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HomeMy WebLinkAbout6080 Docusign Envelope ID:4B5E04AD-9275-4FFE-9FC6-2D4F671 FCE62 .�PSHINGTO,t, T � D V z • OF NATURP\" WILDFIRE STATE OF WASHINGTON DEPARTMENT OF NATURAL RESOURCES (DNR) AMENDMENT NO. 1 TO FORESTLAND RESPONSE AGREEMENT, DNR CONTRACT NO. 93-098574 PI: 221, 222, 223, 224 Funding Source: State Grant Funded: Z No OMWBE: ❑ Small Business❑ Veteran Owned Z Not Applicable Procurement method: Z Exempt, Department of Enterprise Services, Sole Source Contract Policy No. POL-DES-140-00, Section 5, Item 2, RCW 39.26.125(10) Washington State UBI#: 181-002-539 Statewide Vendor (SWV)#: SWV0000221 Federal EIN#: 91-6001231 The Forestland Response Agreement (FLRA) by and between the Washington State Department of Natural Resources, South Puget Sound Region, hereinafter referred to as"DNR" or AGENCY, and City of Bremerton, hereinafter referred to as"District/Department" is amended as follows: Section 3. Term is hereby amended as follows: 3. Term. The term of this agreement is from February 14, 2020, or date of execution, whichever is later, though December 31, 2026. The reason for this change is to extend the current FLRA to allow more time for the development of revised DNR FLRA Agreement with Fire District and Departments. Section 9. Operation Guidelines is amended to include a new subsection (3) which reads as follows: (3) Prescribed (RX) Fire Dispatch: See Attachment A — Operational Guidelines for resources ordered through the DNR Region or Division for dispatch outside of the District/Department jurisdictional boundaries; which is incorporated by reference herein. The guidelines for Fire Dispatch are the same, whether that be for a Wildland Fire Incident or Prescribed Fire. 1 of 3 DNR Contract Number: 93-098574,(Amendment No. 1) Form update date:12/18/23 Docusign Envelope ID:4B5E04AD-9275-4FFE-9FC6-2D4F671FCE62 Reason for the change is to add a subsection to Section 9 of the FLRA regarding Prescribed Fire Dispatch under this Agreement. Attachment A, Operation Guidelines, last paragraph in the Section titled; "DNR Agrees to:" is amended to read as follows: Rental vehicles for Off-road use must be procured consistent with the National Emergency Rental Vehicle Blanket Purchase Agreement (NERV). Rental vehicles for non-fire line positions must be rented through alternative sources other than the USFS NERV rental vehicle agreement. Rental vehicle authorization must be documented on the resource order. Please speak with your local DNR Region for more specific information. The reason for this change is to clarify the procedure for renting vehicles for Off-road use. The effective date of this Amendment is 12/6/2024 , or the last date of execution, whichever is later. ALL OTHER TERMS AND CONDITIONS of the original contract and any subsequent amendments remain in full force and effect. [INTENTIONALLY LEFT BLANK] 2 of 3 DNR Contract Number:93-098574, (Amendment No. 1) Form update date:12/18/23 Docusign Envelope ID:4B5E04AD-9275-4FFE-9FC6-2D4F671 FCE62 By signature below, the Parties certify that the individuals listed in this document, as representatives of the Parties, are authorized to act in their respective areas for matters related to this instrument. IN WITNESS WHEREOF, the Parties have executed this Agreement. CITY OF BREMERTON STATE OF WASHINGTON DEPARTMENT OF NATURAL RESOURCES — SOUTH PUGET SOUND REGION "—Signed by: ��������pp��,, p-®Signed by:tVLOz '�11 U y"""""" 11/12/2024 [_Vou &tLat , (U 12/6/2024 "—BAF46095E8E747B... ri it,6c FA8849F... Signature Date Signature Date Greg Wheeler Don Melton Name Name Mayor Region Manager -Acting Title Title 911 Park Avenue 950 Farman Avenue North Bremerton,WA 98337 Enumclaw,WA 98022 Address Address 360-473-5380 360-825-1631 Telephone Telephone ,—DocuSigned by: 194- rAt t,u�n 11/12/2024 — —BDD24F8E448F461.. _ 1 signature Date Pat McGanney—Fire Chief Name& Title "—Signed by: kLL((/�GW, raja, 11/12/2024 — —52ACBE8381604 Signature Date Kylie Finnell—City Attorney Name & Title "—Signed by: QvittA. ikoiow.x 11/13/2024 —� 24ED5ED4E45C41F... Signature Date Angela Hoover—City Clerk Name & Title 3 of 3 DNR Contract Number: 93-098574, (Amendment No. 1) Form update date:12/18/23 AGENDA BILL CITY OF BREMERTON 5 M CITY COUNCIL SUBJECT: Forestland Response Study Session Date: January 22, 2020 Agreement with the Department of Natural COUNCIL MEETING Date: February 5, 2020 Resources, South Puget Sound Region for Department: Fire Wildland Firefighting Support Presenter: Pat McGanney Phone: (360) 