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HomeMy WebLinkAbout6642 DocuSign Envelope ID:CO3DE22D-7F90-4A46-9E8A-D7AD2FD68A56 SERVICES REIMBURSEMENT AGREEMENT Salvation Army Security Guard Funding Agreement The City of Bremerton ("City") and Peninsula Community Health Services ("PCHS"), referred to collectively as the"Parties,"enter into the following Agreement for funding of services: L Scope: PCHS shall provide the following service for the benefit of the City: maintaining a contract with the Salvation Army to employ a trained security guard for security services at, its facility at 832 6th Street in Bremerton. The PCHS contract with the Salvation Army, attached hereto as Exhibit A, sets forth the terms of their agreement. The City's role in this Agreement is only reimbursement of expenses for services provided. The City has no interest, control, or liability regarding the contract between PCHS and the Salvation Army. IL Term: The City and the PCHS agree that work will begin on the tasks described in Exhibit A immediately upon execution of this Agreement. The parties agree that the work described in Exhibit A is to be completed by December 31, 2024, that additional time shall be granted by the City for excusable delays or extra work as provided for in Section IX.A of this agreement. III. Compensation: In consideration of the services provided pursuant to this Agreement,the City shall pay PCHS in an amount not to exceed $45,000. PCHS shall submit monthly billing statements detailing the services for which PCHS has contracted and the amount paid to the Salvation Army during the preceding month. Upon receipt of a conforming billing statement,the City shall promptly process payment. If a billing statement does not conform to this Agreement, the City may withhold payment until the statement is brought into compliance. However, City shall not reject payments to PCHS if billing statements to City are delayed as long as it is received prior to January 10th, 2024. Invoicing should be sent to both the City Contact as listed and with copy to: Accounts Payable City of Bremerton Finance Dept. 345 6t' Street, STE 100 Bremerton, WA 98337 PCHS shall not be reimbursed for work beyond the scope of this Agreement, unless the Scope is modified pursuant to section VI herein. If a billing statement does not conform to this Agreement, the City may withhold payment until the statement is brought into compliance. Such withholding does not relieve PCHS of its obligations under this Agreement. IV. Relationship of Parties: PCHS represents that it is skilled in the matters addressed in the Scope of Work and is performing independent functions and responsibilities within its field of expertise. PCHS and its personnel are independent entities and not employees of the City. PCHS and its personnel have no authority to bind the City or to control the City's employees and other consultants. None of the benefits provided by the City to its employees, including, but not limited to, compensation, insurance, and unemployment insurance are available from the City to the Page 1 of 8 Bremerton/[Peninsula Community Health Services] [Security Funding Agreement] Rev. 09/2021 DocuSign Envelope ID:CO3DE22D-7F90-4A46-9E8A-D7AD2FD68A56 employees, agents, representatives, or sub-consultants of PCHS. PCHS will be solely and entirely responsible for its acts and for the acts of PCHS's agents, employees, representatives and sub- contractors during the performance of this Agreement. The City may, during the term of this Agreement, engage other independent contractors to perform the same or similar work. As an independent entity, PCHS is responsible for its own management. The City's administration and enforcement of this Agreement shall not be deemed an exercise of managerial control over PCHS or its personnel. As an independent entity, PCHS is responsible for payment of all taxes and licensing fees necessary to perform its obligations under this Agreement. These taxes and fees include but are not limited to State industrial insurance, Business & Occupation, State professional licensing, and City business licensing. If any taxes or fees due the City have been declared delinquent, the City may withhold the delinquent amount, plus any additional charges arising from the delinquency, from any payments due PCHS. V. Indenmification: A. PCHS 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 performance of this Agreement except for that portion of the injuries and damages caused by the City's sole negligence, unless PCHS is conducting work pursuant to Subsection B below. The City's review or acceptance of any of the work when completed shall not be grounds to avoid any of these covenants of indemnification. B. Architects, Engineers and Any Other Professional Listed In and Performing Services Defined in RCW 4.24.115. Should a court of competent