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05-07-2012-Packet
Page 1 of 4 Milton City Hall City Council Chambers 13000 Deerfield Parkway, Suite E Milton, GA 30004 Persons needing special accommodations in order to participate in any City meeting should call 678-242-2500. CITY OF MILTON, GEORGIA Joe Lockwood, Mayor CITY COUNCIL Karen Thurman Matt Kunz Bill Lusk Burt Hewitt Joe Longoria Lance Large Monday, May 7, 2012 Regular Council Meeting Agenda 6:00 PM INVOCATION - Pastor Jeff Kane, C3 Church, Milton, Georgia. CALL TO ORDER 1) ROLL CALL 2) PLEDGE OF ALLEGIANCE (Led by the Mayor) 3) APPROVAL OF MEETING AGENDA (Add or remove items from the agenda) (Agenda Item No. 12- 098) 4) PUBLIC COMMENT 5) CONSENT AGENDA 1. Approval of the April 9, 2012 Regular Council Minutes. (Agenda Item No. 12- 099) (Sudie Gordon, City Clerk) 2. Approval of the April 16, 2012 Work Session Minutes. (Agenda Item No. 12- 100) (Sudie Gordon, City Clerk) MILTON CITY COUNCIL REGULAR COUNCIL MEETING MAY 7, 2012 Page 2 of 4 Milton City Hall City Council Chambers 13000 Deerfield Parkway, Suite E Milton, GA 30004 Persons needing special accommodations in order to participate in any City meeting should call 678-242-2500. 3. Approval of a Professional Services (Change Order) between The City of Milton and BM&K, P.C. for Right of Way Services – SR 372 at Providence Road and SR 140 at New Providence Road. (Agenda Item No. 12- 101) (Carter Lucas, Public Works Director) 4. Approval of an Intergovernmental Agreement (IGA) between the City of Milton and the City of Roswell for the Periodic Use of a Motor Grader. (Agenda Item No. 12- 102) (Carter Lucas, Public Works Director) 5. Approval of a Contract between the City of Milton and Mike Westmoreland Contracting, Inc. for the Renovation of the Infield at Hopewell Middle School in the Amount of $5,310. (Agenda Item No. 12- 103) (John Rebar, Parks and Recreation Director) 6. Approval for Consent to Assignment of Construction Easements and Right of Entry between Fulton County Board of Education and City of Milton. (Agenda Item No. 12- 104) (Carter Lucas, Public Works Director) 7. Approval of a Construction Services Agreement between Baldwin Paving Company, Inc. and the City of Milton for Intersection Improvements at the Bethany Bend – Cogburn Road Intersection. (Agenda Item No. 12- 105) (Carter Lucas, Public Works Director) 8. Approval of the following plats: Name of Development Action Comments Six Hills HOA Revision Revise property lines between common area and lot 1 Milton Preserve Revision Add easement for landscape at entrance The Heart of Crabapple Minor Plat Divide into two lots Inner Quest Church Combo Plat Combine three lots into one Roxbury Estates Revision Change to private streets Hidden Forest Revision Revise property lines and setbacks according to V10- 017 and ZM10-02 MILTON CITY COUNCIL REGULAR COUNCIL MEETING MAY 7, 2012 Page 3 of 4 Milton City Hall City Council Chambers 13000 Deerfield Parkway, Suite E Milton, GA 30004 Persons needing special accommodations in order to participate in any City meeting should call 678-242-2500. The Manor Final Plat Add two lots Kingsley Estates, Phase 1-2A Final Plat Add six lots (Agenda Item No. 12- 106) (Kathleen Field, Community Development Director) 6) REPORTS AND PRESENTATIONS (None) 7) FIRST PRESENTATION (None) 8) PUBLIC HEARING (None) 9) ZONING AGENDA (None) 10) UNFINISHED BUSINESS (None) 11) NEW BUSINESS 1. Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and YMCA of Metropolitan Atlanta. (Agenda Item No. 12- 107) (John Rebar, Parks and Recreation Director) 2. Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Off Broadway Expressions. (Agenda Item No. 12- 108) (John Rebar, Parks and Recreation Director) 3. Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Kim Saunders Yoga, LLC. (Agenda Item No. 12- 109) (John Rebar, Parks and Recreation Director) 4. Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Overkill Volleyball. (Agenda Item No. 12- 110) (John Rebar, Parks and Recreation Director) 5. Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Sperber Music. (Agenda Item No. 12- 111) (John Rebar, Parks and Recreation Director) MILTON CITY COUNCIL REGULAR COUNCIL MEETING MAY 7, 2012 Page 4 of 4 Milton City Hall City Council Chambers 13000 Deerfield Parkway, Suite E Milton, GA 30004 Persons needing special accommodations in order to participate in any City meeting should call 678-242-2500. 6. Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Eric Snow Sports. (Agenda Item No. 12- 112) (John Rebar, Parks and Recreation Director) 7. Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Newtown Recreation. (Agenda Item No. 12- 113) (John Rebar, Parks and Recreation Director) 8. Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Agape Academy, LLC. (Agenda Item No. 12- 114) (John Rebar, Parks and Recreation Director) 9. Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Core Physique, LLC. (Agenda Item No. 12- 115) (John Rebar, Parks and Recreation Director) 10. Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Eagle Stix Lacrosse, Inc. (Agenda Item No. 12- 116) (John Rebar, Parks and Recreation Director) 11. Approval of a Construction Services Agreement between Hitson Construction, Inc. and the City of Milton for the Replacement of the Cogburn Road Bridge. (Agenda Item No. 12- 117) (Carter Lucas, Public Works Director) 12) MAYOR AND COUNCIL REPORTS 13) STAFF REPORTS 14) EXECUTIVE SESSION (if needed) 15) ADJOURNMENT (Agenda Item No. 12- 118) The minutes will be Provided electronically City of Milton 13000 Deerfield Parkway Suite 107C Milton, Georgia 30004 To: Honorable Mayor and City Council Members From: Sara Leaders, PE – Transportation Engineer Date: April 25, 2012 for the May 7, 2012 Council meeting Agenda Item: Approval of a Professional Services (Change Order) between the City of Milton and BM&K, P.C. for Right of Way Services – SR 372 at Providence Road and SR 140 at New Providence Road. Discussion: The original professional services agreement with BM&K dated October 31, 2011 was to provide right of way and easement acquisition services for intersection improvements at SR 372 at Providence Road and SR 140 at New Providence Road. Three bids were obtained for right of way services and BM&K was the low bidder. When the work began under the original agreement with BM&K, potential septic system conflicts were identified with the proposed construction for these projects. The work to be completed under this change order includes determining if existing septic systems will be impacted by the construction project, providing soil tests if required, and providing a cost to cure to the city. These tasks are required in conjunction with the use of federal funds on these projects and will be in accordance with GDOT policy and procedures. Staff is recommending the approval of a professional services change order between the City of Milton and BM&K to provide additional septic analysis in the amount of $5,700.00. The budget for this work will be from Capital Grant Fund. This task is not reimbursable but the land acquisition costs for the purchase of right of way and easements and cost to cure the septic conflicts will be reimbursable for these projects. Legal Review: Agreement – Paul Higbee, Jarrard & Davis on 4/10/2011 Attachments: 1. Change Order 1 Ci4y of Milton. CHANGE ORDER #1 FOR PROFESSIONAL SERVICES AGREEMENT Right of Way Services WHEREAS, the City of Milton, Georgia and BM&K, P.C. have entered into a Professional Services Agreement (the "Agreement") dated October 31St, 2011, incorporated herein by reference, for right of way services for intersection improvements for SR 372 Birmingham Hwy at Providence Road and SR 140 Arnold Mill Road at New Providence Road; and WHEREAS, the parties desire to issue a change order pursuant to Section 9.0 of the Agreement, it being to the mutual benefit of all parties to do so, as set forth herein for the reasons and consideration set forth herein. NOW THEREFORE, the parties hereto agree to amend the Agreement as follows: 1. Exhibit A to the Agreement is amended by adding the following verbiage to the scope of services: Seatic_Analysis Consultant will identify parcels with potential septic system conflicts with the proposed intersection improvement projects. The parcels with potential conflicts will be investigated by Consultant to determine if the proposed project improvements will impact the existing septic systems. Letters will be provided by Consultant to the City stating the findings and conclusions of Consultant regarding existing septic systems. If any septic system is going to be impacted, Consultant shall provide a cost to cure report, addressing the impacts and providing costs to cure, to the City. A soil study will be provided by Consultant if required by the Fulton County Health Department. All analysis, letters, and reports will be prepared by Consultant in coordination with City of Milton, Georgia Department of Transportation, and Fulton County Health Department. 2. Exhibit B to the Agreement is amended by adding the following per parcel services to the fee schedule: BM&K Construction & Engineering Parcels P10000533 Per Parcel Fee Total P100005448 Parcels Per Parcel Fee Total Septic Analysis Advise if will hit system 3 $ 500.00 $ 1,500.00 2 $ 50o.od $ 1,000.00 Cost to cure 2 $ 1,250.00 $ 2,500.00 0 $ 1,250.00 $ - Soil test 2 $ 350.00 $ 700.00 1 0 $ 350.00 1 $ - Septic Total $ 4,700.00 $ 1,000.00 3. It is agreed by the parties hereto that all of the other terms and conditions of the Agreement, including all unamended portions, shall remain in full force and effect other than as modified herein, Upon execution by all parties, this Change Order shall be attached to and form a part of said Agreement. IN WITNESS WHEREOF, the parties hereto have caused this Change Order to be duly executed by their duly authorized officers as of the day and year set forth next to each signature. ��� ciiy � bra�on M&K, P �J By: Donald Clerici Its: President & Secretary [AFFIX CORPORATE SEAL] SIGNED, SEALED, AND DELIVERED in the presence gf;.. �1 [NOTARY SEAL] �`' My Commis si n Expires: IWOLININ1191H By: Joe Lockwood Its: Mayor [CITY SEAL] SIGNED, SEALED, AND DELIVERED in the presence of: Witness Notary Public [NOTARY SEAL] My Commission Expires: City of Milton 13000 Deerfield Parkway Suite 107C Milton, Georgia 30004 To: Honorable Mayor and City Council Members From: Carter Lucas, PE – Public Works Director Date: April 26, 2012 Council Meeting Date: May 7, 2012 Agenda Item: Approval of an Intergovernmental Agreement between the City of Milton and the City of Roswell for the Periodic Use of a Motor Grader Discussion: In order to provide for the routine maintenance of the city’s gravel road system we are required to rent multiple pieces of equipment during the year. The primary piece of equipment is the motor grader. Because this equipment is needed for short periods of time during the year it has sometimes been difficult to obtain reliable equipment at the time it is needed. The use of the Intergovernmental Agreement (IGA) ensures availability of the primary piece of equipment at the times we have scheduled. Staff is recommending approval of the Intergovernmental Agreement between the City of Milton and the City of Roswell for the periodic use of a motor grader. Legal Review: Jarrard & Davis, LLP – Paul Higbee, 2/3/2012 Financial: Funding for this IGA will come from the Gravel Roads Maintenance capital fund. Attachments: 1. Intergovernmental Agreement STATE OF GEORGIA COUNTY OF FULTON INTERGOVERNMENTAL AGREEMENT FOR THE CITY OF ROSWELL TO RENT EQUIPMENT TO THE CITY OF MILTON THIS AGREEMENT entered into between the City of Milton, Georgia, a Municipal Corporation, lying wholly within the County of Fulton, Georgia, hereinafter referred to as “Milton,” and the City of Roswell, Georgia, a Municipal Corporation, lying wholly within the County of Fulton, Georgia, hereinafter referred to as “Roswell.” WITNESSETH WHEREAS, Roswell owns a 2005 Komatsu GD550 motor grader (the “Equipment”); and WHEREAS, Milton desires from time to time to rent the Equipment from Roswell; and WHEREAS, Roswell has agreed to rent the Equipment to Milton under the terms and conditions set forth herein; and WHEREAS, Milton and Roswell are authorized by Art. IX, Sec. III, Par. 1 of the Constitution of the State of Georgia to enter into such an agreement. NOW, THEREFORE, in consideration of the premises contained herein, the sufficiency of which is hereby acknowledged, it is hereb y agreed by Milton and Roswell as follows; 1. EQUIPMENT RENTAL FEES 1.1 Milton shall submit to Roswell on or about January 1 of each year a proposed schedule for use of the Equipment for the upcoming calendar year. Each such schedule shall be deemed accepted by Roswell unless Roswell objects to the proposed schedule, in writing, to Milton on or about January 30 of the then current calendar year, in which event the parties shall cooperate in good faith in agreeing to a schedule prior to the end of the then current calendar year. a. For the calendar year 2012, the parties agree to the following Equipment use schedule: March 5-23; July 9-10; and November 5-16. b. In the event that the Equipment will not be available for any scheduled period, Roswell shall provide to Milton written notice of such unavailability at least thirty (30) days prior to the first scheduled day of use of the Equipment by Milton, and the parties by mutual agreement may re-schedule such use of the Equipment. Milton shall provide and use its own blades with the Equipment. Roswell shall ensure that the Equipment is filled with fuel at the beginning of each scheduled use of the Equipment by Milton, and Milton shall return the Equipment to Roswell filled will fuel after each use of the Equipment by Milton. 1.2 Milton shall pay Roswell a fee of $1,500 per week (prorated in the case of partial weeks) or $4,500 per month within thirty (30) days of the end of each scheduled use of the Equipment by Milton. 1.3 During periods when the Equipment is used by Milton pursuant to this Agreement, the Equipment shall be deemed to be equipment of Milton, and liability insurance coverage for the Equipment shall be provided by Milton. During all other periods, the Equipment shall remain equipment of Roswell, and liability insurance coverage for the Equipment shall be provided by Roswell. 2. TERM; TERMINATION The term of this Agreement shall commence as of the date of the execution of this Agreement by the last party to sign same and shall continue until ____________. Either party may terminate this Agreement for convenience by providing at least sixty (60) da ys prior written notice of termination to the other party. 3. ASSIGNMENT OR TRANSFER The rights, privileges and obligations under this Agreement shall not be assigned or transferred by any Party. 4. NOTICES All notices required herein shall be in writing and delivered to each party at the address contained herein by: (a) hand delivery to the address below; (b) United States Certified Mail - Return Receipt Requested, postage prepaid; or (c) by reputable overnight delivery service. The day upon which such notice is hand delivered, mailed or otherwise delivered shall be deemed the date of service of such notice. City of Milton: Public Works Department Attn: Public Works Director 13000 Deerfield Parkway, Suite 107G Milton, Georgia 30004 City of Roswell: Department of Transportation Attn: Director of Transportation 38 Hill Street, Suite 235 Roswell, Georgia 30075 5. GENERAL PROVISIONS OF THIS AGREEMENT 5.1 The brief capitalized and underlined headings or titles preceding each paragraph are for purposes of identification, convenience and ease of reference, and shall be disregarded in the construction of this Agreement. 5.2 No failure of either party hereto to exercise any right or power granted under this Agreement, or to insist upon strict compliance by the other party with this Agreement, and no custom or practice of either party at variance with the terms and conditions of this Agreement, shall constitute a waiver of a party's right to demand exact and strict compliance by the other parties hereto with the terms and conditions of this License. 5.3 This Agreement shall be governed by, construed under, performed and enforced in accordance with the laws of Georgia. 5.4 Should any provision of this Agreement require judicial interpretation, it is agreed and stipulated by and between the parties that the court interpreting or construing the same shall not apply a presumption that the terms, conditions and provisions hereof shall be more strictly construed against one party by reason of the rule of construction that an instrument is to be construed more strictly against the party who prepared the same. 5.5 This Agreement may be executed in two (2) or more counte rparts, each of which is deemed an original of equal dignity with the others and which is deemed one and the same instrument as the others. 6. ENTIRE AGREEMENT This Agreement supersedes all prior negotiations, discussions, statements and agreements between the parties and constitutes the full, complete and entire agreement between the parties with respect to the Project; no member, officer, employee, representative or agent of either party has authority to make, or has made, any statement, agreement, representation or contemporaneous agreement, oral or written, in connection herewith, amending, supplementing, modifying, adding to, deleting from, or changing the terms and conditions of this Agreement. No modification of or amendment to this Agreement shall be binding on either party hereto unless such modification or amendment shall be properly authorized, in writing, properly signed by both parties. 