.100, please complete “Vendor Purchase-Local Exceptions” form on Cityspace.
Notice required prior to disclosure?
Yes No
Contract Number:
Agreement Routing Form
For Approvals, Signatures and Records Management
This form combines & replaces the Request for Mayor’s Signature and Contract Cover
Sheet forms.
Visit Documents.KentWA.gov to obtain copies of all agreementsadccW22373_1_20
Budget Account Number:
Budget? Yes No
Sup/Mgr:
rev. 20210513
FOR CITY OF KENT OFFICIAL USE ONLY
* Memo to Mayor must be attached
Dir. Assist:
4 n/a
4
Other
10006240.64190.4550
Contract
08/11/2021
Original34933
Parks, Recreation & Community ServicesTammy Heldt
$6/per class/per student
12/31/2021
8/18/2021
N/A
09/03/2021
4
4
4
08/12/2021
PROFESSIONAL SERVICES AGREEMENT - 1
($20,000 or Less)
PROFESSIONAL SERVICES AGREEMENT
between the City of Kent and
Carolyn Rosenfield
THIS AGREEMENT is made between the City of Kent, a Washington municipal corporation (hereinafter
the "City"), and Carolyn Rosenfield organized under the laws of the State of Washington, located, and
doing business at 3332 SW 172nd St, Burien, WA 98166, (206) 444-0906 (hereinafter the
"Contractor").
I. DESCRIPTION OF WORK.
The Contractor shall perform the following services for the City:
Description: Yoga Instruction
Start Time/Duration/Stop Time: 9:45 AM-10:45 AM
Day, Date, Year: September 3 – October 22 (No class 9/24)
October 29 – December 17 (No class 11/26)
Event Location: Kent Senior Activity Center
The Contractor 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, and the Contractor shall complete
the work by December 30, 2021.
III. COMPENSATION. The City shall pay the Contractor a total amount of $6 per student per
class for services described in this Agreement. The Contractor shall invoice the City monthly based on
registered participants during the preceding month. The hourly rates charged for the Contractor’s services
shall be as delineated in the attached and incorporated Exhibit (No Exhibit required for this contract). All
hourly rates charged shall remain locked at the negotiated rates throughout the term of this Agreement.
Card Payment Program. The Contractor may elect to participate in automated credit card payments
provided for by the City and its financial institution. This Program is provided as an alternative to payment
by check and is available for the convenience of the Contractor. If the Contractor voluntarily participates in
this Program, the Contractor will be solely responsible for any fees imposed by financial institutions or credit
card companies. The Contractor shall not charge those fees back to the City.
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 Contractor 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 Contractor maintains and pays for its own place of business from which the
Contractor’s services under this Agreement will be performed.
PROFESSIONAL SERVICES AGREEMENT - 2
($20,000 or Less)
C. The Contractor has an established and independent business that is eligible for a
business deduction for federal income tax purposes that existed before the City
retained the Contractor’s services, or the Contractor is engaged in an independently
established trade, occupation, profession, or business of the same nature as that
involved under this Agreement.
D. The Contractor 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 Contractor has registered its business and established an account with the state
Department of Revenue and other state agencies as may be required by the
Contractor’s business, and has obtained a Unified Business Identifier (UBI) number
from the State of Washington.
F. The Contractor 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 seven (7) calendar days written notice at its address set forth on the signature
block of this Agreement.
VI. FORCE MAJEURE. Neither party shall be liable to the other for breach due to delay or failure
in performance resulting from acts of God, acts of war or of the public enemy, riots, pandemic, fire, flood,
or other natural disaster or acts of government (“force majeure event”). Performance that is prevented or
delayed due to a force majeure event shall not result in liability to the delayed party. Both parties represent
to
the other that at the time of signing this Agreement, they are able to perform as required and their
performance will not be prevented, hindered, or delayed by the current COVID-19 pandemic, any existing
state or national declarations of emergency, or any current social distancing restrictions or personal
protective equipment requirements that may be required under federal, state, or local law in response to
the current pandemic.
If any future performance is prevented or delayed by a force majeure event, the party whose
performance is prevented or delayed shall promptly notify the other party of the existence and nature of
the force majeure event causing the prevention or delay in performance. Any excuse from liability shall be
effective only to the extent and duration of the force majeure event causing the prevention or delay in
performance and, provided, that the party prevented or delayed has not caused such event to occur and
continues to use diligent, good faith efforts to avoid the effects of such event and to perform the obligation.
