HomeMy WebLinkAboutQuilcene Historical Museum $80,000 ins. 7.23.23 - 121922Of r1(9
CL dub I -S3
AGREEMENT FOR 2023 HOTEL -MOTEL FUNDING FOR TOURISM SERVICES
QUILCENE HISTORICAL MUSEUM
This Agreement is by and between JEFFERSON COUNTY (hereinafter known as
"COUNTY" and the QUILCENE HISTORICAL MUSEUM (hereinafter known as "MUSEUM").
WHEREAS, the MUSEUM 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;
and
WHEREAS, the Jefferson County Lodging Tax Advisory Committee reviewed and
recommended funding the lodging tax proposal by the Quilcene Historical Museum to promote,
operate and maintain the museum as a cultural resource and tourism destination, and to provide
information to tourists and residents about the local area;
IN CONSIDERATION of the mutual covenants and agreements herein it is agreed by the
parties as follows:
SECTION 1: SERVICES TO BE PERFORMED
The MUSEUM shall use its capabilities and utilize up to $80,000 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:
SECTION 2: RESPONSIBILITIES OF THE QUILCENE HISTORICAL MUSEUM
On or before January 31; April 30; July 31; October 31, 2023; and January 31, 2024,
provide to the COUNTY: see Exhibit C, attached hereto and incorporated;
• A quarterly report of the use, services, programs and activities of the MUSEUM 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 2023.
2. On or before January 31, 2023 (OR upon execution of this agreement) and July 31, 2023,
provide to the COUNTY:
• A billing statement requesting payment of Hotel -Motel Funding for the current half
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.
Page: 1 of 12 Quilcene Historical Museum
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.
By February 28" of each year provide the following information on Exhibit B, attached
hereto and incorporated by reference for the previous year.
a. Each festival, event, or tourism facility owned and/or operated by the MUSEUM.
b. The amount of lodging tax revenue allocated for expenditure (whether actually
expended or not) by the MUSEUM on each festival, event or tourism facility.
c. Estimated number of tourists served at each festival, event or tourism facility. ("Tourist"
includes persons traveling more than 50 miles to the location of the event, festival or
facility and overnight stays in the area).
d. Estimated lodging stays. ("Lodging" refers to commercial lodging such as hotels,
motels, resorts, bed and breakfasts, or commercial campgrounds).
e. Measurements that demonstrate the impact of increased tourism attributable to the event,
festival or facility.
SECTION 3: RESPONSIBILITY OF JEFFERSON COUNTY
1. The COUNTY will provide the MUSEUM 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 $80,000 for 2023. Semi-annual payments of $40,000 will be
made in the first and third quarter of 2023. 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, 2023 and ending on
December 31, 2023, except for the reports referenced in Section 2, due January 31, 2024 and
February 28, 2024. 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 by mutual written agreement executed by both parties.
Page: 2 of 12 Quilcene Historical Museum
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
MUSEUM may terminate this Agreement upon thirty (30) days written notice to the COUNTY. In
the event of termination under this clause, the County shall be liable to pay only for services
rendered prior to the effective date of termination. If termination covers a period for which payment
has already been made, the MUSEUM 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 MUSEUM shall indemnify and hold the COUNTY, and its officers, employees, agents and
volunteers (and their marital communities) 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 MUSEUM's
negligence or breach of an of its obligations under this Agreement; provided that nothing herein
shall require the MUSEUM 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, agents and volunteers (and their marital communities), and; provided further that if the
claims or suits are caused by or result from the concurrent negligence of. (a) the MUSEUM's
agents or employees; and , (b) the COUNTY, its officers, employees agents and volunteers (and
their marital communities), 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 MUSEUM's negligence, or the negligence of the
MUSEUM's agents or employees.