7. AUTHORITY TO ENTER INTO AGREEMENT Each of the individuals who executes this Agreement agrees and represents that he is authorized to execute this Agreement on behalf of the respective government and further agrees and represents that this Agreement has been duly passed upon by his respective government and spread upon the Minutes. Accordingly, each party both waives and releases any right to contest the enforceability of this Agreement based upon the execution and/or approval thereof. 8. HOLD HARMLESS Each party does hereby agree, to the extent, if any, allowed by law, to indemnify and hold harmless the other party, its officers, agents, servants, and employees from any and all injuries, claims, actions, lawsuits, damages, judgments or liabilities of any kind whatsoever arising out of the first party’s performance of its obligations under this Agreement. 9. NO THIRD PARTY RIGHTS This Agreement shall be exclusively for the benefit of the parties and shall not provide any third parties with any remedy, claim, liability, reimbursement, cause of action, or other right. IN WITNESS WHEREOF, the parties have hereunto set their hands and affixed their seals this ____ day of __________, 2012. City of Milton City of Roswell _______________________ _______________________ By: Joe Lockwood, Mayor By: Jere Wood, Mayor Attest: _________________ Attest: _________________ City Clerk (Seal) City Clerk (Seal) City of Milton 13000 Deerfield Parkway Suite 107C Milton, Georgia 30004 Page 1 of 1 To: Honorable Mayor and City Council Members From: John Rebar, Parks and Recreation Director Submission Date: April 25, 2012 Meeting Date: May 7, 2012 Regular Council Meeting Agenda Item: Approval of a Contract between the City of Milton and Mike Westmoreland Contracting Inc. for the Renovation of the Infield at Hopewell Middle School in the Amount of $5,310. Background: The City of Milton is a required to renovate the infield area of the baseball/softball field located at Hopewell Middle School per the previously executed Intergovernmental Agreement between the City of Milton and The Fulton County Board of Education. Discussion: The City of Milton solicited quotes for the renovation of the infield at Hopewell Middle School. Mike Westmoreland Contracting Inc. was the lowest quote at $5,310.00. References were also checked and Mike Westmoreland Contracting, Inc. received high praise of their previous work. Funding for this project is available in the Parks and Recreation Capital Budget. Legal Review: Paul Higbee, Jarrard & Davis on April 26, 2012 Attachments: An agreement between the City of Milton and Mike Westmoreland Contracting, Inc. City of Milton CONSTRUCTION SERVICES AGREEMENT — SHORT FORM AGREEMENTS $10,000.00 OR LESS INFIELD RENOVATION at HOPEWELL MIDDLE SCHOOL This Services Agreement (the "Agreement") is made and entered into this day of , 201 by and between the CITY OF MILTON, GEORGIA (hereinafter referred to as the "City"), and MIKE WESTMORELAND CONTRACTING, INC. (hereinafter referred to as the "Contractor"). WITNESSETH THAT: WHEREAS, the City desires to employ a contractor to perform the services described herein (the "Work"); and WHEREAS, Contractor has familiarized itself with the Contract Documents, as defined below, the Work, and with all local conditions and applicable federal, state and local laws, ordinances, rules and regulations. NOW THEREFORE, the City and Contractor, in consideration of the mutual promises contained herein and other good and valuable consideration, the sufficiency of which is hereby acknowledged, agree as follows: Section 1. Contract Documents: This Agreement and the following named Exhibits, attached hereto and incorporated herein by reference, constitute the "Contract Documents": EXHIBIT A -SCOPE OF WORK; EXHIBIT B -INSURANCE CERTFICATE; EXHIBIT C -CONTRACTOR AFFIDAVIT AND AGREEMENT, EXHIBIT D -SAVE AFFIDAVIT To the extent that there may be any conflict among the Contract Documents, the provision operating most to the benefit of the City shall govern. Section 2. The Work: Contractor shall provide all Work described in the Contract Documents. In the event of any discrepancy among the Contract Documents, the provision operating most to the benefit of the City, as determined by the City in its sole discretion, shall govern. Unless otherwise stated in the Contract Documents, the Work shall include Contractor's provision of materials, labor, expenses, and any other cost or item necessary to complete the Work, which is generally described as Infield Renovation at Hopewell Middle School. Section 3. Contract Time: Contractor understands that time is of the essence of this Agreement and warrants that it will perform the Work in a prompt manner, which shall not impose delays on the progress of the Work. It shall commence Work pursuant to this Agreement on or before a date to be specified on a written "Notice to Proceed" from the City, and shall fully complete the Work within 10 days of the "Notice to Proceed". Section 4. Work Changes: Any changes to the Work requiring an increase in the Contract Price, as defined below, shall require a written change order executed by the City in accordance with its purchasing regulations. Section 5. Compensation and Method of Pgyment: City agrees to pay Contractor for the services performed and costs incurred by Contractor upon the City's certification that the services were actually performed and costs actually incurred in accordance with this Agreement. Compensation for services performed and, if applicable, reimbursement for costs incurred shall be paid to Contractor upon the City's receipt and approval of an invoice, submitted upon completion of the Work, setting forth in detail the services performed and costs incurred. Invoices shall reflect charges incurred versus charges budgeted. The total amount paid under this Agreement for the Work shall not, in any case, exceed $5,310.00 (the "Contract Price"), except as outlined in Section 4 above. Contractor shall take no calculated risk in the performance of the Work. Specifically, Contractor agrees that in the event it cannot perform the Work within the budgetary limitations established without disregarding sound principles of Contractor's industry, Contractor will give written notice thereof immediately to the City. Section 6. Covenants of Contractor A. Assignment of Agreement: Contractor covenants and agrees not to assign or transfer any interest in, nor delegate any duties of this Agreement, without the prior express written consent of the City. B. Responsibility of Contractor and Indemnification of City: Contractor covenants and agrees to take and assume all responsibility for the services rendered in connection with the Work. Contractor shall bear all losses and damages directly or indirectly resulting to it on account of the performance or character of the services rendered pursuant to this Agreement. Contractor shall defend, indemnify and hold harmless the City, its officers, boards, commissions, elected and appointed officials, employees and agents from and against any and all claims, suits, actions, liability, judgments, damages, losses, and expenses, including but not limited to, attorney's fees, which may be the result of willful, negligent or tortious conduct arising out of the Work, performance of contracted services, or operations by Contractor, any subcontractor, anyone directly or indirectly employed by Contractor or subcontractor or anyone for whose acts Contractor or subcontractor may be liable, regardless of whether or not the negligent act is caused in part by a party indemnified hereunder_ Contractor shall not be required to indemnify the City or its officers, boards, commissions, elected or appointed officials, employees or agents against liability or claims for damages, losses, or expenses, including attorney fees, arising out of bodily injury to persons, death, or damage to property caused by or resulting from the sole negligence of the City or its officers, boards, commissions, elected or appointed officials, employees or agents. C_ Independent Contractor: Contractor hereby covenants and declares that it is engaged in an independent business and agrees to perform the Work as an independent contractor, not as agent or employee of City. inasmuch as City and Contractor are contractors independent of one another, neither has the authority to bind the other to any third person or otherwise to act in any way as the representative of the other, unless otherwise expressly agreed to in writing by both parties. Contractor agrees not to represent itself as City's agent for any purpose to any party or to allow any employee to do so, unless specifically authorized, in advance and in writing, and then only for the limited purpose stated in such authorization. Contractor shall assume full liability for any contracts or agreements Contractor enters into on behalf of City without the express knowledge and prior written consent of City. D. Insurance: Contractor shall have and maintain in full force and effect for the duration of this Agreement, insurance approved by the City as shown on Exhibit "B". E. Licenses, Certifications and Permits: Contractor covenants and declares that it has obtained and will maintain all diplomas, certificates, licenses, permits or the like required by any national, state, regional, City, and local boards, agencies, commissions, committees or other regulatory bodies to perform the Work. Contractor shall comply with applicable legal requirements and meet the standard of quality ordinarily expected of its industry. F. Ownership of Work: All reports, drawings, specifications, and other items prepared or in the process of being prepared for the Work by Contractor ("materials") shall be the property of the City and the City shall be entitled to full access and copies of all materials. All copyrightable subject matter in all materials is hereby assigned to the City and Contractor agrees to execute any additional documents necessary to evidence such assignment. G. Contractor's Representative: TM WESTMORELAND shall be authorized to act on Contractor's behalf with respect to the Work as Contractor's designated representative. H. Confidentiality: {Contractor acknowledges that it may receive confidential information of the City and that it will protect the confidentiality of any such confidential information and will require any of its subcontractors, consultants, and/or staff to likewise protect such confidential information. 1. Meetings: Contractor shall meet with City's personnel or designated representatives to resolve technical or contractual problems that may occur during the term of the contract, at no additional cost to City. Section 7. Warranty: Contractor shall repair all defects in materials, equipment, or workmanship appearing within one year from the date of completion of the Work at no additional cost to the City. 2 Section 8. Termination: The City may terminate this Agreement for convenience at any time upon written notice to Contractor. Provided that no damages are due to the City for Contractor's breach of this Agreement, the City shall pay Contractor for Work performed to date in accordance with Section 5 herein. Section 9. Miscellaneous A. Governing Law. This Agreement shall be governed by the laws of the State of Georgia. B. Counterparts. This Agreement may be executed in any number of counterparts, each of which shall be deemed to be an original, but all of which together shall constitute one and the same instrument. C. Sovereign Immunity. Nothing contained in this Agreement shall be construed to be a waiver of the City's sovereign immunity or any individual's qualified good faith or official immunities. IN WITNESS WHEREOF, the parties have caused this Agreement to be executed under seal as of the date first above written. MIKE WESTMORELAND CONTRACTING, INC. SignatuPrinted Name: -T" 1 *-N, Title: �4 1 c. C [AFFIX CORPORATE SEAL] CITY OF MILTON, GEORGIA Joe Lockwood, Mayor 3 MIKE WESTMORELAND CONTRACTING, INC. 308 RIDGEVIEW TRACE CANTON, GEORGIA PHONE (770) 926-3197 FAX (770) 592-4437 SINCE 1962 Mr. Torn Gilliam City of Milton Parks & Recreation 13000 Deerfield Parkway Suite 107G Milton, Ga. 30004 February 16, 2012 March 29, 2012 RE: Proposal - Infield Renovation Hopewell Middle School Baseball Field Below is a proposal to remove the existing grass, rocks, and debris inside of the infield. Infield mix will then be added to the field and the infield will then be laser graded to insure a smooth, surface, with positive drainage. This process will create a smooth, safe, playable surface. Stripping Infield Blended Infield Mix $ 1,050.00 34 tons @ $ 90.00 per ton $ 3,060.00 Laser Grading $ 1,200.00 PROJECT TOTAL S 5,310.00 If this proposal fails to meet budget constraints, the quantity of infield mix can be reduced. Let us know and we can explore other options. We appreciate the opportunity to quote this project. If I can be of additional assistance, please give me a call @ 404-291-4887 or email @ TMWMWC@Windstream.net. Sincerely, Tim Westmoreland, Vice Pres. Mike Westmoreland Contracting, Inc. OP ID: KR Ati O�RL]CERTIFICATE OF LIABILITY INSURANCE ATE{ 041/25/251YYYYJ 12 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 POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS], 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 770-479-9823. Fowler Insurance Agency Kim Fowler 770-479-20 Kim PO Box 886 Canton, GA 30169 Karla Rathei CONTACT NAM PHONEFAX fUC Nc Ed1: �.FAX £-MAIL -- ADDRESS: CUSTOM MER ID Ah INSURER(S) AFFORDINIG COVERAGE NAIC x MED EXP (Any one person) $ 10,0DII INSURED Mike Westmoreland INSURER A. Southern Ins. Co of VA 13692 Contracting, Inc. INSURER B-Buildem Insurance 10704 308 Ridgeview Trace Canton, GA 30114 INSURERC: INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES 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. Irm LTR TYPE OF INSURANCE L D POLICY NUM82R M -I POLICY EXP MIDD/YYYY) 1MMfiDDryYYYi LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1XI OCCUR ACCORDANCE WITH THE POLICY PROVISIONS. 13000 Deerfield Pkwy Ste 107A �CPP81 (}3658 09112111 09112/12 EACH OCCURRENCE _ $ 1,000, DAMAGE To PREMISES Ea occurD $ 100,0 MED EXP (Any one person) $ 10,0DII PERSOFIAL & AOV INJURY $ 1,00D,00 GENERAL AGGREGATE $ ZOW,0011 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,00 POLICY PRO- F7 LOC JECT $ A AUTOMOBILE X UiABILITY ANY AUTO CAA8103658 08112111 08112/42 COMBINED SINGLE LIMIT $ 11000100 (Ea acclderk) BODILY INJURY (Per person) $ ALL OWNEDAUTDS BODILY INJURY (Per aoadent) S SCH EDULED AiJTOS HIRED AUTOS PROPERTY DAMAGE S (Per awdent) $ NON -OWNED AUTOS $ X I UMBRELLA LIAR ]( OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ A EXCESS LIAR CLAIMS -MADE C?CS8103Fi58 09112111 08112!12 DEDUCTIBLE $ $ X RETENTION $ WORKERSOOMPENSATION WCSTATU-PTH- B AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVP WCV002724607 09112/11 09112/12 E.L. EACH ACCIDENT $ 500,o0 OFFICERrMEMBER EXCLUDED? F— (Mandatory In NHi N I A E.L DISEASE - EA EMPLOYEO S $00,00 If yyas, describe under DESCRIPTION OF OPERATIONS below E. I. DISEASE - POLICY LIMIT ; 540,0 A Equipment Floater CPP8103658 09/12/11 I 09/12112 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Landscape gardening CERTIFICATE HOLDER CANCELLATION CITYM-2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci of Milton - Georgia City g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FAX#678-242-2499 ACCORDANCE WITH THE POLICY PROVISIONS. 13000 Deerfield Pkwy Ste 107A Milton, GA 30004 AUTHORIZED REPF/REESENTA�TI■VJ�E` �/� 1�y /14 iVTx� 01982-2009ACORID CORPID ATI!0.4. AP A. hts mEerved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD STATE OF GEORGIA CITY OF MILTON EXHIBIT "C" CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10.91 on the Subcontractor Affidavit provided in Rule 300-10-01-.08 in the form attached hereto as Exhibit "D" Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perform such service. 3a-1lb4:)- EEV 1 Basic Pilot Program User Identification Number BY: Authorized Officer or Agent Date MIKE WESTMORELAND CONTRACTING, INC. Vtc ox -T Title of Authorized Officer or Agent of Contractor Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN RE; ME ON ' HIS THE DAYI , 201 n outry r uvi �. .4 J. yd =ii My Coxnrni cion Exp. �` M""' ii �► r— CO PUB\,Nry N : Goan;� 6 STATE OF GEORGIA {CITY OF MILTON EXIISIT "D" SAVE AFFIDAVIT By executing this affidavit under oath, and as an applicant for a public benefit, as referenced in O.C.G.A. § 50-36-1, from the City of Milton, the undersigned applicant verifies one of the following with respect to my application for a public benefit: 1) ,� I arra a United States citizen. 2) I am a legal permanent resident of the United States. 