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HomeMy WebLinkAboutJefferson County Farmers Market - 031521 - (ins ex 2-28-22) c V fj .J&Fitt Cei/u ffi —7e7 Ci: � 3 )) C C_ AGREEMENT FOR 2021 HOTEL-MOTEL FUNDING FOR TOURISM SERVICES JEFFERSON COUNTY FARMERS MARKET �30 This Agreement is by and between JEFFERSON COUNTY(hereinafter known as "COUNTY"and JEFFERSON COUNTY FARMERS MARKET(hereinafter known as "FARMERS MARKET"). WHEREAS, FARMERS MARKET is a Government Agency 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 FARMERS MARKET to implement a strategy for the unincorporated area of Jefferson County to promote tourism activities; IN CONSIDERATION of the mutual covenants and agreements herein it is agreed by the parties as follows: SECTION 1: SERVICES TO BE PERFORMED FARMERS MARKET 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. Promote the Chimacum Farmers Market,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. In recognition of the unavoidable disruption to tourism activities from the COVID-19 pandemic,FARMERS MARKET 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 FARMERS MARKET proceed with the proposed substitution. In such case no amendment to this Agreement shall be required and FARMERS MARKET may use the funding to perform the substitute Promotion Services in 2021. SECTION 2: RESPONSIBILITIES OF FARMERS MARKET: 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 Chimacum Farmers Market 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 Jefferson County Farmers Market 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. 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 FARMERS MARKET. b. The amount of lodging tax revenue allocated for expenditure(whether actually expended or not)by FARMERS MARKET 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 The COUNTY will provide FARMERS MARKET 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$10,200 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 FARMERS MARKET 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 FARMERS MARKET in 2022 and approval by the Board of County Commissioners. Page 2 of 9 Jefferson County Farmers Market 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 28,2022. 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. FARMERS MARKET 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, FARMERS MARKET 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 FARMERS MARKET 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 FARMERS MARKET'S negligence or breach of any of its obligations under this Agreement; provided that nothing herein shall require the FARMERS MARKET 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 FARMERS MARKET'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 FARMERS MARKET's negligence, or the negligence of the FARMERS MARKET's agents or employees. The FARMERS MARKET specifically assumes potential liability for actions brought against the COUNTY by the FARMERS MARKET's employees, or any other persons engaged in the performance of any work or service required of the FARMERS MARKET under this Agreement and, solely for the purpose of this indemnification and defense, the Contractor specifically waives any immunity under the state industrial insurance law, Title 51 RCW. The FARMERS Page 3 of 9 Jefferson County Farmers Market MARKET recognizes that this waiver was specifically entered into pursuant to provisions of RCW 4.24.115 and was subject of mutual negotiation. SECTION 9: INSURANCE The FARMERS MARKET 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 LiabilityInsurance as required bythe State of q Washington. The FARMERS MARKET shall maintain Workers' Compensation coverage as required under the Washington State Industrial Insurance Act,RCW Title 51, for all the FARMERS MARKET employees,agents and volunteers eligible for such coverage under the Industrial Insurance Act. 2. 