The MUSEUM specifically assumes potential liability for actions brought against the COUNTY
by the MUSEUM's employees, including all other persons engaged in the performance of any
work or service required of the MUSEUM under this Agreement and, solely for the purpose of this
indemnification and defense, the MUSEUM specifically waives any immunity under the state
industrial insurance law, Title 51 RCW. The MUSEUM recognize 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 MUSEUM shall obtain and keep in force during the term of the Agreement, or as otherwise
required, the following insurance:
A. Commercial General Liability Insurance. The MUSEUM shall maintain commercial general
liability coverage on a form acceptable to Jefferson County Risk Management for bodily
injury, personal injury, and property damage, with a limits of not less than in the amount of at
least $1 million per occurrence, for bodily injury, including death, and property damage.
B. Worker's Compensation (Industrial Insurance). The MUSEUM shall maintain workers'
compensation insurance at its own expense, as required by Title 51 RCW, for the term of this
Page: 3 of 12 Quilcene Historical Museum
Agreement and shall provide evidence of coverage to Jefferson County Risk Management,
upon request.
SECTION 10: INDEPENDENT CONTRACTOR
The MUSEUM and the COUNTY agree that the MUSEUM 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 MUSEUM nor any employee of the MUSEUM 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 MUSEUM, or any employee, representative, agent
or contractor of the MUSEUM. The MUSEUM shall be responsible for all applicable
withholdings, deductions, state industrial insurance, tax reports, business licenses, registrations,
and all other obligations of an independent organization.
SECTION 11: COMPLIANCE WITH LAWS
The MUSEUM 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 MUSEUM 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 MUSEUM 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 MUSEUM.
SIGNATURES ON THE FOLLOWING PAGE
Page: 4 of 12 Quilcene Historical Museum
APPROVED and signed this
Attest:
0(- ` ��
Carolyn Gallaway, CM�C
Clerk of the Board
Approved as to Form:
t' December 15, 2022
Philip C. Hunsucker,
Chief Civil Deputy Prosecutor
/ day of .)�eUmbc — , 2022
JEFFERSON COUNTY
BO RD OF COMMISSIONERS
e IEisenhour, Chair
QULCEN ISTRh
Authoriza
mugevm
bee
Page: 5 of 12 Quilcene Historical Museum
EXHIBIT A
Itemized List of Proposed Tourism Promotion Services and Lodging Tax Budget
1. Itemized List of Proposed Tourism Promotion Services
Organization (or Event) Name., Qukene Historkai Museum - Worthington Park
10/14/2022
Exponst
ffg 201 1G�20
L Vi dtor Event Support & information 66112 5 11. $ 12..213 S 6,845 , 17,330 $ 19ASO
Signage, exibrts, newsletters, invitations,brochures, conveniences, event materials, COVtR/PPE supplies
2. Ca aperative Partnerships & Coilabwations 66116 5 ? UN7 5 : S00 ; 1,170 5 1,410 $ JAW
FAM tours, Culinary Loop, 101 Brewery, CMIQ, Qudlcene Fair, Quikene Alumni, OPTC f otymj* Peninsula
Tourism Councils, OM (Olympic Peninsula Visitors Bureau), State, Regional, & National memberships,
Chambers of Commerce, Lions! Club, Boy Scouts, Quilcene / Brinnon Garden Club, educational & scholarship
programs, Qulfaene Booster Club, Children programs & events, Local Farms & Seafood producers, Former
Marttets, Car & RV group tours, Victoriana tours & education