3 } I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 50-36-1(e)(1), with this affidavit. The secure and verifiable document provided with this affidavit can best be classified as: In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute. Executed in U., 1 Acej - _- (city), SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF 20 +� NY PUBLIC ommission Expires: (=A (state). Signature of Applicant Printed Name of Applicant City of Milton 13000 Deerfield Parkway Suite 107C Milton, Georgia 30004 To: Honorable Mayor and City Council Members From: Sara Leaders, PE – Transportation Engineer Date: April 25, 2012 Council Date: May 7, 2012 Agenda Item: Consent to Assignment of Construction Easements and Right of Entry Between Fulton County Board of Education and City of Milton Discussion: The City was awarded a Safe Routes to School grant in May 2009 through Georgia Department of Transportation (GDOT). The application included a project to install raised intersections/crosswalks on School Drive. Part of the Federal Highway Administrations Safe Routes to School Program Guidance listed projects on school property as eligible under the grant. The application was signed by all involved. The application stated that the undersigned understand that the proposed infrastructure project, if granted, will be designed and implemented by Georgia Department of Transportation. In August 2009, the city signed a Memorandum of Understanding (MOU) with GDOT and the School Board signed as an acknowledgement. The City signed this document as the project sponsor and agreed to ensure access for GDOT to construct the projects and to maintain the infrastructure installed as part of the projects. The projects are currently under construction through GDOT and their contractors. The easement and right of entry document provides access for work to be performed on school property by GDOT. Approval of this item authorizes the mayor to sign the easement agreement and right of entry. As the project sponsor, the City is responsible for acquiring access for GDOT to perform the work. Legal Review: Paul Higbee, Jarrard & Davis on 4/24/12 Financial: N/A Attachments: 1. Easement Agreements After recording, please retm•n to: Brock, Clay, Calhoun & Rogers LLC Attn: Cheryl V. Shaw, Esq. 49 Atlanta Street Marietta, GA 30060 Construction Easement and Right of Entry Project: Crosswalk &Sidewalks Pareel Tax I.D.: 22-415040624234 Ref: Milton H.S. THIS CONSTRUCTION EASEMENT AND RIGHT OF ENTRY, made this day of 2012, by and between FULTON COUNTY BOARD OR EDUCATION, a political subdivision of the State of Georgia, ("Grantor") and CITY OF MILTON (the "Grantee"). WHEREAS, Grantor is the owner of the property housing the Milton High School, located at 13025 Birmingham Highway, Milton, Georgia 30004 ("Grantor Property"); and WHEREAS, Grantee requests a right of entry and construction easement on Grantor's Property for the purpose of constructing a crosswalk, sidewalks and making storm drainage improvements and Grantor has agreed to grant said easements and right of entry on and subject to the terms and conditions hereinafter set forth. NOW THEREFORE, in consideration of Ten ($10.00) Dollars For good and valuable consideration, in hand paid, the receipt and sufficiency of which is expressly acknowledged and for the premises set forth hereinbelow, Grantor does hereby grant and convey to Grantee, its successors, successors in title and assigns, a non-exclusive construction easement, which includes the perpetual right, privilege and easement to construct certain crosswalks and sidewalks and to maintain same at Grantee's sole expense in the easement area described on Exhibit(s) attached hereto and incorporated herein by reference (the "Easement Area"). This Construction Easement and Right of Entry is granted upon the following terns and conditions: All work shall be promptly performed in accordance with all laws and regulations at the sole expense of Grantee and Grantee shall be responsible for all liability arising from same. The work shall be substantially completed by August 1, 2012. 2. Any construction or other work or activities performed on Grantor's property by Grantee shall be done in a good workmanlike manner and the property shall be left in a clean and good condition. 3. Grantee shall not materially and adversely interfere with or disturb the operations of Milton High School. 4. After construction is completed Grantee shall maintain the crosswalks and sidewalks at Grantee's expense. 5. Grantor's representative for all communications on the project is Mr. David Knotts, whose telephone number is (404) 305-2219. IN WITNESS WHEREOF, the parties hereto have executed this Construction Easement, and Right of Entry in duplicate as of the date first hereinabove written. Witness Notary Public FULTON COUNTY BOARD OF EDUCATION Bv: Name: Linda Schultz Title: President Bv: Name: Robert Avossa, Ed.D. [notary seal] Title: Superintendent CITY OF MILTON By: Name: Witness Title: Notary Public [notary seal] 2- After recm•ding, please return to: Brock, Clay, Calhoun & Rogers LLC Wn: Cheryl V. Shaw, Esq. 49 Atlanta Street Marietta, GA 30060 Construction Easement and Right of Entry Project: Crosswalk & Sidewalks Parcel Tax I.D.: 2241504062-02-47 Ref: Northwestern Middle School THIS CONSTRUCTION EASEMENT AND RIGHT OF ENTRY, made this day of , 2012, by and between FULTON COUNTY BOARD OF EDUCATION, a political subdivision of the State of Georgia, ("Grantor") and CITY OF MILTON (the "Grantee"), RSI-IEREAS, Grantor is the owner of the property housing the Northwesteni Middle School, located at 12805 Birmingham Highway, Milton, Georgia 30004 ("Grantor Properly"); and WHEREAS, Grantee requests a right of entry and construction easement on Grantor's Property for the purpose of constructing a crosswalk, sidewalks and making storm drainage improvements and Grantor has agreed to grant said easements and right of entry on and subject to the terms and conditions hereinafter set forth. NOW THEREFORE, in consideration of Ten ($10.00) Dollars For good and valuable consideration, in hand paid, the receipt and sufficiency of which is expressly acknowledged and for the premises set forth hereinbelow, Grantor does hereby grant and convey to Grantee, its successors, successors in title and assigns, a non-exclusive construction easement, which includes the perpetual right, privilege and easement to construct certain crosswalks and sidewalks and to maintain same at Grantee's sole expense in the easement area described on Exhibit(s) _attached hereto and incorporated herein by reference (the "Easement Area"). This Construction Easement and Right of Entry is granted upon the following terms and conditions: 1. All work shall be promptly performed in accordance with all laws and regulations at the sole expense of Grantee and Grantee shall be responsible for all liability arising from same. The work shall be substantially completed by August 1, 2012. -1- 2. Any construction or other work or activities performed on Grantor's property by Grantee shall be done in a good workmanlike manner and the property shall be left in a clean and good condition. 3. Grantee shall not materially and adversely nue re with or disturb the operations of Northwestern Middle School. 4. Afrer construction is completed Grantee shall maintain the crosswalks and sidewalks at Grantee's expense. 5. Grantor's representative for all communications on the project is Mr. David Knotts, whose telephone number is (404) 305-2219. IN WITNESS WHEREOF, the parties hereto have executed this Construction Easement, and Right of Entry in duplicate as of the date first hereinabove written. V✓itness Notary Public [notary seal] Witness Notary Public [notary seal] FULTON COUNTY BOARD OF EDUCATION Name: Linda Schultz Title: President By: Name: Robert Avossa, Title: Superintendent CITY OF MILTON By: Name: Title: 2- City of Milton 13000 Deerfield Parkway Suite 107C Milton, Georgia 30004 To: Honorable Mayor and City Council Members From: Carter Lucas, PE – Public Works Director Date: April 26, 2012 Council Meeting Date: May 7, 2012 Agenda Item: Approval of a Construction Services Agreement Between Baldwin Paving Company, Inc. and the City of Milton for Intersection Improvements at the Bethany Bend – Cogburn Road Intersection Discussion: Project Location---------------------------------------O Location Map The primary need for the project is to provide intersection improvements at Bethany Bend and Cogburn Roads as a result of the new Cambridge High School construction on the southeast corner of the intersection. The construction of the new high school and the anticipated increase in traffic at peak hours in this area requires increased capacity within the intersection to reduce overall delays. The proposed improvements are being completed in conjunction with the Fult on County School Board. The school board will be constructing improvements along Bethany Bend and the southeast corner of the intersection to include a westbound left turn lane on Bethany Bend and a northbound right turn lane on Cogburn Road. The city will construct an east bound left and an eastbound right turn lane in addition to the existing through lane, a southbound right turn lane as well as signal improvements at the intersection. In accordance with the city procurement procedures an invitation to bid was issued to secure a City of Milton 13000 Deerfield Parkway Suite 107C Milton, Georgia 30004 qualified contractor to complete this project. T he city received 3 bids on the project and Baldwin Paving Company, Inc. was determined to be the lowest reliable bidder. Staff is recommending approval of a Construction Services Agreement with Baldwin Paving Company, Inc. in the amount of $374,450. Legal Review: Jarrard & Davis, LLP – Paul Higbee 4/24/2012 Financial: Funding for this project is available in the Bethany/Cogburn Intersection Improvements capital fund. Attachments: 1. Construction Services Agreement CONSTRUCTION SERVICES AGREEMENT FOR BETHANY BEND AT COGBURN ROAD INTERSECTION IMPROVEMENTS This Agreement (the “Agreement”) to provide intersection pedestrian improvements is made and entered into this ___ day of ____, 2012, by and between the CITY OF MILTON, a municipal corporation of the State of Georgia, acting by and through its governing authority, the Milton City Council (hereinafter referred to as the “City”), and Baldwin Paving Company, Inc., a Georgia corporation with its principal place of business located at 1014 KENMILL DR NW MARIETTA GA 30060-7911 (hereinafter referred to as the “Contractor”). W I T N E S S E T H: WHEREAS, the City issued a Request For Bid BETHANY BEND AT COGBURN ROAD INTERSECTION IMPROVEMENTS (12-PW5), to solicit bids for intersection improvements; and WHEREAS, based upon Contractor’s bid, the City has selected Contractor as the winning bidder, and WHEREAS, Contractor has agreed to perform such work as set forth in this Agreement, according to the terms and conditions provided in this Agreement; and WHEREAS, Contractor has familiarized itself with the nature and extent of the Contract Documents, the Project, and the Work, with all local conditions and federal, state and local laws, ordinances, rules and regulations in any manner that may affect cost, progress or performance of work, and Contractor is aware that he must be licensed to do business in the State of Georgia. NOW THEREFORE, the City and Contractor, in consideration of the mutual promises contained herein and other good and valuable consideration, the sufficiency of which is hereby acknowledged, agree as follows: Section 1 Contract Documents The following documents are incorporated herein by reference and constitute the Contract Documents: A. This Agreement ( 33 Pages); B. Request For Bid RFB , attached hereto as Exhibit “A”; C. Proposal and Bid from Contractor attached hereto as Exhibit “B”; Performance and Other Bonds, attached hereto collectively as Exhibit “C”; D. Contractor Affidavit and Agreement, attached hereto as Exhibit “D”; E. Subcontractor Affidavit, attached hereto as Exhibit “E”; F. Save Affidavit, attached hereto as Exhibit “F”; G. Key Personnel, attached hereto as Exhibit “G”; H. The following which may be delivered or issued after the Effective Date of the Agreement and are not attached hereto: All Written Amendments and other documents amending, modifying, or supplementing the Contract Documents if properly adopted in writing and executed by the Parties; and I. City of Milton Code of Ethics. In the event of any discrepancy among the Contract Documents, that provision that inures most to the benefit of the City, as determined by the City in its sole discretion, shall govern. Section 2 Project Description The scope of this project generally consists of the addition of turn lanes, signal modifications, and other associated roadway, drainage, and shoulder work. Signal mast arms will be provided by the City. All other signal equipment shall be included in the work provided by the Contractor. The project location is at the intersection of Bethany Bend and Cogburn Road approximately ½ mile east of State Route 9. Section 3 The Work The Work is specified and indicated in the Contract Documents (the “Work”). The Work previously described includes all material, labor, insurance, tools, equipment, and any other miscellaneous items necessary to complete the Work as described, except as otherwise stated herein. Contractor shall complete the Work in strict accordance with the Contract Documents. Section 4 Contract Time Contractor agrees to complete the Project within 90 calendar days from the date of Notice to Proceed to be issued by the City. Every effort will be made by Contractor to shorten this period. Section 5 Contractor’s Compensation; Time and Method of Payment Contractor shall be paid in one lump sum for the full agreed -to contract amount of $374,450.00. The City shall pay Contractor upon Final Completion of the Project as such is determined by the City, net thirty (30) days from the date of invoice. No payments will be made for unauthorized work. Upon the City’s certification of Final Completion of the Project, an invoice should be submitted to Rick Pearce (Budget and Procurement Coordinator), for approval. Payment will be sent to the designated address by U. S. Mail only; payment will not be hand - delivered. Section 6 Work Changes A. The City reserves the right to order changes in the Work to be performed under this Agreement by altering, adding to, or deducting from the Work. All such changes shall be incorporated in written change orders executed by the Contractor and the City. Such change orders shall specify the changes ordered and any necessary adjustment of compensation and completion time. If the Parties cannot reach an agreement on the terms for performing the changed work within a reasonable time to avoid delay or other unfavorable impacts as determined by the City in its sole discretion, the City shall have the right to determine reason able terms and the Contractor shall proceed with the changed work. B. Any work added to the scope of this Agreement by a change order shall be executed under all the applicable conditions of this Agreement. No claim for additional compensation or extension of time shall be recognized, unless contained in a written change order duly executed on behalf of the City and the Contractor. C. The City Manager has authority to execute without further action of the Milton City Council, any number of change orders so long as their total effect does not materially alter the terms of this Agreement or materially increase the total amount to be paid under this Agreement. Any such change orders materially altering the terms of this Agreement or increasing the total amount to be paid under this Agreement in excess of $50,000, must be approved by resolution of the Milton City Council. Section 7 Covenants of Contractor. A. Ethics Code Contractor agrees that it shall not engage in any activity or conduct that would be in violation of the City of Milton Code of Ethics. B. Time is of the Essence Contractor specifically acknowledges that TIME IS OF THE ESSENCE for completion of the Project. C. Expertise of Contractor Contractor accepts the relationship of trust and confidence established between it and the City, recognizing that the City’s intention and purpose in entering into this Agreement is to engage an entity with the requisite capacity, experience, and professional skill and judgment to provide the services in pursuit of the timely and competent completion of the Work undertaken by Contractor under this Agreement. D. Budgetary Limitations Contractor agrees and acknowledges that budgetary limitations are not a justification for breach of sound principals of Contractor’s profession and industry. Contractor shall take no calculated risk in the performance of the Work. Specifically, Contractor agrees that, in the event it cannot perform the Work within the budgetary limitations established without disregarding sound principals of Contractor’s profession and industry, Contractor will give written notice immediately to the City. E. City’s Reliance on the Work The Contractor acknowledges and agrees that the City does not undertake to approve or pass upon matters of expertise of the Contractor and that; therefore, the City bears no responsibility for Contractor’s services performed under this Agreement. The Contractor acknowledges and agrees that the acceptance of Work by the City is limited to the function of determining whether there has been compliance with what is required to be produced under this Agreement. The City will not, and need not, inquire into adequacy, fitness, suitability or correctness of Contractor’s performance. Contractor further agrees that no approval of designs, plans, specifications, or work by any person, body or agency shall relieve Contractor of the responsibility for adequacy, fitness, suitability, and correctness of Contractor’s professional and industry standards or for performing services under this Agreement in accordance with sound and accepted professional and industry principals. F. Contractor’s Reliance of Submissions by the City Contractor must have timely information and input from the City in order to perform the services required under this Agreement. Contractor is entitled to rely upon information provided by the City, but Contractor shall be required to provide immediate written notice to the City if Contractor knows or reasonably should know that any information provided by the City is erroneous, inconsistent, or otherwise problematic. G. Contractor’s Representative ___________________________________ shall be authorized to act on Contractor’s behalf with respect to the Work as Contractor’s designated representative. H. Assignment of Agreement The Contractor covenants and agrees not to assign or transfer any interest in, nor delegate any duties of this Agreement, without the prior express written consent of the City. I. Responsibility of Contractor and Indemnification of City The Contractor covenants and agrees to take and assume all responsibility for the services rendered in connection with this Agreement. The Contractor shall bear all losses and damages directly or indirectly resulting to it on account of the performance or character of the services rendered pursuant to this Agreement. Contractor