jurisdiction determine that PCHS's services provided pursuant to this Agreement is subject to RCW 4.24.115, then, in the event of liability for damages arising out of bodily injury to persons or damages to property caused by or resulting from the concurrent negligence of the PCHS and the City, its officers, officials, employees, agents and volunteers,the PCHS's liability hereunder shall be only to the extent of the PCHS's negligence. IT IS FURTHER SPECIFICALLY AND EXPRESSLY UNDERSTOOD THAT THE INDEMNIFICATION PROVIDED HEREIN CONSTITUTES PCHS'S WAIVER OF IMMUNITY UNDER INDUSTRIAL INSURANCE, TITLE 51 RCW, SOLELY FOR THE PURPOSES OF THIS INDEMNIFICATION. THE PARTIES FURTHER ACKNOWLEDGE THAT THEY HAVE MUTUALLY NEGOTIATED THIS WAIVER. The provisions of this section shall survive the expiration or termination of this Agreement. VI. Insurance: The PCHS 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 Page 2 of 8 Bremerton/[Peninsula Community Health Services] [Security Funding Agreement] Rev. 09/2021 DocuSign Envelope ID:CO3DE22D-7F90-4A46-9E8A-D7AD2FD68A56 connection with the performance of the work hereunder by the PCHS, its agents, representatives, employees, or sub-contractors. Before beginning work on the project described in this Agreement,the PCHS shall provide a Certificate of Insurance evidencing: 1. Automobile Liability insurance with limits no less than $1,000,000 combined single limit per accident for bodily injury and property damage; and 2. Commercial General Liability insurance written on an occurrence basis with limits no less than $1,000,000 combined single limit per occurrence and general aggregate for personal injury, bodily injury and property damage. Coverage shall include but not be limited to: blanket contractual; products/completed operations/broad form property damage; explosion, collapse and underground (XCU) if applicable; and 3. Excess Liability insurance with limits not less than $1,000,000 limit per occurrence and aggregate; and 4. Professional Liability insurance with limits no less than $1,000,000 limit per occurrence/claim; and 5. Workers Compensation insurance as statutorily required by the Industrial Insurance Act of the State of Washington, Title 51, Revised Code of Washington and employer's liability with limits not less than $1,000,000. Any payment of deductible or self-insured retention shall be the sole responsibility of PCHS. If required policies cannot be provided on a "occurrence" basis, "claims-made" basis is acceptable, with"evidence of availability" and"agreement to purchase" an extended-reporting period or "tail" coverage for a three-year period after completion of the service, upon approval from the City. The City shall be named as an additional insured on the Commercial General Liability insurance policy, as respects work performed by or on behalf of PCHS and a copy of an endorsement that is acceptable to the City, which names the City as an additional insured shall be attached to the Certificate of Insurance. The City reserves the right to receive a certified copy of all the required insurance policies and endorsements. The City further reserves the right to reject any unacceptable policies and/or endorsements. PCHS's Commercial General Liability insurance shall 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 insurer's liability. if required policies cannot be provided on a "occurrence" basis, "claims-made" basis is acceptable, with "evidence of availability" and "agreement to purchase" an extended-reporting period or "tail" coverage for a three-year period after completion of the service, upon approval from the City. PCHS's insurance shall be primary and non-contributory insurance as respects the City and shall contain a waiver of subrogation against the City for claims arising out of any operations, Page 3 of 8 Bremerton/[Peninsula Community Health Services] [Security Funding Agreement] Rev. 09/2021 DocuSign Envelope ID:CO3DE22D-7F90-4A46-9E8A-D7AD2FD68A56 liabilities and obligations to which coverage applies. It shall be an affirmative obligation upon PCHS to advise the City's Risk Manager by fax at (360) 473-5161, or by certified mail, return receipt requested to City of Bremerton, Attn: Risk Management, 345 6th Street, Suite 100, Bremerton, WA 98337 within two days of the cancellation, suspension or substantive change of any insurance policy set out herein, and failure to do so shall be construed to be a breach of this Agreement. The City also reserves its unqualified right to require at any time and for any reason, proof of coverage in the form of a duplicate of the insurance policy with all endorsements as evidence of coverage. VII. General Conditions: A. Reports and Information: When requested by the City, PCHS shall furnish periodic reports and documents on matters covered by this Agreement. The reports and documents shall be furnished in