473-5381 SUMMARY: This agreement is between the City of Bremerton and the Washington State Department of Natural Resources (DNR), South Puget Sound Region, for wildland firefighting support. DNR agrees to reimburse the city for expenditures associated with personnel or equipment for responding to wildfire assignments. ATTACHMENTS: Washington Department of Natural Resources Forestland Response Agreement FISCAL IMPACTS (Include Budgeted Amount): Temporary financial impact while awaiting reimbursement from DNR STUDY SESSION AGENDA: 0 Limited Presentation ❑ Full Presentation STUDY SESSION ACTION: 0 Consent Agenda ❑ General Business ❑ Public Hearing RECOMMENDED MOTION: Move to approve the Department of Natural Resources Forestland Response Agreement with the City of Bremerton; and authorize the Mayor to finalize and execute the agreement with substantially the same terms and conditions as presented. COUNCIL ACTION: 11 Approve Form Updated 01/02/2018 ❑ Deny ❑ Table ❑ Continue ❑ No Action ..PgµiNGT°. , u gg • ° o- °,e NATuaP�' FORESTLAND RESPONSE AGREEMENT Agreement No. 93-098574 This Agreement is entered into between the state of Washington, Department of Natural Resources,South Puget Sound Region,hereinafter referred to as "DNR", and the below named Fire Protection District/Department, hereinafter referred to as "District/Department." City of Bremerton—Bremerton Fire Department 911 Park Ave Bremerton,WA 98337 Phone: 360-473-5380 FAX: 360-473-5397 Email: patrick.mcganney@ci.bremerton.wa.us Authority: This Agreement is entered into by DNR under the authority of RCW 76.04.015, RCW 76.04.135 and RCW 76.04.610(3); and by the District/Department under the authority of RCW 52.12.031,RCW 52.12.125 and RCW 35.21.010; and DNR and District/Department in conformity with RCW 39.34,the Interlocal Cooperation Act. In consideration of the terms, conditions and covenants contained herein, or attached and incorporated and made a part hereof, the Parties mutually agree as follows: 1. Purpose: The purpose of this Agreement is to (1)provide for mutual assistance and cooperation in the control and suppression of forestland fire and therefore to contract for the District/Department to provide fire protection services to an area within the jurisdiction of DNR and located in, or adjacent to, the District/Department and to contract for the DNR to assist in fire protection services on forestland within District/Department jurisdiction; and (2) dispatch and pay for fire service resources outside the fire service District/Department jurisdictional boundaries. 2. Scope: This Agreement pertains to forestland fire incidents within or adjacent to the District/Department boundaries and to District/Department resources ordered through the DNR Region or Division for dispatch outside of District/Department boundaries for support provided by DNR as outlined in Attachment A—Operational Guidelines for «Agreement No>> Page 1 of 12 FLRA 2017—03.19.18 Resources ordered through the DNR Region or Division for dispatch outside of District/Department boundaries. 3. Term. The term of this agreement is January 2,2020, or date of execution, whichever is later,through January 2,2025. 4. Jurisdictional Responsibility: Within or adjacent to the District/Department boundaries,the statutory jurisdictional responsibility for fire control on forestland varies. It may be: (1) Sole DNR Jurisdiction: Land subject to Forest Fire Protection Assessment and District/Department is NOT collecting fire protection levy (2) Sole District/Department Jurisdiction: Land subject to District/Department fire protection levy and not subject to Forest Fire Protection Assessment. (3) Joint Jurisdiction: Land subject to Forest Fire Protection Assessment and the District/Department is collecting fire protection levy. 5. Mutual Aid Fire Incident Response: (1) Sole DNR Jurisdiction: In the event of a fire emergency in a sole DNR jurisdiction area, the DNR will respond. The District/Department may respond to provide immediate control action,minimize fire loss, and thereby indirectly protect its own jurisdiction area. DNR may request response from the District/Department to gain timely initial attack and control action,or to supplement DNR resources. (2) Sole District/Department Jurisdiction: In the event of a fire emergency in a sole District/Department jurisdiction area,the District/Department will respond. DNR may respond to provide immediate control action, minimize fire loss, and thereby indirectly protect its own jurisdiction area. The District/Department may request that DNR provide supplemental resources for fire emergency operations and support. (3) Joint Jurisdiction: In the event of a fire emergency in a joint jurisdiction area, both DNR and the District/Department will respond, subject to the availability of resources. 