shall defend, indemnify and hold harmless the City, its officers, boards, commissions, elected and appointed officials, employees and agents from and against any and all claims, suits, actions, liability, judgments, damages, losses, and expenses, including but not limited to, attorney’s fees, which may be the result of willful, negligent or tortuous conduct arising out of the Work, performance of contracted services, or operations by the Contractor, any subcontractor, anyone directly or indirectly employed by the Contractor or subcontractor or anyone for whose acts the Contractor or subcontractor may be liable, regardless of whether or not the negligent act is caused in part by a party indemnified hereunder. Such obligation shall not be construed to negate, abridge, or otherwise reduce any other right or obligation of indemnit y which would otherwise exist as to any party or person described in this provision. In any and all claims against the City or any of its agents or employees, by any employee of the Contractor, any subcontractor, anyone directly or indirectly employed by the Contractor or subcontractor or anyone for whose acts the Contractor or subcontractor may be liable, the indemnification obligation set forth in this provision shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable by or for the Contractor or any subcontractor under workers’ or workmen’s compensation acts, disability benefit acts or other employee benefit acts. This obligation to indemnify and defend the City, its members, officers, agents, employees and volunteers shall survive termination of this Agreement. Contractor shall not be required to indemnify the City or its officers, boards, commissions, elected or appointed officials, employees or agents against liability or claims for damages, losses, or expenses, including attorney fees, arising out of bodily injury to persons, death, or damage to property caused by or resulting from the sole negligence of the City or its officers, boards, commissions, elected or appointed officials, employees or agents. J. Independent Contractor Contractor hereby covenants and declares that it is engaged in an independent business and agrees to perform the services as an independent contractor and not as the agent or employee of the City. The Contractor agrees to be solely responsible for its own matters relating to the time and place the services are performed; the instrumentalities, tools, supplies and/or materials necessary to complete the services; hiring of Contractors, agents or employees to complete the services; and the payment of employees, including compliance with Social Security, withholding and all other regulations governing such matters. The Contractor agrees to be solely responsible for its own acts and those of its subordinates, employees, and subcontractors during the life of this Agreement. Any provisions of this Agreement that may appear to give the City the right to direct Contractor as to the details of the services to be performed by Contractor or to exercise a measure of control over such services will be deemed to mean that Contractor shall follow the directions of the City with regard to the results of such services only. The Contractor shall obtain and maintain, at the Contractor’s expense, all permits, licenses, or approvals that may be necessary for the performance of the services. The Contractor shall furnish copies of all such permits, licenses, or approvals to the City of Milton Representative within ten (10) days after issuance. Inasmuch as the City of Milton and the Contractor are contractors independent of one another neither has the authority to bind the other to any third person or otherwise to act in any way as the representative of the other, unless otherwise expressly agreed to in writing signed by both parties hereto. The Contractor agrees not to represent itself as the City’s agent for any purpose to any party or to allow any employee of the Contractor to do so, unless specifically authorized, in advance and in writing, to do so, and then only for the limited purpose st ated in such authorization. The Contractor shall assume full liability for any contracts or agreements the Contract enters into on behalf of the City of Milton without the express knowledge and prior written consent of the City. K. Insurance (1) Requirements: The Contractor shall have and maintain in full force and effect for the duration of this Agreement, insurance insuring against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the Work by the Contractor, its agents, representatives, employees or subcontractors. All policies shall be subject to approval by the City Attorney to form and content. These requirements are subject to amendment or waiver if so approved in writing by the City Manager. (2) Minimum Limits of Insurance: Contractor shall maintain limits no less than: (a) Comprehensive General Liability of $1,000,000 combined single limit per occurrence for bodily and personal injury, sickness, disease or death, injury to or destruction of property, including loss of use resulting there from. (b) Comprehensive Automobile Liability (owned, non-owned, hired) of $1,000,000 combined single limit per occurrence for bodily and personal injury, sickness, disease or death, injury to or destruction of property, including loss of use resulting there from. (c) Professional Liability of $1,000,000 limit for claims arising out of professional services caused by the Contractor’s errors, omissions, or negligent acts. (d) Workers' Compensation limits as required by the State of Georgia and employers Liability limits of $1,000,000 per accident. (3) Deductibles and Self-Insured Retentions: Any deductibles or self-insured retentions must be declared to and approved by the City. (4) Other Insurance Provisions: The policy is to contain, or be endorsed to contain, the following provisions: (a) General Liability and Automobile Liability Coverage. (i) The City, its officials, employees, agents and volunteers are to be covered as insured as respects: liability arising out of activities performed by or on behalf of the Contractor; products and completed operations of the Contractor; premises owned, leased, or used by the Contractor; automobiles owned, leased, hired, or borrowed by the Contractor. The coverage shall contain no special limitations on the scope of protection afforded to the City, its officials, employees, agents or volunteers. (ii) The Contractor’s insurance coverage shall be primary noncontributing insurance as respects to any other insurance or self-insurance available to the City, its officials, employees, agents or volunteers. Any insurance or self-insurance maintained by the City, its officials, employees or volunteers shall be excess of the Contractor’s insurance and shall not contribute with it. (iii) Any failure to comply with reporting provisions of the policies shall not affect coverage provided to the City, its officials, employees, agents or volunteers. (iv) Coverage shall state that the Contractor’s insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. (v) Coverage shall be provided on a “pay on behalf” basis, with defense costs payable in addition to policy limits. There shall be no cross liability exclusion. (vi) The insurer agrees to waive all rights of subrogation against the City, its officials, employees, agents and volunteers for losses arising from work performed by the Contractor for the City. (vii) All endorsements to policies shall be executed by an authorized representative of the insurer. (b) Workers' Compensation Coverage: The insurer will agree to waive all rights of subrogation against the City, its officials, employees, agents and volunteers for losses arising from work performed by the Contractor for the City. (c) All Coverages: (i) Each insurance policy required by this clause shall be endorsed to state that coverage shall not be suspended, voided, canceled, reduced in coverage or in limits except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. (ii) Policies shall have concurrent starting and ending dates. (iii) Policies shall include an endorsement incorporating the Indemnification obligations assumed by the Contractor under the terms of this Agreement, including but not limited to Section 7(I) of this Agreement. (iv) Policies shall include an endorsement incorporating the Indemnification obligations assumed by the Contractor under the terms of this Agreement, including but not limited to Section 7(I) of this Agreement. (5) Acceptability of Insurers: Insurance is to be placed with insurers with an A.M. Bests' rating of no less than A: VII. (6) Verification of Coverage: Contractor shall furnish the City with certificates of insurance and endorsements to the policies evidencing coverage required by this clause prior to the start of work. The certificates of insurance and endorsements for each insurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf. The certificate of insurance and endorsements shall be on a form utilized by Contractor’s insurer in its normal course of business and shall be received and approved by the City prior to execution of this Agreement by the City. The City reserves the right to require complete, certified copies of all required insurance policies, at any time. The Contractor shall provide proof that any expiring coverage has been renewed or replaced at least two (2) weeks prior to the expiration of the coverage. (7) Subcontractors: Contractor shall include all subcontractors as insured under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverage for subcontractors shall be subject to all of the requirements stated in this Agreement, including but not limited to naming the parties as additional insured. (8) Claims-Made Policies: Contractor shall extend any claims-made insurance policy for at least six (6) years after termination or final payment under the Agreement, whichever is later. (9) City as Additional Insured and Loss Payee: The City shall be named as an additional insured and loss payee on all policies required by this Agreement. L. Employment of Unauthorized Aliens Prohibited (1) E-Verify Affidavits It is the policy of the City of Milton that unauthorized aliens shall not be employed to perform work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the Contractor shall provide evidence on City-provided forms, attached hereto as Exhibits “D” and “E” that it and Contractor’s subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perform work on the City contract to ensure that no unauthorized aliens will be employed. The City Manager or his/her designee shall be authorized to conduct an inspection of the Contractor’s and Contractor’s subcontractors’ verification process to determine that the verification was correct and complete. The Contractor and Contractor’s subcontractors shall retain all documents and records of its verification process for a period of three (3) years following completion of the contract. This requirement shall apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. The City Manager or his/her designee shall further be authorized to conduct periodic inspections to ensure that no City Contractor or Contractor’s subcontractors employ unauthorized aliens on City contracts. By entering into a contract with the City, the Contractor and Contractor’s subcontractors agree to cooperate with any such investigation by making its records and personnel available upon reasonable notice for inspection and questioning. Where a Contractor or Contractor’s subcontractors are found to have employed an unauthorized alien, the City Manager or his/her designee may order the Contractor to terminate or require its subcontractor to terminate that person’s employment immediately and to report same to the Department of Homeland Security. The Contractor’s failure to terminate the employee, or otherwise cooperate with the investigation may be sanctioned by termination of the contract, and the Contractor shall be liable for all damages and delays occasioned by the City thereby. Compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 is mandatory. Contractor agrees that, in the event the Contractor employs or contracts with any subcontractor(s) in connection with this Agreement, the Contractor will secure from the subcontractor(s) such subcontractor(s’) indication of the above employee-number category that is applicable to the subcontractor. Contractor’s compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 shall be attested by the execution of the contractor’s affidavit attached as Exhibit “D.” The above requirements shall be in addition to the requirements of State and federal law, and shall be construed to be in conformity with those laws. (2) SAVE Affidavit and Secure Verifiable Document Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor’s legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to O.C.G.A. § 16-10-71), a form of which is attached hereto as Exhibit “F”, and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor’s legal status, to the City either in person or electronically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A. § 50-36-1). M. Records, Reports and Audits (1) Records: (a) Records shall be established and maintained by the Contractor in accordance with requirements prescribed by the City with respect to all matters covered by this Agreement. Except as otherwise authorized, such records shall be maintained for a period of three years from the date that final payment is made under this Agreement. Furthermore, records that are the subject of audit findings shall be retained for three years or until such audit findings have been resolved, whichever is later. (b) All costs shall be supported by properly executed payrolls, time records, invoices, contracts, or vouchers, or other official documentation evidencing in proper detail the nature and propriety of the charges. All checks, payrolls, invoices, contracts, vouchers, orders or other accounting documents pertaining in whole or in part to this Agreement shall be clearly identified and readily accessible. (2) Reports and Information: Upon request, the Contractor shall furnish to the City any and all statements, records, reports, data and information related to matters covered by this Agreement in the form requested by the City. (3) Audits and Inspections: At any time during normal business hours and as often as the City may deem necessary, there shall be made available to the City for examination all records with respect to all matters covered by this Agreement. The Contractor will permit the City to audit, examine, and make excerpts or transcripts from such records, and to audit all contracts, invoices, materials, payrolls, records of personnel, conditions of employment and or data relating to all matters covered by this Agreement. N. Conflicts of Interest Contractor agrees that it shall not engage in any activity or conduct that would result in a violation of the City of Milton Code of Ethics. O. Confidentiality Contractor acknowledges that it may receive confidential information of the City and that it will protect the confidentiality of any such confidential information and will require any of its subcontractors, consultants, and/or staff to likewise protect such confidential information. The Contractor agrees that confidential information it receives or such reports, information, opinions or conclusions that Contractor creates under this Agreement shall not be made available to, or discussed with, any individual or organization, including the news media, without prior written approval of the City. The Contractor shall exercise reasonable precautions to prevent the unauthorized disclosure and use of City information whether specifically deemed confidential or not. P. Licenses, Certifications and Permits The Contractor covenants and declares that it has obtained all diplomas, certificates, licenses, permits or the like required of the Contractor by any and all national, state, regional, county, local boards, agencies, commissions, committees or other regulatory bodies in order to perform the services contracted for under this Agreement. All work performed by Contractor under this Agreement shall be in accordance with applicable legal requirements and shall meet the standard of quality ordinarily expected of competent professionals. Q. Key Personnel All of the individuals identified in Exhibit “G” are necessary for the successful prosecution of the Work due to their unique expertise and depth and breadth of experience. There shall be no change in Contractor’s Project Manager or members of the project team, as listed in Exhibit “G”, without written approval of the City. Contractor recognizes that the composition of this team was instrumental in the City’s decision to award the work to Contractor and that compelling reasons for substituting these individuals must be demonstrated for the City’s consent to be granted. Any substitutes shall be persons of comparable or superior expertise and experience. Failure to comply with the provisions of this section shall constitute a material breach of Contractor’s obligations under this Agreement and shall be grounds for termination. Contractor shall not subcontract with any third party for the performance of any portion of the Work without the prior written consent of the City. Contractor shall be solely responsible for any such subcontractors in terms of performance and compensation. R. Authority to Contract The Contractor covenants and declares that it has obtained all necessary approvals of its board of directors, stockholders, general partners, limited partners or similar authorities to simultaneously execute and bind Contractor to the terms of this Agreement, if applicable. S. Ownership of Work All reports, designs, drawings, plans, specifications, schedules, work product and other materials prepared or in the process of being prepared for the services to