the time and form requested. PCHS shall maintain accounting records in accordance with Generally Accepted Accounting Principles ("GAAP") to substantiate all billed amounts. B. Ownership and Use of Records and Documents: Original documents, drawings, designs and reports, including those in electronic format, developed under this Agreement are the property of the City. All written information submitted by the City to PCHS in connection with the services performed by the PCHS under this Agreement will be safeguarded by PCHS to at least the same extent as PCHS safeguards like information relating to its own business. If such information is publicly available or is already in PCHS's possession or known to it, or is rightfully obtained by PCHS from third parties, PCHS shall bear no responsibility for its disclosure, inadvertent or otherwise. All data, documents and files created by PCHS under this Agreement may be stored in a manner consistent with PCHS's ordinary business practices. PCHS shall make such data, documents, and files available to the City upon its request at all reasonable times for the purpose of editing, modifying, and updating as necessary until such time as the City is capable of storing such information in the City's offices. Duplicate copies of this information shall be provided to the City upon its request, and at reasonable cost. All documents, including all reports, drawings, specifications, computer software or other items prepared or furnished by PCHS pursuant to this Agreement, excluding information protected under the Health Insurance Portability and Accountability Act (HIPAA) and 42 CFR Part 2, are instruments of service with respect to the project and are the property of the City. Any reuse by the City for other than the specific purpose intended will be at City's sole risk. C. Use of Photographs and Images. PCHS shall not use or distribute photographs or images depicting City officials, personnel, property, or equipment whether prepared by PCHS or provided by City without prior written consent of the City. The City will not unreasonably withhold its consent. Page 4 of 8 Bremerton/[Peninsula Community Health Services] [Security Funding Agreement] Rev. 09/2021 DocuSign Envelope ID:CO3DE22D-7F90-4A46-9E8A-D7AD2FD68A56 D. Work Performed at PCHS's Risk: PCHS shall take all precautions necessary and shall be responsible for the safety of its employees, agents, and sub-PCHSs in the performance of the work hereunder and shall utilize all protection necessary for that purpose. All work shall be done at PCHS's own risk, and PCHS 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. E. Place of Work: The PCHS shall perform the work authorized under this Agreement at Salvation Army offices at 632 8th Street, Bremerton, Washington. F. Entire Agreement: This Agreement and its Exhibits constitutes the entire agreement between the Parties, and the Parties acknowledge that there are no other agreements, written or oral, that have not been set forth in the text of this Agreement. G. Severability: Should any part of this Agreement be found void, the balance of the Agreement shall remain in full force and effect. H. Modification: This Agreement may only be modified by written instrument signed by both Parties. L Written Notices: All communications regarding this Agreement shall be sent to the parties at the addresses listed below by registered or 1st class mail, or by personal service, 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. Notices to be sent to: Notices to be sent to: CITY: PCHS: Attn: Melinda Monroe Attn: Brynn Felix, General Counsel City of Bremerton Peninsula Community Health Services 345 6t' Street, Suite 100 400 Warren Avenue, STE 200 Bremerton, WA 98337-1891 Bremerton, WA 98337 J. Waiver: Failure to enforce any provision of this Agreement shall not be deemed a waiver of that provision. Waiver of any right or power arising out of this Agreement shall not be deemed waiver of any other right or power. K. Non-Waiver of Breach: The failure of the City to insist upon strict performance of any of the covenants and agreements contained herein, or to exercise any option herein conferred in one or more instances shall not be construed to be a waiver or relinquishment of said covenants, agreements or options, and the same shall be and remain in full force and effect. L. Compliance with Laws: PCHS shall comply with all applicable Federal, State, and local laws in performing its obligations under this Agreement. Page 5 of 8 Bremerton/[Peninsula Community Health Services] [Security Funding Agreement] Rev. 09/2021 DocuSign Envelope ID:CO3DE22D-7F90-4A46-9E8A-D7AD2FD68A56 M. Choice of Law and Venue: This Agreement shall be interpreted according to the laws of the State of Washington. Any judicial action to resolve disputes arising out of this Agreement shall be brought in Kitsap County