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 the work for a combined single limit of not less than $1,000,000 per occurrence in connection with the FARMERS MARKET's performance of the contract, including: a. Owned Automobiles; b. Hired Automobiles; and c. Non-owned Automobiles. 3. General Commercial 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 bodilyinjury; c. Broad Form Contractual/Commercial Liability—including: completed operations; d. Premises—Operations Liability(M&C); e. Independent Contractors and subcontractors; f. Blanket Contractual Liability. Said commercial automobile liability policy and general commercial 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 Contractor'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 Contractor. Page 4 of 9 Jefferson County Farmers Market If the proof of insurance or certificate indicating the County is an"additional insured"to a policy obtained by the Contractor 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 Contractor to obtain the full text of that endorsement and forward that full text to the County. All insurance policies obtained by the FARMERS MARKET 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 the FARMERS MARKET under this Agreement shall not in any manner limit or qualify the liabilities or obligations of the FARMERS MARKET under this Agreement. SECTION 10: INDEPENDENT CONTRACTOR The FARMERS MARKET and the COUNTY agree that the FARMERS MARKET 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 FARMERS MARKET nor any employee of the FARMERS MARKET 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 FARMERS MARKET, or any employee, representative, agent or contractor of the FARMERS MARKET. The FARMERS MARKET 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 FARMERS MARKET 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 accord with the laws of the State of Washington and venue shall be in Jefferson County, Washington. SECTION 12: DISCRIMINATION PROHIBITED FARMERS MARKET 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 Page 5 of 9 Jefferson County Farmers Market 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 Jefferson County Farmers Market 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 Jefferson County Farmers Market. APPROVED and signed this I day of March,2021. JEFFERSON COUNTY Attest: /�;"/��J^^ BOARD OF COMMISSIONERS 614,f ean,wet,_ Carolyaway,CMC v Kate Dean, Chair Clerk of the Board Approved as to Form: JEFFERSON COUNTY FARMERS MARKET /teabtejletnkty) Philip Hunsucker, March 11, 2021 Authorized Official Chief Civil Deputy Prosecutor Page 6 of 9 Jefferson County Farmers Market EXHIBIT A Itemized List of Proposed Tourism Promotion Services 2021 Budget for Chimacum Farmers Market Promotion Promotion ape. [Funding Source Total Note I Promotion In the Leader,Pub,Visitor VisiIor Guide, IChamber Map ICFM and Market SponsorShi{ ,000 We co-promote the Port Townsend._.ry...__.._-_.._...__..____....