15-057.00 Spokane River Forum IG.-°G1
TOURISM PROMOTION AGREEMENT
WITH
THE CITY OF SPOKANE VALLEY
THIS AGREEMENT is made by and between the City of Spokane Valley, a non-charter code
City of the State of Washington, hereinafter referred to as "City," and Spokane River Forum, hereinafter
referred to as "Entity,"jointly referred to as "parties."
DEFINITIONS
a. Tourism Promotion. "Tourism promotion" means activities, operations, and
expenditures designed to increase tourism, including but not limited to advertising,
publicizing, or otherwise distributing information for the purpose of attracting and
welcoming tourists; developing strategies to expand tourism; operating tourism
promotion agencies; and funding the marketing of or the operation of special events and
festivals designed to attract tourists.
b. Fund(s). "Fund(s)" is defined as any amount of compensation derived from the lodging
tax monies of the City of Spokane Valley which is allocated to Entity for tourism
promotion.
IN CONSIDERATION of the terms and conditions contained herein, the parties covenant and
agree as follows:
1. Purpose of Agreement. The purpose of this Agreement is for City and Entity to
promote tourism in the Spokane Valley. City agrees to make funds available to Entity for the purpose of
tourism promotion in an effort to attract visitors and create business and revenue in the City of Spokane
Valley.
2. Administration. The City Manager or his designee shall administer and be the primary
contact for Entity regarding terms of this Agreement. For good cause, as solely determined by City, City
may direct that Entity is no longer entitled to the use of said funds for tourism promotion and terminate
this Agreement.
3. Representations. Entity shall use the funds received from City for tourism promotion
and advertising solely for the purposes and in accordance with the proposal submitted by Entity to the
City, attached as Exhibit 1 and incorporated herein by reference. Entity shall perform the services and
work set forth in the proposal and promptly cure any failure in performance.
City has relied upon the representations made by Entity in the proposal. By execution of this
Agreement, Entity represents that the funds will be used for tourism promotion as defined by this
Agreement in accordance with all current laws, rules and regulations. No substitutions of purpose or use
of the funds shall be made without the written consent of City. City shall make decisions and carry out its
other responsibilities in a timely manner.
4. Reporting. RCW 67.28.1816 was amended during the 2013 Legislative Session and
includes new reporting requirements for the Entity and the City on the use of funds distributed pursuant to
this Agreement and the estimated and actual number of increased visitors. These reports are required to
be provided from the Entity to City and from the City to the Joint Legislative Audit and Review
Page 1 of 10
Committee (JLARC). The following provisions allow the Entity and City to meet their respective
requirements under RCW 67.28.1816.
A. Estimated Increase in Visitors. Within 30 days of the execution of this Agreement,
the Enti shall complete Exhibit 2 to the City an estimate of the number of visitors resultilig from
the use of funds un c er 1- Agreemenf--The estimated number of visitors provided in Exhibit 2
shall be consistent wit tai`heEnfil-y's proposal to the City for lodging tax funds, to the extent such
estimates were provided therein. The City shall not be obligated to reimburse Entity for any
expenses or distribute any funds under this Agreement until Exhibit 2 is fully completed and
submitted to the City.
B. Final Report on Increase in Visitors. Upon completion of the term of this Agreement,
the Entity shall complete_a_report substantially in the form of Ex 1 W3 and provide to the City a
final reRort_f._the number_of visitors resulting from.the use offunds_under tlils Agreement-and
expenditures and_uses of funds under_this.Agreement. The numbers of visitors shall be based on
an actual count, or if it is not practical to make an actual count, a good faith best-estimate of the
number of visitors resulting from the use of funds under this Agreement. The final report shall
describe the methods used to determine the actual number of visitors, or in the event such
numbers were determined from an estimate, the methods used to determine such estimates. The
City shall notify Entity by December 31, 2015, of a reasonable deadline for Entity to complete
and submit required reporting to the City.
C. City Reporting. The City shall provide the Entity's estimates in Exhibit 2 and final
report in Exhibit 3 to JLARC in a timely manner.
