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AMENDMENT TO THE AGREEMENT WITH JEFFERSON COUNTY FAIR ASSOCIATION
FOR 2020-2022 COMMUNITY SERVICES FUNDING
This Grantee Agreement Amendment ("Amendment") is by and between Jefferson County, a
Washington political subdivision ("County") and Jefferson County Fair Association, ("Grantee").
WHEREAS, on December 16, 2019, the Jefferson County Board of Commissioners
approved a 2020-2022 Community Services Agreement with Grantee; and
WHEREAS, the Grantee has incurred extraordinary costs associated with housing
homeless residents at the Jefferson County Fairgrounds during the Covid-19 pandemic; and
WHEREAS, the Grantee has suffered significant losses in revenue during the Covid-19
panda,.;c; and
WHEREAS, housing the homeless is an important and worthy county objective; and
WHEREAS, the county has funds available to help defray these extra costs; and
WHEREAS, the Parties want to amend the 2020-2022 Community Services Agreement
entered into between them;
NOW, THEREFORE, the Parties agree to amend the grant agreement, as follows:
Section 3.B., which currently reads:
SECTION 3: COMMUNITY SERVICES GRANT
B. Said grant is in the sum of$10,000 for 2020, increasing 3 percent in 2021 and
2022, payable as a lump sum payment.
Is amended to read:
SECTION 3: COMMUNITY SERVICES GRANT
B. Said grant is in the sum of$10,000 for 2020, increasing 3 percent in 2021 and
2022, payable as a lump sum payment. An additional $15,000 shall be payable in
2021 to help defray adequately documented costs associated with housing the
homeless during the Covid-19 pandemic and to help offset adequately documented
revenue losses during the same period.
The Agreement is further amended by adding sub-section H. to SECTION 1, as follows:
H. In order to receive the $15,000 in additional 2021 funding contained in this
Amendment the Grantee will need to adequately document any Covid-19 related
revenue losses or cost increases serving as a basis for reimbursement. Adequate
documentation may include payroll reports,receipts,paid invoices, etc.
1
FOR JEFFERSON COUNTY FAIR ASSOCIATION:
S ue- 61\ S--yte
Name and Signature
E o (c_),(
Date
FOR JEFFERSON COUNTY:
Kate Dean, Chair Board of County Commissioners
3/2 2/2/
Date
APPROVED AS TO FORM ONLY:
' a
Philip C. Hunsucker,
Chief Civil Deputy Prosecuting Attorney
March 22, 2021
Date
Attest:
(11/'1/1' c(l'v 7 a Pv „ 2/L
Carolyn G laway J Date
Clerk to the Board
2
Board of County Commissioners
7ON00& 1820 Jefferson Street
pQ' w �.a '' PO Box 1220
Port Townsend, WA 98368
-181II NGtO Kate Dean,District 1 Heidi Eisenhour,District 2 Greg Brotherton,District 3
March 26, 2021
Jefferson County Fair Association
Sue McIntire
P.O. Box 242
Port Townsend,WA 98368
Dear Ms. Kingsolver,
1.Enclosed for signature are two (2) originals for AGREEMENT,Amendment No. 1 re: 2020-
2022 Community Services Funding from Federally Appropriated Covid-19 Relief Funds
for Costs Associated with Housing the Homeless at the Fairgrounds during the Covid-19
Pandemic; Additional Amount of$15,000 for a Project Total of$25,000; Jefferson County
Central Service; Jefferson County Fair Association
Please sign both, keep one and return the second to:
Jefferson County Commissioner's Office
Attn: Adiel McKnight
P.O. Box 1220
Port Townsend, WA 98368
• Please remember that on or before April 30; July 31; October 31, 2021 and January 31, 2022
you are required to provide to the County: A quarterly report of the use, services, programs
and activities 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 by February 28th of each year. j
• The Strongertowns (dba The Production Alliance) shall obtain insurance as outlined in the
terms of the Agreement and provide a copy to this office.
• Payment will be provided upon invoice, subject to the terms of the Agreement.
Thank you for your assistance.
Sincerely,
Adiel McKnight
Executive Assistant
Phone (360) 385-9100 Fax(360) 385-9382 jeffbocc@co.jefferson.wa.us
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
CONSENT AGENDA REQUEST
TO: Board of County Commissioners
FROM: Mark McCauley, Central Services Director
DATE: March 22, 2021
RE: Amendment No. 1 re: AGREEMENT re: 2020-2022 Community Services Funding;
Adding an additional amount of$15,000 in 2021;Jefferson County Fair Association
STATEMENT OF ISSUE: On December 16, 2019, the Board of County Commissioners approved a
2020-2022 Community Services Agreement with the Jefferson County Fair Association (JCFA).