Superior Court. N. Attorneys' Fees: In the event of litigation to enforce any of the terms or provisions herein, each party shall pay all its own costs and attorney's fees. O. Assignment: Any assignment of this agreement by the Contractor without the written consent of the City shall be void. IX. Termination: This Agreement shall remain in force until completion and acceptance of the services, terminated by written instrument upon mutual consent, or by the City of Bremerton for convenience. This Agreement may be immediately terminated for cause by a Party if the other Party substantially fails to perform through no fault of the terminating Party, and the non- performing Party does not commence correction of the failure of performance within thirty (30) days of the terminating Party's sending notice to the non-performing Party. Any Notice by PCHS shall include a report showing the status of all items listed in the Scope of Work current through the termination date. If the City receives reimbursement by any federal, state, or other source for work described in Section I herein, and that funding is withdrawn, reduced or limited in any way, or the project is cancelled or substantially reduced after the execution date of this Agreement and prior to the completion of the work,the City may summarily terminate this Agreement. A. Excusable Delays: The right of PCHS to proceed shall not be terminated nor shall PCHS be charged with liquidated damages for any delays in the completion of the work due to: 1) any acts of the federal government in controlling, restricting, or requisitioning materials, equipment,tools, or labor by reason of war, national defense, or other national emergency; 2) any acts of the City, its PCHSs, or other public agencies causing such delay; and 3) causes not reasonably foreseeable by the parties at the time of the execution of the Agreement that are beyond the control and without the fault or negligence of the PCHS, including, but not restricted to, acts of God, fires, floods, strikes, or weather of unusual severity. PROVIDED, HOWEVER, that the PCHS must promptly notify the City within ten (10) calendar days in writing of the cause of the delay. If, on the basis of the facts and the terms of this Agreement,the delay is properly excusable, the City shall, in writing, extend the time for completing the work for a period of time commensurate with the period of excusable delay. B. Rights Upon Termination: In the event of termination, the City shall pay for all services performed by the PCHS to the effective date of termination, as described on a final invoice submitted to the City. After termination,the City may take possession of all records and data within the PCHS's possession pertaining to this project, excluding information protected under the HIPAA and 42 CFR Part 2, which may be used by the City without restriction. Any such use not related to the project which PCHS was contracted to perform shall be without liability or legal exposure to the PCHS. Page 6 of 8 Bremerton/[Peninsula Community Health Services] [Security Funding Agreement] Rev. 09/2021 DocuSign Envelope ID:CO3DE22D-7F90-4A46-9E8A-D7AD2FD68A56 X. Equal Employment Opportunity Statement. It is the policy of the City of Bremerton to offer equal employment opportunity to all individuals. The City of Bremerton will administer all actions with respect to employment practices in compliance with federal, state and local laws, and will not discriminate in any employment practice on the basis of age (40+), sex, race, creed, color, national origin, sexual orientation/gender identity, marital status, military status, or the presence of any physical, mental or sensory disability. XI. ADA Statement. The City of Bremerton does not discriminate on the basis of disability in programs and activities, which it operates pursuant to the requirements of the Americans with Disabilities Act of 1990, and ADA Amendments Act. This policy extends to both employment and admission to participation in the programs, services, and activities of the City of Bremerton. Reasonable accommodation for employees or applicants for employment will be provided. XII. Suspension & Debarment. For contracts involving Washington State and Federal funding, Consultant hereby certifies, by signing this agreement, that neither it nor its principals are presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any State or Federal department or agency. Consultant shall provide immediate written notice to the City if at any time it learns that it is or has become ineligible for certification. Should Consultant enter into a covered transaction with another firm, Consultant agrees by signing this agreement that it will verify that the firm with whom it intends to do business is not debarred, suspended, ineligible, excluded or disqualified. IN WITNESS WHEREOF, the parties below