HomeMy WebLinkAboutQuilcene Fair and Parade Association re: LTAC - 021621 (ins ex 9-15-19) will send update at time of event or:5 fctiv, eilean
AGREEMENT FOR 2021 HOTEL-MOTEL FUNDING FOR TOURISM SERVICES
QUILCENE FAIR& PARADE ASSOCIATION
This Agreement is by and between JEFFERSON COUNTY(hereinafter known as "COUNTY"
and QUILCENE FAIR&PARADE ASSOCIATION(hereinafter known as "QUILCENE FAIR").
WHEREAS, QUILCENE FAIR&PARADE ASSOCIATION is a non-profit corporation of the ,
State of Washington; and
WHEREAS,the COUNTY desires to promote tourism in unincorporated Jefferson County, as
authorized by Chapter 67.28 RCW and Jefferson County Code Chapter 3.25; and
WHEREAS,the Jefferson County Lodging Tax Advisory Committee reviewed and
recommended funding the lodging tax proposal by the QUILCENE FAIR to implement a strategy for
the unincorporated area of Jefferson County to promote tourism activities;
1N CONSIDERATION of the mutual covenants and agreements herein it is agreed by the
parties as follows:
SECTION 1: SERVICES TO BE PERFORMED
The QUILCENE FAIR shall use its capabilities and utilize the funding provided under this agreement
to continue and update the ongoing performance of the following tourism promotion services, as
outlined below:
1. The QUILCENE FAIR shall use its capabilities and utilize up to $10,000 of funding provided under
this agreement to promote the Quilcene Fair and Parade restricted to any of the eligible items in the
itemized list of proposed tourism promotion services, a copy of which is incorporated herein as
Exhibit A.
2. In recognition of the unavoidable disruption to tourism activities from the COVID-19 pandemic,
QUILCENE FAIR may substitute other Promotion Services in 2021 in using the funding provided
through this Agreement,upon prior presentation of an itemized list to the Lodging Tax Advisory
Committee(LTAC) and affirmative vote by the LTAC recommending that QUILCENE FAIR
proceed with the proposed substitution. In such case no amendment to this Agreement shall be
required and QUILCENE FAIR may use the funding to perform the substitute Promotion Services
in 2021.
SECTION 2: RESPONSIBILITIES OF THE QUILCENE FAIR& PARADE ASSOCIATION:
1. On or before January 31; April 30; July 31; October 31,2021; and January 31,2022,provide to
the COUNTY:
• A quarterly report of the use, services,programs and activities of the QUILCENE FAIR
under this Agreement for the prior quarter;
• A quarterly financial statement detailing revenues, expenses and cash balances for the prior
quarter; and for the final quarter report,the financial statement shall also include a detailed
financial statement for all 2021.
Page: 1 of 9 Quilcene Fair& Parade Association
2. On or before January 31, 2021 OR upon execution of this agreement,whichever is later,
provide to the COUNTY:
• A billing invoice requesting payment of Hotel-Motel Funding for the current year.
3. For a minimum of six (6)years, maintain documented proof of payments made, contracts
executed, and other expenditures authorized under this Agreement. Upon reasonable notice,
provide access to County or State representatives to audit those records.
4. Funding provided by this Agreement may only be expended on the services described in
Section 1 of this Agreement. Any monies used for other services or purposes shall be
refunded to Jefferson County Hotel/Motel Fund. Any monies under-expended of the total
funding allocated under this Agreement shall be refunded to Jefferson County by January 31,
2022.
5. By February 28th of each year provide the following information on Exhibit B, attached hereto
and incorporated by reference for the previous year.
a. Each festival, event, or tourism facility owned and/or operated by the QUILCENE FAIR.
b. The amount of lodging tax revenue allocated for expenditure(whether actually expended or
not)by the QUILCENE FAIR on each festival, event or tourism facility.
c. Estimated number of tourists served at each festival, event or tourism facility. ("Tourist"
includes persons traveling more than 50 miles to the location of the event, festival or facility
and overnight stays in the area).
d. Estimated lodging stays. ("Lodging"refers to commercial lodging such as hotels,motels,
resorts,bed and breakfasts, or commercial campgrounds).
e. Measurements that demonstrate the impact of increased tourism attributable to the event,
festival or facility.