5. Modifications. City may modify this Agreement and order changes in the work
whenever necessary or advisable. Entity will accept modifications consistent with state and local law
when directed orally or in writing by the City Manager or his designee.
6. Term of Contract. This Agreement shall be in full force and effect upon full execution,
and shall remain in effect until terminated either by Entity expending the allocated City funds or
completion of the tourism promotion activities.
Either party may terminate this Agreement by 30 days written notice to the other party or
with no notice upon a determination by the City Manager, City Council, ordinance or state law that the
funds will not be or have not been used for the purpose as stated in this Agreement. In the event of such
termination, City shall cease and desist from distributing any further funds to Entity for work performed
or otherwise.
7. Compensation. City agrees to reimburse Entity for out of pocket costs incurred in an
amount not to exceed $1,000.
8. Payment. City will reimburse Entity periodically upon presentation of an invoice to
City. Entity shall be responsible for showing that the City funds were used for tourism promotion.
Qualified expenditures shall be expended in calendar year 2015. The proof of expenses shall be forwarded
to the Finance Director at the below stated address no later than January 15, 2016.
City reserves the right to withhold payment of funds under this Agreement which is determined in
the reasonable judgment of the City Manager or his designee to be noncompliant with the scope of work,
City standards, and City ordinances,directed by the City Council or federal or state law.
Page 2 of 10
9. Notice. Notice shall be given in writing as follows:
TO CITY: TO ENTITY:
Name: Mark Calhoun,Finance Director Andy Dunau
Phone Number: 509-720-5040 Phone Number: 509-535-7084
Address: 11707 E. Sprague Ave., Ste 106 Address: 2206 S Sherman St.
Spokane Valley, WA 99206 Spokane, WA 99203
10. Applicable Laws and Standards. The parties, in the performance of this Agreement,
agree to comply with all applicable federal, state, and local laws,ordinances, and regulations.
11. Relationship of the Parties. It is understood, agreed and declared that Entity, its
employees, agents and assigns shall not be the agent or employee of City with regard to any state, federal
or local laws. Any and all employees who perform services to City under this Agreement shall be
deemed employees of Entity. Entity shall be solely responsible for the conduct and actions of all
employees of Entity under this Agreement and any liability that may attach thereto.
12. Records. The City or State Auditor or any of their representatives shall have full access
to and the right to examine during normal business hours all of Entity's records with respect to all matters
covered in this Agreement. Such representatives shall be permitted to audit, examine and make excerpts
or transcripts from such records and to make audits of all contracts, invoices, materials, payrolls and
record of matters covered by this contract for a period of three years from the date final payment is made
hereunder.
13. Insurance. Entity shall procure and maintain for the duration of the Agreement,
insurance against claims for injuries to persons or damage to property which may arise from or in
connection with the performance of the work hereunder by Entity, its agents, representatives, employees
or subcontractors.
A. Minimum Scope of Insurance. Entity shall obtain insurance of the types described below:
1. Automobile liability insurance covering all owned, non-owned, hired and leased
vehicles. Coverage shall be written on Insurance Services Office (ISO) form CA 00 01
or a substitute form providing equivalent liability coverage. If necessary,the policy shall
be endorsed to provide contractual liability coverage. If use of vehicles pursuant to the
Agreement is only incidental, and Entity will not transport any persons not directly
related or affiliated with Entity, then Entity is only required to have automobile liability
insurance to meet at least minimum Washington state requirements.
2. Commercial general liability insurance shall be written on ISO occurrence form CG 00
01 and shall cover liability arising from premises, operations, independent contractors
and personal injury and advertising injury. The City shall be named as an insured under
Entity's commercial general liability insurance policy with respect to the work performed
for the City.
3. Workers' compensation coverage as required by the industrial insurance laws of the
State of Washington.
B. Minimum Amounts of Insurance. Entity shall maintain the following insurance limits:
Page 3 of 10
1. Automobile liability insurance with a minimum combined single limit for bodily injury
and property damage of$1,000,000 per accident. If Entity will not use its vehicles in the
performance of this Agreement, automobile liability insurance is only required to meet
Washington statutory minimum requirements.