JCFA has incurred extraordinary costs associated with housing the homeless at the Fairgrounds
during the Covid-19 pandemic. Consequently, the parties to the agreement wish to amend it to
add an additional $15,000 to defray the extraordinary costs incurred.
ANALYSIS: The attached amendment proposes adding an additional $15,000 to the agreement
payable in 2021.
FISCAL IMPACT: This request is for$15,000 from the General Fund. This is an expense eligible
for reimbursement from federally appropriated Covid-19 relief funds. A supplemental budget
appropriation will be submitted to the Board of Commissioners for approval.
RECOMMENDATION: That the Board of County Commissioners approve the attached contract
amendment increasing the grant amount and extending the term.
f D T$Y:
347 21
ilip Morle , o my Administr or Date
CONTRACT REVIEW FORM
CONTRACT WITH: Jefferson County Fair Association TRACKING NO.:
(Contractor/Consultant)
CONTRACT FOR: Community Services Funding 1st Amend. TERM: December 31, 2022
COUNTY DEPARTMENT: Central Services
��' For More Information Contact Mark McCauley ,"! h Vol, d-q�„
1 li .L: 6u 3' ijrr lalli�lC t 011ihnl r�- e +' A, h At _
�� 1 a I', Con �t p 360 385 913 b �0� as � ,��III� ��:,
U br -_--,-,,,,,,,,,port,------ i s reu�11:,, .+ �a ii u r iy c
RETURN TO: Mark McCauleyl't a. - RETURN BY: ASI�'��i0 .
Y
ti,
(Person in Department) (Date)
AMOUNT: $15,000 PROCESS: 1=1 Exempt from Bid Process
❑ Consultant Selection Process
Revenue N/A ❑ Cooperative Purchase
Expenditure $ 15,000 ❑ Competitive Sealed Bid
Matching funds Required N/A ❑ Small Works Roster
Source(s) of Matching Funds N/A ❑ Vendor List Bid
❑ RFP or RFQ
Other
Step 1 : REVIEW BY RISK— M T _
Review€ ( / / /2_,,e
Date Reviewed:
APPROVED FORM ❑ Returned for revision(See Comments)
Comments
Step 2: REVIEW BY p.OSE 9U I G ATTORNEY
Review by: �� -Philip C. Hunsucker
Date Reviewed: 3 / 1./ Chief Civil Deputy Prosecuting Attorney
y� APPROVED FORM a urned for revision(See Comm nts)
Comments Q Cot dY7�r1-Thaiat,,,,j /AO "`.4.4 i/ z2z."
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.)
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7
C-
Cs AGREEMENT
J By and Between
THE JEFFERSON COUNTY FAIR ASSOCIATION
And
JEFFERSON COUNTY
2020-2022 Community Services Funding
Purpose: The purpose of this Community Services Funding is to ensure the continued availability,
use and maintenance of the Jefferson County Fair Grounds and to ensure said facility is available to
the general public and for the event informally known as the "County Fair".
Parties: The JEFFERSON COUNTY FAIR ASSOCIATION,hereinafter known as
"ASSOCIATION", a private non-profit corporation, and is an entity provided funds allocated by
JEFFERSON COUNTY,hereinafter known as "COUNTY", a Washington municipal corporation
and political subdivision of the State of Washington.
Whereas, on June 12,2000 the ASSOCIATION and the COUNTY executed a memorandum of
understanding outlining mutual obligations whereby the ASSOCIATION agreed to operate and
maintain the Jefferson County Fair Grounds, and organize and operate the Jefferson County Fair;
and
Whereas,the parties wish to re-establish and make more precise their duties and obligations to one
another;and
Whereas,the benefits to the COUNTY include but are not limited to the ASSOCIATION
providing citizens of Jefferson County an annual County Fair as well as other public activities on
the County Fair Grounds including camping;the ASSOCIATION providing repair and maintenance
of grounds and County owned buildings and improvements located at the County Fair Grounds;and
the ASSOCIATION providing risk management for activities at the Fair Grounds; and
Whereas,the COUNTY wishes to support the ASSOCIATION'S responsibilities for the Fair
Grounds and the County Fair and the operations thereof; and
Whereas, good and valuable consideration,as described above,has been bargained for and
exchanged by the parties in support of this Agreement,
Now,Therefore,the ASSOCIATION and COUNTY agree as follows:
SECTION 1: RESPONSIBILITIES OF THE ASSOCIATION
A. Operate the Jefferson County Fair Grounds and all the buildings and facilities located there.
Operate, as used in this Agreement, shall be defined to include, but not be limited to,
establishing,promulgating and implementing policies for use of the County Fair Grounds
(and the structures located there)by business invitees, licensees, guests and the public, the
scheduling, renting and management of all buildings, facilities and campgrounds; contracting
. 2020-2022 Community Services Funding with Jefferson County Fair Association
with vendors; booth operators; security forces; local law enforcement agencies; ticket takers;
ride operators and the like.