SECTION 3: RESPONSIBILITY OF JEFFERSON COUNTY
1. The COUNTY will provide the QUILCENE FAIR funding from Hotel-Motel Tax receipts to be
used in support of their responsibilities as defined under this agreement.
2. Said funding is in the sum of$10,000 for 2021. Payments are to be predicated on submittal of
reports defined in Section 2. Payment will be made by the COUNTY upon receipt of an invoice
on the next available billing cycle.
3. The County recognizes that the original allocation to the QUILCENE FAIR in Hotel-Motel
funds for promotional services in Jefferson County may be voluntarily reduced because of the
impacts of the COVID-19 pandemic. Any voluntary reduction from 2021 funding is earmarked
for potential use in 2022, contingent on a recommendation by the Lodging Tax Advisory
Committee to award those funds to the QUILCENE FAIR in 2022 and approval by the Board of
County Commissioners.
SECTION 4: TERM
This Agreement shall be for a term of one year, commencing on January 1,2021 and ending on
December 31, 2021, except for the reports referenced in Section 2, due January 31,2022 and February
Page: 2 of 9 Quilcene Fair& Parade Association
28, 2022. Work performed during the term and pursuant to this Agreement,but prior to its complete
execution, is hereby ratified.
SECTION 5: ASSIGNMENT
Either party to the agreement shall not assign this Agreement, except by signed amendment.
SECTION 6: MODIFICATION
This Agreement may be modified by mutual written agreement executed by both parties.
SECTION 7: TERMINATION
The Agreement may be terminated, in whole or in part,by the County upon thirty(30)days written
notice in the event expected or actual revenue from the Hotel-Motel Tax is reduced or limited in any
way, or for non-performance of duties under this Agreement, or for any reason. The QUILCENE
FAIR may terminate this Agreement upon thirty(30)days written notice to the COUNTY. In the event
of termination under this clause,the County shall be liable to pay only for services rendered prior to the
effective date of termination. If termination covers a period for which payment has already been made,
the QUILCENE FAIR shall refund to the COUNTY a pro-rated share of the payment based upon the
balance of time remaining in the paid period, unless otherwise negotiated.
SECTION 8: HOLD HARMLESS
The QUILCENE FAIR shall indemnify and hold the COUNTY, and its officers, employees, and
agents harmless from and shall process and defend at its own expense, including all costs, attorney
fees and expenses relating thereto, all claims, demands, or suits at law or equity arising in whole or
in part, directly or indirectly, from the QUILCENE FAIR's negligence or breach of any of its
obligations under this Agreement; provided that nothing herein shall require the QUILCENE FAIR
to indemnify the COUNTY against and hold harmless the COUNTY from claims, demands or suits
based solely upon the conduct of the COUNTY, its officers, employees and agents, and; provided
further that if the claims or suits are caused by or result from the concurrent negligence of: (a)the
QUILCENE FAIR's agents or employees; and, (b)the COUNTY, its officers, employees and agents,
this indemnity provision with respect to claims or suits based upon such negligence, and/or the costs
to the COUNTY of defending such claims and suits, etc., shall be valid and enforceable only to the
extent of the QUILCENE FAIR's negligence, or the negligence of the QUILCENE FAIR's agents or
employees.
The QUILCENE FAIR specifically assumes potential liability for actions brought against the
COUNTY by the QUILCENE FAIR's employees, or any other persons engaged in the performance
of any work or service required of the QUILCENE FAIR under this Agreement and, solely for the
purpose of this indemnification and defense,the QUILCENE FAIR specifically waives any
immunity under the state industrial insurance law, Title 51 RCW. The QUILCENE FAIR recognizes
that this waiver was specifically entered into pursuant to provisions of RCW 4.24.115 and was
subject of mutual negotiation.
Page: 3 of 9 Quilcene Fair& Parade Association
SECTION 9: INSURANCE
The QUILCENE FAIR shall obtain and keep in force during the term of the Agreement, or as
otherwise required,the following insurance with companies or through sources approved by the State
Insurance Commissioner pursuant to RCW 48:
1. Worker's Compensation and Employer's Liability Insurance as required by the State of
Washington. The QUILCENE FAIR shall maintain Workers' Compensation coverage as
required under the Washington State Industrial Insurance Act, RCW Title 51, for all
QUILCENE FAIR employees, agents and volunteers eligible for such coverage under the
Industrial Insurance Act.