have executed this Agreement. CITY: PCHS: CITY OF BREMERTON PENINSULA COMMUNITY HEALTH SERVICES DocuSigned by: DocuSigned by: B . By: jum&trile IMss) C Y bAF4b09bEt5 AEA6E57 CE734,9 Print Name: fig. Wheeler Print Name: Jennifer Kreidler-Moss Its: Mayol/31/2024 Its: Chief Executive Officer 1/31/2024 Date: Date: APPROVED AS TO FORM: ATTEST: DocuSigned by: DocuSigned by: By:: it G64,L rale, By: gt,r6Ait, {,Sbin, y. 52ACBC8381B0462 84D301C360134 Kylie J. Finnell, Bremerton City Attorney 414aliMrdnCitYh3Clerk Page 7 of 8 Bremerton/[Peninsula Community Health Services] [Security Funding Agreement] Rev. 09/2021 DocuSign Envelope ID:CO3DE22D-7F90-4A46-9E8A-D7AD2FD68A56 Page 8 of 8 Bremerton/[Peninsula Community Health Services] [Security Funding Agreement] Rev. 09/2021 DocuSign Envelope ID:CO3DE22D-7F90-4A46-9E8A-D7AD2FD68A56 EXHIBIT A: SOW SECOND AMENDMENT TO THE PROFESSIONAL SERVICES AGREEMENT Between PENINSULA COMMUNITY HEALTH SERVICES And THE SALVATION ARMY WHEREAS, Peninsula Community Health Services ("PCHS"), and the Salvation Army, Bremerton Corps ("Contractor"), referred to collectively as the "Parties," entered into the Professional Services Agreement("Agreement")to provide the services of a trained security guard in security services for the crisis response team performing work related to the "Stand By Me" grant project, effective January 1, 2022; and WHEREAS, the Parties agree that they would like to continue supporting and delivering the "Stand By Me" program at the Salvation Army, Bremerton Corps, located at 832 6th Street, Bremerton, WA 98337; and WHEREAS, PCHS seeks to enter into a new and continuing Services Reimbursement Agreement with the City of Bremerton for the reimbursement of funding provided by PCHS to Contractor for the "Stand By Me"program; THEREFORE, the Parties agree to extend the current Agreement by adding the following language and agreeing to the following terms and conditions: 1. Section I. Period of Performance: Is amended to include the following language: "The period of performance of this Agreement is extended to include anew term beginning January 1, 2024, and to be completed no later than December 31, 2024, unless terminated sooner or extended as provided for herein." 2. Section IV. Compensation: Is amended to include the following language: "In consideration of the services provided for the period of performance beginning January 1, 2024 and ending December 31, 2024, PCHS shall pay Contractor in an annual amount not to exceed $45,000." 3. All other terms and conditions of the Agreement shall remain in full force and effect. [SIGNATURE PAGE FOLLOWS] Page 1 of 2 !Peninsula Community Health Services/Salvation Army Bremerton] 12024 Professional Services Agreement Amendment] DocuSign Envelope ID:CO3DE22D-7F90-4A46-9E8A-D7AD2F D68A56 IN WITNESS WHEREOF,the Parties below have executed this Amendment. Contractor: PCHS: SALVATION ARMY,BREMERTON CORPS PENINSULA COMMUNITY HEALTH SERVICES DocuSigned by: -e a1.; . L. 161.411.t441 444 By:_ �o By: Print Name: Cynthia Foley Print Name: Jennifer Kreidler-Moss Its: Divisional Commander Its: Chief Executive Officer Date: 12/19/2023 Date: 12/20/2023 Page 2 of 2 [Peninsula Community Health Services/Salvation Army Bremerton) 12024 Professional Services Agreement Amendmentl DocuSign Envelope ID:7556E0C5-222A-4334-B74B-CDB15342E2CB ACCPR E)� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/10/2023 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 CONTACT NAME: Parker,Smith&Feek Insurance,LLC. PHONE 253 359 9700 FAX 1707 Dock Street (A/C,No,Ext): (A/C,No): E-MAIL Tacoma,WA 98402 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: ProSelect Insurance Company INSURED INSURER B: Trumbull Insurance Company Peninsula Community Health Services PO Box 960 INSURER C: Bremerton,WA 98337 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY 002WA000001349 04/01/2023 04/01/2024 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300,000 K COMMERCIAL GENERAL LIABILITY X X PREMISES(Ea occurrence) $ K CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 5,000,000 K POLICY PRO- JECT B AUTOMOBILE LIABILITY 52UENC18553 10/01/2022 10/01/2023 (O aBI ED)SINGLE LIMIT $ 1 000 000 K ANY AUTO X BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) A UMBRELLA LIAB OCCUR 002WA000001349 04/01/2023 04/01/2024 EACH OCCURRENCE $ 2,000,000 K EXCESS LIAB K CLAIMS-MADE AGGREGATE $ 2,000,000 DED K RETENTION$ -0- $ WORKERS COMPENSATION 002WA000001349 WC STATU- K OTH- WA Stop Ga A AND EMPLOYERS'LIABILITY 04/01/2023 04/01/2024 TORY LIMITS ER p p ANY PROPRIETOR/PARTNER/EXECUTIVE **WA State Stop Gap E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1 000 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Exhibit of Insurance City of Bremerton is an additional insured on the general liability and automobile policies per the attached endorsements/forms... (See