HomeMy WebLinkAboutJefferson County Historical Society (ex 6.1.23) - 010322IOC► �C�S � ' 2d- 904
AGRE ENT FOR 2022 HOTEL -MOTEL FUNDING FOR TOURISM SERVICES
JEFFERSON COUNTY HISTORICAL SOCIETY
This Agreement is by and between JEFFERSON COUNTY (hereinafter known as
"COUNTY" and the JEFFERSON COUNTY HISTORICAL SOCIETY (hereinafter known as
"HISTORICAL SOCIETY").
WHEREAS, the HISTORICAL SOCIETY is a non-profit corporation of the State of
Washington; and
WHEREAS, the COUNTY desires to promote tourism by documenting, preserving
and displaying County heritage for the benefit of its residents and to encourage tourist interest in
Jefferson County, as authorized by Chapter 67.28 RCW and Jefferson County Code Chapter 3.25;
ro '
IN CONSIDERATION of the mutual covenants and agreements herein it is agreed
by the parties as follows:
SECTION 1: SERVICES TO BE PERFORMED
The HISTORICAL SOCIETY shall use its capabilities and utilize up to $72,530 of funding
provided under this agreement to continue and update the ongoing performance of the following
tourism promotion services consistent with the Itemized List of Proposed Tourism Promotion
Services and Lodging Tax Budget a copy of which is incorporated herein and attached hereto as
Exhibit A:
The HISTORICAL SOCIETY shall use the Hotel -Motel Tax funding under this agreement to fund
staff salaries to continue and update the ongoing performance of the following specific services:
Operation of the following tourism facilities in Jefferson County:
• Jefferson Museum of Art & History
• Rothschild House Museum
• Commanding Officers Quarters at Fort Worden State Park
• Historical Research Center
• Collaborating with many local organizations for cross promoting
2. Operation of the County Museum and care of the collection for its long-term maintenance.
3. Outreach to County residents through educational programs and Museum exhibits regarding
cultural and natural heritage.
4. Promotion of heritage awareness through countywide recognition programs and the
establishment of new and traveling exhibits and publications.
5. Continued documentation of County heritage through collecting, oral history, research and
other means.
Page: 1 of 12 Jefferson County Historical Society
6. Advocacy of heritage preservation through all available means including the enhancement
of Heritage based tourism for the economic development of the County.
7. Assistance as requested to the Quilcene Historical Museum in development of its Museum,
in implementation of basic museum practices and procedures and in promotion of the
Museum as a local, public cultural and education organization.
8. Tourism promotion services provided by JCHS Staff and volunteers at each facility as
follows:
• Verbal information, displays and brochures;
• Telephone communications during normal office hours (9:00 a.m. — 5:00 p.m.) year
round;
• Website access to tourism information
SECTION 2: RESPONSIBILITIES OF THE JEFFERSON COUNTY HISTORICAL
SOCIETY
1. On or before January 31; April 30; July 31; October 31, 2022; and January 31, 2023,
provide to the COUNTY: see Exhibit C, attached hereto and incorporated;
• A quarterly report of the use, services, programs and activities of the HISTORICAL
SOCIETY 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 2022.
2. On or before January 31 (OR upon execution of this agreement, whichever is later); April
30; July 31; and October 31, 2022, provide to the COUNTY:
• A billing statement requesting payment of Hotel -Motel Funding for the current quarter.
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, 2023.
5. By February 28t' 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 HISTORICAL
SOCIETY.
b. The amount of lodging tax revenue allocated for expenditure (whether actually
expended or not) by the HISTORICAL SOCIETY on each festival, event or tourism
facility.
Page: 2 of 12 Jefferson County Historical Society
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 the HISTORICAL SOCIETY 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 $72,530 for 2022. 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.
SECTION 4: TERM
This Agreement shall be for a term of one year, commencing on January 1, 2022 and ending on
December 31 2022 except for the reports referenced in Section 2, due January 31, 2023 and
February 28, 2023.
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
HISTORICAL SOCIETY 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, HISTORICAL SOCIETY 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
Page: 3 of 12 Jefferson County Historical Society
The HISTORICAL SOCIETY 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 HISTORICAL SOCIETY's
negligence or breach of any of its obligations under this Agreement; provided that nothing herein
shall require the HISTORICAL SOCIETY 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 HISTORICAL SOCIETY'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
HISTORICAL SOCIETY's negligence, or the negligence of the HISTORICAL SOCIETY's
agents or employees.