2. Commercial general liability insurance shall be written with limits no less than
$1,000,000 each occurrence, $2,000,000 general aggregate.
C. Other Insurance Provisions. The insurance policies are to contain, or be endorsed to contain,
the following provisions for automobile liability, professional liability and commercial general
liability insurance:
1. Entity's insurance coverage shall be primary insurance with respect to the City. Any
insurance, self-insurance, or insurance pool coverage maintained by the City shall be
excess of Entity's insurance and shall not contribute with it.
2. Entity shall fax or send electronically in .pdf format a copy of insurer's cancellation
notice within two business days of receipt by Entity.
D. Acceptability of Insurers. Insurance is to be placed with insurers with a current A.M. Best
rating of not less than A:VII.
E. Evidence of Coverage. As evidence of the insurance coverages required by this Agreement,
Entity shall furnish acceptable insurance certificates to the City at the time Entity returns the
signed Agreement. The certificate shall specify all of the Parties who are additional insureds, and
will include applicable policy endorsements, and the deduction or retention level. Insuring
companies or entities are subject to City acceptance. If requested, complete copies of insurance
policies shall be provided to the City. Entity shall be financially responsible for all pertinent
deductibles, self-insured retentions,and/or self-insurance.
14. Indemnification and Hold Harmless. Entity shall, at its sole expense, defend,
indemnify and hold harmless City and its officers, agents, and employees, from any and all claims,
actions, suits, liability, loss, costs, attorney's fees and costs of litigation, expenses, injuries, and damages
of any nature whatsoever relating to or arising out of the wrongful or negligent acts,errors or omissions in
the services provided by Entity, Entity's agents, subcontractors, subconsultants and employees to the
fullest extent permitted by law, subject only to the limitations provided below.
Entity's duty to defend, indemnify and hold harmless City shall not apply to liability for damages arising
out of such services caused by or resulting from the sole negligence of City or City's agents or employees.
Entity's duty to defend, indemnify and hold harmless City against liability for damages arising out of such
services caused by the concurrent negligence of(a) City or City's agents or employees, and (b) Entity,
Entity's agents, subcontractors, subconsultants and employees, shall apply only to the extent of the
negligence of Entity,Entity's agents, subcontractors, subconsultants and employees.
Entity's duty to defend, indemnify and hold City harmless shall include, as to all claims, demands, losses
and liability to which it applies, City's personnel-related costs, reasonable attorneys' fees, and the
reasonable value of any services rendered by the office of the City Attorney, outside consultant costs,
court costs,fees for collection,and all other claim-related expenses.
Page 4 of 10
Entity specifically and expressly waives any immunity that may be granted it under the Washington State
Industrial Insurance Act, Title 51 RCW. These indemnification obligations shall not be limited in any
way by any limitation on the amount or type of damages, compensation or benefits payable to or for any
third party under workers' compensation acts, disability benefit acts, or other employee benefits acts.
Provided, that Entity's waiver of immunity under this provision extends only to claims against Entity by
City, and does not include,or extend to,any claims by Entity's employees directly against Entity.
Entity hereby certifies that this indemnification provision was mutually negotiated.
15. Waiver. No officer, employee, agent or other individual acting on behalf of either party
has the power, right or authority to waive any of the conditions or provisions of this Agreement. No
waiver in one instance shall be held to be waiver of any other subsequent breach or nonperformance. All
remedies afforded in this Agreement or by law, shall be taken and construed as cumulative, and in
addition to every other remedy provided herein or by law. Failure of either party to enforce at any time
any of the provisions of this Agreement or to require at any time performance by the other party of any
provision hereof shall in no way be construed to be a waiver of such provisions nor shall it affect the
validity of this agreement or any part thereof.
16. Assignment and Delegation. Neither party shall assign,transfer or delegate any or all of
the responsibilities of this Agreement or the benefits received hereunder without first obtaining the
written consent of the other party.
17. Subcontracts. Except as otherwise provided herein, Entity shall not enter into
subcontracts for any of the work contemplated under this agreement without obtaining written approval of
City.