__ and Chimacum farmers Markets with monthly ads. Port Townsend Leader print advertisement in-Kind print sponsorship $2,000 As a spocsor.the Leader provides us with two 1/2 page ads. "Guest Column"In monthly --- i newsletters of area non- r, -<promotion broadens Market audience,and raises awareness of our Food Access profltS and businesses in"Kind print sponsorship $2,000 t,rn.im,,. Print Flyer Distribution In-Kmd $2,000 Monthly Myers distributed through Port Townsend School District. i 6300 Postcards printed,and Inserted in The Leader Distribution,touching Jeff.Co Port Townsend Leader print and City audiences.Printing will also generate 200 cards for sharing at area lodging, • {advertisement Jeff Co Lodging Tax Grant $1,000 businesses,and visitor's centers. Facebook/Instagram Jeff Co Lodging tax Grant $630 Weekly boosted FB poets,21 weeks X$30 KPTZ-Radio promotion Jeff Co Lodging Tax Grant $375 Scheduled Expanded PSA's airing 15. times between April-December. _.v. `Advertising Market opening-For Chlmacum and Port Townsend Farmers Markets(25 posters Poster Production Er Print Jeff Co Lodging Tax Grant $500 each) Ad design Jeff Co Lodging Tax Grant $1,500 Contracted design work for ads. Produced videos aired 60.90 second videos air like'commercials"on regional Public N.Market/local Food regionally on Cascade Producer videos pair with promo to visit Chimacum Farmers Markets and the abundant Public Media. Jeff Co Lodging Tax Grant $4,000 flavors and beauty of Jefferson County. Waterside Magazine Jeff Co Lodging Tax Grant $1,195 On the WA ferries all season longi Live Music Fund Jeff Co Lodging Tax Grant t $1,000 Help us bring visitors back to Jefferson Co.with weekly live market musics Total Request Jeff Co Lodging Tax Grant $10,200 �CFM Total Advertising G Budget $22,200; Page 7 of 9 Jefferson County Farmers Market 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 Organizations receiving flouting to promote festivals,special event;and tourism-related a_ovule:through tourism-related facilities owned or spoo.saaed by r.cu-paofit orpnizations or the local jraisdiction are required to ccmpkte this form for EACH activity 1 Ot rinizl rac Name: Rey year Spousal Type;CheckOw) 0501(0.0i 0501(cl(6) Q Local lun;trt r Q Other(Explain): 3 Acttciry Nam 4 Activm Type(Check One): Q EvmuFesuval' V Reality' 0 Marketing' 5 Armin Stan Date': 6 Acu it i End Date': Taal Cost of Activity. S 8 Ammon Requested; S 9 AMOlmt Amidst 10 Oswalt An.s?..cce• 13 Number of Attendees Who Stayed OAQnight it Unpaid Atccmmoimmit• a) Protected' a) Projected' b) Actual' b) Actual' t) Methodology(Check One) (`l?e>:cr,-our• c) Ntetbodobgy(Check Octet' ')Daect Count' } trx:;:aa QF. rexetatn e 5rz: ' . J n .-a Ccar:` 1Peptss cart Surrey' :r.fontl Ss r;' 0 Stntcttt:od Euimare ,1 serest.+I Sul ay' 0 Smictuted Estimate' [1 Number of Attendees 0.'ho Traveled 59 Miles ar Mote" 14 Number of Attendees Ala Stayed Overnight in Paid Acco ).,•tons• a) Projected' a; Projected' b, Actual' b) Actual' ti'e�c c ate;tCL e ©Direct Correa• c S[z:.`ac5l rr?;+=ltt Out)- ( ? atcr ,tar„ u:x :Fc•' QReire;mtarive5un'ey' ti 5 Let ..:rr_t" ?e zeerui a m" tr„,) s.:es' 0 Structured Emtnate• f, aforarlS:n•r.' ( �;rates acF'czr•.e Otter i lam) 0 Other(esptain): 1:Number of Attendees Who Traveled(Tom Another State or coma}' 15 Number of Paid I mrinr Nights• a) Protected• a; Projected' b) Actual' hi Actual' • Methodology(Check Ouei ():rest)aW.•' ci 4fe r+n a€: C`k c (anal: f) nit : ." QIndirect C oitn' - ' - -.. -. -•` -I�a�2�. r c .n.. -_ i /S=::M...�:IGi' ._ORt7rL GC:aT::Sat VS' r tfeet,• >cn a.