6. Off-Season Incidents: For this Agreement,no incident will be considered off-season. Fire season will be January 1-December 31 each year. 7. Command: (1) Sole DNR Jurisdiction Incidents: When the District/Department is the first arriving agency,the District/Department on-site initial responders shall establish command until released by a representative of DNR. <<Agreement No>> Page 2 of 12 FLRA 2017—03.19.18 (2) Sole District/Department Jurisdictional Incidents: When DNR is the first arriving agency,the DNR on-site initial responders shall establish command until released by a representative of the District/Department. (3) Joint Jurisdiction Incidents: The first arriving agency initial responders shall establish command and, upon the arrival of the other agency,unified command will be established and used for incident management. 8. Fire Control and Suppression Definitions: (1) Forestland: As the term is defined by RCW 76.04.005. (2) Ordering: Prior to the arrival of DNR at the incident,the initial attack incident commander may order special resources through DNR. That decision may be documented and payment authorized(see Section 11 of this Agreement)by DNR prior to the mobilization of special resources. (3) Special Resources: Air resources, dozers,heavy equipment, or other resources deemed necessary to contain and control the fire. 9. Operation Guidelines: (1) Forestland Response: Representatives of the District/Department and DNR shall mutually develop operation guidelines that provide principles,direction and guidance for the conduct of fire control operations related to forest land response. The operation guidelines shall be reviewed at least annually, and revised as necessary to achieve cooperation and understanding. (2) DNR Dispatch: See Attachment A- Operation Guidelines for resources ordered through the DNR Region or Division for dispatch outside of the District/Department jurisdictional boundaries;which is incorporated by reference herein. 10. Fire Investigation: The District/Department and DNR agree to protect the origin area of any fire to the best of its ability. Fires will be jointly investigated when an incident originated in a joint jurisdiction area. A DNR fire investigator may investigate fires originating on, spreading to or threatening land subject to Forest Fire Protection Assessment(i.e., sole DNR or joint jurisdiction areas). 11. Costs: (1) Charges Not Required: One purpose of this Agreement is mutual assistance and cooperation in the control and suppression of fires (see Section 1 -Purpose). In most instances,resource costs will not be charged to the other party. However,there may be circumstances or conditions where the District/Department or DNR desires or is required to charge, or request reimbursement, for resource costs as described in Subsections (2), (3), (4), and(5) below. <<Agreement No>> Page 3 of 12 FLRA 2017—03.19.18 (2) Sole DNR Jurisdiction: If the District/Department responds,DNR will pay for District/Department personnel and equipment costs outside of mutual aid unless otherwise negotiated. (3) Sole District/Department Jurisdiction: If DNR responds,the District/Department will pay for DNR personnel and equipment costs outside of mutual aid unless otherwise negotiated. (4) Joint Jurisdiction: Initial attack through complete extinguishment of the fire, each party will pay its own costs. (5) DNR Dispatch: If District/Department personnel is dispatched by DNR outside of District/Department jurisdictional boundaries, DNR will pay for District/Department personnel and equipment costs. 12. Cost Reimbursement Procedures: (1) Forestland Response: Provisions within this Agreement for reimbursement of costs related to forest land response are subject to the following conditions: (a) Notice: Prior to costs being incurred as allowed by this Agreement(other than DNR Dispatch),notice of such expenditure must be given to DNR of the requesting agency prior to the expenditure or commitment of funds. (b)Invoice: Any resource provider costs,which are to be billed,must be invoiced within sixty(60)business days of the last date of incurred expense for the incident. (2) DNR Dispatch: Provisions within this Agreement for reimbursement of costs related to DNR dispatch are outlined in Attachment A- Operation Guidelines for resources ordered through the DNR Region or Division for dispatch outside of the District/Department jurisdictional boundaries;which is incorporated by reference herein. 