Notwithstanding other provisions of this section, the Contractor shall not be entitled to, and the City
shall not be liable for, the payment of any part of the contract price during a force majeure event, or any
costs, losses, expenses, damages, or delay costs incurred by the Contractor due to a force majeure event.
Performance that is more costly due to a force majeure event is not included within the scope of this Force
Majeure provision.
If a force majeure event occurs, the City may direct the Contractor to restart any work or performance that
may have ceased, to change the work, or to take other action to secure the work or the project site during
the force majeure event. The cost to restart, change, or secure the work or project site arising from a
direction by the City under this clause will be dealt with as a change order, except to the extent that the
loss or damage has been caused or exacerbated by the failure of the Contractor to fulfill its obligations under
this Agreement. Except as expressly contemplated by this section, all other costs will be borne by the
Contractor.
VII. DISCRIMINATION. In the hiring of employees for the performance of work under this
Agreement or any subcontract, the Contractor, its subcontractors, or any person acting on behalf of the
Contractor or subcontractor shall not discriminate against any person who is qualified and available to
PROFESSIONAL SERVICES AGREEMENT - 3
($20,000 or Less)
perform the work to which the employment relates as provided for by the City of Kent’s Equal Employment
Opportunity Policy. The Contractor 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.
VIII. INDEMNIFICATION. The Contractor 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 Contractor'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 the Contractor's work when completed shall not
be grounds to avoid any of these covenants of indemnification. The provisions of this section shall survive
the expiration or termination of this Agreement.
In the event the Contractor 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 Contractor’s part, then
the Contractor 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 Contractor’s part.
IX. INSURANCE. The Contractor shall procure and maintain for the duration of the Agreement,
insurance of the types and in the amounts described in Exhibit A attached and incorporated by this reference.
X. CONTRACTOR’S WORK AND RISK. The Contractor agrees to comply with all federal, state,
and municipal laws, rules, and regulations that are now effective or in the future become applicable to the
Contractor’s business, equipment, and personnel engaged in operations covered by this Agreement or
accruing out of the performance of those services. All work shall be done at the Contractor's own risk, and
the Contractor 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.
XI. 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 VIII 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.
PROFESSIONAL SERVICES AGREEMENT - 4
($20,000 or Less)
E. Assignment. Any assignment of this Agreement by either party without the written consent
of the non-assigning party shall be void.
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 the
Contractor.
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. Should any language in any of the exhibits to this Agreement
conflict with any language contained in this Agreement, the terms of this Agreement shall prevail.
H. Public Records Act. The Contractor acknowledges that the City is a public agency subject to
the Public Records Act codified in Chapter 42.56 of the Revised Code of Washington and documents, notes,
emails, and other records prepared or gathered by the Contractor in its performance of this Agreement may
be subject to public review and disclosure, even if those records are not produced to or possessed by the
City of Kent. As such, the Contractor agrees to cooperate fully with the City in satisfying the City’s duties
and obligations under the Public Records Act.
I. City Business License Required. Prior to commencing the tasks described in Section I, the
Contractor agrees to provide proof of a current city of Kent business license pursuant to Chapter 5.01 of the
Kent City Code.
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PROFESSIONAL SERVICES AGREEMENT - 5
($20,000 or Less)
J. Counterparts and Signatures by Fax or Email. 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. Further, upon executing this Agreement, either party may deliver the signature page
to the other by fax or email and that signature shall have the same force and effect as if the Agreement
bearing the original signature was received in person.
IN WITNESS, the parties below execute this Agreement, which shall become effective on
the last date entered below. All acts consistent with the authority of this Agreement and prior
to its effective date are ratified and affirmed, and the terms of the Agreement shall be deemed
to have applied.
CONTRACTOR:
By: _______________________________
Print Name: _________________________
Its: _______________________________
DATE: _____________________________
CITY OF KENT:
By: _______________________________
Print Name: Lori Hogan_
Its: Recreation Superintendent_
DATE: _____________________________
NOTICES TO BE SENT TO:
CONTRACTOR:
Carolyn Rosenfield
3332 SW 172nd St
Burien, WA 98166
(206) 444-0906 (telephone)
NOTICES TO BE SENT TO:
CITY OF KENT:
Tammy Heldt – Parks Program Coordinator
City of Kent
220 Fourth Avenue South
Kent, WA 98032
(253) 856-5165 (telephone)
(253) 856-6150 (facsimile)
ATTEST:
Kent City Clerk
Lori Hogan (Aug 11, 2021 17:43 PDT)
Aug 11, 2021
Carolyn Rosenfield (Aug 12, 2021 05:44 PDT)
Carolyn Rosenfield
Aug 12, 2021
Carolyn Rosenfield
EEO COMPLIANCE DOCUMENTS - 1
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 ____ , 20___.