-" Su-:u-sJ F. .IT:: C)iri r ai Survey' O Scrucnired Estimate' ic`'1 it;:is lJ Other *FLlul: *Sec Lodging Taa Yearly Reporting Definitions'Instructious Name of Individual idual Who Prepared Report Phone=: i:anti Addreti RETURN IHIS FORM TO: Jefferson County Ar{n: -ator s Office 1S20 Jefferon Street P O.Box 1220 Port I;:t :<ud.WA 9836S 3efCbocc,r1 cc.lefferonava.tr': DEADLL>T: February 28th of Each Reporting Year Page 8 of 9 Jefferson County Farmers Market 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 Jefferson County Farmers Market 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: March 15,2021 SUBJECT: AGREEMENT re: 2021 Hotel Motel (Lodging Tax) Grant Funding; In the Amount of$10,200 Jefferson County Farmers Market 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. ANALYSIS: On January 25, 2021, the County Commissioners approved the recommendation of the Lodging Tax Advisory Committee for 2021 grant funding allocations. The Lodging Tax Advisory Committee (LTAC)received a late proposal from the Jefferson County Farmers Market(JCFM)to assist in promoting their events. Their request was reviewed at a special LTAC meeting on February 26, 2021. At that meeting LTAC members unanimously approved a motion recommending the Board of County Commissioners fully fund the JCFM's request of$10,200 for promotion costs. FISCAL IMPACT: Jefferson County Farmers Market $10,200 RECOMMENDATION: Approve and sign the agreement. ' IE ' . B 1 Y P jr ` ✓ l/2-- .'J. ip Mor - ['• t •e • • or Date: CONTRACT REVIEW FORM CONTRACT WITH: Jefferson County Farmers Market TRACKING NO.: (Contractor/Consultant) CONTRACT FOR: 2021 Lodging Tax Grant Funding TERM: 12/31/21 COUNTY DEPARTMENT: County Administrator For More Information Contact: Philip Morley Contact Phone #: Ext.383 RETURN TO: Adiel McKnight RETURN BY: ASAP (Person in Department) (Date) AMOUNT: $10,200 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 BY E ReviewL��Lrr Date Rev' w APPROVED FORM ❑ Returned for revision(See Comments) Comments • Step 2: REVIEW BY PROSECUTING ATTORNEY Review by: <�""tz` Philip C. Hunsucker Date Reviewed: March 11,2021 Chief Civil Deputy Prosecuting Attorney x❑ 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.) Billing Number: 0007504470 COUNTRY Policy Number. AB 9295249 01 FINANCIAL COMMON POLICY DECLARATIONS COUNTRY Mutual Insurance Company 1701 Towanda Ave,P.O,Box 2100.Bloomington Illinois61702-2100 Item 1.Named Insured and Mailing Address Agent Name and Address JEFFERSON COUNTY FARMERS BELFORD JIM R MARKET TACOMA AGENCY PO BOX 1384 4707 S 19TH ST PORT TOWNSEND WA 98368-0026 TACOMA WA 98405- 0000 Agent No. 23563 Agent Phone No.: (2 5 3) 4 7 2 -2 9 3 2 Item2. Policy Period From: 02 -28 -2021 To: 02 -28 -2022 at 12:01 A.M.,Standard Time at your mailing address shown above. Item 3. Business Description: FARMERS MARKET Form of Business: NON-PROFIT CORPORATION Item 4, In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. This policy consists of the following coverage parts for which a premium is indicated. Where no premium is shown, there is no coverage. This premium may be subject to adjustment. Coverage Part(s) Premium COMMERCIAL GENERAL LIABILITY COVERAGE PART $ 346 .00 COMMERCIAL INLAND MARINE COVERAGE PART $ 294 . 00 COMMERCIAL AUTOMOBILE COVERAGE PART $ 1, 129 . 00 TAX OR SURCHARGE $ 1 . 73 Total Policy Premium/ Total Advance Premium $ 1, 770 . 73 Standard Payment Plan Charges - Policy Grand Total $ 1, 770 . 73 Payment Plan Annual If you wish to requesta copy of your policy, contact your COUNTRY Financial° representative or call our m b. -orr'ms antl Ite t corsements"N 3" 3666. Form(s) and Endorsement(s) made a part of this policy at time of issue: See Schedule of Forms and Endorsements Countersigned: Date: _ 01 - 24 -21 By: i,'�'�/� • oriz 'epresentative TO REPORT A CLAIM ANY TIME DAY OR NIGHT,CALL 1-800-846-0100. THIS COMMON POLICY DECLARATION AND THE SUPPLEMENTAL DECLARATIONS), TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART(S), COVERAGE FORM(S) AND