3. Museum web-sfces & Social M"s, tr, Phone 66118 5 6.0()10 5 S. 0C , >w,, 36 4 5 8,8W S 7,O0
don*ns, upgrades & maintenance, enhancement with links to JeffCo lodging, dining and events, video
teleconferencing
4. Spedal Events, Promotions, Marketing 66120 $ 7,4Wi 5 11,433 $ 6,65o 5 mow S 3S l=
Marketing Media / Acts & Promcition, Rental Portfolio Packet, Museum Season Opener (April), "little Women"
Performances (Mar -April), PT Victorian Heritage Assn - Victorian Festival (April), QHS Alumni Reunion exhibits
(Junes, "Bon Jon Pau Out" Bike Trek (tune), Worthington Mansion open house tours (June,July,Sept), IC Library
Summer Reading Program (July, Aug), Key City Public Theater (Aug), Wine & Spirits Tasting Gala (Aug),
Worthington Park Circus and Outdoor Movie Night (Aug), Farm Tour Outdoor Movie (Sept), Qudcene Festival
Weekend (Sept), Quilcene Oyster Run (Sept), Worthington Park Scarecrow Contest IOct], Docent Appreciation
Dinner (Nov), Qukene Fiber *Sheep to Shawl" Festival (Nov)
S. Prehs"01 Sovk4iii, Projects 66122 1 iu 4- $ 10,883 $ 7,036 5 13,055 S "Am
Accessioning input, Oral History Project, History / culture publications, Document Storage Project, professional
services, facilities maintenance/operations
6. Tranrtl / conftre+nms, ptager copies. Orifice
Conference / Convention / Meeting,
Office Expenses - Program
Postage -Program
Travel
Office Expense, Administration
Postage, Administration Printing
anc t �pying, Ad-i• n
Total LTAC Funding; Requested
66130
5
2,4X1
$
2,400
$
7 75,
5
700
$
M
66171
5
3W
5
-Xio
5
100
5
104
5
Im
66273
5
1 ??
5
100
$
$
150
S
ISO
66195
5
3+ f
5
300
$
5
800
5
sw
66265
$
50-n
5
Soo
600
5
fim
66267
5
7
$
MO
$
275
600
$
600
66269
5
300
$
300
$
150
$
200
S
200
$ 37,040-- $ 46,629 S 29,615 $ 62,935 $ 13o,000
Page 6 of 12 Quilcene Historical Museum
Exhibit B
Jurisdiction Lodging Tax Reporting Form - To Be Submitted to Jefferson
County Administrator's Office
No Later than February 28th of each Year
Lodgiug Tat Reportiug Forin
Oruro. ations recerc» fimduLg to promote festrval>. Waal eyen=r and tourism -related activitie, through tour m-reared facL:v es
owned or spommed by non-profit orgau nno= or the local jun:;&,non me requrred to complete thn form for EACH acn are•
1 Orpa mum Name: F.epaatsce Yew:
2 5p-- Tape ;Check 0oe) 0 ;+-wC,(j) s l c;+x; Loca: Jansmcnan 00ther'T PUM)
3 Acum Name
4 Act3mT4pe(CheckOne): OFvmc-fesaval• t Fr i tc' �,!.ixdcaan
J
S Acunty 5tmt Bate•:
6 Acu uyEnd Date•:
Toot CostodAcmjrr S
8 Amon F.egaested: S
9 Amara Aaxrde& S
10 Om22 ATDmd ace•
e) Pmerted•
b) Acma•
c) bfelbodo;op (Check Ouei
(>Xecr Cac�c'
()Imdlm Ceram-
F.etrrewttam.,e sua`.,w
]¢formal Sane+•"
s,=MT917:Mmace•
8 01ber f ecplaia :
11 "Number of Artecdees %1w Tnveted :,O Hiles w More*
a) Pal erred`
7t Acton':•
c) Met odoieg • ft_hed Ore
C re r =oucr'
Oleduwt Ceram•
0F.epreseattatosa srnw.
0 iefora:al St -w—
C.) Sm cm ei Emmaae"
0 Odw (esplam):
12 Nuata ere: Arasdees %1w Trrveled 5rvm Amatber Stage err Corna5'
e) Pm-Ied•
b) Acatal•
c) 'lrdwdakgv rCheck Orel**,, gnct C+aoer'
Okdirett C.-0F.elueseware Suns w'
8 I foncal s %ey- 3a�Lctw-ei Exrcaaaa"
Other ieWlwuY
"See Lodging Tax Yearl} Reporting Definidow. In.:rruction>
Nature of Ind i-aal !%T o Avpa ed Fxpor
r6tame a E-VaL : iz--a-,
RETUMN THIS FOPW TO:
Jefferson County Adamustrator`'s Ofaa-e
1820 Jelferson Street
P.O. Box 1220
Post Townsend. WA 9S368
jeflboccerr.co.pef u-oa.vra.=.