18. Confidentiality. Entity may, from time to time, receive information which is deemed by
the City to be confidential. Entity shall not disclose such information without the prior express written
consent of the City or upon order of a Court of competent jurisdiction.
19. Jurisdiction and Venue. This Agreement is entered into in Spokane County,
Washington. Disputes between the City and Entity shall be resolved in the Superior Court of the State of
Washington in Spokane County. Notwithstanding the foregoing, Entity agrees that it may, at the City's
request, be joined as a party in any arbitration proceeding between the City and any third party that
includes a claim or claims that arise out of, or that are related to Entity's services under this Agreement.
Entity further agrees that the Arbitrator(s) decision therein shall be final and binding on Entity and that
judgment may be entered upon it in any court having jurisdiction thereof.
20. Cost and Attorney's Fees. The prevailing party in any litigation or arbitration arising
out of this Agreement shall be entitled to its attorney's fees and costs of such litigation (including expert
witness fees).
21. Entire Agreement. This written Agreement constitutes the entire and complete
agreement between the parties and supersedes any prior oral or written agreement. This Agreement may
not be changed, modified or altered except in writing signed by the parties hereto.
22. Anti-kickback. No officer or employee of City,having the power or duty to perform an
official act or action related to this Agreement shall have or acquire any interest in this Agreement, or
have solicited, accepted or granted a present or future gift, favor, service or other thing of value from any
person with an interest in this Agreement.
Page 5 of 10
23. Severability. If any section, sentence,clause or phrase of this Agreement should be held
to be invalid for any reason by a court of competent jurisdiction, such invalidity shall not affect the
validity of any other section, sentence, clause or phrase of this Agreement.
24. Exhibits. Exhibits attached and incorporated into this Agreement are
Exhibit 1: Entity's Proposal
Exhibit 2: Estimated Increases in Number of Visitors
Exhibit 3: Final Report on Number of Visitors
Exhibit 4: Insurance Certificates
The Parties have executed this Agreement thday of , 2015.
CITY OF SPOKANE VALLEY Entity: 1:;-.01 -4.4-11--
/ I �I: 4
M'ftrJ c son,] ity Manager By: A- J' -
Its: Authorized Representative
ATTEST: APPROVED AS TO FORM:
V.1 Christine Bainbridge, City Clerk Office he City Attorney
Page 6 of 10
Exhibit 1 and 2
ON FILE WITH CITY CLERK .
Page 7 of 10
Exhibit 3
Final Report on Numbers of Visitors and Paid Room Nights
Total Paid Rooms Nights: Paid Lodging Nights for 2015 as a
result of the award dollars used, and the methodology used to
arrive at this number:*
Overall Attendance as a result of the award dollars used:
Category Number of Number of
In-State Out-of State
Visitors Visitors
1. (A) Visitors staying overnight in paid accommodations away
from their place of residence or business, (B) Describe method
to actually determine or estimate numbers:**
2. (A) Visitors staying overnight in unpaid accommodations
(e.g. with friends and family) and traveling 50 miles or more one
way from their place of residence or business, (B) Describe
method to actually determine or estimate numbers:**
3. (A) Visitors staying for the day only and traveling more than
50 miles or more one way from their place of residence or
business, (B) Describe method to actually determine or estimate
numbers:**
4. (A) Visitors attending but not included in one of the three
categories above, (B) Describe method to actually determine or
estimate numbers:**
Page 8 of 10
Exhibit 3 - continued
Use of Funds
Please complete the following table with amount of funds received under this Agreement, Entity
matching amounts for the same event, festival, or purpose, and total amount spent for each
category:
GRANT
AMOUNT ENTITY
CATEGORY RECEIVED MATCH TOTAL
To be filled out by Public/Municipal Agencies:
1. Municipality tourism marketing $ $ $
2. Municipality event and festivals $ $ $
3. Municipality facilities (operations
and capital) $ $ $
To be filled out by Non-Profit Agencies:
4. Non-municipal entities promoting
and advertising tourism $ $ $
5. Non-municipal entities for marketing
and operating events and festivals $ $ $
6.Non-municipal entities for
operations of tourism-related facilities
owned by non-profit organizations $ $ $
TOTALS $ $ $
Page 10 of 10
K*JLARC defines the Paid Lodging Night as "One Lodging night= one or more persons
occupying one room for one night"
**Methods in determining actual or estimated number of visitors and/or paid room nights:
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 m 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)
Page 9of10
NEW Mount Vernon Fire Insurance Company
Renewal of Number 1190 Devon Park Drive, Wayne, Pennsylvania 19087
POLICY DECLARATIONS A Member Company of United States Liability Insurance Group
No. NPP2561822
This contract is registered and delivered as a surplus line
NAMED INSURED AND ADDRESS: coverage under the insurance code of the state of
Washington, Title 48 RCW. It is not protected by any
Spokane River Forum Washington state guaranty association law.