Attached Description) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Bremerton 345 6th Street,STE 100 AUTHORIZED REPRESENTATIVE Bremerton,WA 98337 /4/k'-' -dAA/1At— ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1 of 8 (AWI00) ^DocuSign Envelope ID:7556E0C5-222A-4334-B74B-CDB15342E2CB DESCRIPTIONS (Continued from Page 1 ) Waiver of subrogation applies on the general liability policy per the attached endorsement/form. 2 of 8 (AWI00) DocuSign Envelope ID.7556E0C5-222A-4334-B74B-CDB15342E2CB COMMERCIAL AUTOMOBILE HA 99 16 12 21 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM To the extent that the provisions of this endorsement provide broader benefits to the "insured" than other provisions of the Coverage Form, the provisions of this endorsement apply. 1. BROAD FORM INSURED e. Employees as Insureds Paragraph .1. - WHO IS AN INSURED - of (1). Any "employee" of yours while using a Section II - Liability Coverage is amended to covered "auto" you don't own, hire or add the following: borrow in your business or your personal d. Subsidiaries and Newly Acquired or affairs. Formed Organizations f. Lessors as Insureds The Named Insured shown in the Declarations (1). The lessor of a covered "auto" while the is amended to include: "auto" is leased to you under a written (1) Any legal business entity other than a agreement if: partnership or joint venture, formed as a (a) The agreement requires you to subsidiary in which you have an provide direct primary insurance for ownership interest of more than 50% on the lessor and the effective date of the Coverage Form. (b) The "auto" is leased without a driver. However, the Named Insured does not Such a leased "auto" will be considered a include any subsidiary that is an "insured" covered "auto" you own and not a covered under any other automobile policy or would be an "insured" under such a policy "auto" you hire. but for its termination or the exhaustion of g. Additional Insured if Required by Contract its Limit of Insurance. (1) When you have agreed, in a written (2) Any organization that is acquired or contract or written agreement, that a formed by you and over which you person or organization be added as an maintain majority ownership. However, additional insured on your business auto the Named Insured does not include any policy, such person or organization is an newly formed or acquired organization: "insured", but only to the extent such (a) That is a partnership or joint venture, person or organization is liable for "bodily injury' or "property damage" caused by (b) That is an "insured" under any other the conduct of an "insured" under policy, paragraphs a. or b. of Who Is An Insured (c) That has exhausted its Limit of with regard to the ownership, Insurance under any other policy, or maintenance or use of a covered "auto." (d) 180 days or more after its acquisition The insurance afforded to any such or formation by you, unless you have additional insured applies only if the given us notice of the acquisition or "bodily injury" or "property damage" formation. occurs: Coverage does not apply to "bodily injury" (a) During the policy period, and or "property damage" that results from an (b) Subsequent to the execution of such "accident" that occurred before you written contract, and formed or acquired the organization. Fo nn HA 99 16 12 21 Page 1 of 5 ©2021, The Hartford (Includes copyrighted material of Insurance Services Office, Inc. with its permission.) DocuSign Envelope ID:7556E0C5-222A-4334-B74B-CDB15342E2CB (c) Prior to the expiration of the period of This insurance is primary if you have time that the written contract requires agreed in a written contract or written such insurance be provided to the agreement that this insurance be primary. additional insured. If other insurance is also primary, we will (2) How Limits Apply share with all that other insurance by the If you have agreed in a written contract or method described in Other Insurance 5.d. written agreement that another person or (2) Primary And Non-Contributory To Other organization be added as an additional Insurance When Required By Contract insured on your policy, the most we will If you have agreed in a written contract or pay on behalf of such additional insured is written agreement that this insurance is the lesser of: primary and non-contributory with the (a) The limits of insurance specified in the additional insured's own insurance, this written contract or written agreement; insurance is primary and we will not seek or contribution from that other insurance. (b) The Limits of Insurance shown in the Paragraphs (1) and (2) do not apply to other Declarations. insurance to which the additional insured has Such amount shall be a part of and not in been added as an additional insured. addition to Limits of Insurance shown in When this insurance is excess, we will have the