The HISTORICAL SOCIETY specifically assumes potential liability for actions brought against
the COUNTY by the HISTORICAL SOCIETY's employees, or any other persons engaged in the
performance of any work or service required of the HISTORICAL SOCIETY 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
HISTORICAL SOCIETY 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 HISTORICAL SOCIETY 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.
The HISTORICAL SOCIETY shall maintain Workers' Compensation coverage as required
under the Washington State Industrial Insurance Act, RCW Title 51, for all HISTORICAL
SOCIETY employees, agents and volunteers eligible for such coverage under the Industrial
Insurance Act.
SECTION 10: INDEPENDENT CONTRACTOR
The HISTORICAL SOCIETY and the COUNTY agree that the HISTORICAL SOCIETY 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 HISTORICAL SOCIETY nor any employee of the
HISTORICAL SOCIETY 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 HISTORICAL SOCIETY, or any employee, representative, agent or contractor of the
HISTORICAL SOCIETY. The HISTORICAL SOCIETY shall be responsible for all applicable
Page: 4 of 12 Jefferson County Historical Society
withholdings, deductions, state industrial insurance, tax reports, business licenses, registrations,
and all other obligations of an independent organization.
SECTION 11: COMPLIANCE WITH LAWS
The HISTORICAL SOCIETY 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
The HISTORICAL SOCIETY 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 HISTORICAL SOCIETY 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 HISTORICAL SOCIETY.
APPROVED and signed this day of
JEFF RSON COUNTY
Attest: BO OF COMMISSIONERS
(arolymn�,allaway, C
Clerk of the Board
Approved as to Form: JEFFERSON COUNTY HISTORICAL
SOCIE
Philip C. Hunsucker, December 28, 2021 Authorized Ofiial f
Chief Civil Deputy Prosecutor S KGh S
Page: 5 of 12 Jefferson County Historical Society
Exhibit A
1. Itemized List of Proposed Tourism Promotion Services
Organization (or Event) Name: Jefferson County Historical Society
In the following space or on a separate sheet of paper, please specify each proposed tourism
promotion, facility, event or activity, including quantities and costs (see examples at bottom of page).
Heritage, Arts & Culture Tourism Support
• Research Center Staff
o .5 FTE Director $27,500
o .5 FTE Assistant $17,680
Visitor Experience and Facilities Manager
v .5 FTE Staff $27,350
$72, 530
Page 6 of 12 Jefferson County Historical Society
EXHIBIT B
Jurisdiction Lodging Tax Reporting Form - To Be Submitted to Jefferson County
Administrator's Office
Lodging Tax Reporting Form
Otpntm ans receiving fu &zq- to promote fe-.wvzls. venal e,--nr- and tour m-related acts,%Vw. through tontrsm-related facrunes
owned or sponsoaed bt• non-profit otganazatrow or the local junsdretron are requrred to complete thu form for EA(H aca,.uv
I Ckganizrtla Name Repattmg Year
5paascr Type `,-,-heck One.: 0.01 1 CX. 0 5otrc4l�0 Loca3lwr5ctran 006r EvLam
Amary Name
Acataty Type (Check One) (EventTesvil- 0 Fanhty" C)!datkeau
i Armm• Srmr Daoe':
S Acnm End Date'
' Taal 'ou of Acmvv S
8 Amount Requested: S
9 Amwmt Avazded S
10 Over", Attendance'
3, Pmwted'
bi Actual*
`tethodaiogc+Chectt One;
(Drrect Covet'
0Ituiuea Coven'
ORpremarwe ivase<,•
kionral Svney'
5nvcttued E use'
tevlaln,::
I I Number of Attetulees Mw Try 4O Miles or Ywe'
a) Ptaytcted•
b i Anita;'
c) Me&AdWovc r-lech Oce"
MV Corms`
RLMT Calm'
0 B.apte;et wt%-e Sur e4^
otlt"yal Stnv
0 Str c=ed Ea amtate"
0 Other .explmn..
1: `dtmlber of Attendees %le Traveled `ram Aomber State at Camas•
a , Shosected•
b « Uma:'
c Me+hodoijor Check One'�e + DUW Casa'
�it>vuect Canny q-)B.,zpresemarn•e Stme<•
IcSarsal SJtccv" Strtutured Emmxe-
CoRrher
eNplam
'See Lodging Tax Yearh• Reporting Definition: Instruction-
`: ame a: Ind. Jdia Whe TeWed P.epors
?hm-e a E-vau Ai ei.