l; ' nabs mf Aneciees?Jlho hayed Ot�snight m trpaad A :i moms•
a: Pmj�acted•
b� Actaa:•
h% bado cre;' iCheck Omei: Caen a=,
:ad�rect Caact• �F�aresa:xatite Sta:tr�'
l,.l�n?rmm,al un=e5^ Sawctwed EsCmaoe•
�Cther r�?:
14 Number of Amecdee: Who Srayed Oremiglu m Paid Acccc=o& rats`
aj Projected*
bi Acraa_•
cj bietbad6agy (Check One,,: 0 Caen "01mr•
.adawt Coast' oRgrKettaaiw 5wws,
sfwarl Survey- S=naad Esamare•
0 e iaml:
1 z Number of P.md Lod;= ; Lhts'
a Praj�d•
h'� A. -ran:•
c NfebodoAevfChock Cue j:•*DuectC®emu"
:a&recr t�mara' 0FePtaea =,e Stases^
p:aigratl S.ey • i=urad Estimate•
i1 Oterewbtm):
DEADI I'+E: Februan- :8th of Each Reporting hear
Page 7 of 12 Quilcene Historical Museum
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 yeaf.
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 Quilcene Historical Museum
EXHIBIT C 1 st QUARTER
Organization:
Contact person:
Mailing Address:
Phone Number/Email:
1. LTAC Funds received from the County 11t QTR:
Due by April 301h to afmcknight0co.jefferson.wa.11s
2. LTAC funds spent by your organization 1st QTR (include 200 word limit regarding activities and funds spent with
supporting documentation ie: reports outlining LTAC funds,):
3. LTAC funds balance remaining 1" QTR:
4. Please attach your organization's report for all revenue, marketing, services, programs and activities of the prior
quarter.
This report and any attachments may be subject to disclosure as a public record under the Public Records Act, RCW
Chapter 42.56. A minimum of six years, you must maintain documented proof of payments made, contracts executed
and other expenditures authorized under your Agreement with Jefferson County. Upon reasonable notice, you must be
able to provide access to County or State representatives to audit those records.
Page 9 of 12 Quilcene Historical Museum
EXHIBIT C 2nd QUARTER
Organization:
Contact person:
Mailing Address:
Phone Number/Email:
1. LTAC Funds received from the County 15t QTR:
Due by July 31s' to afmcknightPco.jefferson.wa.us
1. LTAC funds spent by your organization 151 QTR (include 200 word limit regarding activities and funds spent with
supporting documentation ie: reports outlining LTAC funds,):
2. LTAC funds balance remaining 15t QTR:
3. Please attach your organization's report for all revenue, marketing, services, programs and activities of the
prior quarter.
This report and any attachments may be subject to disclosure as a public record under the Public Records Act, RCW
Chapter 42.56. A minimum of six years, you must maintain documented proof of payments made, contracts executed
and other expenditures authorized under your Agreement with Jefferson County. Upon reasonable notice, you must be
able to provide access to County or State representatives to audit those records.
Page 10 of 12 Quilcene Historical Museum
EXHIBIT C 3rd QUARTER
Organization:
Contact person:
Mailing Address:
Phone Number/Email:
1. LTAC Funds received from the County V QTR:
Due by October 31st to afmcknight0co.jefferson wa us
LTAC funds spent by your organization Vt QTR (include 200 word limit regarding activities and funds spent
with supporting documentation ie: reports outlining LTAC funds,):
3. LTAC funds balance remaining 1st QTR:
4. Please attach your organization's report for all revenue, marketing, services, programs and activities of the
prior quarter.
This report and any attachments may be subject to disclosure as a public record under the Public Records Act, RCW
Chapter 42.56. A minimum of six years, you must maintain documented proof of payments made, contracts executed
and other expenditures authorized under your Agreement with Jefferson County. Upon reasonable notice, you must be
able to provide access to County or State representatives to audit those records.