be performed by the Contractor (“materials”) shall be the property of the City and the City shall be entitled to full access and copies of all such materials. Any such materials remaining in the hands of the Contractor or subcontractor upon completion or termination of the work shall be delivered immediately to the City. The Contractor assumes all risk of loss, damage or destruction of or to such materials. If any materials are lost, damaged or destroyed before final delivery to the City, the Contractor shall replace them at its own expense. Any and all copyrightable subject matter in all materials is hereby assigned to the City and the Contractor agrees to execute any additional documents that may be necessary to evidence such assignment. T. Meetings The Contractor is required to meet with the City’s personnel, or designated representatives, to resolve technical or contractual problems that may occur during the term of the contract, at no additional cost to the City. Meetings will occur as problems arise and will be coordinated by the City. The Contractor will be given a minimum of three full working days notice of meeting date, time, and location. Face-to-face meetings are desired. However, at the Contractor’s option and expense, a conference call meeting may be substituted. Consistent failure to participate in problem resolution meetings, two consecutive missed or rescheduled meetings, or to make a good faith effort to resolv e problems, may result in termination of the contract. Section 8 Covenants of the City A. Right of Entry The City shall provide for right of entry for Contractor and all necessary equipment. B. City’s Representative Sara Leader shall be authorized to act on the City’s behalf with respect to the Work as the City’s designated representative Section 9 Warranty Except as may be otherwise specified or agreed, the Contractor shall repair all defects in materials, equipment, or workmanship appearing within one year from the date of Final Completion of the Project at no additional cost to the City. An inspection shall be conducted by the City or its representative(s) near the completion of the one-year general warranty period to identify any issues that must be resolved by the Contractor. Section 10 Termination A. The City may terminate this Agreement for convenience at any time upon written notice to Contractor. In the event of a termination for convenience, Contractor shall take immediate steps to terminate work as quickly and effectively as possible and shall terminate all commitments to third-parties unless otherwise instructed by the City. Provided that no damages are due to the City for Contractor’s failure to perform in accordance with this Agreement, the City shall pay Contractor for work performed to date in accordance with Section 5 herein. The City shall have no further liability to Contractor for such termination. B. The City may terminate this Agreement for cause if Contractor breaches any material provision of this Agreement. The City shall give Contractor seven (7) days written notice of its intent to terminate the Agreement and the reasons therefore, and, if Contractor, or its Surety, fails to cure the default within that period, the termination shall take place without further notice. The City shall then make alternative arrangements for completion of the Project and deduct the cost of completion from the unpaid Contract Price. The City will make no payment to the Contractor or its Surety until all costs of completing the Project are paid. If the unpaid balance of the amount due the Contractor, according to this agreement, exceeds the cost of finishing the Project, the Contractor or its Surety will receive the applicable funds due. If the costs of completing the Project exceed the unpaid balance, the Contractor or its Surety will pay the difference to the City. C. If the City terminates this Agreement for cause, and it is later determined that the City did not have grounds to do so, the termination will be treated as a termination for convenience under the terms of this Section (A) above. D. Upon termination, the Contractor shall: (1) promptly discontinue all services affected, unless the notice directs otherwise; and (2) promptly deliver to the City all data, drawings, reports, summaries, and such other information and materials as may have been generated or used by the Contractor in performing this Agreement, whether completed or in process, in the form specified by the City. E. The rights and remedies of the City and the Contractor provided in this Section are in addition to any other rights and remedies provided under this Agreement or at law or in equity. Section 11 Miscellaneous A. Complete Agreement. This Agreement contains all of the understandings and agreements of whatsoever kind and nature existing between the parties hereto with respect to the subject matter contained herein. B. Governing Law. This Agreement shall be governed by and construed un der the laws of the State of Georgia. C. Counterparts. This Agreement may be executed in any number of counterparts, each of which shall be deemed to be an original, but all of which together shall constitute one and the same instrument. D. Invalidity of Provisions. Should any part of this Agreement for any reason be declared by any court of competent jurisdiction to be invalid, such decision shall not affect the validity of any remaining portion, which remaining portion shall continue in full force and effect as if this Agreement had been executed with the invalid portion hereof eliminated, it being the intention of the parties that they would have executed the remaining portion of this Agreement without including any such part, parts or portions which may for any reason be hereafter declared invalid. E. Notice. All notices requests, demands and other communications hereunder shall be in writing and shall be deemed received, and shall be effective when personally delivered or on the third day after the postmark date when mailed by certified mail, postage prepaid, return receipt requested or upon actual delivery when sent via national overnight commercial carrier to the parties at the addresses given below, unless a substitute address shall first be furnished to the other parties by written notice in accordance herewith: NOTICE TO CITY shall be sent to: City of Milton Attn: City Manager 13000 Deerfield Parkway, Suite 107F Milton, Georgia 30004 NOTICE TO CONTRACTOR shall be sent to: [INSERT COMPANY CONTACT INFORMATION] F. Sovereign Immunity. Nothing contained in this Agreement shall be construed to be a waiver of the City’s sovereign immunity or any individual’s qualified good faith or official immunities. G. Force Majeure. Neither the City nor Contractor shall be liable for their respective non-negligent or non-willful failure to perform or shall be deemed in default with respect to the failure to perform (or cure a failure to perform) any of their respective duties or obligations under this Agreement or for any delay in such performance due to: (i) any cause beyond their respective reasonable control; (ii) any act of God; (iii) any change in applicable governmental rules or regulations rendering the performance of any portion of this Agreement legally impossible; (iv) earthquake, fire, explosion or flood; (v) strike or labor dispute, excluding strikes or labor disputes by employees and/or agents of Contractor; (vi) delay or failure to act by any governmental or military authority; or (vii) any war, hostility, embargo, sabotage, civil disturbance, riot, insurrection or invasion. In such event, the time for performance shall be extended by an amount of time equal to the period of delay caused by such acts and all other obligations shall remain intact. H. Headings. All headings herein are inserted only for convenience and ease of reference and are not to be considered in the construction or interpretation of any provision of this Agreement. IN WITNESS WHEREOF, the parties have caused this Agreement to be executed under seal as of the date first above written. [SIGNATURES ON FOLLOWING PAGE] Attorney Approval___________________ Baldwin Paving Company, Inc. ___________________________________ John B. Harrison, President [AFFIX CORPORATE SEAL] SIGNED, SEALED, AND DELIVERED In the presence of: _____________________________ Attest: Katherine D. Dewitt, Secretary _____________________________ Notary Public [NOTARY SEAL] My Commission Expires: __________________ MILTON CITY COUNCIL: Joe Lockwood, Mayor ___________________________________ [CITY SEAL] SIGNED, SEALED, AND DELIVERED In the presence of: _____________________________ Witness _____________________________ Notary Public [NOTARY SEAL] My Commission Expires: __________________ EXHIBIT “A” REQUEST FOR BID EXHIBIT “B” BID FROM CONTRACTOR EXHIBIT “C” BONDS PAYMENT BOND CITY OF MILTON, GEORGIA KNOW ALL MEN BY THESE PRESENTS THAT Baldwin Paving Company, Inc. (as CONTRACTOR, hereinafter referred to as the “Principal”), and ______________________ _________________________________________(as SURETY COMPANY, hereinafter referred to as the “CONTRACTOR’S SURETY”), are held and firmly bound unto the City of Milton, Georgia (as OWNER, hereinafter referred to as the “City”), for the use and benefit of any “Claimant,” as hereinafter defined, in the sum of $374,450.00 (Three Hundred Seventy Four Thousand Four Hundred and Fifty dollars) lawful money of the United States of America, for the payment of which the Principal and the Contractor’s Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has entered, or is about to enter, into a certain written agreement with the City, dated , which is incorporated herein by reference in its entirety (hereinafter referred to as the “CONTRACT”), for the construction of a project known as BETHANY BEND AT COGBURN ROAD INTERSECTION IMPROVEMENTS (hereinafter referred to as “the PROJECT”). NOW THEREFORE, the condition of this obligation is such that if the Principal shall promptly make payment to any Claimant, as hereinafter defined, for all labor, services and materials used or reasonably required for use in the performance of the Contract, then this obligation shall be void; otherwise to remain in full force and effect. A “Claimant” shall be defined herein as any Subcontractor, person, Party, partnership, corporation or other entity furnishing labor, services or materials used or reasonably required for use in the performance of the Contract, without regard to whether such labor, services or materials were sold, leased or rented, and without regard to whether such Claimant is or is not in privity of the Contract with the Principal or any Subcontractor performing Work on the Project. In the event of any claim made by the Claimant against the City, or the filing of a Lien against the property of the City affected by the Contract, the Contractor’s Surety shall either settle or resolve the Claim and shall remove any such Lien by bond or otherwise as provided in the Contract. The Parties further expressly agree that any action on this Bond may be brought within the time allowed by Georgia law for suit on contracts under seal. IN WITNESS WHEREOF, the Principal and Contractor’s Surety have hereunto affixed their corporate seals and caused this obligation to be signed by their duly authorized officers on this day of , 2012. Baldwin Paving Company, Inc. By: John B. Harrison, President (SEAL) (Signatures Continued on Next Page) Attest: ______________________ Katherine D. Dewitt, Secretary Date:__________________ [AFFIX CORPORATE SEAL (Name of Contractor’s Surety) By: Title: (SEAL) Attest: _____________________ Date:_________________ (ATTACH SURETY’S POWER OF ATTORNEY) PERFORMANCE BOND CITY OF MILTON, GEORGIA KNOW ALL MEN BY THESE PRESENTS THAT Baldwin Paving Company, Inc. (as CONTRACTOR, hereinafter referred to as the “Principal”), and (as SURETY COMPANY, hereinafter referred to as the “CONTRACTOR’S SURETY”), are held and firmly bound unto the City of Milton, Georgia (as OWNER, hereinafter referred to as the “City”), for the use and benefit of any “Claimant,” as hereinafter defined, in the sum of $374,450.00 (Three Hundred Seventy Four Thousand Four Hundred and Fifty dollars)lawful money of the United States of America, for the payment of which the Principal and the Contractor’s Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has entered, or is about to enter, into a certain written agreement with the City, dated the of , 2012 which is incorporated herein by reference in its entirety (hereinafter referred to as the “CONTRACT”), for the construction of a project known as BETHANY BEND AT COGBURN ROAD INTERSECTION IMPROVEMENTS, (hereinafter referred to as “the PROJECT”). NOW THEREFORE, the conditions of this obligation are as follows: 1. That if the Principal shall fully and completely perform each and all of the terms, provisions and requirements of the Contract, including and during the period of any warranties or guarantees required thereunder, and all modifications, amendments, changes, deletions, additions, and alterations thereto that may 24 hereafter be made, and if the Principal and the Contractor’s Surety shall indemnify and hold harmless the City from any and all losses, liability and damages, claims, judgments, liens, costs and fees of every description, including but not limited to, any damages for delay, which the City may incur, sustain or suffer by reason of the failure or default on the part of the Principal in the performance of any and all of the terms, provisions and requirements of the Contract, including all modifications, amendments, changes, deletions, additions, and alterations thereto and any warranties or guarantees required thereunder, then this obligation shall be void; otherwise to remain in full force and effect; 2. In the event of a failure of performance of the Contract by the Principal, which shall include, but not be limited to, any breach of default of the Contract: a. The Contractor’s Surety shall commence performance of its obligations and undertakings under this Bond no later than thirty (30) days after written notice from the City to the Contractor’s Surety; and b. The means, method or procedure by which the Contractor’s Surety undertakes to perform its obligations under this Bond shall be subject to the advance written approval of the City. The Contractor’s Surety hereby waives notice of any and all modifications, omissions, additions, changes and advance payments or deferred payments in or about the Contract, and agrees that the obligations undertaken by this Bond shall not be impaired in any manner by reason of any such modifications, omissions, additions, changes, and advance payments or deferred payments. The Parties further expressly agree that any action on this Bond may be brought within the time allowed by Georgia law for suit on contracts under seal. 25 IN WITNESS WHEREOF, the principal and Contractor’s Surety have hereunto affixed their corporate seals and caused this obligation to be signed by their duly authorized officers or attorneys-in-fact, this day of , 2012. Baldwin Paving Company, Inc. By: ___________ John B. Harrison, President (SEAL) Attest: _____________________ Katherine D. Dewitt, Secretary Date:_________________ [AFFIX CORPORATE SEAL] (Name of Contractor’s Surety) By:____ _____ Title: (SEAL) Attest: _____________________ Date:_________________ (ATTACH SURETY’S POWER OF ATTORNEY) 26 MAINTENANCE BOND CITY OF MILTON, GEORGIA KNOW ALL MEN BY THESE PRESENTS THAT Baldwin Paving Company, Inc. (as CONTRACTOR, hereinafter referred to as the “Principal” located at [FIRM ADDRESS], and _________________________ (as SURETY COMPANY, hereinafter referred to as the “Contractor’s Surety”), are held and firmly bound unto the City of Milton, Georgia (as OWNER, hereinafter referred to as the “City”), for the use and benefit of the City for maintenance of Improvements as described below in the sum of ____________________ Dollars ($__________), lawful money of the United States of America, for the payment of which the Principal and the Contractor’s Surety bind themselves, their heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. WHEREAS, the Principal has entered, or is about to enter, into a certain written Agreement with the City, dated ____________________, which is incorporated herein by reference in its entirety (hereinafter referred to as the “Agreement”), for the construction of certain Improvements as contemplated by that Project for BETHANY BEND AT COGBURN ROAD INTERSECTION IMPROVEMENTS (hereinafter referred to as the “Project”); and WHEREAS, said Project is to be approved by the City of Milton, under the terms that a maintenance bond is required of said Principal and good and sufficient surety payable to the City, and conditioned that the Principal shall, for a period of five (5) years beginning on ______________, maintain all improvements (“Improvements”) involved in said Project in accordance with all applicable federal and state laws, with the Agreement, and with all applicable City regulations, including but not limited to the Code of Ordinances for the City of 27 Milton, Georgia, in force as of the date of said approval. NOW THEREFORE, the conditions of this obligation are as follows: 1. That if the Principal shall maintain the Improvements as described above; and if the Principal and the Contractor’s Surety shall indemnify and hold harmless the City from any and all losses, liability and damages, claims, judgments, liens, costs and fees of every description, including but not limited to, any damages for costs of maintenance of Improvements, which the City may incur, sustain or suffer by reason of the failure or default on the part of the Principal in the performance of any and all of the terms, provisions and requirements described herein, then this obligation shall be void; otherwise to remain in full force and effect; 2. In the event of a failure of performance by the Principal; a. The