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HomeMy WebLinkAbout6677 DocuSign Envelope ID:59100735-05CA-4E11-A40D-B980DDB1 D897 City of Bremerton PUBLIC WORKS & UTILITIES Forestry Division 100 Oyster Bay Ave N. Bremerton,WA 98312 Re: Cordwood Salvage on Water Utility Lands Mr. Robert Bacon 9381 W Belfair Valley Road Bremerton, WA 98312 Dear Mr. Bacon, By this letter agreement, permission is given to enter Water Utility lands for the purpose of cordwood salvage at locations selected by the Forestry Manager and marked on the attached map. By signing this agreement, you (hereinafter Permittee), agree to the following conditions for removal of salvaged cordwood. 1. Term/Hours of Operation. This agreement commences upon signature and terminates Dec 31st, 2024 unless terminated earlier by the City for any reason. Entry to and work performed on Water Utility lands is limited to Monday-Friday between the hours of 7:30 am and 4:00 pm. 2. Type of Salvage. Only cordwood cut from logging slash at landings as located on the attached map is included in this agreement. No standing trees or downed logs marked as wildlife logs shall be cut or removed without the permission of the Forestry Manager. No cedar shall be harvested under this permit. 3. Payment. Payment for salvaged cordwood is $20.00/cord payable to the City of Bremerton and receivable within two weeks after removal. 4. Number of Persons. Entry shall be limited to the Permittee and up to 2 additional persons. Permittee shall provide in writing the names and addresses of additional persons. 5. Entry Exceptions. No entry shall be allowed within the Union River Surface Supply area, wellhead facilities, or the Bremerton Police Range unless authorized by the Forestry Manager. No entry shall be allowed during Industrial Fire Precaution Levels (IFPL) of II or higher. Permittee is responsible for checking IFPL status. No entry shall be allowed during inclement weather when travel on forest access roads has the potential for damage to roads or water courses. 6. Restrictions. Permittee is allowed entry for the above express purpose only and is allowed ingress and egress to specified work locations only by the most direct route. Cutting and removal operations shall not cause damage to water courses, soils, roads, standing timber or reforested areas as determined by the Forestry Manager. No smoking or open fires on Water Utility lands during the closed season as defined by State of Washington regulations. All other closed season regulations as defined by the State of Washington that pertain to this operation shall be observed. No firearms allowed in the Permittee's possession or in Permittee's vehicle(s) while on Water Utility lands. 7. Insurance Before beginning work on the project described in this Agreement, the Contractor shall provide a Certificate of Insurance evidencing: Automobile Liability insurance with limits no less than $1,000,000 combined single limit per accident for bodily injury and property damage; and 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, Cordwood Salvage Agreement 2/23/2024 DocuSign Envelope ID:59100735-05CA-4E11-A40D-B980DDB1 D897 • Page 2 February 23, 2024 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 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 the Contractor. All required policies shall be provided on an "occurrence" basis except professional liability insurance (if required), which shall be provided on a "claims-made" basis. 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 the Contractor and a copy of the endorsement naming the City as 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. The Contractor'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. The Contractor'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, liabilities and obligations to which coverage applies. It shall be an affirmative obligation upon Contractor 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 required 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. 