FORMS AND ENDORSEMENTS, IF ANY, COMPLETE THE ABOVE NUMBERED POLICY. AIL DS 03 08 07 I'SU,9j Copy • Policy Number COUNTRY AB 9295249 01 INANCIAi SCHEDULE OF LOCATIONS COUNTRY Mutual Insurance Company Named Insured JEFFERSON COUNTY FARMERS Effective Date: 02 -2 8-21 12:01 A.M., Standard Time Agent Name BELFORD JIM R Agent No. 23563 Loc. Bldg. Designated Locations Occupancy No. No. (Address, City, State, Zip Code) 001 001 618 POLK ST, PORT TOWNSEND, WA 98368 002 001 LAWRENCE & TYLER 600 BLOCK, PORT TOWNSEND, WA 98368 003 001 440 12TH ST, PORT TOWNSEND, WA 98368 - 1824 004 001 9122 RHODY DR, CHIMACUM, WA 98325 LOC-SCHED(01/97) Insured Copy COUNTRY Policy Number/} FINANCIAL. j AB 9295249 01 COMMERCIAL GENERAL LIABILITY COVERAGE PART SUPPLEMENTAL DECLARATIONS COUNTRY Mutual Insurance Company Named Insured JEFFERSON COUNTY FARMERS Effective Date: 02 -28 -2021 12:01 A.M., Standard Time Agent Name BELFORD JIM R Agent No. 235 6 3 Item 1. Business Description: FARMERS MARKET Item 2. Limits of Insurance Coverage Limit of Liability Aggregate Limits of Liability Products/Completed $ 4, 000, 000 Operations Aggregate General Aggregate(other than $ 4, 000, 000 Products/Completed Operations) Coverage A- Bodily Injury and $ 2, 000, 000 any one occurrence subject to Property Damage Liability the Products/Completed Operations and General Aggregate Limits of Liability any one premises subject to the Damage To Premises Coverage A occurrence and the Rented To You General Aggregate Limits of $ 100, 000 Liability Coverage B- Personal and any one person or organization Advertising Injury subject to the General Aggregate Liability $ 2, 000, 000 Limits of Liability Coverage C - Medical Payments any one person subject to the Coverage A occurrence and the General Aggregate Limits of $ 10, 000 Liability Item 3. Retroactive Date This Insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" which occurs before the Retroactive Date, if any, shown here: (Enter Date or"None"it no Retroactive Date applies) Item 4. Form of Business and Location of Premises Forms of Business: NON-PROFIT CORPORATION Location of All Premises You Own, Rent or Occupy: See Schedule of Locations Item 5. Forms and Endorsements Form(s) and Endorsement(s) made a part of this policy at time of issue: See Schedule of Forms and Endorsements Item 6. Premiums Coverage Part Premium: $ 346 .00 Other Premium: Total Advance Premium: $ 346 .00 Minimum Premium: $ 100.00 THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD. ACGDS0112/01 ^sureo'aPP`r Policy Number COUNTRY , AB 9295249 01 FINANCIAL COMMERCIAL GENERAL LIABILITY COVERAGE SCHEDULE COUNTRY Mutual Insurance Company Named Insured JEFFERSON COUNTY FARMERS Effective Date: 02 -28 -21 12:01 A.M., Standard Time Agent Name BELFORD JIM R Agent No. 23563 Item 5. Location of Premises Location of All Premises You Own, Rent or Occupy: See Schedule of Locations Code No. Premium Basis Premises/Operations 61212 Square Feet. Location 001/001 Exposure 500 Rate Advance Premium Classification: 47 . 609 $ 24 .-00 BUILDINGS OR PREMISES - BANK OR OFFICE - MERCANTILE OR MANUFACTURING (LESSOR' S RISK ONLY) - OTHER THAN NOT-FOR-PROFIT Products/Completed Operations (PRODUCTS-COMPLETED OPERATIONS ARE 'SUBJECT TO THE GENERAL AGGREGATE LIMIT) Rate Advance Premium INCL Code No. Premium Basis Premises/Operations 15124 Gross Sales Location 002/001 Exposure $80, 000 Rate Advance Premium Classification: 3 . 503 $ 283 . 00 MARKETS - OPEN AIR (LESSOR' S RISK ONLY) NOT-FOR-PROFIT ONLY (PRODUCTS-COMPLETED OPERATIONS ARE SUBJECT TO THE GENERAL Products/Completed Operations AGGREGATE LIMIT) • Rate Advance Premium TNC Code No. Premium Basis Premises/Operations 15124 Gross Sales Location 003/001 Exposure $5, 000 Rate Advance Premium Classification: - 3 . 