2. Automobile Liability Insurance:
a. In the event QUILCENE FAIR shall own any vehicle during the term of this Agreement,
Commercial Automobile Liability Insurance providing bodily injury and property damage
liability coverage for all owned and non-owned vehicles assigned to or used in the
performance of work under this Agreement for a combined single limit of not less than
$1,000,000 each occurrence.
b. For hired vehicles used in the performance of work under this Agreement QUILCENE
FAIR shall obtain bodily injury and property damage liability coverage for a combined
single limit of not less than $1,000,000 each occurrence.
c. The QUILCENE FAIR will ensure
sure any third party drivers performing work under this
Agreement, other than under paragraph b., shall obtain the following coverages at a
minimum: a limit of$25,000 for bodily injury or death of 1 person in any single accident,
$50,000 for bodily injury or death of 2 people in any single accident, and $10,000 of
property damage coverage in any single accident for their owned& non-owned vehicles
assigned to or used in the performance of their work.
3. General Commercial Liability Insurance or Event Liability Insurance in an amount not less
than a single limit of one million dollars ($1,000,000.00)per occurrence and an aggregate of
not less than two (2)times the occurrence amount($2,000,000.00 minimum) for bodily
injury, including death and property damage, unless a greater amount is specified in the
contract specifications. The insurance coverage shall contain no limitations on the scope of
the protection provided and include the following minimum coverage:
a. Broad Form Property Damage, with no employee exclusion;
b. Personal Injury Liability, including extended bodily injury;
c. Broad Form Contractual/Commercial Liability—including: completed operations;
d. Premises—Operations Liability(M&C);
e. Independent Contractors and subcontractors;
f. Blanket Contractual Liability.
Page: 4 of 9 Quilcene Fair& Parade Association
Said commercial automobile liability policy and general commercial liability or event liability policy
shall name the County as an additional insured and shall include a provision prohibiting cancellation
or reduction of coverage of said policy except upon thirty(30) days prior written notice to the
County. Certificates of coverage as required by this Section shall be delivered to the County within
thirty(30) days of execution of this Agreement.
The County may, upon the QUILCENE FAIR's failure to comply with any or all provisions of this
contract relating to insurance, withhold payment or compensation that would otherwise be due to the
QUILCENE FAIR.
If the proof of insurance or certificate indicating the County is an"additional insured"to a policy
obtained by the QUILCENE FAIR refers to an endorsement(by number or name)but does not
provide the full text of that endorsement, then it shall be the obligation of the QUILCENE FAIR to
obtain the full text of that endorsement and forward that full text to the County.
All insurance policies obtained by QUILCENE FAIR in order to comply with this Section shall be
primary and non-contributory as against any coverage provided through any memorandum of
coverage for third party liability claims or actions obtained and retained by the County through a Ch.
48.62 RCW"Risk Pool."
It is agreed by the parties that insurers shall have no right of recovery or subrogation against the
County(including its employees and other agents and agencies), it being the intention of the parties
that the insurance policies so affected shall protect both parties and be primary coverage for any and
all losses covered by the above described insurance.
The insurance maintained by QUILCENE FAIR under this Agreement shall not in any manner limit
or qualify the liabilities or obligations of QUILCENE FAIR under this Agreement.
SECTION 10: INDEPENDENT CONTRACTOR
The QUILCENE FAIR and the COUNTY agree that the QUILCENE FAIR is an independent
contractor with respect to the services provided pursuant to this agreement. Nothing in this
agreement shall be considered to create the relationship of employer and employee between the
parties hereto. Neither the QUILCENE FAIR nor any employee of the QUILCENE FAIR shall be
entitled to any benefits accorded County employees by virtue of the services provided under this
agreement. The COUNTY shall not be responsible for withholding or otherwise deducting federal
income tax or social security or for contributing to the state industrial insurance program, otherwise
assuming the duties of an employer with respect to the QUILCENE FAIR, or any employee,
representative, agent or contractor of the QUILCENE FAIR. The QUILCENE FAIR shall be
responsible for all applicable withholdings, deductions, state industrial insurance, tax reports,
business licenses, registrations, and all other obligations of an independent organization.