Page 11 of 12 Quilcene Historical Museum
EXHIBIT C 41h QUARTER Due by January 31s'to afmcknight wco. efferson_wa us
Organization:
Contact person:
Mailing Address:
Phone Number/Email:
1. LTAC Funds received from the County 1" QTR:
2. LTAC funds spent by your organization 15t QTR (include 200 word limit regarding activities and funds spent with
supporting documentation ie: reports outlining LTAC funds,):
3. LTAC funds balance remaining Vt QTR:
4. Please attach your organization's report for all revenue, marketing, services, programs and activities of the prior
quarter.
port and any attachments may be subject to disclosure as a public record under the Public Records Act, RCW
42.56. A minimum of six years, you must maintain documented proof of payments made, contracts executed
expenditures authorized under your Agreement with Jefferson County. Upon reasonable notice, you must be
able to provide access to County or State representatives to audit those records.
Quilcene Historical Museum
Coverage Is Provided In: Policy Number:
Liberty West American Insurance Company gKW (23) 57 2163 73
Mutual. Policy Period:
INSURANCE From 07/23/2022 To 07/23/2023
Commercial General Liability 12:01 am Standard Time
Declarations at Insured Mailing Location
Basis: Occurrence
Named lassoed Agent
QIUILCENE HISTORICAL MUSEUM
SUMMARY OF LIMITS AND CHARGES
Commemilal
General
Liawlity
Limits N
Insurance
Exilitan don of
Charges
DESCRIPTION
(360) 385-3711
HOMER SMITH INSURANCE INC
KI,
Each Occurrence Limit 1,000,000
D-Amage To Premises Rented To You Limit (Any One Premise) 1,000,000
Medical Expeme Limit (Any One Person) 15,000
Personal and Advertising Injury Limit 1,000,000
General Aggregate Limit (0)thcr than Products - Completed Operations) 2,000,000
Products - Completed Operations Aggregate lamit 2,000,000
DESCRIPTION
PREMIUM
General Liability Schedule Totals 1,776.00
Certified Acts of Terrorism Coverage 11.00
Total Advance Charges: $1, 787. DQ
Note: This is not a bill
report a claim, call your Agent or 1-844-325-2467
DS 70 22 41 08
06/19/22 57216373 POLSVCS 235 NCXEPPNO INSURED COPY 0004/9 PAGE 43 OF 116
coverage Isprev/dedIn. Policy Number:
Liberty West American Insurance Company BKW (23) 57 21 83 73
IIAMu RANCE Policy Period:
From 07/23/2022 To 07/23/2023
Commercial General Liability 12:01 am Standard Time
Declarations Schedule at Insured Mailing Location
Named Insured Agent
QUILCENE HISTORICAL MUSEUM (360) 385-3711
HOMER SMITH INSURANCE INC
SUMMARY OF CLASSIFICATIONS - BY LOCATION
0001 191 Columbia St
Main Office and Museum
QVILCENE, WA 98376
Insured: QUILCENE HISTORICAL MUSEUM
CLASSIFICATION- 46427
Museums - Not For Profit
ProdueL,Xo►ripleted Operations Are Subject To IV General
Aggregate Limit.
COVERAGE DESCRIPTION
PREIiNUM BASED ON -
RATED / PER
1,000 PREAWW
Premise/Operations 2,080 Square Feet Of Area 186,279 $387.00
TWal:
101 C8108 la St
WCOWe, WA9W6
insured: QUILCENE HISTORICAL MUSEUM
CLASSIFICATION - 46427
Museums - Not For Profit
Products -Completed Operations Are Subject To The General
Aggregate Limit.