2206 S Sherman Street • Cochrane&Company
Spokane,WA 99203
NO FLAT CANCELLATIONS
POLICY PERIOD: (MO. DAY YR.) From: 04/03/2015 To: 04/03/2016 12:01 A.M. STANDARD TIME AT YOUR
MAILING ADDRESS SHOWN ABOVE
FORM OF BUSINESS: Non Profit Organization
BUSINESS DESCRIPTION: Premises Preferred
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY.WE AGREE
WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY.
THIS POLICY CONSISTS OF THE FOLLOWING COVERAGE PARTS FOR WHICH A PREMIUM IS INDICATED.
THIS PREMIUM MAY BE SUBJECT TO ADJUSTMENT.
Coverage Form(s) and Endorsement(s) made a part of this policy at time of issue
See Endorsement EOD (1/95)
Agent COCHRANE AND COMPANY 11677) Issued 04!0712015 2:27 PM
P.O. Box 19150
Spokane, WA 99219
Blok.er �
By Authorized Represe atl e
THESE DECLARATIONS TOGETHER WITH THE COMMON POLICY CONDITIONS, COVERAGE PART DECLARATIONS.
UPr; ;GF• r COVERAGE PART COVERAGE FORM(S►AND FORMS AND ENDORSEMENTS, IF ANY. ISSUED TO FORM A PART THEREOF,
COMPLETE THE ABOVE NUMBERED POLICY.
COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS
Policy No. NPP2561822 Effective Date: 04/03/2015
12:01 AM STANDARD TIME
1,.1....T.LSF t1.StU ANCE . »...
Each Occurrence Limit $1,000,000
Personal &Advertising Injury Limit(Any One Person/Organization) Excluded
Medical'Expense Limit(Any One Person) $5,000
Damages To Premises Rented To You (Any One Premises) $100,000
Products/Completed Operations Aggregate Limit Excluded
General Aggregate Limit $2,000,000
g:imwkgrp.g:px.:Ip'jetglzgr,gutt:Rq:r4:;:pv;:;N:;::0-azifiagim.gi•g-gppm4zpg:4:mzimn.lm.g:;t:::=gggtuis;:5::..,r4:!!i-;!pzp;.t:.lg,:;pq$0,:g
RC1 71C'ifr15 IRF AL:[ PRET 1S1;S YQ pwg REN.Of. OCCUFY
Location Address Territory
1 2206 S Sherman Street, Spokane, WA 99203 002
Rate Advance Premium
oc Classification Code No. Premium Basis Pr/Co All Other Pr/Co All Other
1 Social/Human Services-Not-For-Profit only 61229 1,100 Per 1,000 Sq. Exduded 135.569 Excluded $149
Ft.
MINIMUM PREMIUM FOR GENERAL LIABILITY COVERAGE PART: $500
TOTAL PREMIUM FOR GENERAL LIABILITY COVERAGE PART: $500 MP
(This Premium may be subject to adjustment.) MP-minimum premium
overage Form(s)/Part(s)and Endorsement(s) made a part of this policy at time of issue:
See Form EOD(01/95)
THESE DECLARATIONS ARE PART OF THE POLICY DECLARATIONS CONTAINING THE NAME OF THE INSURED AND THE POLICY PERIOD.