Contractor’s Surety shall commence performance of its obligations and undertakings under this Bond no later than thirty (30) days after written notice from the City to the Contractor’s Surety; b. The means, method or procedure by which the Contractor’s Surety undertakes to perform its obligations under this Bond shall be subject to the advance written approval of the City. The Parties further expressly agree that any action on this Bond may be brought within the time allowed by Georgia law for suit on contracts under seal. IN WITNESS WHEREOF, the Principal and Contractor’s Surety have hereunto affixed their corporate seals and caused this obligation to be signed by their duly authorized officers on this ____ day of __________, 20___. [SIGNATURES ON THE FOLLOWING PAGE] 28 Baldwin Paving Company, Inc. By: ______________________________ John B. Harrison, President (SEAL) Attest: By:______________________________ Katherine D. Dewitt, Secretary Date: ____________________ [AFFIX CORPORATE SEAL] (Name of Contractor’s Surety) By: ______________________________ Name, Title:________________________ (SEAL) Attest: By:______________________________ Name, Title:_______________________ Date: ____________________ (ATTACH SURETY’S POWER OF ATTORNEY) 29 EXHIBIT “D” STATE OF GEORGIA CITY OF MILTON CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-.08 in the form attached hereto as Exhibit “E” Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perform such service. ________________________________________ EEV / Basic Pilot Program User Identification Number ________________________________________ BY: Authorized Officer or Agent Date Baldwin Paving Company, Inc. _________________________________________ Title of Authorized Officer or Agent of Contractor _________________________________________ Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE _____ DAY OF ______________________, 2012 ________________________________________ Notary Public My Commission Expires: ___________________ 30 EXHIBIT “E” STATE OF GEORGIA CITY OF MILTON SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with Baldwin Paving Company, Inc. on behalf of the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. ________________________________________ EEV / Basic Pilot Program User Identification Number ________________________________________ BY: Authorized Officer or Agent Date ________________________________________ Subcontractor Name _________________________________________ Title of Authorized Officer or Agent of Subcontractor _________________________________________ Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE _____ DAY OF ______________________, 2012 _________________________________________ Notary Public My Commission Expires: 31 EXHIBIT “F” STATE OF GEORGIA CITY OF MILTON SAVE Affidavit By executing this affidavit under oath, and as an applicant for a public benefit, as referenced in O.C.G.A. § 50-36-1, from the City of Milton, the undersigned applicant verifies one of the following with respect to my application for a public benefit: 1) _________ I am a United States citizen. 2) _________ I am a legal permanent resident of the United States. 3) _________I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is:____________________. The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 50-36-1(e)(1), with this affidavit. The secure and verifiable document provided with this affidavit can best be classified as: _______________________________________________________________________. In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute. Executed in ___________________ (city), __________________(state). ____________________________________ Signature of Applicant ____________________________________ Printed Name of Applicant SUBSCRIBED AND SWORN BEFORE ME ON THIS THE ___ DAY OF ___________, 20____ _________________________ NOTARY PUBLIC My Commission Expires: ____________________________________ 32 EXHIBIT “G” KEY PERSONNEL City of Milton 13000 Deerfield Parkway, Suite 107 Milton, GA 30004 [REVISED Staff Memo Minor subdivision plat approval memo- April 16 2012 (a)] To: Honorable Mayor and City Council Members From: Kathleen Field, Community Development Director Date: April 16, 2012 for Submission onto the May 7, 2012 City Council Meeting – Consent Agenda Agenda Item: Approval of Subdivision Plats CMO (City Manager’s Office) Recommendation: To approve the subdivision related plats and revisions stated below Background: The Milton Subdivision Regulations requires that the Mayor and City Council approve all Final Plats, Final Plat Re-recording, Revisions, and Minor Plats once the matter has been reviewed and certified by the Community Development Director in according with the Subdivision Regulations. Discussion: The following Final Plats, Final Plat Re -recording, Revisions, and Minor Plats have been reviewed and certified by the Community Development Director in accordance with the City’s Subdivision Regulations: Name of Development Action Comments Six Hills HOA Revision Revise property lines between common area and lot 1 Milton Preserve Revision Add easement for landscape at entrance The Heart of Crabapple Minor plat Divide into two lots Inner Quest Church Combo Plat Combine three lots into one Roxbury Estates Revision Change to private streets Hidden Forest Revision Revise property lines and setbacks according to V10-017 and ZM10-02 The Manor Final Plat Add two lots Kingsley Estates, Phase 1-2A Final Plat Add six lots Concurrent Review: Chris Lagerbloom, City Manager City of Milton 13000 Deerfield Parkway Suite 107C Milton, Georgia 30004 To: Honorable Mayor and City Council Members From: John Rebar, Parks and Recreation Director Submission Date: April 25, 2012 Meeting Date: May 7, 2012 Agenda Item: Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and YMCA of Metropolitan Atlanta Background: The Parks and Recreation Department is eager to continue offering programs and additional services to the citizens of Milton. Many of these programs may be offered by outside providers through an agreement with the City of Milton based on a submitted program proposal rather than offering these programs through a paid independent contractor or a paid employee of the City. Discussion: The Parks and Recreation Department recommends entering into agreement with the YMCA of Metropolitan Atlanta provide miscellaneous recreation programs for our residents and visitors. Programs may include: Y Babysitting Y Junior CPR Y Junior World of Fun Y Book Club Y Cake Decorating Y Parents Morning Out A commission of 30% of all registration fees will be paid to the City of Milton two weeks following the end of registration. Non-resident fees will be collected by the provider and paid to the City at a rate of 50% more. Legal Review: Contract Template - Paul Higbee, Jarrard & Davis on February 23, 2012 Attachments: A Parks and Recreation Department Agreement between the City of Milton and YMCA of Metro Atlanta CITY OF MILTON PARKS & RECREATION DEPARTMENT AGREEMENT FOR OUTSIDE PROVIDERS THIS IS AN AGREEMENT, made this day of , 2012, between: THE CITY OF MILTON, a municipal corporation organized and operating under the laws of the State of Georgia, with a business address of 13000 Deerfield Parkway, Suite 107 A, MILTON, Georgia 30004, hereinafter referred to as the "CITY." and YOUNG MEN'S CHRISTIAN ASSOCIATION OF METROPOLITAN ATLANTA, INC., hereinafter referred to as "PROVIDER". CITY and PROVIDER may hereinafter collectively be referred to as "the Parties". In consideration of the mutual obligations of the Parties and for good and valuable consideration, the adequacy and receipt of which are hereby acknowledged, the Parties agree as follows: ARTICLE 1.0 PROVIDER's Services and Responsibilities 1.1 PROVIDER shall conduct services generally described as Recreation Classes at the following location: Sethwell Community Center, 2695 Hopewell Road, Milton GA 30004. 1.2 The PROVIDER's services shall be performed during the days and hours described in Exhibit "A," attached hereto and incorporated herein by reference. 1.3 The PROVIDER and The Director of the Parks & Recreation Department or his designee, hereinafter referred to as the "DEPARTMENT", will agree upon program schedules. PROVIDER agrees to submit a Program Request Form to the Coordinator for each program being proposed eight (8) weeks prior to the beginning of each session. 1.4 The fees charged to each participant will be as described in Exhibit "A" for residents of MILTON and a surcharge of 50% more for non-residents of MILTON. The entire balance of this surcharge for non-residents shall be paid to the CITY. 1.5 The PROVIDER warrants to CITY that it is not insolvent, it is not in bankruptcy proceedings or receivership, nor is it engaged in or threatened with any litigation or other legal or administrative proceedings or investigations of any kind which would have an adverse effect on its ability to perform its obligations under this Agreement. 1.6 The PROVIDER agrees that it shall be solely responsible for all costs and/or expenses associated with, or as a result of its operation under this Agreement. The PROVIDER stipulates and certifies that it is qualified to provide the programs it is hired 1 to provide, maintains the education and required licenses or permits necessary to provide the programs, and shall continue to maintain such licenses or permits during the term of this Agreement. 1.7 This Agreement is considered a non-exclusive Agreement between the Parties. The CITY shall have the right to purchase the same kind of services to be provided by the PROVIDER from other sources during the terns of this Agreement. The PROVIDER is not precluded from providing the same or similar services for other parties so long as such other engagements do not interfere with the PROVIDER'S provision of services to the CITY. 1.8 The .DEPARTMENT must approve any promotional material, flyers, and posters advertising the programs prior to its release. The following content and topics shall specifically be prohibited: sexually explicit materials, profanity, child pornography, alcoholic beverages, tobacco products, adult movies, adult booklvideo stores, adult entertainment establishments, massage parlors, pawn shops, and tattoo parlors or shops. 1.9 The PROVIDER shall not promote any privately owned business in a CITY park/facility or solicit any participant in a CITY park/facility activity for any privately owned business. The PROVIDER may not use said facilities to conduct personal business including workshops, clinics, seminars, camps, or any other activities that are outside the scope of service described in (Exhibit "A"). It is further understood that such action(s) may result in immediate termination of the Agreement and the forfeiture of all compensation due to the PROVIDER. 1.10 The PROVIDER shall abide by the policies, procedures, rules and regulations of the DEPARTMENT, the CITY, and the FULTON COUNTY BOARD OF EDUCATION as promulgated from time to time. PROVIDER understands and agrees that the DEPARTMENT shall have first Priority for use of CITYfacilities, notwithstanding anv other provisions of this Agreement 1.11 All assistants, substitutes, and subcontractors utilized by the PROVIDER must have prior written approval of the DEPARTMENT. 1.12 PROVIDER shall provide necessary supervisory personnel to ensure that the participants of the programs obey all applicable policies, procedures, Rules and Regulations. 1.13 The DEPARTMENT or CITY may require that the PROVIDER not be permitted to utilize specific assistants, substitutes, or subcontractors of PROVIDER who have failed to follow any policies, procedures, rules or regulations applicable to the use of the facility. 1.14 Although the CITY shall not control the PROVIDER's techniques, methods, procedures, or sequence of instruction, the PROVIDER will comply with the CITY's and DEPARTMENT's policies, rules, regulations and procedures, as well as those of the FULTON COUNTY BOARD OF EDUCATION, and shall not interfere with their operation, nor harm or damage the equipment or facilities afforded to PROVIDER for his/her programs, nor otherwise disrupt the other on-site activities being offered at such public facilities. 1.15 The PROVIDER also acknowledges that he or she is primarily responsible for the conduct of the participants in all programs under the PROVIDER's charge. 1.16 If the PROVIDER will be providing services directly with minor children without parental supervision, the PROVIDER shall, prior to commencing services under this Agreement, comply with the CITY's policy regarding criminal background screening. The CITY will furnish the PROVIDER with a background release form (Exhibit "B") for all the provider's counselors, coaches, volunteers, subcontractors, employees or any other individuals that will come in contact with a child, at the PROVIDER's sole expense. A Consent and Release Form to conduct a criminal background must be executed by any of PROVIDER's employees or any individual who will come in contact with a child at the CITY through PROVIDER or at PROVIDER's direction, such form authorizing the CITY to conduct a search of each such individual's criminal background. The result of such inquiry may be deemed acceptable by the CITY in its sole and complete discretion, and the CITY may reject any individual from participating in any program based upon such results. If the PROVIDER has recently had a background screening conducted by another agency, the CITY, at its sole discretion, may accept that background screening and waive the requirement of a new background screening. PROVIDER and its employees must also execute a Waiver and Release of Liability holding the CITY and FULTON COUNTY BOARD OF EDUCATION harmless. 1.17 The CITY shall require all participants in all programs to sign a Waiver and Release of Liability. ARTICLE 2.0 Equipment & Materials 2.1 All program materials and equipment needed or pertaining to the above stated programs will be provided by the PROVIDER at his/her own cost and expense. However, PROVIDER may require participants to obtain certain materials required in the programs by providing a list of such materials (with approximate costs) to the participants. If PROVIDER makes such materials available to participants, they must be sold at PROVIDER's cost. All equipment provided by the PROVIDER shall be used in strict accordance with equipment manufacturer's instructions and in accordance with all applicable laws. PROVIDER shall coordinate storage of goal posts with the principal of the school located at the facility. 2.2 The sale of merchandise is restricted to those materials utilized in and for the programs. Fundraising activities conducted by the PROVIDER will not be permitted. The 3 PROVIDER shall obtain the CITY's approval of any merchandise to be sold prior to its distribution or sale. 2.3 The CITY will provide no storage space to the PROVIDER, unless otherwise mutually agreed upon in a separate written agreement_ 2.4 Any supplies or equipment left at the facility will be the responsibility of the PROVIDER. The CITY will not be responsible for any lost, stolen, or broken equipment or supplies. 2.5 The PROVIDER shall inspect the premises and equipment offered to him/her for his/her proposed activity and if he or she finds anything wrong with the premises or equipment before each program commences that cannot be corrected immediately by the DEPARTMENT, the program shall be canceled and the matter reported to the DEPARTMENT for correction. If the PROVIDER elects to hold his/her programs in the facility provided, it will be presumed that the PROVIDER has inspected the premises and facilities and equipment provided for such programs and has accepted same as being safe and suitable for the use intended. ARTICLE 3.0 Program Size Minimums - 3.1 ACTIVE: Program sizes shall meet the minimum numbers of participants for each program as designated in Exhibit "A." ARTICLE 4.0 Compensation and Method of Payment 4.1 In consideration of the releases and indemnities contained herein and of the PROVIDER's services in connection with the programs and activities described herein, the CITY shall be entitled to 30% of the registration fees paid by all program participants to the PROVIDER, and the PROVIDER shall be entitled to 70% of such fees paid, exclusive of the 50% non-resident surcharge. The 50% non-resident surcharge is fully payable to the CITY and shall not be included in PROVIDER's gross income calculation. PROVIDER shall be entitled to retain all non -registration fees paid by participants to PROVIDER, i.e. PROVIDER membership fees and costs for uniforms and pictures to participants. 4.2 The PROVIDER agrees to collect all fees from participants, and the PROVIDER agrees to provide CITY with schedules of fees to be charged to participants in conformance with Exhibit "A". It is agreed that the PROVIDER's sole obligation shall be to collect the fees from the participants and to remit the 30% of the fees collected as well as all 50% non-resident surcharge amounts to the CITY with a pay -out report of all monies collected. Payment will be made to the CITY within fourteen (14) business days of the end of each month or session or program. whichever occurs first. W 4.3 It is the responsibility of the PROVIDER to pay all applicable local, state, and federal taxes associated with this Agreement, and to acquire and pay for all necessary permits, licenses, and insurance required for the execution of this Agreement. ARTICLE 5.0 Independent PROVIDER 5.1 This Agreement does not create an employee/employer relationship between the Parties. It is the intent of the Parties that the PROVIDER is an independent contractor under this Agreement and not a CITY employee for all purposes, including but not limited to, the application of the Fair Labor Standards Act minimum wage and overtime payments, Federal Insurance Contribution Act, the Social Security Act, the Federal Unemployment Tax Act, the provisions of the Internal Revenue Code, The State Workers Compensation Act, and the State unemployment insurance law. The PROVIDER shall retain sole and absolute discretion in the judgment of the manner and means of carrying out PROVIDER's activities and responsibilities hereunder. The PROVIDER agrees that it is a separate and independent enterprise from the CITY, that it had full opportunity to find other business, that it has made its own investment in its business, and that it will utilize a high level of skill necessary to perform the work required hereunder. This Agreement shall not be construed as creating any joint employment relationship between the PROVIDER and the CITY and the CITY will not be liable for any obligation incurred by PROVIDER, including but not limited to unpaid minimum wages or overtime premiums. 