RET1XV THIS FORM TO.
Jeffet�on Corms Adtnrm:tr-3tor ; Otf.ce
1S2n, Jeffer,on Street
P 0 Box 1 _2C
Port loun:end. WA 9S36S
`ef} oic a zo 'effei:on.it,. ul
I3 ?:umber of Attendees %19 Stayed CKvmL ist to Lmpad Accommodations'
a': Pmected'
bi Actual
c; Methodo*v fCbeck Oney Duect Cantor'
01dtrect C.=— oReprmcnmv 5tervy'
mfannal Sunrey SntutuYed Esamme•
00t-,
14 Number of Aromdees Who Sm--ed Ooeraw t m Pud Acccanodanatn'
a'. Pro}ecad'
b i Actual*
c', 4ierbadolagf (C%Ir One) Direct otnu'
1duect CO;mt' 0Repr t3axv Smw*
mama itUver" Stiw=ed Esamare'
11 \ meber ofPaid iade:mg \ i;hr'
a prmecad'
h Acrtai'
c �N�^fyerhodology !Check Onei: Duect Cotmr'
J aduect Covent' ()Reprrerwtiae Sun,
.ntnml Survey Smuaued Estmoaoe'
Odser 'eviam :
DUADLI�E Februarl :8th of Each Reporhug Year
Page 7 of 12 Jefferson County Historical Society
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 8 of 12 Jefferson County Historical Society
EXHIBIT C 1st OUARTER Due by April 30th to afmckn ght@co: jefferso_n.wa.us
Organization:
Contact person:
Mailing Address:
Phone Number/Email:
STARTING BALANCE + REVENUE THIS EXPENSES THIS _ ENDING BALANCE
PREVIOUS QUARTER QUARTER _ QUARTER — THIS QUARTER
Please attach supportive documents. Any attachments may be subject to disclosure as a public record under the Public
Records Act, RCW Chapter 42.56. 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.
Please provide your reports of the revenue, marketing, services, programs and activities of the prior quarter.
JANUARY
Incoming Revenue
Outgoing Expenses
Total
FEBRUARY
Incoming Revenue
Outgoing Expenses
Total
MARCH
Incoming Revenue
Outgoing Expenses
Total
Page 9 of 12 Jefferson County Historical Society
EXHIBIT C 2°d QUARTER Due by July 311 to afmcoight&o, jefferson.wa.us
Organization:
Contact person:
Mailing Address:
Phone Number/Email:
STARTING BALANCE + REVENUE THIS EXPENSES THIS ENDING BALANCE
PREVIOUS QUARTER QUARTER QUARTER — THIS QUARTER
Please attach supportive documents. Any attachments may be subject to disclosure as a public record under the Public
Records Act, RCW Chapter 42.56. 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.
Please provide your reports of the revenue, marketing, services, programs and activities of the prior quarter.
APRIL
Incoming Revenue
Outgoing Expenses
Total
MAY
Incoming Revenue
Outgoing Expenses
Total
JUNE
Incoming Revenue
Outgoing Expenses
Total
Page 10 of 12 Jefferson County Historical Society
EXHIBIT C 3rd QUARTER Due by October 3111 to afmckn ght a@co jefferson.wa.us
Organization:
Contact person:
Mailing Address:
Phone Number/Email:
STARTING BALANCE + REVENUE THIS _ EXPENSES THIS _ ENDING BALANCE
PREVIOUS QUARTER QUARTER QUARTER — THIS QUARTER
Please attach supportive documents. Any attachments may be subject to disclosure as a public record under the Public
Records Act, RC W Chapter 42.56. 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.
Please provide your reports of the revenue, marketing, services, programs and activities of the prior quarter.
JULY
Incoming Revenue
Outgoing Expenses
Total
AUGUST
Incoming Revenue
Outgoing Expenses
Total
SEPTEMBER
Incoming Revenue
Outgoing Expenses
Total
Page 11 of 12 Jefferson County Historical Society
EXHIBIT C 4" QUARTER Due by January 311 to afmcknight@cojefferson.wa.us
jefferson.wa.us
Organization:
Contact person:
Mailing Address:
Phone Number/Email:
STARTING BALANCE REVENUE THIS _ EXPENSES THIS _ ENDING BALANCE
PREVIOUS QUARTER + QUARTER QUARTER THIS QUARTER
Please attach supportive documents. Any attachments may be subject to disclosure as a public record under the Public
Records Act, RCW Chapter 42.56. 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.