13. Cost Reimbursement Rates: (1) Forestland Response: (a) Equipment costs shall be paid to the resource provider at the DNR Wage and Equipment Rates or as otherwise agreed to in writing by the respective authorized agency representatives. (b) Career/permanent and seasonal personnel costs will be reimbursed to the resource provider at the resource provider's actual total cost. This will include backfill costs as outlined in the State Mobilization Plan. (2) DNR Dispatch: Cost reimbursement rates related to DNR dispatch are outlined in Attachment A - Operation Guidelines for resources ordered through the DNR Region or Division for dispatch outside of the District/Department boundaries. «Agreement No>> Page 4 of 12 FLRA 2017—03.19.18 14. Insurance: DNR is an agency of the state of Washington and is therefore self-insured under the State's Self-Insurance Liability Program. The District/Department shall, at all times during the term of this Agreement at its sole cost and expense,buy and maintain insurance of the types and amounts listed below. Failure to buy and maintain the required insurance may result in the termination of the Agreement at DNR's option. If the District/Department is self-insured,evidence of its status as self-insured will be provided to DNR, and if deemed acceptable by DNR, shall satisfy the insurance requirements specified by this Section. The limits of insurance to be bought and maintained by the District/Department shall not be less than as follows: Minimum Coverage Requirements: These limits may not be sufficient to cover all liability losses and related claim settlement expenses. Purchase of these minimum limits of coverage does not relieve the District/Department from liability for losses and settlement expenses greater than these amounts. DNR shall not be charged for the cost for insurance coverage(s). District/Department is required to purchase insurance for a period of 36 months after completion of this Agreement. This requirement may be satisfied by the continuous purchase of an extended agreement. This requirement may be satisfied by the continuous purchase of an extended reporting period. During the term of the Agreement, District/Department must purchase and maintain the insurance coverage and limits specified below: (1) Commercial General Liability (CGL)Insurance or District/Department Equivalent. District/Department must purchase and maintain CGL on an Insurance Services Office (ISO)form CG 00 01 or equivalent form, covering liability arising from premises, operations, independent contractors,personal injury,products- completed operations, and liability assumed under an insured contract. Such insurance must be provided on an occurrence basis. If insurance is written on a "claims made"basis,the policy shall provide full coverage for prior acts or include a retroactive date that precedes the effective date of this Agreement. Insurance must include liability coverage with limits not less than those specified below: Description Dollar Amount General Aggregate Limit $2,000,000 (Other than products-completed operations) Each Occurrence Limit $2,000,000 (2) Employer's liability("Stop Gap") Insurance: District/Department shall purchase and maintain employer's liability insurance and if necessary, commercial umbrella liability insurance with limits not less than$1,000,000 each accident for bodily injury by accident or$1,000,000 each employee for bodily injury by disease. (3) Business Auto Policy(BAP)Insurance: If activities pursuant to this Agreement involve the use of vehicles,to include FEPP vehicles, the District/Department must purchase and maintain a BAP on an Insurance Services Office (ISO)form CA 00 01 or equivalent form. The Description of Covered Autos must include one or more of the following: «Agreement No>> Page 5 of 12 FLRA 2017—03.19.18 a. "Any Auto"(Symbol 1). b. If District/Department-owned personal vehicles are used,the BAP must cover "Owned Autos Only" (Symbol 2). c. If District/Department hires autos,the BAP must cover"Hired Autos Only" (Symbol 8). d. If District/Department employee's vehicles are used,the BAP must cover"Non- Owned Autos Only" (Symbol 9). Such insurance must be provided on an occurrence basis. The BAP insurance must include liability coverage with limits not less than those specified below. The District/Department is responsible for any deductible. Description Each Accident Bodily Injury and Property Damage $1,000,000 (4) Workers Compensation Insurance or Equivalent: The District/Department shall comply with all state of Washington workers compensation statutes and regulations. Coverage shall be provided for all employees and volunteers of the District/Department and shall include bodily injury (including death)that arises out of or in connection with the performance of this Agreement. 