By: __________________________________________
For: _________________________________________
Title: ________________________________________
Date: ________________________________________
Carolyn Rosenfield (Aug 12, 2021 05:44 PDT)
Carolyn Rosenfield
Carolyn Rosenfield
Aug 12, 2021Aug 12, 2021 Aug 12, 2021
Aug 12, 2021
EEO COMPLIANCE DOCUMENTS - 2
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 - 3
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.
Dated this day of , 20___.
By: __________________________________________
For: _________________________________________
Title: ________________________________________
Date: ________________________________________
Exhibit A
tnsurance & lndemnity Requirements for Cultural Performance Agreements
lnsurance
The Contractor 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 Contractor, their agents, representatives, employees or
subcontractors.
A. Minimum scoPe of lnsurance
Contractor shall obtain insurance of the types described below:
L. Commercial General Liability insurance shall be written on ISO occurrence form CG 00 01 and
shall cover liability arising from premises, operations, independent contractors, products-
completed operations, personal injury and advertising injury, and liability assumed under an
insured contract. The commercial General Liability insurance shall be endorsed to provide the
Aggregate per Project Endorsement ISO form CG 25 03 11 85. There shall be no endorsement or
modification of the Commercial General Liability insurance for liability arising from explosion,
collapse or underground propefi damage. The City shall be named as an insured under the
Contractors Commercial General Liability insurance policy with respect to the work performed
for the City using ISO additional insurance endorsement CG 20 10 11 85 or a substitute
e ndorsement providing equiva lent coverage.
B. Minimum Amounts of lnsurance
Contractor shall maintain the following insurance limits:
1. Commercial General Liability insurance shall be written with limits no less than S1,000,000
each occurrence, $1,000,000 general aggregate and a $1,000,000 products-completed
operation aggregate limit.
C. Other lnsurance Provisions
The insurance policies are to contain, or be endorsed to contain, the following provisions for
Commercial General Liability insurance:
1. The Contractors' insurance coverage shall be primary insurance as respect to the City. Any
lnsurance, self-insurance, oi insurance pool coverage maintained by the City shall be excess of
the Contractors insurance and shall not contribute with it.
2. The Contracto/s insurance shall be endorsed to state that coverage shall not be cancelled by
either party, except after thirty (30) days prior written notice by certified mail, return-receipt
requested, has been given to the City.
3. The City of Kent shall be named as an additional insured on all policies ( except professional
Liability) as respects work performed by or on behalf of the contractor and a copy of the
endorsement naming the City as additional insured shall be attached to the Certificate of
lnsurance. The City reserves the right to receive a certified copy of all required insurance
policies. The Contractors Commercial General Liability insurance shall also contain a clause
stating that coverage shall apply separately to each insured against whom claim is made or suit
is brought, except with respects to the limits of the insure/s liability.
D. Acceptability of lnsurers
lnsurance is to be placed with insurers with a current A.M. Best rating of not less than A: Vll
E. Verification of Coverage
Contractor shall furnish the City with original certificates and a copy of the amendatory
endorsements, including but not necessarily limited to the additional insured endorsement,
evidencing the insurance requirements of the Contractor before commencement of the work.
F, _ S_ubc_gntractors
Contractor shall include allsubcontractors as insured's under its policies orshallfurnish
separate certificates and endorsements for each subcontractor. All coverage for subcontractors
shall be subject to all the same insurance requirements as stated herein for the Contractor.
oifio"CERTIFICATE OF TIABILITY INSURANCE
CANCETTATION
@ 1988-2009 ACORD CORPORATION. All rights reserved
The ACORD name and logo are registered marks of ACORD
COVERAGES
CERTIFICATE HOTDER
DATE (MM/DD/YYYYI
osl04l202t
PRODUCER
Maguire lnsuEnce Agency, lnc. FWI
1 Bala Plz Ste 100
Bala Cynwyd, PA 19004-1401
6LO.6t7,7900
THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION
ONIY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POTICIES BEIOW.