B. Organize, operate and supervise a recurring event to be commonly known as the "County
Fair", including, but not limited to, contracting with vendors, booth operators, security
forces, local law enforcement agencies, ticket takers, ride operators and the like.
C. Maintain the real property known commonly as the Jefferson County Fair Grounds and all
the buildings and facilities located there. Maintenance shall include,but not be limited to,
routine maintenance activities that are intended to keep the facilities and buildings in good
repair, appearance, and working order. The ASSOCIATION shall provide materials and
labor for these routine maintenance activities.
D. Employ such persons as may be necessary. In doing so, the ASSOCIATION shall comply
with all State and Federal Laws and regulations dealing with employee and contracted
service. The ASSOCIATION shall be responsible for its internal payroll accounting,
including, but not limited to, withholding, where applicable, of federal, state and local taxes.
E. The ASSOCIATION will not discriminate against any person in performance of
ASSOCIATION's responsibilities under this Agreement or in the selection and retention of
employees or procurement of materials or supplies on the basis of age, sex, marital status,
sexual orientation, religion, creed, race, 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.
F. Manage the risks and hazards associated with events and activities at the Fair Grounds in a
manner satisfactory to the COUNTY and the Washington Counties Risk Pool. The
ASSOCIATION shall specifically manage for risks associated with the use and maintenance
of the facilities, including but not limited to participation agreements for all events utilizing
fair ground facilities for which a fee is charged, and the identification and mitigation of
building and facility hazards.
G. All financial forms and reports (W2's, 1099's Annual Report, etc.) are the responsibility of
the Fair Association for 2019 and beyond. The Fair Association will provide independent
audit reports of the Fair Association to the Board of County Commissioners once completed.
SECTION 2: RESPONSIBILITIES OF THE COUNTY
A. Risk Management services including walk-through of facilities, and assistance in the
review of contracts, operating procedures, cash handling procedures and the like, as
requested by the ASSOCIATION, or as may be initiated by the COUNTY.
B. As requested by the ASSOCIATION, assist the ASSOCIATION in attaining appropriate
liability and other insurance coverage. Expenses for such liability and other insurance
coverage shall be paid in their entirety by the ASSOCIATION.
Page 2 of 6
2020-2022 Community Services Funding with Jefferson County Fair Association
SECTION 3: COMMUNITY SERVICES GRANT
A. The COUNTY will provide the ASSOCIATION grant funds to be used in support of their
responsibilities as defined under this Agreement.
B. Said grant is in the sum of$10,000 for 2020, increasing 3 percent in 2021 and 2022,payable
as a lump sum payment.
C. Said grant funds may not be utilized for any other expenses other than those related to
carrying out the responsibilities outlined in Section 1.
SECTION 4: TERM
This Agreement shall be for a term of three years,commencing on January 1,2020 and ending
December 31,2022. All activities performed pursuant to this Agreement within its term and prior to
its execution are 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 during the term of the agreement by mutual agreement of the
parties and appended in writing to the Agreement.
SECTION 7: TERMINATION
The Agreement may be terminated, upon thirty(30) days written notice for any material breach
of any of the terms of the Agreement by either party. After receipt of notice, and before
termination, the party in default may cure the defect, in which case the Agreement shall continue
in force for the full term. The COUNTY shall be refunded a pro-rated share of the agreed
funding upon termination based upon the balance of time remaining in the term unless otherwise
negotiated.
SECTION 8: AGREEMENT TO COMPLY WITH APPLICABLE LAWS
ASSOCIATION shall comply with all Federal, State, and local laws and ordinances applicable to
the work to be done by it pursuant to 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, WA.
SECTION 9: HOLD HARMLESS
All services to be rendered or performed under this Agreement will be performed or rendered
entirely at the ASSOCIATION's own risk and ASSOCIATION expressly agrees to hold
Page 3 of 6
2020-2022 Community Services Funding with Jefferson County Fair Association
harmless the COUNTY and all of its officers, agents, employees, or otherwise, from any and all
liability, loss or damage, including reasonable costs of defense that they may suffer as a result of
claims, demands, actions or damages to any and all persons or property, costs or judgments
against the COUNTY which result from, arise out of, or are in any way connected with the
services to be performed by the ASSOCIATION under this Agreement.