8. Sales Tax/Resellers Permit. Washington State Sales tax must be collected on harvest sales unless Permittee has a valid current Reseller Permit issued through the Washington State Department of Revenue, a copy of which is to be provided to the City. 9. Bremerton Business License. Permittee shall contact Bremerton's tax and license office at 360.473.5311 regarding a City of Bremerton business license. 10. Hold Harmless. Permittee shall be solely responsible for the acts and failures to act of its personnel, which arise in any way out of performance of this agreement. Permittee agrees to defend, indemnify, and hold harmless the City and its officials and employees from and against all liability, loss, damages, and expenses, including costs and attorney's fees, resulting from actions, claims, and lawsuits arising or alleged to have arisen, in whole or in part, out of or in consequence of the acts or failures to act of Permittee, its employees, its subcontractors, its agents, or its assigns in the performance of this agreement. The City and Permittee have DocuSign Envelope ID:59100735-05CA-4E11-A40D-B980DDB1 D897 • Page 3 February 23, 2024 specifically negotiated Permittee's waiver of its immunity under Title 51 RCW, which is hereby waived for purposes of the Permittee's indemnification and hold harmless of the City, including duty to defend. This provision shall be inapplicable to the extent such action, claim, or lawsuit is judicially found to arise solely from the acts or failures of the City. 11. Severability. If any one or more sections, sub-sections, or sentences of this agreement are held to be unconstitutional or invalid, that decision shall not affect the validity of the remaining portion of this agreement and the remainder shall remain in full force and effect. Permittee: i—DocuSigned by: leolitAL 15A6b1n., 4/15/2024 ,,_npro 6nnrnoeF4 Dated: Robert Bacon, Owner Please sign and date where indicated above and return via email or to the above address, my attention. A copy and location map will be returned to you. Your signature signifies agreement with the conditions contained within this document. The Certificate of Insurance can also be sent to my attention. Contact me at 360.473.5928 if you have any questions. Sincerely, Sean Walsh Ditally signed by Sean Walsh a e:2024.04.08 08:31:59-07'00' Sean Walsh Forestry Manager CC: Water Resources Manager BPD Patrol File 9 in j DocuSign Envelope ID:59100735-05CA-4E11-A40D-B980DDB1 D897 j 12 7 8 i9 I • 1 rm 6 15 1 ' h!p0 13 18 17 Pr a O r 4 N �i��ss : � N 4200 - __.__ i 5000 0 roe' j 21 O t� ~ 'Z W ■ 22 �O 0 • 4J 1�) r r, ❑ %<�y' 0 4250// .S0 ge 19 11) i E N : Z Z 461 /rr .1 42o sf Aoi Pficfri :. illir 0 o~ J *' Ny 0) rsi 9 -41 1 eo '1 47 / 1O 5r,0 3, - _...;.._t i g o 0 1 S� ' pa �01-° /4010 O 210 �a +`� 0 0`h s A �..r �j�14 pM CVO 0 0 33 �1���� 5 s 0 '� 3 O■ O°° --wi. 32 h N c%.O° 1% gljw a T24 R1 0 � `a ' R'� g020 a !o T23Hk - 8260��a T 4N R1E Qcf, T23N R1 E • O O o� j 4 3 000 i [ °1 '9p9r ■ W 6 •I g ti� 1 Z Z N N O I- H 9 10 ° 11 12 7 8 1 i i Legend West Belfair Township ii Excluded Areas Valley RD Section Firewood Watershed p Gates 1222 Salvage N Roads Location Property Line 0 0.5 1 1 .5 2 2.5 3 Miles DocuSign Envelope ID:59100735-05CA-4E11-A40D-B980DDB1 D897 FA RMERS Fire Insurance Exchange(A Reciprocal Insurer) N 5 U RA N C E A Part Of The Farmers Insurance Group Of Companies® Home Office:6301 Owensmouth Ave.,Woodland Hills,CA 91367 POLICY DECLARATIONS BUSINESS AUTO v 04.00 ITEM ONE Named BACON, ROBERT Insured BACON'S CHRISTMAS TREE FARM Mailing 9381 W BELFAIR VALLEY RD Address BREMERTON,WA 98312-9724 Policy Number 60696-88-80 m 11-15-2023 O Policy From Period To 1 1 15 2024 12:01 A.M.Standard time at your mailing address