SECTION 11: COMPLIANCE WITH LAWS
The QUILCENE FAIR shall comply with all Federal, State, and local laws and ordinances applicable
to the work to be done under this Agreement. This Agreement shall be interpreted and construed in
Page: 5 of 9 Quilcene Fair& Parade Association
accord with the laws of the State of Washington and venue shall be in Jefferson County,
Washington.
SECTION 12: DISCRIMINATION PROHIBITED
The QUILCENE FAIR with regard to the project to be completed under this agreement,will not
discriminate on the grounds of age, sex,marital status, sexual orientation,race,creed,color,national
origin,honorably discharged veteran or military status,or the presence of any sensory,mental,or
physical disability or the use of a trained dog guide or service animal by a person with a disability,
unless based upon a bona fide occupational qualification in the selection and retention of employees,
materials, supplies,contractors or subcontractors.
SECTION 13: INTEGRATED AGREEMENT
This agreement together with attachments or addenda represents the entire and integrated agreement
between the County and the QUILCENE FAIR and supersedes all prior negotiations,representations,
or agreements written or oral. This agreement may be amended only by written instrument signed by
both the County and the QUILCENE FAIR.
4'1r7
APPROVED and signed this day of bt tV+'LJ ,2021.
J
JEFFERSON COUNTY
Attest: BOARD OF COMMISSIONERS
Oa t (
Carolyn Gallaway, Kate D an,Chair
Clerk of the Board
Approved as to Form: Quilcene Fair&Parade Association
0 .„..,-_,,......A.,-----
'*.. February 12, 2021 ti J
Aut ' LIJ
Philip Hunsucker, horized O ial
Chief Civil Deputy Prosecutor
Page: 6 of 9 Quilcene Fair&Parade Association
EXHIBIT A
Itemized List of Proposed Tourism Promotion Services
19,319.39 Revenue-Bank Interest 0.39
Revenue-Booth 2,555 00
Revenue-Car Show and 50/50 Raffle 3,000.00
Revenue-Sponsorship 2,215.00
215.00 Qullcene Fair and Parade
Revenue- BS Races/Fish Game 163.00
Revenue- Raffle/Silent Auction 1,386.00
Budget-2021
Revenue LTAC Grant 10,000.00
15,101.80 Expense-Vendor Relations 166.10
Expense-Entertainment 1,200 00
Expense-Envelopes 18.48
Expense. Port A Potty 775.00
Expense-Insurance 638.13
Expense -Janitorial 300 00
Expense-Miscellaneous? 868.18
Expense - Bank Checks-Order 76.10
Expense- Postage 109.85
Expense-Quilcenery Photo Prize Money 15.43
Expense-Raffle 165.63
Expense-Car Show 250.00
Expense - Sec of State Annual Rpt 10.00
Expense-Printing 450.00
Expense-Advertising - Theaters 500.00
Expense -Advertising -Durable Goods 1,800.00
Expense-Advertising-Publications 5,860.00
Expense-Games for Youth 2,065.00
4,217.59 <-.--- PROFIT --- ---,> _ 4,217.59
Page: 7 of 9 Quilcene Fair& Parade Association
Exhibit B
Jurisdiction Lodging Tax Reporting Form - To Be Submitted to Jefferson
County Administrator's Office
No Later than February 28th of each Year
Lodging Tax Reporting Form
Or gammatiom receiving funding to promote fe:trraL-, :pec:al event •a.:d•ourr.:m-reLlted actilatic through tourum-eLated fact:mos
owned or Tomored by non-profit orrot trawl:L.:or the local jun:di:non are I equued to complete du:form for EACH actrvir:
1 Organuation Name:
ReForm;Year
2 Sparser Type:Clerk Cue): 0 5101:c.x3:. 0 5.12.3(cet Lem:PM:Ain:ice 0 Oter•ELnu:):
3 Arum!:Nome
4 Armory 1.'ve(Chad;One): 0 E7fILLFeakrat* 0 Feirry* 0 mailemr
5 Anwny Stan Date:
3 Accurry Eud Cate
7 Total Cam of Anivrty 3
B Am=P-Kared: S
9 Anaeurs Amnia' I
10 Overall Arom-bore
13 Numbs.of Awe Who Stayed.Overnight in Lipid Arrecomcdanow a) Projecred•
a: Projecred•
-,:, Acme
ir:i A..-rri•
c) Methodology raecl Omer 024rarr. Carr* c) Matodp:orr f Chet One): rue,'Came
Ordirea Came' ORemerematire;army* andiren cam' Okepresematne Sorpey*
Ortivs,.1 Sorvex• 0 Secured lecure aufneral Siarrer 0 Structured Lamm*
00±or tftsgbern:
Othher(eclaix):