COVERAGE DESCRIPTION
Included
RATED / PER
1,000 PRE111M NN
Premise/Operations 380 Square Feet Of Area 186.279 $71. 00
Included
report a claim, call your Agent or 1-8"-325-2467
US 74 23 10 16
06/19/22 57216373 POLSVCS 235 NCXI PPNO INSURED COPY 000479 PAGE 44 OF 176
Mo
Coverage Is Provided In. Policy Number:
Wk Liberty West American Insurance Company BKW (23) 57 2163 73
Mutual. Policy Period
INSURANCE From 07/23/2022 To 07/23/2023
1 S d T'
12.0 am tan and tme
Commercial General Liability at Insured Mailing Location
Declarations Schedule
Named Insured Agent
QUILCENE HISTORICAL MUSEUM (360) 385-3711
HOMER SMITH INSURANCE INC
SUMMARY OF CLASSIFICATIONS - BY LOCATION - continued
0001 191 Columbia st
Main Office and Museum
QUILCENE, WA 98376
Insured: QUILCENE HISTORICAL, MUSEUM
CLASSIFICATION - 99718
Theatrical Companies - Traveling
Products -Completed Operations Are Subject To The General
Aggregate Limit.
RATED / PER
COVERAGE DESCRIPTION P10EI1i11IMA BASED ON - IndividiW Payroll 1,000 pNE
Premise/Operatiorus 17,8(it) Dollars Of Payroll 9.704 $173.00
Total: Included
CLASSIFICATION - 99718
Theatrical Companies - Traveling
Prod tic ts--Completed Operations Are Subject To The General
Aggregate Limit.
RATED i PER
COVERAGE DESCRIPTION PREMIUM BASED ON - Employees Payroll 1,000 PREMIUM
Premise/Operations Dollars Of Payroll - if any 9.704
Total:
report a claim, call your Agent or 1-844-325-2467
DS 70 23 10 16
06/19122 5/216313 POI SVCS 235 N(,XEPPN0 INSURED COPY 000419 PAGE 45 Of 176
Coverage Is Provided in.
Wk H berty West American Insurance Company
Policy Number
BKW (23) 57 2163 73
�-INSURAN
i`
Policy Period
From 07/23/2022 To 07/23/2023
Commercial General Liability
12:01 am standard Time
Declarations Schedule
at Insured Mailing location
Named Insured Agent
QUILCE?NE HISTORICAL MLiSEUA✓I (360) 385-3711
HOMER SMITH INSURANCE INC
SUMMARY OF CLASSIFICATIONS - BY LOCATION - conUnrml
0003 101 Columbia St
Music Stage
Quilcene, WA 98376
Insured: CIUILCENE HISTORICAL MUSEUM
CLASSIFICATION - 46427
Museums - Not For Profit
Products-Comj)lcted Operations Are Subject To The Gencral
Aggregate Limit.
RATED / PER
COVERAGE DESCRIPTION PREMIUM BASED ON -
1,000 PREMIUM
Premise/Operations 250 Square Feet Of Area
186.279 $47.00
151 Columbia St
Garage 1
QVILCENE, WA 98376
Insured: QUILCENE HISTORICAL MUSEUM
CLASSIFICATION - 46427
Museurrts - Not For Profit
Pr(Aucts-Cornpleted Operations Are Subject To The General
Aggregate I.irrit.
COVERAGE DESCRIPTION
E'rci�tiscl0l>erations
PREMIUM BASED ON -
AX) Square Feet Of Area
Total.
Included
RATED / PER
1,000 PREMIUM
186.279 $130, 00
Total. Included
report a claim, call your Agent or 1-844-325-2467
US70231016
06/19/22 50163/3 P01 SVCS 235 NCXFPPNO INSURFt) COPY 0004/9 PAGE 46 Of 1 /6
Mo
Coverage Is Provided In: Policy Number:
Liberty West American Insurance Company BKW (23) 57 2163 73
Mutual. Policy Period.
INSURANCE From 07/23/2022 To 07/23/2023
Commercial General Liability 12.01 am Standard Time
Declarations Schedule at insured Mailing Location
Feted Insured Agent
QUILCENE HISTORICAL MUSEUM (360) 385-3711
HOMER SMITH INSURANCE INC
SUMMARY OF CLASSIFICATION - BY LOCATION - continued
0006 151 Columbia St
Garage 2
QUILCENE, WA 00376
Insured: QUILCENE HISTORICAL MUSEUM
CLASSIFICATION - 46427
Museums - Not For Profit
Products -Completed Operations Are Subject To The General
Aggregate Limit.