Includes copynghted material of ISO Commercial Risk Services.Inc with its perm ss on.
CL150(10/03) Copyright. ISO Commercial Risk Services,Inc.. 1983. 1984. 1988 Page 1 Of 1
EXTENSION OF DECLARATIONS
Policy No. NPP2561822 Effective Date: 04103/2015
12:01 AM STANDARD TIME
FORMS AND ENDORSEMENTS
The following forms apply to the Commercial Liability coverage part
Endt# Revised Description of Endorsements
2110WA 09/10 Service Of Suit
CG 0181 05/08 Washington Changes
CG0001 12/07 Commercial General Liability Coverage Form
CG0068 05/09 Recording And Distribution Of Material Or Information In Violation Of
Law Exclusion
CG2104 11/85 Exclusion -Products-Completed Operations Hazard
CG2107 05/14 Exclusion -Access Or Disclosure Of Confidential Or Personal
Information And Data-Related Liability-Limited Bodily Injury Exception
Not Included
CG2136 01/96 Exclusion -New Entities
CG2138 11/85 Exclusion -Personal And Advertising Injury
CG2147 12/07 Employment-Related Practices Exclusion
CG2429 09/13 Washington Changes- Binding Arbitration
IL0017 11/98 Common Policy Conditions
IL0021 09/08 Nuclear Energy Liability Exclusion Endorsement
L-224 10/10 Punitive Or Exemplary Damages Exclusion
L-232s 09/05 Classification Limitation Endorsement
L-278 03/14 Independent Contractors/Subcontractors Exclusion
L-367 02/11 Minimum Earned Premium Endorsement
L-428 01/12 Absolute Firearms Exclusion
L-500 02/11 Bodily Injury Exclusion-All Employees, Volunteer Workers, Temporary
Workers, Casual Laborers, Contractors, And Subcontractors
L-516 02/11 Premises Contractual Liability Limitation
L-526 06/06 Absolute War Or Terrorism Exclusion
L-549 11/12 Absolute Professional Liability Exclusion
L-599 10/12 Absolute Exclusion for Pollution, Organic Pathogen, Silica, Asbestos and
Lead with a Hostile Fire Exception
L-622 02/11 Molestation Or Abuse Exclusion
L-685 05/10 Premises Limitation Endorsement
L-783 02/14 Amendment Of Liquor Liability Exclusion
LLO100 07/06 Amendatory Endorsement
LLO368 08/10 Separation Of Insureds Clarification Endorsement
TRIADN 01/15 Disclosure Notice of Terrorism Insurance Coverage
NPP Jacket 09/10 Non Profit Package Policy Jacket
EOD(01/95) AlSother terms and conditions remain unchanged. Page 1 of 1
AR CERTIFICATE OF LIABILITY INSURANCE DATE
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(ies)must 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 rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
Hub International Northwest LLC-SpokaneNE
No.Est): FAX
Not:
PO Box 8237
L
Spokane,WA 99203-8237 INSURER(S)URER(S)AFFORDfNG COVERAGE NAtC s
BNNJRER A;Mount Vernon Fire Insurance Company
INSURED INSURER B:
Spokane River Forum INSURER C:
2206 S Sherman St INSURERD:
Spokane,WA 99203 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INLTR TYPE OF INSURANCE INSR 1A POUCY MINER (Iq (YYY) HADD F POLICY
QTS
GENERAL UABLITY X NPP-2561822 4/3/2015 4/3/2016 EACH OCCURRENCE $ 1,000,000.00
DAMAGE ENTED
X COiANERCIAL GENERAL LIABILITY P (sea ) $ 100,000.00
A CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000.00
PERSONAI.aADv INJURY s EXCLUDED
GENERAL AGGREGATE $ 2,000,000.00
GENT AGGREGATE UNIT APPLIES PER PRODUCTS-COMP/OP AGG $ EXCLUDED
—1 POLICY n JJECT n LOC
AUTOMOBILE LIABILITY COMBINED SINGLE UNIT
(Ea accident)
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS NON- ED PROPERTY DAMAGE
HIRED AUTOS _ AUTOS (Per accident) $
$
UMBRELLA UAB OCCUR EACH OCCURRENCE $
EXCESS UAB CLAIMS-MADE AGGREGATE $
DED RETENTIONS s
WORKERS COMPENSATION WC STATU- WH-
AM/EMPLOYERS'UABMJTY Y/N TORY LIMITS ER
ANY PROPRETOR/PARTNER/EXEC1TIVE N/A E.L EACH ACCIDENT $
OFFICER/MEMIBER EXCLUDED?