IA NILIC.617 of Ansidet5 WIte Trate 5.3 Mies(17 Mace 14 Number 05 Anerdees Who Stayed Ov.rri&ma Pre:Accommadmorm•a) PReed•
aj Paciemed•
b) Acria:•
10 A-ra
c) Metbodeiogy f.Chad Ono:: 0:ter Come c) MetadEory C.1brcit Coe): 0 Caen:guar+
g 2cdinerr Calor 0 Represematte Sumer* 0 0oferecr Corer 07.ernesemarris Sorpey*
Itir0TrJ1 Sarver 0 imarreiEarmara, 0 Mforscal Sumer 0 Structured Lamm"
0 Oder)erplaim):
0 Oiler(replant):
12 Number of Anendees Who Traveled am Another Stave or Calmar 13 Number 05 Paid LAVA;Night:,
a) Pie
a) Pratered•
10 ACCIK.
b) Anua:'
c) Methedaiogy tChek Otei 0 Direr Come c) Merlioar:oar iarcir Cue): 0 Caen Comm*
_ 0 ludirrn coma' ORepresersnwe Saxer' 0 lindirecc Catmr• 072presername Survey*
0 It'itwItai Sucre 0 Soumwed Bp:inure' 0:13earcal Survey 0 Structure Lamm*
°Otter feviiiir:
01 Oskar(explano:
*See Lodging Tax Yearly Report*Deluota— =In:(rut Etelbi
Name of lodir.tial%lc?moue imam
E-Mail Adirms7
RETI:FIN THIS FORM TO:
Jeffenon County Adroira.:trator',..Office
1820 JetTernou Street
P.O.Box 1220
Port Tosrmencl.WA 983.68
jeffbocoa co 1 effer:on.wa.u
DEADLINE: February 29th of Each Reportrog Year
Page: 8 of 9 Quilcene Fair& Parade Association
LTAC Yearly Reporting
Definitions/Instructions
Activity Type: Event/Festival: Short-term activity occurring between specific dates(e.g.,4th of July celebration, local marathon)
Facility:Municipally-owned facility that operates some or all of the year(e.g.,county historical museum,convention
center)
Marketing:Activity that provides information to encourage visitors to an area; is typically a year-round activity but
may also operate for less than a full year.
Activity Date: Activity beginning and ending dates.
Actual: Persons estimated to have actually participated in event/festival or visiting a facility. For marketing activity,enter
the number of persons estimated to have actually visited area as result of marketing activity.
Projected: Persons expected to participate in event/festival or visiting a facility.For marketing activity,enter the number of
persons expected to visit area as result of marketing activity.
Methodology: Select the methodology used to estimate the actual number of visitors/participants.
Direct Count:Actual count of visitors using methods such as paid admissions or registrations, clicker counts at
entry points, vehicle counts or number of chairs filled.A direct count may also include information collected directly
from businesses, such as hotels,restaurants or tour guides, likely to be affected by an event.
Indirect Count:Estimate based on information related to the number of visitors such as raffle tickets sold,redeemed
discount certificates,brochures handed out,police requirements for crowd control or visual estimates.
Representative Survey: Information collected directly from individual visitors/participants.A representative
survey is a highly structured data collection tool,based on a defined random sample of participants,and the results
can be reliably projected to the entire population attending an event and includes margin of error and confidence
level.
Informal Survey: Information collected directly from individual visitors or participants in a non-random manner
that is not representative of all visitors or participants. Informal survey results cannot be projected to the entire
visitor population and provide a limited indicator of attendance because not all participants had an equal chance of
being included in the survey.
Structured Estimate: Estimate produced by computing known information related to the event or location. For
example,one jurisdiction estimated attendance by dividing the square footage of the event area by the international
building code allowance for persons(3 square feet).
Other: (please describe)
Overall Attendance: Total projected and estimated actual attendance recorded for event,facility or resulting from marketing activity.