Declarations and described in this no duty to defend the insured against any Section. "suit" if any other insurer has a duty to defend (3) Additional Insureds Other Insurance the insured against that "suit". If no other insurer defends, we will undertake to do so, If we cover a claim or "suit" under this but we will be entitled to the insured's rights Coverage Part that may also be covered against all those other insurers. by other insurance available to an When this insurance is excess over other additional insured, such additional insured insurance, we will pay only our share of the must submit such claim or "suit" to the amount of the loss, if any, that exceeds the other insurer for defense and indemnity. sum of: However, this provision does not apply to (1) The total amount that all such other the extent that you have agreed in a insurance would pay for the loss in the written contract or written agreement that absence of this insurance; and this insurance is primary and non-contributory with the additional (2) The total of all deductible and self-insured insured's own insurance. amounts under all that other insurance. (4) Duties in The Event Of Accident, Claim, We will share the remaining loss, if any, by Suit or Loss the method described in SECTION IV- If you have agreed in a written contract or Business Auto Conditions, B. General Conditions, Other Insurance 5.d. written agreement that another person or organization be added as an additional 3. AUTOS RENTED BY EMPLOYEES insured on your policy, the additional Any "auto" hired or rented by your "employee" on insured shall be required to comply with your behalf and at your direction will be the provisions in LOSS CONDITIONS 2. - considered an "auto" you hire. DUTIES IN THE EVENT OF ACCIDENT, The SECTION IV- Business Auto Conditions, B. CLAIM , SUIT OR LOSS — OF SECTION General Conditions, 5. OTHER INSURANCE IV — BUSINESS AUTO CONDITIONS, in Condition is amended by adding the following: the same manner as the Named Insured. 2. Primary and Non-Contributory if Required e. If an "employee's" personal insurance also applies on an excess basis to a covered by Contract "auto" hired or rented by your "employee" on Only with respect to insurance provided to an your behalf and at your direction, this additional insured in A.1.g. - Additional insurance will be primary to the "employee's" Insured If Required by Contract, the following personal insurance. provisions apply: (1) Primary Insurance When Required By Contract Page 2 of 5 Form HA 99 16 12 21 DocuSign Envelope ID:7556E0C5-222A-4334-B74B-CDB15342E2CB COVE RYS : :sM ProSelect Insurance Company ADDITIONAL INSURED — DESIGNATED PERSON OR ORGANIZATION Attached to and forming First Named Insured: Policy Period: part of Policy Number: 002WA000001349 Peninsula Community Health Services 04/01/2023 to 04/01/2024 At 12:01 AM Standard Time at the address of the First Named Insured as stated herein. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part SCHEDULE Name of Additional Insured Person(s)or Organization(s): US Bank N A City of Bremerton Kitsap Pride Network Mason County Public Health Bremerton Foodline Lesli Dullum Tutterrow;Optimal Wellness Inc. dba Live Well Kitsap; Hazelwood Fa A. Section II. Definition of Insured is amended to include as an additional INSURED the person(s) or organization(s) shown in the Schedule above, but only with respect to liability for INJURY caused, in whole or in part, by a NAMED INSURED'S acts or omissions or the acts or omissions of those acting on a NAMED INSURED'S behalf: 1. In the performance of a NAMED INSURED'S ongoing operations; or 2. In connection with a NAMED INSURED'S premises owned by or rented to a NAMED INSURED. However: 1. The insurance afforded to such additional INSURED only applies to the extent permitted by law; and 2. If 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 a NAMED INSURED is required by the contract or agreement to provide for such additional INSURED. B. With respect to the insurance afforded to the additional INSUREDS shown in the Schedule above, if 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 Limit of Liability shown in the DECLARATIONS; whichever is less. Activity No:757270 CGL 017 07/14 r5 Date Produced: 03/28/23 20:02 Page 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission 5 of 8 (AWI00) DocuSign Envelope ID:7556E0C5-222A-4334-B74B-CDB15342E2CB COVE RYSJ ProSelect Insurance Company Nothing in this endorsement shall vary, alter, waive or extend any of the terms and conditions of the POLICY, other than as expressly stated above. . , Joseph G. Murphy Kim A. Tobin President&CEO Secretary Activity No:757270 CGL 017 07/14 r5 Date Produced: 03/28/23 20:02 Page 2 Includes copyrighted material of Insurance Services Office, Inc.,with its permission 6 of 8 (AWI00) DocuSign Envelope ID:7556E0C5-222A-4334-B74B-CDB15342E2CB COVE RYSS : :__: • ProSelect Insurance Company MANUSCRIPT ENDORSEMENT — ADDITIONAL INSURED — PRIMARY NON CONTRIBUTORY WITH WAIVER OF SUBROGATION Attached to and forming First Named Insured: Policy Period: Effective Date of Change part of Policy Number: 004WA000001349 Peninsula Community Health 05/01/2020 to 05/01/2021 12/31/2020 Services At 12:01 AM Standard Time at the address of the First Named Insured as stated herein. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part SCHEDULE Name and Address of Person(s)or Party ID: Retroactive Date: Activities: Organization(s): City of Bremerton, its officers, officials,employees, With respect to those security activities agents and volunteers rendered on behalf of the Insured as described in a contract with the Salvation Army Securty Guard Funding Agreement Subject to all other terms and conditions of the POLICY, and with respect to the Interest of the Person(s) or Organization(s) listed in the Schedule above, it is agreed and understood that: A. Section II. Definition of Insured is amended to include as an additional INSURED the Person(s) or Organization(s) shown in the Schedule above, subject to the RETROACTIVE DATE shown in the Schedule above, but only with respect to the activities indicated above. However: 1. The insurance afforded to such additional INSURED only applies to the extent permitted by law; and 2. If 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 a NAMED INSURED is required by the contract or agreement to provide for such additional INSURED. B. The following is added to the Section IV. General Conditions of the Common Policy Terms, Paragraph O. Other Insurance and supersedes any provision to the contrary only with respect to the Person(s)or Organization(s) shown in the Schedule above: This POLICY is primary to and will not seek contribution from any OTHER INSURANCE available to the Person(s) or Organization(s) shown in the Schedule above provided that: Activity No: MAN 002 07/14 r2 Date Produced:12/30/2020 Page 1 7 of 8 (AWI00) DocuSign Envelope ID:7556E0C5-222A-4334-B74B-CDB15342E2CB COVE RYS ": : ProSelect Insurance Company 1. The additional INSURED is a Named Insured under such OTHER INSURANCE; and 2. YOU have agreed in writing in a contract or agreement that this POLICY would be primary and would not seek contribution from any OTHER INSURANCE. C. Subject to all other terms and conditions of the POLICY, the following is added to Section IV. General Conditions, paragraph Q. Subrogation of the Common Policy Terms: WE will waive any right of recovery WE may have against the person or organization shown in the Schedule above because of payments WE make for INJURY or DAMAGE arising out of YOUR WORK done under a contract with that person or organization. The waiver applies only to the person(s) or organization(s) shown in the Schedule above. D. With respect to the insurance afforded to the additional INSURED shown in the Schedule above, the following is added to Section III. Our Limit of Liability: If 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 Liability shown in the DECLARATIONS; whichever is less. E. This additional INSURED shall share in the Limits of Liability of the FIRST NAMED INSURED, and this extension of coverage shall not increase OUR Limit of Liability. Nothing in this endorsement shall vary, alter, waive or extend any of the terms and conditions of the POLICY, other than as expressly stated above. -100 Gregg L. Hanson Erin B. Bagley President&CEO Assistant Secretary Activity No: MAN 002 07/14 r2 Date Produced:12/30/2020 Page 2 8 of 8 (AWI00) DATE(MM/DD/YYYY) A o° CERTIFICATE OF LIABILITY INSURANCE 12/29/2023 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 CONTACT NAME: Parker,Smith&Feek Insurance,LLC. PHONE 425-709-3600 FAx 425 709 7460 E-M 2233 112th Avenue NE No,Ext): (A/C,No): -MAI L Bellevue,WA 98004 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: ProSelect Insurance Company INSURED INSURER B: Peninsula Community Health Services PO Box 960 INSURER C: Bremerton,WA 98337 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY 002WA000045425 10/01/2023 10/01/2024 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300,000 K COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ K CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 5,000,000 K POLICY PRO- JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) A UMBRELLA LIAB OCCUR 002WA000045425 10/01/2023 10/01/2024 EACH OCCURRENCE $ 2,000,000 K EXCESS LIAB K CLAIMS-MADE AGGREGATE $ 2,000,000 DED K RETENTION$ -0- $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE n E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Salvation Army Security. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Bremerton 345 6th Street,Ste. 100 AUTHORIZED REPRESENTATIVE Bremerton,WA 98337 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1 of 1 (MKA00)