15. Service Limitations. The responses and fire suppression services provided for under this Agreement are intended to be rendered on the same basis as such services are rendered to other areas within the District/Department or DNR jurisdictions and neither party assumes liability for failure to provide services by reason of any circumstances beyond the party's control. In the event of simultaneous fires or medical aid calls within the areas covered by this Agreement whereby facilities of either party are taxed beyond the party's ability to render equal protection,the officers and agents of the party shall have sole discretion as to which call shall be answered first. The responding party shall have sole discretion to determine the manner and method of responding to and handling emergencies under this Agreement consistent with Section 7 - Command of this Agreement. 16. Benefits. This agreement is entered into for the benefit of the parties to this agreement only and shall confer no benefits, direct or implied, on any third persons. 17. Renegotiation and Modification: The terms and conditions of this Agreement may be renegotiated at the request of either Party between January 1 and March 1 of any year. Any modification or amendment of this Agreement must be in writing and must be signed by duly authorized agents of the Parties. 18. Assignment and Delegation: This Agreement, or any right or interest therein,may not be assigned or otherwise transferred by either Party without the prior written consent of the other Party. Any attempted assignment shall be void unless made in strict conformity with this section. Either Party may perform its duty through a delegate or agent,but shall not be thereby relieved of any duty to perform or any liability for breach of this Agreement. <<Agreement No>> Page 6 of 12 FLRA 2017—03.19.18 19. Remedies: Any remedy exercised by either Party shall not be deemed exclusive and either Party may pursue any and all other remedies available to it under the law. 20. Compliance with Laws: Parties shall comply with all applicable federal, state, and local laws,rules and regulations that govern each component of this Agreement. 21. Non—Waiver: Waiver by either Party of strict performance of any provision of this Agreement shall not act as a waiver of the right of the other Party to require future strict performance of the same provision or any other provision. 22. Interpretation and Venue: This Agreement shall be construed and interpreted in accordance with the laws of the state of Washington. The venue of any action brought under this Agreement shall be in the Superior Court of Thurston County. 23. Severability: If any provision of this Agreement is held to be invalid, such invalidity shall not affect the other provisions of this Agreement that can be given effect without the invalid provision(s), and to this end the provisions of this Agreement are declared severable. 24. Termination: This Agreement may be terminated by either Party by the provision of ninety(90) days written notice,provided that neither Party may terminate this Agreement at any time between April 15 and October 15 of any year due to the fire danger during this period. 25. Agreement Managers: DNR AGREEMENT MANAGER Name: Jane Potter Title: Fire Regulations Coordinator Address: 950 Farman Ave No City/State/Zip: Enumclaw, WA. 98022 Phone: 360-825-1631 Email: jane.potter@dnr.wa.gov DISTRICT/DEPARTMENT AGREEMENT MANAGER Name: Patrick McGanney Title: Fire Chief Address: 911 Park Ave City/State/Zip: Bremerton, WA. 98337 Phone: 360-473-5380 Email: patrickmcganney@ci.bremerton.wa.us This Agreement supersedes all previous agreements. <<Agreement No>> Page 7 of 12 FLRA 2017—03.19.18 By signature below, the Agencies certify that the individuals listed in this document, as representatives of the Agencies, are authorized to act in their respective areas for matters related to this instrument. IN WITNESS WHEREOF, the parties have executed this Agreement. DISTRICT/DEPARTMENT STATE OF WASHINGTON DEPARTMENT OF NATURAL RESOURCES 