Total Attendees Traveling 50 miles or more:
Total: Total projected and estimated actual number of visitors traveling more than 50 miles to attend event or facility. For
marketing organizations,report visitors traveling more than 50 miles to visit area.
Of total,attendees who traveled from another state or country: Of the total projected and estimated actual number of
visitors traveling more than 50 miles to attend event or facility or visit area,report projected and estimated actual number of
visitors who traveled from another state or country.
Attendees who stayed overnight:
Paid Accommodations: Total projected and estimated actual number of visitors staying in paid lodging establishments such
as hotels,motels,bed and breakfasts,etc.
Unpaid Accommodations: Total projected and estimated actual number of visitors staying in unpaid accommodations such
as family and friends.
Paid Lodging Nights: Total projected and estimated actual number of paid lodging nights. One Lodging night=one or more persons
occupying one room for one night.
Page: 9 of 9 Quilcene Fair& Parade Association
Consent Agenda
Commissioners Office
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Adiel McKnight,Executive Assistant
DATE: February 2021
SUBJECT: AGREEMENT re: 2021 Hotel Motel (Lodging Tax) Grant Funding; In the
Amount of$10,000 Quilcene Fair Association
STATEMENT OF ISSUE:
This agreement provides grant funding for 2021 to certain non-profit agencies for the promotion of
tourism and ongoing preservation of Jefferson County's heritage. This funding has been budgeted from
the Hotel Motel (Lodging Tax) Fund, as recommended by the Lodging Tax Advisory Committee.
FISCAL IMPACT:
Quilcene Fair Association $10,000
RECOMMENDATION:
Approve and sign the agreement.
+ +WED BY:
p orle , ty ministrat r ate:
CONTRACT REVIEW FORM
CONTRACT WITH: Quilcene Fair Association TRACKING NO.: BOCC 2021-06
(Contractor/Consultant)
CONTRACT FOR: 2021 Lodging Tax Funding Ilige 12/31/21
COUNTY DEPARTMENT: County Administrator
For More Information Contact: Philip Morley JAN 2 7 2021
Contact Phone #: Ext.383 JEFFERSON COUNTY
RETURN TO: Leslie Locke RETURN BY: ASAP COMMISSIONERS
(Person in Department) (Date)
AMOUNT: $10,000 PROCESS: ❑ Exempt from Bid Process
❑ Consultant Selection Process
Revenue ❑ Cooperative Purchase
Expenditure ❑ Competitive Sealed Bid
Matching funds Required ❑ Small Works Roster
Source(s)of Matching Funds ❑ Vendor List Bid
❑ RFP or RFQ
❑ Other
Step 1 : REVIEW B .!- - . * G
Revi by: � �
Date Revi we.
dr- 400
APPROVED FORM ❑ Returned for revision(See Comments)
Co ents
Step 2: REVIEW BY PROSECTTTING ATTORNEY
Review by: 0 C Philip C. Hunsucker
Date Reviewed: February 12,2021 Chief Civil Deputy Prosecuting Attorney
in APPROVED AS TO FORM ❑ Returned for revision(See Comments)
Comments
Step 3: (If required) DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK
MANAGEMENT AND PROSECUTING ATTORNEY
Step 4: CONTRACTOR/CONSULTANT SIGNS APPROPRIATE NUMBER OF
ORIGINALS
Step 5: SUBMIT TO BOCC FOR APPROVAL
Submit original Contract(s),Agenda Request,and Contract Review form. Also,please send 2 copies of
just the Contract(s)(with the originals)to the BOCC Office. Place"Sign Here"markers on all places the
BOCC needs to sign.
MUST be in BOCC Office by 4:30 p.m.TUESDAY for the following Monday's agenda.
(This form to stay with contract throughout the contract review process.)
PO Box 19150 I Spokane,WA 99219 I www.cochraneco.com v�ense Number: Cohrane
&COMPANY
' Established in 1960
Over 50 Years of Excellence
1.800.441.4535
Date: September 5, 2019 T.509.838.0655
To: Maggie Merritt
Homer Smith Insurance, Inc.AGT304 From: Toni Hill
(360)385-3726 Underwriting Assistant
maggie@homersmith.com thill@cochraneco.com
Phone Number: 509.838.0655
Fax Number: 800.605.5563
Re: Named Insured: Quilcene Fair
Policy Number: CPS-3231075
Coverage Dates: 9/14/2019 to 9/15/2019
Reference#: 2890633
Thank you for your order to bind, following is a confirmation of binding for the above account. Your policy
will be issued shortly and sent to your office.