ASSOCIATION specifically assumes potential liability for actions brought against the
COUNTY by ASSOCIATION's employees, including all other persons engaged in the
performance of any work or service required of ASSOCIATION under this Agreement and,
solely for the purpose of this indemnification and defense, ASSOCIATION specifically waives
any immunity under the state industrial insurance law, Title 51 RCW. ASSOCIATION
recognizes that this waiver was specifically entered into pursuant to provisions of RCW 4.24.115
and was subject of mutual negotiation.
SECTION 10: INDEPENDENT CONTRACTOR
The ASSOCIATION and the COUNTY agree that the ASSOCIATION 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 ASSOCIATION nor any employee of the ASSOCIATION 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,
or otherwise assuming the duties of an employer with respect to the ASSOCIATION, or any
employee of the ASSOCIATION.
SECTION 11: INSURANCE
The ASSOCIATION 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.
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 ASSOCIATION's performance of the Agreement.
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
million dollars ($2,000,000) for bodily injury, including death and property damage,
unless a greater amount is specified in the contract specifications. The insurance coverage
Page 4 of 6
. 2020-2022 Community Services Funding with Jefferson County Fair Association
shall contain no limitations on the scope of the protection provided and include the
following minimum coverages:
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.
4. Said 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.
5. The COUNTY may, upon the ASSOCIATION'S failure to comply with any or all
provisions of this Agreement relating to insurance, withhold payment or compensation
that would otherwise be due to the ASSOCIATION.
6. If the proof of insurance or certificate indicating the COUNTY is an "additional insured"
to a policy obtained by the ASSOCIATION 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 ASSOCIATION to obtain the full text of that endorsement and forward
that full text to the COUNTY.
7. All insurance policies obtained by ASSOCIATION in order to comply with this Section
shall be primary and non-contributory as against any coverage for third party liability
claims obtained and retained by the COUNTY through Ch. 48.62 RCW"Risk Pool."
8. 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.
9. The insurance maintained by the ASSOCIATION under this agreement shall not in any
manner limit or qualify the liabilities or obligations of the ASSOCIATION under this
agreement.
SECTION 12. ENTIRE AGREEMENT
This Agreement together with attachments or addenda, and with the June 12,2000 memorandum
of understanding, represents the entire and integrated agreement between the COUNTY and the
ASSOCIATION and supersedes all prior negotiations, representations, or agreements written or
oral.
Page 5 of 6
_ 2020-2022 Community Services Funding with Jefferson County Fair Association
SECTION 13. SEVERABILITY
If a court of competent jurisdiction holds any provision of the Agreement to be illegal, invalid or
unenforceable, in whole or in part,the validity of the remaining provisions will not be affected,
and the parties' rights and obligations will be construed and enforced as if the Agreement did not
contain the particular provision held to be invalid. If any provision of the Agreement conflicts
with any statutory provision of the State of Washington, the provision will be deemed
inoperative to the extent of the conflict or modified to conform to statutory requirements.
Notwithstanding the foregoing, if such modification or elimination would materially and
adversely alter the rights or obligations of a party, such party may terminate this Agreement by
written notice to the other.
PP
APPROVED and signed this • day of DeCPtk-ir,2019.
JEFFERSON COUNTY
Attest: �7/� BOARD OF COMMISSIONERS c
Carol Gallaway, Ka e Dean, Chair Date
Deputy Clerk of the Board.
Approved as to Form: JEF RSON COUNTY FAIR ASSOCIATION
0 C. «/e f,y i
Philip C. Hunsucker ame. Date
Chief Civil.Deputy Prosecutor Title: V -A'�Z
Page 6 of 6
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
CONSENT AGENDA REQUEST
TO: Board of County Commissioners N/!"Philip Morley,County Administrator/444 V -641AViI �
FROM: Mark McCauley,Central ices Director
DATE: December 16,2019
RE: Request for Board of County Commissioners approval of an agreement with the
Jefferson County Fair Association for operation of the Jefferson County
Fairgrounds and the Jefferson County Fair
STATEMENT OF ISSUE: For a number of years Jefferson County has entered in an annual agreement
with the Jefferson County Fair Association for operating and maintaining the Jefferson County
Fairgrounds and organizing and operating the Jefferson County Fair.
ANALYSIS: Staff is proposing a three-year agreement for 2020-2022 rather than executing three annual
agreements over the same time period. This is an efficiency measure as the annual agreement process
consumes staff time unnecessarily.