2., za 2/y/20 ZO Signature Date Signature Date Greg Wheeler Scott Sargent Printed Name Printed Name Mayor South Puget Sound Region Manager Title Title DISTRICT NTH y s 2 ure > ti Date I,05 r *edger Lubovich Printed Name City Attorney Title DISTRICT/DEPARTMENT Signature Date Patrick McGanney Printed Name Bremerton Fire Chief Title DISTRICT/DEPARTMENT Signature Date Printed Name Title <<Agreement No>> Page 8 of 12 FLRA 2017—03.19.18 Attachment A Operation Guidelines Resources ordered through the DNR Region or Division for dispatch outside of District/Department jurisdictional boundaries Department of Natural Resources (DNR) agrees to dispatch District/Department resources to incidents outside of the Districts/Department jurisdictional boundaries as needed to meet DNR responsibilities and as approved by the District/Department. Dispatches can include out of the state of Washington. Participation by a District/Department with incidents outside its jurisdiction is voluntary and separate from involvement in State Fire Mobilization. This Agreement extends to paid members: ■ Washington Fire Service (WFS)paid members who participate on the Northwest Interagency Incident Management Teams(NWIMT primary/alternate pool/trainee) and any paid members who wish to participate in any other capacity on incidents in which District/Department supports. This agreement does NOT extend to volunteers: • Members of Washington Fire Service who are volunteers will need to be hired by the DNR via the DNR casual hire process. This may be completed pre-season or at the time of the incident. Your local DNR Region office will handle the casual hire process. District/Department agrees: 1) All personnel dispatched outside of their jurisdictional boundaries will have a valid Incident Qualification Card(red card) stating current qualifications; and will adhere to qualifications and standards described in PMS 310-1; 2) To provide a copy of the Master IQS Record for each participating employee(needed to update status in the Resource Ordering Status System(ROSS); 3) To keep equipment and personnel status current in ROSS by selecting option a. or b. below as the preferred option. List available resources on the following resource list addendum. (Check one): a. n DNR Region will give Web-Status rights to ROSS for district employees. It is the employee's responsibility to ensure that their status is accurate. b. ® DNR Region will status your employees. For this option, you would need to provide your local DNR Region Dispatch with the status of your employees every Monday by 1200 hours. Dispatch would then update their status in ROSS for that week(0800 Tuesday to 0800 Tuesday). For dispatches outside of the DNR region, approval from DNR host region fire staff is required. Host region fire staff will coordinate with Wildfire Division in order to ensure statewide readiness. 4) To notify your local DNR Region of any changes in status of personnel/equipment(i.e.; dispatched/demob under State Fire Mobilization, demob &ETA home from incidents dispatched thru DNR, etc.); «Agreement No>> Page 9 of 12 FLRA 2017—03.19.18 5) All personnel and equipment dispatched will be paid by the District/Department; (except volunteers will follow payment procedures outlined in their individual agreement and be paid directly by DNR); 6) All Equipment and Personnel dispatched under this agreement will arrive at each incident with a copy of their current Forestland Response Agreement. 7) Invoice for personnel and equipment costs billed to DNR will include: a. Original Emergency Fire Time Report(OF-288);hourly wage rate (regular and OT) for personnel hours on the OF-288. This applies to paid district/department staff. Volunteers will be paid directly by DNR. b. Original shift ticket (OF-286) documenting mileage to/from incident as well as mileage incurred on the incident signed by the incident supervisor. c. Copy of Resource Order card. 8) Invoices requesting payment for equipment(engines/tenders)will be submitted to DNR within sixty(60) business days of the last date of the incurred expense for the incident and shall include Original Emergency Equipment Use Invoice Form(OF-286) and shift tickets (OF-297); and 9) Invoices requesting payment for other travel costs (meals, lodging not provided by the incident)must be submitted to DNR within sixty(60)business days of the last date of the incurred expense for the incident. 