Please review all terms, conditions and underwriting requirements on this binder for accuracy. If there are
any pending underwriting requirements, please forward those to our office as soon as possible.
Thank you so much for your business, it is greatly appreciated.
f °?7 gaaf*.figmmr x sti o ` ..tv-v 2 .m...s. ,mat. -> ..m gcae v E ,. _._>, n TM :. ? srnM ... >
PO Box 19150 I Spokane,WA 99219 I www.cochraneco.com . ` ��
License Number: 8520 k• CochrGill
&COMPANY
Established in 1960
Over 50 Years of Excellence
1.800.441.4535
INSURANCE BINDER
T.509.838.0655
In accordance with your instructions, and in reliance upon the statements made by the Retail Broker in the
Insured's application/submission, we have obtained insurance at your request as follows:
Date Issued:September 5, 2019
Insured:Quilcene Fair Producer:Homer Smith Insurance, Inc.(AGT304)
DBA: Fax: (360)385-3726
PO Box 761 Reference Number: 2890633
Quilcene,WA 98376 Commission:10%
Policy Number:CPS-3231075 Term:9/14/2019 to 9/15/2019
Insurer:Scottsdale Insurance Company AM Best Rating:A+*
Coverage:Commercial General Liability
Limits Deductible MEP
2,000,000 General Aggregate 0 Per Claimant 100%
2,000,000 Prod/Compl Ops Aggregate
1,000,000 Personal &Advertising Injury
1,000,000 Each Occurrence
$ 100,000 Fire Damage
$ 5,000 Medical Payments
Premium: $500.00
Fee Schedule: Policy Fee $100.00
Terrorism Coverage:
Taxes: $12.60
Total: $612.60
Policy Form:Occurrence Coinsurance:
Retroactive Date: Valuation:
Exposure:
e) 1,000. 10378 Fairs-Other than Not-For-Profit
e) 1 . 49950 Additional Insured-CG2010
Please see the following page for applicable Terms/Conditions and Endorsements.
Page 1 of 2
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•
Terms/Conditions:
Requirements in order to bind:
_X_Subject to vendors and amusement device operators providing certificates of insurance (evidence is
ok)
1. Note that terms and conditions may or may not conform to what was requested in the application.
2. Premium is fully earned; midterm cancellation will result in no returned premium.
It is your responsibility as a producer for Cochrane&Company to notify our office if certificates are
required for this account. Cochrane&Company will not be held responsible for additional fees charged for
failure to issue certificates that are not requested in a timely manner. Certificates can be issued at
www.cochraneco.com or you may submit a request to our office for certificate generation.
Endorsements:
CG 00 01 4-13 COMMERCIAL GENERAL LIABILITY COVERAGE FORM
CG 2010 4-13 ADDITIONAL INSURED-OWNERS, LESSEES OR
CONTRACTORS-SCHEDULED PERSON OR ORGANIZATION
CG 21 06 5-14 EXCLUSION-ACCESS OR DISCLOSURE OF CONFIDENTIAL OR
PERSONAL INFORMATION AND DATA-RELATED LIABILITY-WITH LIMITED BODILY INJURY
EXCEPTION
CG 21 16 4-13 EXCLUSION - DESIGNATED PROFESSIONAL SERVICES
CG 21 44 4-17 LIMITATION OF COVERAGE TO DESIGNATED PREMISES OR PROJECT
CG 21 47 12-07 EMPLOYMENT-RELATED PRACTICES EXCLUSION
CG 21 67 12-04 FUNGI OR BACTERIA EXCLUSION
CG 21 73 1-15 EXCLUSION OF CERTIFIED ACTS OF TERRORISM
CG 24 26 4-13 AMENDMENT OF INSURED CONTRACT DEFINITION
CG 24 45 01-19 WASHINGTON-LIMITED COVERAGE FOR BODILY INJURY, PROPERTY
DAMAGE OR PERSONAL AND ADVERTISING INJURY INVOLVING EFFICIENT PROXIMATE
CAUSE (DEFENSE WITHIN LIMITS)
CLS-SD-1L (8-01) COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL
DECLARATIONS
CLS-SP-1L (10-93) COMMERCIAL GENERAL LIABILITY COVERAGE PART EXTENSION OF
SUPPLEMENTAL DECLARATIONS
GLS-106s (12-13) TOTAL LIQUOR LIABILITY EXCLUSION