RATE®/ PER
COVERAGE OPTION PREMIUM BASED ON - I'm PRE#/fNil
Premise/Operations S(lt) Square Feet Of Area 186.279 $56.00
Total: Included
151 Columbia St
Barn
QVILCENE, WA ON76
Insured: QUILCENE HISTORICAL MUSEUM
CLASSIFICATION - 46427
Museums - Not For Profit
Products -Completed Operations Are Subject To The General
Aggregate Limit.
RATED / PER
COVERAGE DESCRIPTION PREMIUM BASED ON - 1,000 PREMIUM
Prerrjise/Operations 1,5W Square Feet Of Area 186.279 $279. 00
Total. included
report a claim, call your Agent or 1-844-325-2467
DS 70 23 10 16
06/19/22 57216373 POLSVCS 235 NCXFPPNO INSURED COPY 000479 PAGE 41 OF 176
Coverage is Provided In: Policy Number:
Mutual.
udL�. West American Insurance Company BKW )23) 57 2163 73
�� Policy Period:
From 07/23/2022 To 07/23/2023
Commercial General Liability 12:01 am Standard Time
Declarations Schedule at Insured Mailing Location
Named Insured At
QUILCENE HISTORICAL MUSEUM (360) 385-3711
HOMER SMITH INSURANCE INC
SUMMARY OF CLASSIFICATIONS - BY LOCATION - continued
0004 151 Columbia St
Museum
QUILCENE, WA 98376
Imured: QUILCENE HISTORICAL MUSEUM
CLASSIFICATION - 46427
Museums - Not For PruGl
Praiuc:ts-Cermpleted Operations Arc Subject To The C,cneral
Aggregate Limit,
COVERAGE DESCRIPTION
Premise/Operations
C ornmercial general Liability S'chedi le Total
PREMIUM BASED ON -
3,4(9) Square Feel (A Area
report a claim, call your Agent or 1-844-325-2467
RATED J PER
1,000 PREMION
186,279 $633.00
Total: Incladcd
$1,776.00
I)S 70 23 10 16
01519122 50163/3 POLSVCS 235 NCXfPPNO INSURED COPY 000479 PAGE 48 OF 116
Coverage Is Provided In: Policy Number:
Liberty West American Insurance Company BKW 123) 57 2163 73
Mutual. Policy Period
INSURANCE From 07/231= To 07/23j2023
Liquor Liability 12:01 am Standard Time
Declarations at Insured Mailing Location
Basis: Occurrence
Named Insured Agent
QUILCENE HISTORICAL MUSEUM (360) 385-3711
HOMER SMITH INSURANCE INC
SUMMARY OF LIMITS AND CHARGES
Liquor DESCRIPTION LINT
Liability Each Common Cause Limit 1,000,000
Limits M
lulu of Aggregate Limit 2,000,000
Inurance
DESCRIPTION
Liquor Liability 259.00
Certified Acts of "Terrorism Coverage 2,00
Total Advance Charges:
report a claim, call your Agent or 1-844-325-2467
$261.00
Nate: This is not a bill
WS 70 22 01 08
06/19/22 57216373 POLSVCS 235 NGXFPPNO INSURED COPY 000419 PAGE 49 Of 176
Coverage is Provided in. Policy Number:
1,iberty West American Insurance Company BKW 123) 57 2163 73
�10 Mutual. Policy Period:
_-_
INSURANCE From 07/23/2022 To 07/23/2025
Liquor Liability 12:01 am Standard Time
at Insured Mailing Location
Declarations Schedule
Nawd Inured Agent
QUILCENE HISTORICAL MUSEUM (360) 385-3711
HOMER SMITH INSURANCE INC
SUMMARY OF CLASSIFICATIONS - BY LOCATION
M1 101 Columbia $t
Main Office and Museum
QUILCENE, WA 98376
Insured: QUILCENE HISTORICAL MUSEUM
CLASSIFICATION - 58168
Temporary Licenses
COVERAGE DESCRIPTION
Liquor Liability
PREMUM BASED ON -
I Per Liquor Permit
Total.