503 $ 18 .-00 MARKETS - OPEN AIR (LESSOR' S RISK ONLY) NOT-FOR-PROFIT ONLY (PRODUCTS-COMPLETED OPERATIONS ARE SUBJECT TO THE GENERAL Products/Completed Operations AGGREGATE LIMIT) Rate Advance Premium INCL Code No. Premium Basis Premises/Operations 15124 Gross Sales Location 004/00'1 Exposure $6, 000 Rate Advance Premium Classification: 3 . 503 $ 21 . 00 MARKETS - OPEN AIR (LESSOR' S RISK ONLY) NOT-FOR-PROFIT ONLY (PRODUCTS -COMPLETED Products/Completed Operations OPERATIONS ARE SUBJECT TO THE GENERAL AGGREGATE LIMIT) Rate Advance Premium INCE ACG DS 02 01/97 Insured Cops Lodging Tax Reporting Form Organizations receiving funding to promote festivals,special events and tourism-related activities through tourism-related facilities owned or sponsored by non-profit organizations or the local jurisdiction are required to complete this form for EACH activity. 1 Organization Name: Jefferson County Farmers Markets Reporting Year: 2021 2 Sponsor Type(Check One): ()501(c)(3) °501(c)(6) °Local Jurisdiction °Other(Explain): 3 Activity Name: Chimacum Farmers Market 4 Activity Type(Check One): ()Event/Festival* ° Facility* °Marketing* 5 Activity Start Date*: 01/01/2021 6 Activity End Date*: 10/31/2021 7 Total Cost of Activity: $17,475.56 8 Amount Requested: $17,424.00 9 Amount Awarded: $17,424.00 10 Overall Attendance* 13 Number of Attendees Who Stayed Ovemight in Unpaid Accommodations* a) Projected* 6,600 a) Projected* 1,000 b) Actual* 6,600 b) Actual* 1,900 c) Methodology(Check One): °Direct Count* c) Methodology(Check One): °Direct Count* °Indirect Count* ()Representative Survey* °Indirect Count* ()Representative Survey* °Informal Survey* °Structured Estimate* °Informal Survey* °Structured Estimates °Other(explain): °Other(explain): I 1 Number of Attendees Who Traveled 50 Miles or More* 14 Number of Attendees Who Stayed Ovemight in Paid Accommodations* a) Projected* 1,500 a) Projected* 1,000 b) Actual* 1,800 b) Actual* 1,650 c) Methodology(Check One): °Direct Count* c) Methodology(Check One): °Direct Count* °Indirect Count* ()Representative Survey* °Indirect Count* ()Representative Survey* 0 Informal Survey* °Structured Estimate* °Informal Surveys °Structured Estimate* 0 Other(explain): °Other(explain): 12 Number of Attendees Who Traveled from Another State or Country* 15 Number of Paid Lodging Nights* a) Projected* 500 a) Projected* 1,000 b) Actual* 500 b) Actual* 1,650 c) Methodology(Check One): °Direct Count* c) Methodology(Check One): °Direct Count* °Indirect Count* ()Representative Survey* °Indirect Count* ()Representative Survey* °Informal Survey* °Structured Estimate* °Informal Survey* 0 Structured Estimate* °Other(explain): °Other(explain): *See Lodging Tax Yearly Reporting Definitions/Instructions Name of Individual Who Prepared Report: Amanda Milholland Phone#: (360)379-9098 E-Mail Address: info@jcfmarkets.org RETURN THIS FORM TO: Jefferson County Administrator's Office 1820 Jefferson Street P.O.Box 1220 Port Townsend,WA 98368 j effbocc@co.j efferson.wa.us DEADLINE: February 28th of Each Reporting Year \t i NJ I-, F-, Ma V •• I-, I-, IV6�1 NO J 01 I71 A W NJ I-, 0 VI ID a V CD Sr tc.�, ,<_ �� C. <,� 0 YJ Ns1-' I-' F� I--' NJ N NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ NJ in Uri In In In in in In at, V1 U1 V1 U1 V1 V1 V1 V1 In In U1 In In 0 S( Vl Vl VI U1 V1 In In In In Vl ID UriIn Xi --I v.) 1.71 U1 U1 V V V V V V V V V V V V V CO W W U.) 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