10)Only utilize agency owned vehicles or procured rental vehicles on the fire line or offload. DNR agrees to: 1) Assist the District/Department with updating status' in ROSS; 2) Maintain IQS records for District/Department personnel with wildland fire qualifications, if red carded through the DNR; 3) Reimburse District/Department within 30 days of invoice receipt and documentation as required above; 4) Reimburse the Fire Service District/Department at the Total Cost of personnel. This includes,regular time, overtime, and District/Department backfill for that position as outlined in the State Mobilization Plan. The DNR will not pay for muster time,wildland premium pay, or other unspecified pay provisions. **Rental vehicles must be procured consistent with the R6 USFS rental vehicle agreement. Rental vehicle authorization must be documented on the resource order. Please speak with your local DNR Region for more specific information. In order to provide audit tracking for all rental vehicles,rentals ordered for overhead resources with ROSS 0#Resource Orders,will have a support request ROSS order attached to that O#resource, with an E#assigned to the vehicle. The overhead resource and Dispatch will ensure that if that person is re-assigned or released,the supporting vehicle order will also be re-assigned or released. <<Agreement No>> Page 10 of 12 FLRA 2017—03.19.18 DISTRICT/DEPARMENT RESOURCE LIST OVERHEAD AND EQUIPMENT ADDENDUM DNR will dispatch and process invoices for the following fire district members and equipment when dispatched by DNR outside of their fire district. Overhead Resources Name Career or Backfill Position/Qualifications Team Affiliation or Volunteer Required Single Resource Raymond Grahn Career YES Crew/Eng Single Bremerton Fire Resource Single Resource Daniel Baker Career YES Firefighter 2 Bremerton Fire Carlo Celeste Career YES Firefighter 2 Bremerton Fire Alexander Magallon Career YES Firefighter 2 Bremerton Fire Kurt VanNess Career YES Firefighter 2 Bremerton Fire Brian Allen Career YES Firefighter 2 Bremerton Fire Patrick French Career YES Firefighter 2 Bremerton Fire Christopher Ritter Career YES Bremerton Fire EQUIPMENT make,model,year, license,VIN and type RATE/NEGOTIATED RATE* 1 2004 Seagrave Pumper Type 1 Lic.#39533D Vin# 1F9ED28T44CST2032 *The negotiated rate must be agreed upon between the signing parties prior to dispatch. CONTACT INFORMATION: <<Agreement No>> Page 11 of 12 FLRA 2017—03.19.18 <<Agreement No>> Page 12 of 12 FLRA 2017—03.19.18 Page 1 of 1 Ac/ D CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 02/11/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Willis Towers Watson Certificate Center NAME: Willis Towers Watson Insurance Services West, Inc. fka Willis of Seattle, Inc. (A/CNE No.Extl: 1-877-945-7378 (A/C,No):AX 1-888-467-2378 c/o 26 Century Blvd ADDRESS: certificates@willis.com P.O. Box 305191 INSURER(S)AFFORDINGCOVERAGE NAIC# Nashville, TN 372305191 USA INSURER A: VantaPro Specialty Insurance Company 44768 INSURED Midwest Employers Company 23612 City of Bremerton INSURER B: Casualty P Y Attn: Melina Folmar INSURER C: 345 Sixth Street _INSURER D: Suite 100 Bremerton, WA 983371873 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W15435498 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTRINSD WV() POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 10,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 100,000 PREMISES(Ea occurrence) $ A MED EXP(Any one person) $ 5155-0013-00 02/01/2020 02/01/2021 PERSONAL BADVINJURY $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 12,000,000 POLICY PRO LOC 12,000,000 PRO- JECT PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 10,000,000 X ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED 5155-0013-00 02/01/2020 02/01/2021 BODILY INJURY(Peraccident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) Retention $ 500,000.00 UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 10,000,000 A )( EXCESSLIAB CLAIMS-MADE 5155-0013-00 02/01/2020 02/01/2021 AGGREGATE $ 10,000,000 DED X RETENTION$500,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE 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 $ B Excess Workers Compensation EWC008924 02/01/2020 02/01/2021 E.L. EA Accident $1,000,000 and Employers Liability E.L. Disease EA. Emp. $1,000,000 Per Statute E.L. Disease-Policy 0 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) 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. AUTHORIZED REPRESENTATIVE Department of Natural Resources 950 Farman St N i 3 Enumclaw, WA 98022 g I ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD i SR ID: 19246197 BATCH: 1572135