Please provide your reports of the revenue, marketing, services, programs and activities of the prior quarter.
OCTOBER
Incoming Revenue
Outgoing Expenses
Total
NOVEMBER
Incoming Revenue
Outgoing Expenses
Total
DECEMBER
Incoming Revenue
Outgoing Expenses
Total
Page 12 of 12 Jefferson County Historical Society
Consent Agenda
Commissioners Office
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
FROM: Adiel McKnight, Executive Assistant
DATE: January 3, 2022
SUBJECT: AGREEMENT re: 2022 Hotel Motel (Lodging Tax) Grant Funding; In the
Amount of $72,530; Jefferson County Historical Society
STATEMENT OF ISSUE:
This agreement provides grant funding for 2022 to certain non-profit agencies for the promotion of
tourism and ongoing preservation of Jefferson County's heritage. The Lodging Tax Advisory
Committee met on November 2, 2021 and reviewed request for proposals. This funding has been
budgeted from the Hotel Motel (Lodging Tax) Fund, and approved by the Board of County
Commissioners on November 15, 2021.
FISCAL IMPACT:
Jefferson County Historical Society $75,530
RECOMMENDATION:
Approve and sign the agreement.
REVIEWED BY -
ark McCa y, Interim County A i 'strator Dat
CONTRACT REVIEW FORM
(INSTRUCTIONS ARE ON THE NEXT PAGE)
CONTRACT WITH: Jefferson County Historical Society
Contract For: Lodging Tax
COUNTY DEPARTMENT: county Administrator
Contact Person: Adiel McKnight
Contact Phone: 360-385-9102
Contact entail: afmcknight@oo.Jeffersoni.wa.us
AMOUNT: $72,530
Term: 1 yr
PROCESS:
Revenue:
Expenditure:
Matching Funds Required:
Sources(s) of Matching Funds
Fund # 125
Munis Org/Obj 12555730/411101
APPROVAL STEPS:
STEP 1: DEPARTMENT CERTIFIES C-If PL E H JCC
CERTIFIED: FEI N/A:
STEP 2: DEPARTMENT CERTIFIES PERSON PAOPOE
COUNTY (CONTRACTOR) HAS O EEN DEBARIKED BY
AGENCY. r' /- ] c_ G
Clear Form
Contract No: LTAC JCHS
Exempt from Bid Process
Cooperative Purchase
Competitive Sealed Bid
Small Works Roster
Vendor List Bid
RFP or RFQ
Other:
180 AND CHAPTER 42.23 RCW.
Date
FOR CONTRACTING WITH THE
Y FEDERAL, STATE, OR LOCAL
0
Date
STEP 3: RISK MANAGEMENT REVIEW (will be added electrWically through Laserfiche):
Electronically approved by Risk Management on 12/10/2021.
STEP 4: PROSECUTING ATTORNEY REVIEW (will be added electronically through Laserfiche):
Electronically approved as to form by PAO on 12/28/2021.
Is this a redo of one we approved earlier?
STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND
PROSECUTING ATTORNEY(IF REQUIRED).
STEP 6: CONTRACTOR SIGNS
STEP 7: SUBMIT TO BOCC FOR APPROVAL
OF COM IAl
w�SON
O!C` 4,
IN;�
January 5, 2022
Board of County Commissioners
1820 Jefferson Street
PO Box 1220
Port Townsend, WA 98368
Kate Dean, District 1 Heidi Eisenhour, District 2 Greg Brotherton, District 3
Jefferson County Historical Society
Shelly Leavens
540 Water Street
Port Townsend, WA 98368
Dear Shelly Leavens,
Enclosed for signature are two (2) originals for AGREEMENT re: 2022 Hotel Motel (Lodging
Tax) Grant Funding; In the Amount of $72,530; Jefferson County Historical Society
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, 2022 and January 31, 2023
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.
• The JC Historical Society 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,
btcKnig ht
Executive Assistant
Phone (360) 385-9100 Fax (360) 385-9382 jeffbocc@coJefferson.wa.us
4/12/22, 9:47 AM
Labor & Industries (https:/IIni.wa.gov).
JEFFERSON COUNTY HISTORICAL SO
Contractors
JEFFERSON COUNTY HISTORICAL SO
Owner or tradesperson 540 WATER STREET
PORT TOWNSEND. WA 98368-6739
WA UBI No.
161 001 597
Certifications & Endorsements
OMWBE Certifications
No active certifications exist for this business.