shown above. m m In return for the payment of premium and subject to all the terms of this policy, we agree with you to provide insurance as o stated in this policy. We provide insurance only for those Coverages described and for which a specific limit of insurance is o shown. co co co The following premium credits and discounts applied to the premium associated with this coverage part: Multiple Policy Discount-Homeowners And Personal Auto Insurance o There may be other credits and discounts you may be able to enjoy,please contact your agent for full details. _ Your Agent Dennis H Dye Insurance Agency Inc Dennis Dye Ins Agency Inc 4517 Calfrna Ave SwA Seattle,WA 98116 (206)937-8850 Email:ddye©farmersagent.com License#:224699 56-6190 2ND EDITION 07-17 C6190201 Page 1 of 6 DocuSign Envelope ID:59100735-05CA-4E11-A40D-B980DDB1 D897 Policy Number: 60696-88-80 Effective Date: 11-15-2023 ITEM TWO-SCHEDULE OF COVERAGES AND COVERED AUTOS *This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply only to those"autos" shown as covered "autos". "Autos" are shown as covered "autos"for a particular coverage by the entry of one or more of the symbols from the COVERED AUTO Section of the Business Auto Coverage Form next to the name of the coverage. *Covered Auto Coverage Designation Limit Of Insurance Premium Symbols Liability 7 $1,000,000 $2,068 Comprehensive 7 Actual Cash Value or Cost of Repair,whichever is $80 less,minus applicable deductible for each covered auto. But no deductible applies to loss caused by Fire or Lightning.See ITEM FOUR for hired or borrowed"Autos". Collision 7 Actual Cash Value or Cost of Repair,whichever is $185 less,minus applicable deductible for each covered auto.See ITEM FOUR for hired or borrowed"Autos". Towing And Labor 7 $500 $25 **Premium for Other Coverages and Endorsements Total Premium $2,358 **For details of "Other Coverages",see ITEM FOUR, ITEM FIVE,and POLICY FORMS AND ENDORSEMENTS. 56-6190 2ND EDITION 07-17 c6190202 Page 2 of 6 DocuSign Envelope ID:59100735-05CA-4E11-A40D-B980DDB1 D897 Policy Number: 60696-88-80 Effective Date: 11-15-2023 ITEM THREE-SCHEDULE OF COVERED AUTOS YOU OWN(DETAIL) Covered Auto No.: 002 VIN: 1 HTGEAYR9MH374318 Description: 1991 INTERNATIONAL 2000 2574 Garaging Zip: 98312 Coverage Limit Of lnsurane Or Deductible Premium Liability $1,000,000 $1,111 Collision $1,000 Deductible $83 Special Equipment Lesser of Actual Cash Value,Replacement Included DUMP TRUCK Cost or$5,000 Vehicle Total Premium $1,194 M O O N Covered Auto No.: 003 YIN:JNAU4T1J8TA503002 Description: 1996 NISSAN DIESEL UD1400 Garaging Zip: 98312 Coverage LimitOflnsuranceOrDeductible Premium 0 Liability $1,000,000 $957 co Comprehensive $1,000 Deductible $80 o Collision $1,000 Deductible $102 0 Towing And Labor $500 $25 0 Vehicle Total Premium $1,164 56-6190 2ND EDITION 07-17 C6190204 Page 3 of 6 DocuSign Envelope ID:59100735-05CA-4E11-A40D-B980DDB1 D897 Policy Number: 60696-88-80 Effective Date: 11-15-2023 ITEM FOUR-HIRED OR BORROWED COVERED AUTO Cost of hire means the total amount you incur for the hire of "autos" you don't own (not including "autos" you borrow or rent from your employees or their family members). Cost of hire does not include charges for services performed by motor carriers of property or passengers. . .................................... ....................... . Liability Coverage Rating Basis,Cost Of Hire State Estimated Annual Cost Of Hire Premium IFor Each State Subtotal Physical Damage Coverage Limit Of Insurance Estimated Annual Coverages Cos# •Of Hire Premium And Deductible Subtotal ITEM FIVE-NON-OWNERSHIP LIABILITY Non-Ownership Liability covers bodily injury or property damage arising out of the maintenance or use of a non-owned automobile in the business by any person other than the insured. .................................. Named Insured'sBusiness Rating Basis Number