RATED / PER
EACH PRENNUM
259.2(X) $259.00
$259.00
Liquor liability ScheduM Total $259.00
report a claim, call yourAgeat or 1-W325-2467
US 70 23 10 16
06/19/22 57216373 POI SVCS 235 NCXFPPNO INSURED COPY OW479 PAGE 50 OF 176
January 2, 2023
Dear Adiel McKnight,
Enclosed is the signed 2023 Hotel Motel (Lodging Tax) Grant Agreement for the
Quilcene Historical Museum. Also attached is a copy of our 2022-2023 Liability
Insurance documents.
Please let me know if you need anything else or if you have questions.
Happy New Year!
Ma u h
?yvdczClu I;
Treasurer
Quilcene Historical Museum
360-765-3420
Consent Agenda
Commissioners Office
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
FROM: Adiel McKnight, Executive Assistant
DATE: December 19, 2022
SUBJECT: AGREEMENT re: 2023 Hotel Motel (Lodging Tax) Grant Funding; In the
Amount of $80,000; Quilcene Historical Museum
STATEMENT OF ISSUE:
This agreement provides grant funding for 2023 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 October 28, 2022 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 21, 2022.
FISCAL IMPACT:
Quilcene Historical Museum $80,000
RECOMMENDATION:
Approve and sign the agreement.
REVIEWED BY:
j . ;5�7
01
Mark McC iffy, County Administrato Date:
CONTRACT REVIEW FORM L
Clear Form
(INSTRUCTIONS ARE ON THE NEXT PAGE)
CONTRACT WITH: Quilcene Historical Museum Contract No: LTAC Museum
Contract For: Lodging Tax Term: January through December 2023
COUNTY DEPARTMENT: County Administrator
Contact Person: Adiel McKnight
Contact Phone: x102
Contact email: afmcknight@co.jefferson.wa.us
AMOUNT: $80,000 PROCESS: Exempt from Bid Process
Revenue: Cooperative Purchase
Expenditure: $80,000 Competitive Sealed Bid
Matching Funds Required: Small Works Roster
Sources(s) of Matching Funds Vendor List Bid
Fund # 125 RFP or RFQ
Munis Org/Obj 12555730/411103 Other:
APPROVAL STEPS:
STEP 1: DEPARTMENT CERTIFIESI%-
ICE W TH JC , :55.080 AND CHAPTER 42.23 RCW.
CERTIFIED: ❑ N/A: RE
Signature Date
STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE
COUNTY (CONTRACTOR) HAS NOT BEEN DEBARRED BY ANY FEDERAL, STATE, OR LOCAL
AGENCY. r
CERTIFIED: R NIA:
Signature Date
STEP 3: RISK MANAGEMENT REVIEW (will be added electronically through Lasertiche):
Electronically approved by Risk Management on 12/15/2022.
STEP 4: PROSECUTING ATTORNEY REVIEW (will be added electronically through Lasertiche):
Electronically approved as to form by PAO on 12/15/2022.
Pre -approved language.
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
0 S
�g4w¢sONc0� Q2
December 19, 2022
Quilcene Historical Museum
Brian Cullin
P.O. Box 574
Quilcene, WA 98376
Dear Brian Cullin,
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
Enclosed for signature are two (2) originals for AGREEMENT re: 2023 Hotel Motel (Lodging
Tax) Grant Funding; In the Amount of $80,000; Quilcene Historical Museum
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 281h of each year along with Exhibit B attached to
your contract.
• Insurance shall be obtained 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.
Cordially,
Adiel McKnight
Executive Assistant
Phone (360) 385-9100 Fax (360) 385-9382 jeffbocc@co.jefferson.wa.us