GLS-152s (8-16) AMENDMENT TO OTHER INSURANCE CONDITIONS
GLS-227s (2-18) ASSAULT AND/OR BATTERY EXCLUSION
GLS-271s (8-04) AMUSEMENT RIDE EXCLUSION
GLS-289s (11-07) KNOWN INJURY OR DAMAGE EXCLUSION - PERSONAL AND
ADVERTISING INJURY
GLS-30s (1-15) CONTRACTORS SPECIAL CONDITIONS
GLS-341s (8-12) HYDRAULIC FRACTURING EXCLUSION
GLS-455s (10-18) MARIJUANA/CANNABIS LIABILITY EXCLUSION
GLS-457s (10-14) AIRCRAFT EXCLUSION
GLS-47s (10-07) MINIMUM AND ADVANCE PREMIUM ENDORSEMENT
GLS-5s (4-08) SPECIAL EVENT PARTICIPANT EXCLUSION
IL 00 1711-98 COMMON POLICY CONDITIONS
IL 00 219-08 NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT
NOTX0178CW (3-16) CLAIM REPORTING
NOTX0423CW (2-15) POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE
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COVERAGE
OPS-D-1 (1-17) COMMON POLICY DECLARATIONS
UTS-119g (6-14) MINIMUM EARNED CANCELLATION PREMIUM
UTS-266g (5-98) ASBESTOS EXCLUSION
UTS-267g (5-98) LEAD CONTAMINATION EXCLUSION
UTS-365s (2-09) AMENDMENT OF NONPAYMENT CANCELLATION CONDITION
UTS-428g (11-12) PREMIUM AUDIT ENDORSEMENT
UTS-74g (8-95) PUNITIVE OR EXEMPLARY DAMAGE EXCLUSION
UTS-85g (2-98) ANIMAL EXCLUSION
UTS-9g(5-96) SERVICE OF SUIT CLAUSE
UTS-COVPG (1-16) COVER PAGE
UTS-SP-2 (12-95) SCHEDULE OF FORMS AND ENDORSEMENTS
UTS-SP-3 (8-96) SCHEDULE OF LOCATIONS
Prepared by: Toni Hill, Underwriting Assistant
Email: thill@cochraneco.com
Fax: 800.605.5563
The terms and conditions of this confirmation of insurance may not comply with the specifications
submitted for consideration. Please read this confirmation carefully and compare it with any quote and
submission documents and review the policy forms for the actual coverages provided.
This binder is valid for 30 days from the date issued. This insurance binder will be terminated and
superseded upon delivery of the formal policy issued to replace it.
No flat cancellations. This policy is subject to the cancellation provisions as found in the policy or
certificate(s)currently in use by the Insurer. The insurance effected under the Insurer's binder can be
cancelled by the Insurer(subject to statutory regulations) by mailing to the Insured at th eaddress stated
on the face of this Confirmation of Insurance, written notice stating when such cancellation shall be
effective. In the event of cancellation by the Insured., the earned premium would be subject to the
minimum earned premium applicable.
Premium payment is due within twenty (20) days from the effective date unless otherwise stipulated.
*AM Best is an independent rating service which rates the financial strength of insurance companies on a
graduated scale from "S" (suspended) to AA++ (superior), with a variety of rating classifications between.
Inclusion of the rating classification is for informational purposes only.
This confirmation of insurance is issued based upon the Insurer's agreement to bind and is issued by the
Undersigned without any liability whatsoever as an Insurer.
The following pertains to insured locations in the State of Washington, issued with a Non-Admitted
Company:
This contract is registered and delivered as a Surplus Lines coverage under the Insurance Code of the
State of Washington, enacted in 1947. It is not issued by a company regulated by the Washington State
Insurance Commissioner and is not protected by any Washington State Guaranty Fund Law.
For fillable documents and submission email addresses for our other departments, please visit our website
at www.cochraneco.com.
.
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