Premium Other than a Number of Employees Social Service Agency Number of Partners Number of Employees Social Service Agency Number of Volunteers Subtotal 56-6190 2ND EDITION 07-17 C6190205 Page 4 of 6 DocuSign Envelope ID:59100735-05CA-4E11-A40D-B980DDB1 D897 Policy Number: 60696-88-80 Effective Date: 11-15-2023 POLICY FORMS AND ENDORSEMENTS Number Title 25-9200ED3 Farmers Privacy Notice 25-9230ED3 Reminder-Review Your Coverages 31-8345 Washington PIP* 56-5166ED5 Additional Policy Conditions CA00010310 Business Auto Policy CA01350108 Changes In Policy CA20480299 Addl Insd-Designated Insured CA23920106 Washington Exclusion Of Terroris CA23940306 Silica Or Silica-Related Dust Ex CA99170306 Individual Named Insured E2013-ED1 Farm Tow Coverage E3027-ED1 No Covg-Cert Computer Rel Losses E3153-ED1 Waiver Of Subrogation E4277-ED1 Policy Changes IL00030498 Calculation Of Premium IL01231113 Washington Changes-Defense Costs IL01460810 Common Policy Conditions-Wa IL01980900 Wa-Nuclear Energy Liab Excl End J6738-ED1 Two Or More Coverage Forms J7106-ED2 Amendment To Additional Insured J7118-ED1 Auto Rideshare Exclusion J7119-ED3 Ded For Unlisted Employee Driver J7153-ED1 Additional Benefits And Services J7499-ED4 Bus Auto Coverage Amendatory End 57918-ED1 Wa-Amend To Membership/Policy Fe N M O O (N N Z 0 0 co C 0 O 0 O N N O O O N LOSS PAYEES Countersigned(Date) By Authorized Representative 56-6190 2ND EDITION 07-17 C6190206 Page 5 of 6 DocuSign Envelope ID:59100735-05CA-4E11-A40D-B980DDB1 D897 Policy Number: 60696-88-80 Effective Date: 11-15-2023 DRIVERS THAT ARE LISTED UNDER THIS POLICY License Driver License# First Name Last Name State Robert Bacon Jr WA XXXXXX91CK Robert Bacon WA XXXXXXC83B Nikki Bacon WA XXXXXX873B Barbara Bacon WA XXXXXX823B Excluded drivers will be listed in the Excluded Driver Endorsement or Restriction Endorsement,if attached. 56-6190 2ND EDITION 07-17 C6190208 Page 6 of 6 DocuSign Envelope ID:59100735-05CA-4E11-A40D-B980DDB1 D897 POLICY NUMBER: 60696-88-80 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s)who are"insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below. Endorsement Effective: Countersigned By: 11/15/23 �, Named Insured: M BACON, ROBERT o - (Authorized Representative) m SCHEDULE 2 Name of Person(s) or Organization(s): CITY OF BREMERTON IT'S 0 0 COMMISSIONERS, OFFICERS, co co (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent CO that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 DocuSign Envelope ID:59100735-05CA-4E11-A40D-B980DDB1 D897 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. tiPA FARMERS E3153 INSURANCE i st Edition CHANGES IN TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: Countersigned By: 11/15/23 Named Insured: BACON, ROBERT BACON'S CHRISTMAS TREE FARM (Authorized Representative) SCHEDULE Name Of Person(s) Or Organization(s): CITY OF BREMERTON IT'S o COMMISSIONERS, OFFICERS, M Additional Premium $ m 0 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) 0 The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person(s) or 0 organization(s) shown in the Schedule. We will retain the additional premium shown above, regardless of any Nearly termination of this endorsement or the policy. 0 0 0 This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy. 91-3153 1STEDITION 6-06 E3153-ED1 E3153101 Pogo 1 of 1 DocuSign Envelope ID:59100735-05CA-4E11-A40D-B980DDB1 D897 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. kTA FARMERS E3153 INSURANCE 1st Edition CHANGES IN TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: Countersigned By: 11/15/23 Named Insured: BACON, ROBERT BACON'S CHRISTMAS TREE FARM (Authorized Representative) SCHEDULE 0 Name Of Person(s) Or Organization(s): 0 0 ) cv Additional Premium $ 0 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person(s) or 0 organization(s) shown in the Schedule. We will retain the additional premium shown above, regardless of any early termination of this endorsement or the policy. 