INSURERS AFFORDING COVERAGE NAIC f,
ll{5URED
Carolyn Rosenfield
Movement Arts
3332 SW 172nd St.
Burlen, wA 98156-
INSURER A: Philadelphla lndemnity lnsurance Company 18058
INSI,JRER g:
INSIIRER C:
INSIJRER D:
INSURER E:
THE POTICIES OF INSURANCE TISTED BETOW HAVE EtstsN I5)UEU TO THE INSURED NAMED ABOVE POTICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENI, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECI TO WHICH THIS CERIFICATION MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED
POIICIES. AGGREGATE TIMITS SHOWN MAY
BY THE POTICIES DESCRIBED HERETN tS SUBJECT TO Alt THE TERMS, EXCTUSIONS AND CONDITIONS OF SUCH
HAVE BEEN REDUCED BY PAID CI.AIMS.
INSR
LTR
ADD'L
INSRD WPE OF INSURAI{CE POUCY NUMSER
POUCY EFFECINE
OATE{MM/OD/VYW
POUCY flflRANON
I'ATE IMM/DD/YYYN UMITS
A x GEIIERAI TUIBILTTV
x COMMERCIAL GENERAL LIABILITY
CTAIMS MADE OCCUR
x PROFESSIONAL TIABITITY
GEN'L AGGREGATE TIMIT APPLIES PER:
x POLICY PROIECT LOC
x
PHPK559069{t11 06lou2o2L 06lo7l2022 EACH OCCURENCE s2.000.000
s100,000
MED EXP (Any one petron)s2,s00
PERSONAT & ADV INIURY s2,0oo,oo0
GENERAL AGGREGATE $4000,m0
PRODUCIS - COMP/OP AGG $4000,000
AlrToMoBllE uABrufi
ANY AUTO
AI"I. OWNED AUIOS
SCHEDUtED AUTOS
HIRED AUTOS
NON.OWNED AUTOS
COMBINEDSINGLE TIMIT
(EA accldentl
BODITY INJURY
(Per petron)
SODITY INJURY
(Per accident)
PROPERTY DAMAGE
(Per accldent)
6ARAGE UABIUIY
ANY AUTO
AUTO ONTY- EA ACCIDENT
OTHERTHAN
AUTO ONtY
EA ACC
AGG
EXCESS / UMBRE1IA LIABILITY
OCCUR CTAIMS IVADE
OEDUCTIBLE
RETENTION
EACH OCCURENCE
AGGREGATE
WORXES COMtsIN$IIgN ANUiMProYERs'UABrurr Y/N
ANY PROPRIFTOR/PARTNER/EXECUTIVE T---']
OFFICER/IVEMsER EXCI-UDEC|? I I
lM.nd.tory ln NHI
lfvei, deicrlbe undersplaiar PRovrsroNs b.ldw
I ToRY IIMITS
I Utn-lEo
E,T. EACH ACCIDENT
E.T. DISEAS€ _ EAAMPTOYEE
E.r. DTSEASE - POUCY Ut\flT
OTHER
negligence.
City of Kent, Senior Center of (ent
500 East smlth Street
Kent . WA 98030-
STIOUI.O ITY OT TXE ATOVE DESCRIBEO POLICIE5 BE CANCETIED BEFORE THE EXPIRATION DATE
THEREOF, THE ISSUING II{SURER WIIL ENDEAVOR TO MAIL 10 DAYS WRIITEI{ NOTICE TO THE
CERTIFICATE HOII'ER I{AMED TO THE I."EFI, 8UT FAIIJJRE TO DO SO SHATL IMPOSE NO OBUGATIOI{ OR
TIABIUW OF ANY TII{D UPON THE INSURE& ITSAGENI5 OR REPRESETTATruE.
AUIHORIZED REPREsENTATIVE
XNW
ACORD 2s (z00gl0tl
IMPORTANT
lf the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
lf SUBROGATION lS 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).
DISCTAIMER
This Certificate of lnsurance does not constitute a contract between the issuing insurer(s), authorized
representative or producer, and the certificate holder, nor does it affirmatively or negatively amend,
extend or alter the coverage afforded by the policies listed thereon.