Staff is also recommending a change to the agreement to comply with a State Auditor recommendation
made during the 2017 annual audit. Previous agreements required the County to provide County
Treasurer and Auditor services to the Fair Association. The State Auditor opined that the County cannot
provide these services to a non-profit organization unless specifically authorized by the Revised Code of
Washington(RCW). There is no such authorization in the current RCW. The proposed three-year
agreement does not contain that requirement.
Because the services provided by the County Treasurer and Auditor had value and since that value is no
longer being provided to the Jefferson County Fair Association staff is proposing increasing the annual
grant amount from $5,215 to$10,000 in 2020 with a three percent annual cost escalator.
FISCAL IMPACT: The agreement calls for the County to provide the Jefferson County Fair Association
$10,000 in grant funds to be used in support of their services in 2020 with a three percent cost escalator
built in for 2021 and 2022. We will submit a supplemental budget request in the 1st Quarter,2020 to cover
the increase.
RECOMMENDATION: That the Board of County Commissioners approve the attached agreement with
the Jefferson County Fair Association.
D BY:
f
7;9
1 or ey ty Admin(istrator Date
•
CONTRACT REVIEW FORM
CONTRACT WITH: Jefferson County Fair Association TRACKING NO.: 1 9-f 13
(Contractor/Consultant)
CONTRACT FOR: 2020-22 Community Services Grant Funding ec 31 2022
COUNTY DEPARTMENT: Central Services ```
For More Information Contact: Mark McCauley NOV 18 201g
Contact Phone #: 360-385-9130
RETURN TO: Mark McCauley RETURN BY J ', �` S T
(Person in Department)
AMOUNT: $10,000 (3%ESC) PROCESS: ❑ Exempt from Bid Process
❑ Consultant Selection Process
Revenue General Fund ❑ Cooperative Purchase
Expenditure $10,000 ❑ Competitive Sealed Bid
Matching funds Required N/A ❑ Small Works Roster
Source(s)of Matching Funds N/A ❑ Vendor List Bid
❑ RFP or RFQ
0 Other
Step 1: REVIEW BY E T -
Review • e"
Date Revie
prk_APPROVED FORM ❑ Returned evision(See Comments)
S c� t(
Comments c l-ti tti� C��%.�rtart.4-)i 5 €~�.:13
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Step 2: REVIEW BY PROSECUTING ATTORNEY
Review by: <: / Philip C. Hunsucker
Date Reviewed: limy,7 Chief Civil Deputy Prosecuting Attorney
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.)
Client#:2062 JEFFECOU
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ACORD2020
N CERTIFICATE OF LIABILITY INSURANCE Dare(MM11/09/DDNY
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 POUCIES
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(les)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 any rights to the certificate holder In lieu of such endorsement(s).
PRODUCER NN"COMTACT Debbie Johnson
Haas&Wilkerson Insurance P 913 432�t400 (AIC,No):
913 748-4868
Vino,Eo,Eel):
4300 Shawnee Mission Parkway ADDRESS: debbie.johnson@hwins.com
Fairway, KS 66205 — INSURER(S)AFFORDING COVERAGE NAIC H
913 432-4400
•INSURER A:ACE American Insurance Company(CHUBS) 22667
INSURED ,INSURER B
Jefferson County Fair Association
INSURER C
PO Box 242 — -_
Port Townsend,WA 98368 'INSURER D
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INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOPMTHSTANDING 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
!NM TYPE OF INSURANCE �� SU POUCY NUMBER {AIM/DD .(IdN/DCD/YYYY UNITS
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A XI COMMERCIAL GENERAL LIABILITY G21438837 12/12/2020 12/12/2021 EACH
OCCURRENCE T S1 000,000
,CLAIMS-MADE Xi OCCUR I PREMISES(Eaocarrence)_ S500,000
RENTED
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4 PERSONAL&ADV INJURY S 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER. I GENERAL AGGREGATE S5,000,000
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1 JECT PRO- F.—-1 LOC j POLICY PRODUCTS-COMP/OP AGG $5,000,000
OTHER: . i I S
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DESCRIPTION OF OPERATIONS/LOCATIONS(VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required)
Governmental Entity(Form CG2026/LD-22318)
The certificate holder is named as an additional insured on the general liability policy but only with
respect to liability arising out of the named insured's operations or premises owned by or rented to the
named insured per form CG2026/LD-22318. This insurance is primary and non-contributory. Wavier of
Subrogation applies in favor of certificate holder. 30 days written notice of cancellation will be provided
except for non-payment of premium,which is 10 days notice.
CERTIFICATE HOLDER CANCELLATION
Jefferson CountySHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
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