Apprentice Training Agent
No active Washington registered apprentices exist for this business. Washington allows the use of apprentices
registered with Oregon or Montana. Contact the ,)regon Bureau of Labor & industries or Montana Department of Labor
', ,� r,!r/ to verify if this business has apprentices.
Workers' Comp
Do you know if the business has employees? If so, verify the business is up-to-date on workers' comp premiums.
L&I Account ID
472,601-00
Doing business as
JEFFERSON COUNTY HISTORICAL
Estimated workers reported
Pending current quarter filing
Account is in good standing.
Quarterly report received and is being
processed.
L&I account contact
T2 / CHARLEEN GREGORY (360)902-5787 - Email: GOHA235@lni.wa.gov
Public Works Requirements
Verify the contractor is eligible to perform work on public works projects
Required Training— Effective July 1, 2019
Needs to complete training.
Contractor Strikes
No strikes have been issued against this contractor.
Contractors not allowed to bid
No debarments have been issued against this contractor.
Workplace Safety & Health
Check for any past safety and health violations found on jobsites this business was responsible for.
No inspections during the previous 6 year period.
https://secure.Ini.wa.gov/verify/Detail.aspx?UBI=l61001597&LIC=&SAW= 1/1
Issue Date 4/12/2022 Cert # 0000039867
Non Profit Insurance Program
Certificate of Coverage
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONVERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES
NOTAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF COVERAGE DOES NOT CONSTITUE A CONTRACT
BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed If SUBROGRATION IS WAIVED, subject to the terms and conditions of
the policy, certain coverage may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
COMPANIES AFFORDING COVERAGE
Clear Risk Solutions GENERAL LIABILITY
451 Diamond Drive American Alternative Insurance Corporation, et al.
Ephrata, WA 98823
AUTOMOBILE LIABILITY
American Alternative Insurance Corporation, et al.
WSURED PROPERTY
American Alternative Insurance Corporation, et al.
Jefferson County Historical Society MISCELLANEOUS PROFESSIONAL LIABILITY
540 Water Street Princeton Excess and Surplus Lines Insurance Company
Port Townsend, WA 98368
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE COVERAGE PERIOD
INDICATED, NOT WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP
DESCRIPTION
LIMITS
DATE
DATE
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY N1-A2-RL-0000013-12 6/1/2021
6/1/2022
PER OCCURRENCE
$5,000,000
OCCURRENCE FORM
PER MEMBER AGGREGATE
$10,000,000
INCLUDES STOP GAP
PRODUCT-COMP/OP
$5,000,000
PERSONAL & ADV. INJURY
$5,000,000
(LIABILITY IS SUBJECT TO A $150,000 SIR PAYABLE FROM PROGRAM FUNDS)
ANNUAL POOL AGGREGATE
$50,000,000
rcY
ANY AUTO N1-A2-RL-0000013-12 6/1/2021
6/1/2022
COMBINED SINGLE LIMIT
$5,000,000
(LIABILITY IS SUBJECT TO A $150,000 SIR PAYABLE FROM PROGRAM FUNDS)
ANNUAL POOL AGGREGATE
NONE
PROPERTY
N1-A2-RL-0000013-12 6/1/2021
6/1/2022
ALL RISK PER OCC EXCL EQ & FL
$75,000,000
EARTHQUAKE PER OCC
Excluded
FLOOD PER OCC
Excluded
(PROPERTY IS SUBJECT TO A $150,000 SIR PAYABLE FROM PROGRAM FUNDS)
ANNUAL POOL AGGREGATE
NONE
MISCELLANEOUS PROFESSIONAL LIABILITY
N1-A3-RL-0000060-12 6/1/2021
6/1/2022
PER CLAIM
$5,000,000
(LIABILITY IS SUBJECT TO A $150,000 SIR PAYABLE FROM PROGRAM FUNDS)
ANNUAL POOL AGGREGATE
$40,000,000
IDWRIPTIC114ANINEW4. I LOCATIONS / VEHICLES / SPECIAL ITEMS
Evidence of Coverage only.
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE
WI IN I HE POLICY PROVISIONS.
CERTIFICATE HOLDER AUTHORIZED REPRESENTATIVE
Jefferson County
PO Box 1220
Port Townsend, WA 98368
10/12/22, 4:56 PM
JEFFERSON COUNTY HISTORICAL SO
(5)
57A 1 E OF WASHING7oN
Department of Labor & Industries
01
OCT 13 20',-2
JEFFERSON COUNTY
COMMISSIONERS
Certificate of Workers' Compensation Coverage
WA UBI No.