0 This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy. 91-3153 1STEDITION 6-06 E3153-ED1 E31531111 Page 1 of 1 DocuSign Envelope ID:59100735-05CA-4E11-A40D-B980DDB1 D897 POLICY NUMBER: 60696-88-80 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. kVA FARMERS j7106 INSURANCE 2nd Edition AMENDMENT OF ADDITIONAL INSURED This endorsement modifies insurance provided under the: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE Name Of Additional Insured Person Or Organization: CITY OF BREMERTON IT'S COMMISSIONERS,OFFICERS, AGENTS,VOLUNTEERS,EMPLOYEES 0 O Z 2 m 0 O C ro CO C m 0 O C O N N O O O *+k J7106-ED2 03-16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of2 93-7106 J7106201 DocuSign Envelope ID:59100735-05CA-4E11-A40D-B980DDB1 D897 The person or organization listed above is added to the Schedule of the following endorsement: Additional Insured and Loss Payee Additional Insured-Garages-Grantor of Franchise Additional Insured-Lessor of Leased Equipment Owners of Garage Premises Kansas Additional Insured-Garages-Grantor of Franchise Texas Additional Insured Texas Lessor Additional Insured and Loss Payee(Limited Coverage) Virginia Lessor-Additional Insured and Loss Payee Waiver of Rights Recovery X Other This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy. J7106-ED2 03-16 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page106202 93-7106 DocuSign Envelope ID 59100735-05CA-4E11-A40D-B980DDB1 D897 ir IRV &FAL -D r "r red STATE OF ,MASTER LICENgt wm rrq L vul.i hor is lu tic rola 49 ' Fri•. WASHINQTON 101 I EMIR l 004 t'+U f Lr14 r T1'b `4Jt..L. iNti,1M'4 L 114 I Id jor a I ,- IMF # fIGerlitY 11 1 the ha twitrgd k 4t u,.I rr> bl . Omptidd cpionwnwr.FrtL r i Lt I9, �1 � '•s r� �``titi� •'�M $1F41.0: i ASIJL A.;;,[ -4. a- i. °WINIONED i Dii ,IWr*u r c LICIEK10 U. . F: FM I. Fall ■ i - OocuSign Envelope ID: 59100735-05C.A-4El 1-A400-898000810897 • w o -- CO— : t RESELLER PERMIT ., , • �!' Washington State Department of Revenue R �;:' 'f wAwM 1'Vaw•)17e•Of)myy.WA vefw)�• )e•IeiePM)•1700 7.;:r;...... rf su N<fn t f ised to: Permit Number:A00938425 r•.�L T J' 600-293-105 .virr -.r ?I BACON.ROBERT L ACON'S CHRISTMAS TREE FARM Effective Date:Jan-01-2022 Wsf, 9381 W 6ELFAIR VALLEY RO Expiration Date:DeC-31-2025 ..e, + BREMERTON.WA 98312-9724 :t'x„ , ,,1 Business Activities: Nursery end Tree Production v 4r�,'�>% - This permit can be used to purchase: t • Merchandise and inventory for resale without intervening use ;:;?.'•}ti • Ingredients,components,or chemicals used in processingnew articles of tangiblepersonal property sale 9 P PertY produced for `l.. • Feed•seed.seedlings,fertilizer and spray materials by a farmer • Materials and contract labor for retail/wholesale construction • • Items for dual purposes(see Purchases for Dual Purposes on back) - This permit cannot be used to purchase: • Hems for personal or household use • Promotional items or giftsO. • p Items used in your business that are not resold,such as office supplies,equipment,tools,and equipment rentals Qj Materials and contract labor for public road construction or U.S.government contracting(see Definitions on back) o h: <?I • Materials and contract labor for speculative building This permit is no longer valid if the business is closed. \Cli 1 The business named on this permit acknowledges: 1 0 • It is solely responsible for all purchases made under this permit Q • Misuse of the permit: Ri a -Subjects the business to a penalty of 50 percent of the tax due,in addition to the tax,interest,and penalties imposed(RCW 82.32.291) 711 -May result in this permit being revoked 31 + Notes(optional): --1 -f1 • Important: The Department of Revenue may use information from sellers to verify all purchases made with this permit were qualified. 2