(Mandatory In NH) E.L DISEASE-EA EMPLOYEE $
DES&RI OF OOPERATIONS below EL DISEASE-POLICY UNIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is masked)
Certificate holder is listed as an additional insured.
CERTIFICATE HOLDER CANCELLATION
City of Spokane Valley SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE
11707 E Sprague Ave#106 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED tN
Spokane Valley,WA 99206 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
r i
` I
Sarah Farr
From: Andy Dunau [andy@dunau.com]
Sent: Wednesday, April 29, 2015 2:02 PM
To: Sarah Farr
Subject: FW: Spokane River Forum Insurance-Auto&Additional Insured PDFs
Attachments: Auto Insurance.pdf; Spokane River Forum Cert.pdf
Hi Sarah,
Attached is insurance certificate showing City of Spokane Valley as additional insured.
Also attached is auto insurance.The Spokane River Forum does not own any vehicles and thus does not insure any
vehicles.The attached auto insurance is in my name and would be used in any circumstance where there was an auto
accident.
Thanks,
Andy
13, This email has been checked for viruses by Avast antivirus software.
www.avast.com
1
State I-arm Mutual Automobile Insurance company
v Dot,5000 State Far n.
DuPont,PWA 98327-5000
Art 008241 0006 A-94B3 A '�f
DUNAU,206 S
2SHERMAN ST AUTO RENEWAL
.v. % SPOKANE WA 99203-2367
>i= PREMIUM PAID: $329.76
DO NOT PAY.
"1IIliiIIIllsIIitIiII1Ii111"111111111111111111111111111111I11il Your premium is billed through the State Farm Payment Plan
State Farm Payment Plan Number: 1097579615
vN
01s
01-J.
Your State Farm Agent
J PRAXEL INSURANCE AGENCY INC
Policy Number: 137 6272-E03-47 Office:509-624-7073
Policy Period: May 03,2015 to November 03,2015 Address: 1507 S GRAND BLVD
Vehicle: SPOKANE, WA 99203-2248
2005 NISSAN ALTIMA Ifyou have a new or different car,have added any drivers,or have moved,
Principal Driver: pease contact your agent
ANDREW DUNAU
Based on your driving record,you have our Accident-Free information from your check to make an electronic fund
Discount for preferred customers. transfer,funds may be withdrawn from your account as soon
When you provide a check as payment,you authorize us as the same day we receive your payment, and you will not
either to use information from your check to make a receive your check back from your financial institution. -
offe-time electronic fUntttra infer from-your accoun-t orlo'
process the payment as a check transaction. When we use
Policy Number:137 6272-E03-47 Page number 1 of 4
Prepared March 27,2015
1004583 143562 201 11-12-2014
CONVENIENCE SAVES
TIME, MONEY
... AND
TREEs■
You have the option to pay your bills online by opting
for ePayment on statefarm.comf.
Get to a better State°. rn06
019280
A State Farm-
VEHICLE INFORMATION
Review your policy information carefully. If anything is incorrect,or if there are any changes,please let us know right away.
How is this vehicle normally used?
Vehicle Identification National average:12,000 miles driven
Vehicle Description Number(VIN) Who principally drives this vehicle? annually per vehicle
2005 NISSAN ALTIMA 1N4BL11E75N494020 ANDREW DUNAU,a single male,who will To Work,School or Pleasure.Driven over
be age 55 as of May 03,2015. 7,500 miles annually.