L&I Account ID
Legal Business Name
Doing Business As
Workers' Comp Premium Status:
Estimated Workers Reported
(See Description Below)
Account Representative
Licensed Contractor?
October 12, 2022
161 001 597
472,601-00
JEFFERSON COUNTY HISTORICAL SO
JEFFERSON COUNTY HISTORICAL
Account is current.
Quarter 2 of Year 2022 " 7 to 10 Workers"
Employer Services Help Line, (360) 902-4817
No
What does "Estimated Workers Reported"
mean?
Estimated workers reported represents the number of
full time position requiring at least 480 hours of work
per calendar quarter. A single 480 hour position may
be filled by one person, or several part time workers.
Industrial Insurance Information
Employers report and pay premiums each quarter
based on hours of employee work already performed,
and are liable for premiums found later to be due.
Industrial insurance accounts have no policy periods,
cancellation dates, limitations of coverage or waiver of
subrogation (See RCW 51.12.050 and 51.16.1901.
https:Hsecure.Ini.wa.gov/verify/Details/liabilityCertificate.aspx?UBI=161001597&LIC=&VIO=&SAW=false&ACCT=47260100 1 /1
Issue Date 5/21/2022 Cart #:0000039867
Non Profit Insurance Program
Certificate of Coverage
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONVERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES
NOTAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF COVERAGE DOES NOT CONSTITUE A CONTRACT
BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certifcate hdlder is en ADDITIONAL INSURED, the policy(ies) must be endorsed If SUBROGRATION IS WAIVED, subject to the terms and conditions of
the policy, certain coverage may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
COMPANIES AFFORDING COVERAGE
Clear Risk Solutions
GENERAL LIABILITY
451 Diamond Drive
American Alternative Insurance Corporation, at al.
Ephrata, WA 98823
AUTOMOBILE LIABILITY
American Alternative Insurance Corporation, at al.
INSURED
PROPERTY
American Alternative Insurance Corporation, at al.
Jefferson County Historical Society
MISCELLANEOUS PROFESSIONAL LIABILITY
Princeton Excess and Surplus Lines Insurance Company
540 Water Street
Port Townsend, WA 98368
COVERAGES
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE COVERAGE PERIOD
INDICATED, NOT WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP
DESCRIPTION
LIMITS
DATE
DATE
GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY N1-A2-RL-0000013-13 6/1/2022
6/1/2023
PER OCCURRENCE
$5,000,000
OCCURRENCE FORM
PER MEMBER AGGREGATE
$10,000,000
INCLUDES STOP GAP
PRODUCT-COMP/OP
$5,000,000
PERSONAL & ADV. INJURY
$5,000,000
(LIABILITY IS SUBJECT TO A $250,000 SIR PAYABLE FROM PROGRAM FUNDS)
ANNUAL POOL AGGREGATE
$50,000,000
AUTOMOBILE LIABILITY
ANY AUTO N1-A2-RL-0000013-13 6/1/2022
6/1/2023
COMBINED SINGLE LIMIT
$5,000,000
(LIABILITY IS SUBJECT TO A $250,000 SIR PAYABLE FROM PROGRAM FUNDS)
ANNUAL POOL AGGREGATE
NONE
PROPERTY
N1-A2-RL-0000013-13 6/1/2022
6/1/2023
ALL RISK PER OCC EXCL EQ & FL
$75,000,000
EARTHQUAKE PER OCC
Excluded
FLOOD PER OCC
Excluded
(PROPERTY IS SUBJECT TO A $250,000 SIR PAYABLE FROM PROGRAM FUNDS)
ANNUAL POOL AGGREGATE
NONE
MISCELLANEOUS PROFESSIONAL LIABILITY
N1-A3-RL-0000060-13 6/1/2022
6/1/2023
PER CLAIM
$5,000,000
(LIABILITY IS SUBJECT TO A $250,000 SIR PAYABLE FROM PROGRAM FUNDS)
ANNUAL POOL AGGREGATE
$40,000,000
DESCRIPTION OF OPERATIlONS / LOCATIONS / VEHICLES / SPECIAL ITEMS
Evidence of Coverage only.
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE
WITH THE POLICY PROVISIONS.
CERTIFICATE HOLDER
AUTHORIZED REPRESENTATIVE
Jefferson County
PO Box 1220�
Part Townsend, WA 98368