ACORD 2s (200sl01)
POLICY CHANGE DOCUMENT
CHANGE#2 CHANGEEFFECTIVE:0610112020POLICY NO:
PHPK559069-010
Philadelphia lndemnity lnsurance Company PRODUCER: Maguire lnsurance Agency, lnc. FWI
NAMED INSURED: Carolyn Rosenfield
MAILING ADDRESS 3332 SW 172nd St.
Burien, WA 98166-
POLICY PERIOD:FROM 0610112020 TO 0610'112021 at
12:01 A.M. Standard Time at your mailing address shown above'
DESCRIPTION:
ln consideration of the premium reflected, the policy is amended as indicated below:
lnsured requesting COI listing City of Kent, Senior Center of Kent, 600 East Smith Street Kent, WA 98030 as
additionally insured.
Total Annual
Additional/Retum Premium
Total Annual
Additional/Retum
Tax/Surcharge/Fee
$0.00
$o.oo
Totral Prorate
Additional/Retum Premium
Total Prorate
Additional/Retum
Tax/Surcharge/Fee
$0.00
$o.oo
Page 1 of 1
PoLlcY NUMBER: PHPK559069-010 coMMERctAL GENERAt bri."H[
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 lnsured Or
Gity of Kent, Senior Center of Kent
600 East Smith Street
Kent WA 98030-
lnformation required to this Schedule, if not shown above, will be shown in the Declarations
A. Section ll - Who ls An lnsured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whole or in part, by your acts or
omissions or the acts or omissions of those acting
on your behalf:
1. ln the performance of your ongoing operations;
or
2. ln connection with your premises owned by or
rented to you.
However:
1. The insurance afforded to such additional
insured only applies to the extent permitted by
law;and
2. lf 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.
B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section lll - Limits Of Insurance:
lf coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:
1. Required by the contract or agreement; or
2. Available under the applicable Limits of
lnsurance shown in the Declarations;
whichever is less.
This endorsement shall not increase the
applicable Limits of lnsurance shown in the
Declarations.
cG 20 260413 @ lnsurance Services Office, lnc.,2O12 Page 1 of I
Signature:
Email:
Melissa McCormick (Aug 12, 2021 11:03 PDT)
Melissa McCormick
cityclerk@kentwa.gov
Carolyn Rosenfield - Yogo Instruction 2021
Final Audit Report 2021-08-12
Created:2021-08-11
By:Tyler Goff (tgoff@kentwa.gov)
Status:Signed
Transaction ID:CBJCHBCAABAAFM9n-PN8fEenNWfXjxfFy-L8qSltBvO9
"Carolyn Rosenfield - Yogo Instruction 2021" History
Document created by Tyler Goff (tgoff@kentwa.gov)
2021-08-11 - 8:44:45 PM GMT- IP address: 146.129.252.126
Document emailed to Lori Hogan (lhogan@kentwa.gov) for signature
2021-08-11 - 8:54:15 PM GMT
Email viewed by Lori Hogan (lhogan@kentwa.gov)
2021-08-12 - 0:38:02 AM GMT- IP address: 146.129.252.126
Document e-signed by Lori Hogan (lhogan@kentwa.gov)
Signature Date: 2021-08-12 - 0:43:01 AM GMT - Time Source: server- IP address: 146.129.252.126
Document emailed to Carolyn Rosenfield (jocar206@gmail.com) for signature
2021-08-12 - 0:43:03 AM GMT
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Document e-signed by Carolyn Rosenfield (jocar206@gmail.com)
Signature Date: 2021-08-12 - 12:44:31 PM GMT - Time Source: server- IP address: 71.212.155.199
Document emailed to Kim Komoto (kkomoto@kentwa.gov) for signature
2021-08-12 - 12:44:34 PM GMT
Email viewed by Kim Komoto (kkomoto@kentwa.gov)
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Document e-signed by Kim Komoto (kkomoto@kentwa.gov)
Signature Date: 2021-08-12 - 5:00:38 PM GMT - Time Source: server- IP address: 146.129.252.126
Document emailed to Melissa McCormick (cityclerk@kentwa.gov) for signature
2021-08-12 - 5:00:40 PM GMT
Email viewed by Melissa McCormick (cityclerk@kentwa.gov)
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Document e-signed by Melissa McCormick (cityclerk@kentwa.gov)
Signature Date: 2021-08-12 - 6:03:15 PM GMT - Time Source: server- IP address: 146.129.252.126
Agreement completed.
2021-08-12 - 6:03:15 PM GMT