Other Household Vehicle(s)
Your premium may be influenced by other State Farm
policies that currently insure the following vehicle(s)
in your household:
1999 PLYMOUTH VOYAGER
Premium Adjustment annually to determine which makes and models have
Each year,we review our medical payments and personal earned decreases or increases from State Farm's standard
injury protection coverages claim experience to determine rates. If any changes result from our reviews, adjustments
the vehicle safety discount that is applied to each make and are reflected in the rates shown on this renewal notice.
model. In addition,we review the comprehensive,collision,
bodily injury and property damage claim experience
DRIVER INFORMATION
Assigned Driver(s)
The following driver(s)are assigned to the vehicle(s)on this policy.
Age as of Marital
Name May 03,2015 Gender Status
ANDREW DUNAU 55 Male Single
Other Household Driver(s)
In addition to the Principal Driver(s)and Assigned
Driver(s), your premium may be influenced by the
drivers shown below and other individuals permitted to
drive your vehicle. This list does not extend or expand
coverage beyond that contained in this automobile
policy. The drivers listed below are the drivers reported
to us that most frequently drive other vehicles in your
household.
CASEY S DUNAU
Principal Driver&Assigned Drivers Your premium may be influenced by the information shown
For each automobile,the Principal Driver is the individual for these drivers.
who most frequently drives it.
Each driver is designated as an Assigned Driver on the
household automobile that he or she most frequently drives.
Policy Number:137 6272-E03-47 Page number 2 of 4
Prepared March 27,2015
illbStateFarm
COVERAGE AND LIMITS See your policy for an exp!anatkin of these coverages.
A Liability
Bodily Injury 100,000/300,000
Property Damage 100,000 $142.62
D 100 Deductible Comprehensive $39.85
G 500 Deductible Collision $101.53
U Underinsured Motor Vehicle
Bodily Injury 100,000/300,000 $43.96
F-
o U1 Underinsured Motor Vehicle
Property Damage 100,000 $1.80
Total Premium ,,/, rj. R.r,. $329.76
If any coverage you carry is changed to give broader you the broader protection without issuing a new policy,
protection with no additional premium charge,we will give starting on the date we adopt the broader protection.
DISCOUNTS These adjustments have already been applied to your premium.
Multiple Line
Multicar ✓
Accident-Free ✓
SURCHARGES AND DISCOUNTS
AUTOMOBILE RATING PLAN -Applies to private property damage liability and collision coverages for an
passenger cars only. at-fault accident.
Accident-Free Discount -Once your policy has been in Surcharges -If there are chargeable accidents,you may
force for at least three years with no chargeable accidents, lose your Good Driving Discount or Accident-Free Discount
you may qualify for our Accident-Free Discount. Once you and receive accident surcharges. But if the accident is the
qualify,this discount applies as long as there are no first to become chargeable in nine years and this policy has
chargeable accidents, and may even increase over time. been in force for at least that long, the Accident-Free
Good Driving Discount -Newer policyholders who do not Discount will continue and no surcharge will apply. The
yet qualify for our Accident-Free Discount (available after surcharge for each accident depends upon the number and
three years with no chargeable accidents)may already be timing of the accidents, and each accident surcharge will
receiving a Good Driving Discount. This discount continues remain in effect up to three years.
to apply until your policy qualifies for the Accident-Free Surcharges will be removed if the company is given
Discount as long as there are no chargeable accidents and satisfactory evidence that the driver involved is no longer a
no new drivers. If you add new drivers, they must also member of the household or will not be driving the car in the
qualify in order for your Good Driving Discount to continue. future. If that driver is insured on another State Farm policy,
Chargeable Accidents -For new business rating,an his or her driving record will be considered in the rating of
accident is chargeable if it results in$750 or more of the other policy.
damage to any property. For renewal business, an accident These discounts and surcharges do not apply to all
is chargeable as of the date State Farm pays at least$750 coverages. For complete details, see your State Farm agent.
(for accidents occurring on or after April 1, 1999)under
(continued on next page)
Policy Number:137 6272-E03-47 Page number 3 of 4
Prepared March 27,2015
019201