5.2 PROVIDER warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the PROVIDER to solicit or secure this Agreement, and that it has not paid or agreed to pay any person, company, corporation, individual or firm any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of this provision, the CITY shall have the right to terminate the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover the full amount of such fee, commission, percentage, gift or consideration. ARTICLE 6.0 Insurance 6.1 PROVIDER shall not provide any service until all insurance required under this paragraph has been obtained and approved by the CITY. 6.2 Certificates of Insurance. Certificates of Insurance reflecting evidence of the required insurance shall be filed with the CITY prior to the commencement of this Agreement. These Certificates shall contain a provision that coverages afforded under- these policies will not be cancelled until at least forty-five days (45) prior written notice has been given to the CITY. Policies shall be issued by companies authorized to do business under the laws of the State of Georgia. Financial Ratings must be not less than "A -VI" in the latest edition of "Best Key Rating Guide", published by A.M. Best Guide. 6.3 Insurance shall be in force until the obligations required to be fulfilled under the terms of the Agreement are satisfied. In the event the insurance certificate provided indicated that the insurance shall terminate and lapse during the period of this Agreement, then in that event, the PROVIDER shall furnish, at least thirty (30) days prior to the expiration of the date of such insurance, a renewed Certificate of Insurance as proof that equal and like coverage for the balance of the period of the Agreement and extension thereunder is in effect. The PROVIDER shall not provide any service pursuant to this Agreement unless all required insurance remains in full force and effect. 6.4 Commercial General Liability insurance to cover liability bodily injury and property damage. Exposures to be covered are: premises, operations, products/completed operations, and certain contracts. Coverage must be written on an occurrence basis, with the following limits of liability: $1,000,000 Combined Single Limit — each occurrence $2,000,000 Combined Single Limit --- general aggregate $1,000,000 Personal Injury $1,000,000 Products/Completed Operations Aggregate PROVIDER shall have its insurer name the City of MILTON as an additional insured on its General Liability policy. 6.5 Worker's Compc nsation insurance shall be maintained during the life of this Agreement to comply with the statutory limits for all employees, and in the case any work is sublet, the PROVIDER shall require the subcontractor(s) similarly provide Workers Compensation Insurance for all the latter's employees unless and until such employees are covered by the protection afforded by the PROVIDER. The PROVIDER and his subcontractors shall maintain during the life of this Agreement Employers Liability Insurance. The following limits must be maintained: A. Workers Compensation Statutory B. Employer's Liability $100,000 each accident $500,000 Disease -policy limit $100,000 Disease -each employee If PROVIDER or its subcontractor claims to be exempt from this requirement, PROVIDER shall provide CITY proof of such exemption along with a written request for CITY to exempt PROVIDER, written on PROVIDER or subcontractor's letterhead. 6.6 PROVIDER shall also maintain Auto Liability and Directors and Officers insurance with limits reasonably acceptable to CITY during the term of this Agreement. 6.7 The CITY and the Fulton County Board of Education shall each be named as an additional insured and loss payee on all policies required by this Agreement. ARTICLE 7.0 Term and Termination 7.1 After a two (2) month trial period, the programs will be evaluated by the DEPARTMENT, and the remainder of this Agreement will either be terminated or continue in full force and effect. If at any time after the two (Z) month evaluation, program enrollment should fall below the required minimum, the PROVIDER will be allotted four (4) weeks to bring enrollment up to the required minimum. The programs will be reevaluated and execution or termination of the contract will be determined by the DEPARTMENT. 7.2 The term of this Agreement shall commence upon the date of execution hereof and shall remain in effect for a period of one (1) year from the date of execution of this Agreement by the CITY, unless terminated sooner as provided in this Article. Renewal of this Agreement beyond the one (1) year term shall require the mutual written agreement of the CITY and PROVIDER. 7.3 This Agreement may be terminated by the CITY for convenience upon giving of at least thirty (30) days prior written notice of termination to the PROVIDER at the PROVIDER's address set forth herein at the sole and exclusive discretion of the CITY. This Agreement may be terminated by the City immediately by written notice to PROVIDER upon any willful, reckless, or grossly negligent act or omission by PROVIDER or any of its officers, agents, employees, or volunteers. 7.4 This Agreement may be terminated by PROVIDER upon giving at least thirty (30) days written notice of termination to the CITY. 7.5 PROVIDER must notify the DEPARTMENT in writing of any program cancellations at least ten (10) business days prior to the scheduled cancellation. 7.5 CITY reserves the right to cancel or reschedule any of the PROVIDER's programs, in the case of scheduling conflicts or other emergencies, as determined by the DEPARTMENT. ARTICLE 8.0 Indemnification 8.1 PROVIDER agrees to indemnify and hold harmless the CITY and the FULTON COUNTY BOARD OF EDUCATION, their trustees, elected and appointed officers, agents, servants and employees, from and against any and all claims, demands, or causes of action of whatsoever kind of nature, and the resulting losses, costs, expenses, reasonable attorneys' fees, including paralegal fees, liabilities, damages, orders, judgments, or decrees, sustained by the CITY, the FULTON COUNTY BOARD OF EDUCATION, or any third party arising out of, or by reason of, or resulting from the will 7 full or negligent acts, errors, or omissions of the PROVIDER or its agents, officers, volunteers or employees. 8.2 The Parties understand and agree that the covenants and representations relating to this indemnification provision shall survive the term of this Agreement and continue in full force and effect as to the PROVIDER's responsibility to indemnify. ARTICLE 9.0 Americans With Disabilities Act 9.1 PROVIDER shall not discriminate against any person in its operation and activities in its use or expenditure of the funds or any portion of the funds provided by this Agreement and shall affirmatively comply with all applicable provisions of the Americans With Disabilities Act ("ADA"), in the programs while providing any services funded in whole or in part by the CITY, including Titles I and II of the ADA and all applicable regulations, guidelines, and standards. 9.2 PROVIDER's decisions regarding the delivery of services under this Agreement shall be made without regard to or consideration of race, age, religion, color, gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation, or any other factor which cannot be lawfully or appropriately used as a basis for delivery of service. ARTICLE 10.0 Miscellaneous 10.1 No modification, amendment, or alteration of the terms and conditions contained shall be effective unless contained in a written document executed with the same formality and equal dignity herewith. 10.2 This Agreement is non -transferable or assignable, and PROVIDER agrees not to transfer or assign the performance of services called for in the Agreement. 10.3 This Agreement sets forth the full and complete understanding of the Parties as of the effective date, and supersedes any and all negotiations, agreements, and representations made or dated prior to this Agreement. 10.4 The PROVIDER shall pay reasonable attorney's fees to the City should the City be required to incur attorney's fees in enforcing the provisions of this Agreement. 10.5 Time is of the essence of this Agreement. 10.5 Each of the individuals who executes this Agreement agrees and represents that he is authorized to execute this Agreement on behalf of the respective entity. Accordingly, the City and PROVIDER both waive and release any right to contest the enforceability of this Agreement based upon the execution and/or approval thereof. 10.7 It is the policy of City that unauthorized aliens shall not be employed to perform work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the PROVIDER shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and "D" that it and its subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perform work on the City contract to ensure that no unauthorized aliens will be employed. The City Manager or his/her designee shall be authorized to conduct an inspection of the PROVIDER's and its subcontractors' verification process to determine that the verification was correct and complete. The PROVIDER and its subcontractors shall retain all documents and records of its verification process for a period of three (3) years following completion of the contract. This requirement shall apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. Compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 is mandatory. PROVIDER's compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300- 10-1-.02 shall be attested by the execution of the contractor's affidavit attached as Exhibit "C .15 Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to O.C.G.A. § 16-10-71), a form of which is attached hereto as Exhibit "E", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A. § 50-36-1). 0j IN WITNESS OF THE FOREGOING, the Parties have set their hands and seal the day and year first written. above. CITY: ATTEST: SUDIE GORDON, CITY CLERK WITNESS: BY: BY: JOE LOCKWOOD, MAYOR EDWARD MUNSTER, PRESIDENT [AFFIX CORPORATE SEAL] 10 EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals_ Use one farm per program. Name of Program: Y Babysitting Participant Ages: 10-17 Day/s of the week program is offered: one Saturday a month Time of Program: 9:00 am to 4:00 pm Program Dates: starting August 2012 to July 2013 Program Fee: Resident: $70.00 Non Resident: $105.00 per class Program Enrollment: Minimum 4 _ Maximum: 10 Materials to be supplied by participants: Snacks, drink and lunch Materials to be supplied by PROVIDER: Participant Manual along with all supplies needed to run the program will be provided by the provider. Materials to be supplied by the City of MILTON: Facility (rent _cost _to be paid by the provider) w Additional Program Requirements: PROVIDER (s)Name. Ed_Isakson/Alpharetta Family YMCA Address: 3655 Preston Ridge Road City/State/Zip Code: Alpharetta, GA 30005 Phone Number: (Day) 770-664-1220(Evening) 770-664-1220 (E-mail): kimn@ymccatlant.org (Fax) 770-664-0337 Minimum Reauirements: 1,000,000 General Liability Insurance Office Use Only. Program Rate:$ # of programs in Session: ii" Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form_ per program. Name of Program: Y Jr. CPR Participant Ages: 10-17 Day/s of the week program is offered: one Saturday a month Time of Program: 1:00 pm to 4:00 pm Program Dates: starting August 2012 to July 2013 Program Fee: Resident: $25.00 Non Resident: $37.50 per class Program Enrollment: Minimum 4 Maximum: 10 Materials to be supplied by participants: Must take Babysitting course first. Snacks, drink and lunch. Materials to be supplied by PROVIDER: Participant Manual along with all supplies needed to run the program will be provided by the provider. Materials to be supplied by the City of MILTON: Facility (rent cost to be paid by the provider) Additional Program Requirements: PRCVIDERCOName: Ed lsakson/AI hhaaretta Family YMCA Address: 3655 Preston Ridge Road City/State/Zip Code: Alpharetta, GA 30005 Phone Number: (Day) 770--664-1220(Evening) 770-664-1220 (E-mail): kimn@ymccatlant.org (Fax) 770-664-0337 Minimum Reauirements: 1,000,000 General Liability Insurance Office Use Only. Program Rate:$ # of programs in Session: Fee/Program: I 5 i EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals_ Use one form per program. Name of Program: Y Jr. World of Fun Participant Ages: 5-12 Day/s of the week program is offered: Tuesdays Time of Program: 3:30 pm to 4:30 pm Program Dates: starting August 2012 to May 2013 Program Fee: Resident: $75.00 Non Resident: $112.50 per class per six week session Program Enrollment: Minimum 7 Maximum: 15 Materials to be supplied by participants: Materials to be supplied by PROVIDER: Recreational equipment provided to promote physical fitness and social skills for special need individuals. All supplies needed to _run the program will be provided by the provider. Materials to be supplied by the City of MILTON: Facility (rent cost to be paid by the provider) Additional Program Requirements: Parent/Guardian must complete child special needs evaluation form before participating_in_program. PROVIDER(`s}Name: Ed Isakson/Alpharetta Family YMCA Address: 3655 Preston Ridge Road City/State/Zip Code: Alpharetta, GA 3000S Phone Number: (Day) 770-664-1220(Evening) 770-664-1220 (E-mail). kimn@ymccatlant.org (Fax) 770-664-0337 Minimum Reouirements: 1,000,000 General Liability Insurance Office use only: Program Rate:$ # of programs in Session: 7 r Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one farm per program. Name of Program: Y Book Club Participant Ages: 18+ Day/s of the week program is offered: 1St Friday of the month Time of Program: 10:30 am to 12:00 pm Program Dates: starting September 2012 to May 2013 Program Fee: Resident: Free Non Resident: CDM residents only Program Enrollment: Minimum Maximum: Materials to be supplied by participants: book of the month Materials to be supplied by PROVIDER: Volunteer to lead grou Materials to be supplied by the City of MILTON: Facility (rent cost to be paid by the provider Additional Program Requirements: PROVIDERCOName: Ed Isakson/Alpharetta Family YMCA Address: 3 655 Preston Ridge Road City/State/Zip Code: Alpharetta, GA 30005 Phone Number: (Day) 770-664-1220(Evening) 770-664-1220 (E-mail): kimn@ymccatlant.org (Fax) 770-664-0337 Minimum Requirements: 1,000,000 General Liability Insurance Office Use Only. Program Rate:$ # of programs in Session: S Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: Y Cake Decorating Participant Ages: 18 + Day/s of the week program is offered: 1 day a month Time of Program: 10:00 am to 11:00 am Program Dates: starting August 2012 to July 2013 Program Fee: Resident: $12.00 Non Resident: $19.50 per class or Three classes Resident: $35 Non Resident: $52.50 Program Enrollment: Minimum 3 Maximum: 15 Materials to be supplied by participants: Cake decorating kit Materials to be supplied by PROVIDER: Instructor's supplies will be provided by the provider. Materials to be supplied by the City of MILTON: Facility gent cost to b_p_paidL by the provider) Additional Program Requirements: PROVIDER Cs) Name: Ed Isakson/Alpharetta Family YMCA Address: 3655 Preston Ridge Road City/State/Zip Code: Alpharetta, GA 30005 Phone Number: (Day) 770-664-1220(Evening) 770-664-1220 (E-mail): kinin@ymccatlant.org (Fax) 770-654-0337 Minimum Reauirements: 1,000,000 General Liability Insurance office Use Only.- Program nly: Program Rate:$ # of programs in Session: Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program, Name of Program: Y Parents Morning Out Participant Ages: 2 1/2 - Day/s of the week program is offered: Monday/Wednesday Time of Program: 9:00 am to 1:00 pm Program Dates: August 2012 to May 2013 (follows Fulton County School schedule Program Fee: Resident: $51.00 Non Resident: $76.50 per week Program Enrollment: Minimum 8 Maximum: 20 Materials to be supplied by participants: Snacks, drink and lunch Materials to be supplied by PROVIDER: All supplies needed to run the program will be ,provided by the provider — arts & crafts, books, outside equipment, toys, etc.. Materials to be supplied by the City of MILTON: Facility (rent cost to be paid by the provider Additional Program Requirements: PROVIDER Cs) Name: Ed Isakson/Alpharetta Family YMCA Address: 3655 Preston Ridge Road City/State/Zip Code: Alpharetta, GA 30005 Phone Number: (Day) 770-664-1220(Evening) 770-664-1220 (E-mail): kimn@ymccatlant.orq (Fax) 770-664-0337 Minimum Requirements: 1,000,000 General Liability Insurance Office Use Only. - Program Rate:$ # of programs in Session: S Fee/Program: 1) This Request Is For: (Check onlyone) Q Employment o Military ❑ Licensing o Personal Use a Other Use Not Listed (E) * International Travel n Firefighters Employment (E) * Prospective AdoptivelFoster Parents {E + Nate & 2 copies} * Employment Working With The Elderly (N) * Employment At A Child Care Facility (W) X Volunteer working with Children (W) o Employment Working With The Mentally Ill (m) • Police Ride Along Request (C) o Police Department VendorlCon tractor {C) 2) A History is Requested On The Following Person: Name: Social Security Number: Fara Sex - kiddie Race: o White o Bek oftan o American Indian o Unknawn/bther Date Of Birth. Phone Number: - - 01W y— El Check h Request is For Yourself And Proceed To Section 5 At The Bottom Of This Page. 3) Person Requesting Criminal History: Name: City of MiltonlCompany Name (TBD) Address: 13000 Deerfield Parkway Suite 107 Phone: 678 242 2500 City!State,'Zip: Milton, GA 30004 d) Consent: This portion is to be used if the person requesting the criminal history is different than whom the criminal history is being inquired on (sections 11 & III above are not the same person). Third party notary is required, I hereby give my consent for my crimcal history to be nun and for the move named persm m sectton Elf to have access to it. MMI Seal. - t cv� n� 5) In making this request, I agree #hal the City of Mco Police Department, its employees, heirs. trustees. etc.. std in no way be heM at tMA for the use or misuse of this record. A photocopy of Utt release vrill be placed on ifle and is valid as an original hereof, even "h ase photocopy does not contain an onginal "nature, lr=mp;e� requests %Mll be denied. This report Is crosWered accurate at time of inquiry and may change at anytime. Qfhcial Use Only— fo Not Ma* Below This Line WNW 5& 11 Operator ARM Bate Submitted i Inquiry date I—/- 11 1 EXHIBIT "C" STATE OF GEORGIA CITY OF MILTON CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-.08 in the form attached hereto as Exhibit "D." Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perform such service. EEV l Basic Pilot Program User Identification Number BY: Authorized Officer or Agent Date Young Men's Christian Association of Metropolitan Atlanta, Inc. Title of Authorized Officer or Agent of Contractor Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF , 201 Notary Public My Commission Expires: 12 STATE OF GEORGIA CITY OF MILTON EXHIBIT "D" SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with Young Men's Christian Association of Metropolitan Atlanta, Inc. on behalf of the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. EEV 1 Basic Pilot Program User Identification Number BY: Authorized Officer or Agent Date [INSERT SUBCONTRACTOR NAME] Title of Authorized Officer or Agent of Subcontractor Printed Name of Authorized Officer or Agent SUBSCRIBER AND SWORN BEFORE ME ON THIS THE DAY OF , 201 Notary Public My Commission Expires: 13 EXHIBIT "E„ SAVE Affidavit By executing this affidavit under oath, and as an applicant for a public benefit, as referenced in O.C.G.A. § 50-36-1, from the City of Milton, the undersigned applicant verifies one of the following with respect to my application for a public benefit: 1) 1 am a United States citizen. 2) 1 am a legal permanent resident of the United States. 3) 1 am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verifies that he or she is 1$ years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 50-35-1(e)(1), with this affidavit. The secure and verifiable document provided with this affidavit can best be classified as: In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute. Executed in SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF , 20 NOTARY PUBLIC My Commission Expires: (city), (state). Signature of Applicant Printed Name of Applicant 14 CITY OF MILTON PARKS & RECREATION DEPARTMENT AGREEMENT FOR OUTSIDE PROVIDERS THIS IS AN AGREEMENT, made this day of , 2012, between: THE CITY OF MILTON, a municipal corporation organized and operating under the laws of the State of Georgia, with a business address of 13000 Deerfield Parkway, Suite 107 A, MILTON, Georgia 30004, hereinafter referred to as the "CITY." and YOUNG MEN'S CHRISTIAN ASSOCIATION OF METROPOLITAN ATLANTA, INC., hereinafter referred to as "PROVIDER". CITY and PROVIDER may hereinafter collectively be referred to as "the Parties". In consideration of the mutual obligations of the Parties and for good and valuable consideration, the adequacy and receipt of which are hereby acknowledged, the Parties agree as follows: ARTICLE 1.0 PROVIDER's Services and Responsibilities 1.1 PROVIDER shall conduct services generally described as Recreation Classes at the following location: Sethwell Community Center, 2695 Hopewell Road, Milton GA 30004. 1.2 The PROVIDER's services shall be performed during the days and hours described in Exhibit "A," attached hereto and incorporated herein by reference. 1.3 The PROVIDER and The Director of the Parks & Recreation Department or his designee, hereinafter referred to as the "DEPARTMENT", will agree upon program schedules. PROVIDER agrees to submit a Program Request Form to the Coordinator for each program being proposed eight (8) weeks prior to the beginning of each session. 1.4 The fees charged to each participant will be as described in Exhibit "A" for residents of MILTON and a surcharge of 50% more for non-residents of MILTON. The entire balance of this surcharge for non-residents shall be paid to the CITY. 1.5 The PROVIDER warrants to CITY that it is not insolvent, it is not in bankruptcy proceedings or receivership, nor is it engaged in or threatened with any litigation or other legal or administrative proceedings or investigations of any kind which would have an adverse effect on its ability to perform its obligations under this Agreement. 1.6 The PROVIDER agrees that it shall be solely responsible for all costs and/or expenses associated with, or as a result of its operation under this Agreement. The PROVIDER stipulates and certifies that it is qualified to provide the programs it is hired 1 to provide, maintains the education and required licenses or permits necessary to provide the programs, and shall continue to maintain such licenses or permits during the term of this Agreement. 1.7 This Agreement is considered a non-exclusive Agreement between the Parties. The CITY shall have the right to purchase the same kind of services to be provided by the PROVIDER from other sources during the terns of this Agreement. The PROVIDER is not precluded from providing the same or similar services for other parties so long as such other engagements do not interfere with the PROVIDER'S provision of services to the CITY. 1.8 The .DEPARTMENT must approve any promotional material, flyers, and posters advertising the programs prior to its release. The following content and topics shall specifically be prohibited: sexually explicit materials, profanity, child pornography, alcoholic beverages, tobacco products, adult movies, adult booklvideo stores, adult entertainment establishments, massage parlors, pawn shops, and tattoo parlors or shops. 1.9 The PROVIDER shall not promote any privately owned business in a CITY park/facility or solicit any participant in a CITY park/facility activity for any privately owned business. The PROVIDER may not use said facilities to conduct personal business including workshops, clinics, seminars, camps, or any other activities that are outside the scope of service described in (Exhibit "A"). It is further understood that such action(s) may result in immediate termination of the Agreement and the forfeiture of all compensation due to the PROVIDER. 1.10 The PROVIDER shall abide by the policies, procedures, rules and regulations of the DEPARTMENT, the CITY, and the FULTON COUNTY BOARD OF EDUCATION as promulgated from time to time. PROVIDER understands and agrees that the DEPARTMENT shall have first Priority for use of CITYfacilities, notwithstanding anv other provisions of this Agreement 1.11 All assistants, substitutes, and subcontractors utilized by the PROVIDER must have prior written approval of the DEPARTMENT. 1.12 PROVIDER shall provide necessary supervisory personnel to ensure that the participants of the programs obey all applicable policies, procedures, Rules and Regulations. 1.13 The DEPARTMENT or CITY may require that the PROVIDER not be permitted to utilize specific assistants, substitutes, or subcontractors of PROVIDER who have failed to follow any policies, procedures, rules or regulations applicable to the use of the facility. 1.14 Although the CITY shall not control the PROVIDER's techniques, methods, procedures, or sequence of instruction, the PROVIDER will comply with the CITY's and DEPARTMENT's policies, rules, regulations and procedures, as well as those of the FULTON COUNTY BOARD OF EDUCATION, and shall not interfere with their operation, nor harm or damage the equipment or facilities afforded to PROVIDER for his/her programs, nor otherwise disrupt the other on-site activities being offered at such public facilities. 1.15 The PROVIDER also acknowledges that he or she is primarily responsible for the conduct of the participants in all programs under the PROVIDER's charge. 1.16 If the PROVIDER will be providing services directly with minor children without parental supervision, the PROVIDER shall, prior to commencing services under this Agreement, comply with the CITY's policy regarding criminal background screening. The CITY will furnish the PROVIDER with a background release form (Exhibit "B") for all the provider's counselors, coaches, volunteers, subcontractors, employees or any other individuals that will come in contact with a child, at the PROVIDER's sole expense. A Consent and Release Form to conduct a criminal background must be executed by any of PROVIDER's employees or any individual who will come in contact with a child at the CITY through PROVIDER or at PROVIDER's direction, such form authorizing the CITY to conduct a search of each such individual's criminal background. The result of such inquiry may be deemed acceptable by the CITY in its sole and complete discretion, and the CITY may reject any individual from participating in any program based upon such results. If the PROVIDER has recently had a background screening conducted by another agency, the CITY, at its sole discretion, may accept that background screening and waive the requirement of a new background screening. PROVIDER and its employees must also execute a Waiver and Release of Liability holding the CITY and FULTON COUNTY BOARD OF EDUCATION harmless. 1.17 The CITY shall require all participants in all programs to sign a Waiver and Release of Liability. ARTICLE 2.0 Equipment & Materials 2.1 All program materials and equipment needed or pertaining to the above stated programs will be provided by the PROVIDER at his/her own cost and expense. However, PROVIDER may require participants to obtain certain materials required in the programs by providing a list of such materials (with approximate costs) to the participants. If PROVIDER makes such materials available to participants, they must be sold at PROVIDER's cost. All equipment provided by the PROVIDER shall be used in strict accordance with equipment manufacturer's instructions and in accordance with all applicable laws. PROVIDER shall coordinate storage of goal posts with the principal of the school located at the facility. 2.2 The sale of merchandise is restricted to those materials utilized in and for the programs. Fundraising activities conducted by the PROVIDER will not be permitted. The 3 PROVIDER shall obtain the CITY's approval of any merchandise to be sold prior to its distribution or sale. 2.3 The CITY will provide no storage space to the PROVIDER, unless otherwise mutually agreed upon in a separate written agreement_ 2.4 Any supplies or equipment left at the facility will be the responsibility of the PROVIDER. The CITY will not be responsible for any lost, stolen, or broken equipment or supplies. 2.5 The PROVIDER shall inspect the premises and equipment offered to him/her for his/her proposed activity and if he or she finds anything wrong with the premises or equipment before each program commences that cannot be corrected immediately by the DEPARTMENT, the program shall be canceled and the matter reported to the DEPARTMENT for correction. If the PROVIDER elects to hold his/her programs in the facility provided, it will be presumed that the PROVIDER has inspected the premises and facilities and equipment provided for such programs and has accepted same as being safe and suitable for the use intended. ARTICLE 3.0 Program Size Minimums - 3.1 ACTIVE: Program sizes shall meet the minimum numbers of participants for each program as designated in Exhibit "A." ARTICLE 4.0 Compensation and Method of Payment 4.1 In consideration of the releases and indemnities contained herein and of the PROVIDER's services in connection with the programs and activities described herein, the CITY shall be entitled to 30% of the registration fees paid by all program participants to the PROVIDER, and the PROVIDER shall be entitled to 70% of such fees paid, exclusive of the 50% non-resident surcharge. The 50% non-resident surcharge is fully payable to the CITY and shall not be included in PROVIDER's gross income calculation. PROVIDER shall be entitled to retain all non -registration fees paid by participants to PROVIDER, i.e. PROVIDER membership fees and costs for uniforms and pictures to participants. 4.2 The PROVIDER agrees to collect all fees from participants, and the PROVIDER agrees to provide CITY with schedules of fees to be charged to participants in conformance with Exhibit "A". It is agreed that the PROVIDER's sole obligation shall be to collect the fees from the participants and to remit the 30% of the fees collected as well as all 50% non-resident surcharge amounts to the CITY with a pay -out report of all monies collected. Payment will be made to the CITY within fourteen (14) business days of the end of each month or session or program. whichever occurs first. W 4.3 It is the responsibility of the PROVIDER to pay all applicable local, state, and federal taxes associated with this Agreement, and to acquire and pay for all necessary permits, licenses, and insurance required for the execution of this Agreement. ARTICLE 5.0 Independent PROVIDER 5.1 This Agreement does not create an employee/employer relationship between the Parties. It is the intent of the Parties that the PROVIDER is an independent contractor under this Agreement and not a CITY employee for all purposes, including but not limited to, the application of the Fair Labor Standards Act minimum wage and overtime payments, Federal Insurance Contribution Act, the Social Security Act, the Federal Unemployment Tax Act, the provisions of the Internal Revenue Code, The State Workers Compensation Act, and the State unemployment insurance law. The PROVIDER shall retain sole and absolute discretion in the judgment of the manner and means of carrying out PROVIDER's activities and responsibilities hereunder. The PROVIDER agrees that it is a separate and independent enterprise from the CITY, that it had full opportunity to find other business, that it has made its own investment in its business, and that it will utilize a high level of skill necessary to perform the work required hereunder. This Agreement shall not be construed as creating any joint employment relationship between the PROVIDER and the CITY and the CITY will not be liable for any obligation incurred by PROVIDER, including but not limited to unpaid minimum wages or overtime premiums. 5.2 PROVIDER warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the PROVIDER to solicit or secure this Agreement, and that it has not paid or agreed to pay any person, company, corporation, individual or firm any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of this provision, the CITY shall have the right to terminate the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover the full amount of such fee, commission, percentage, gift or consideration. ARTICLE 6.0 Insurance 6.1 PROVIDER shall not provide any service until all insurance required under this paragraph has been obtained and approved by the CITY. 6.2 Certificates of Insurance. Certificates of Insurance reflecting evidence of the required insurance shall be filed with the CITY prior to the commencement of this Agreement. These Certificates shall contain a provision that coverages afforded under- these policies will not be cancelled until at least forty-five days (45) prior written notice has been given to the CITY. Policies shall be issued by companies authorized to do business under the laws of the State of Georgia. Financial Ratings must be not less than "A -VI" in the latest edition of "Best Key Rating Guide", published by A.M. Best Guide. 6.3 Insurance shall be in force until the obligations required to be fulfilled under the terms of the Agreement are satisfied. In the event the insurance certificate provided indicated that the insurance shall terminate and lapse during the period of this Agreement, then in that event, the PROVIDER shall furnish, at least thirty (30) days prior to the expiration of the date of such insurance, a renewed Certificate of Insurance as proof that equal and like coverage for the balance of the period of the Agreement and extension thereunder is in effect. The PROVIDER shall not provide any service pursuant to this Agreement unless all required insurance remains in full force and effect. 6.4 Commercial General Liability insurance to cover liability bodily injury and property damage. Exposures to be covered are: premises, operations, products/completed operations, and certain contracts. Coverage must be written on an occurrence basis, with the following limits of liability: $1,000,000 Combined Single Limit — each occurrence $2,000,000 Combined Single Limit --- general aggregate $1,000,000 Personal Injury $1,000,000 Products/Completed Operations Aggregate PROVIDER shall have its insurer name the City of MILTON as an additional insured on its General Liability policy. 6.5 Worker's Compc nsation insurance shall be maintained during the life of this Agreement to comply with the statutory limits for all employees, and in the case any work is sublet, the PROVIDER shall require the subcontractor(s) similarly provide Workers Compensation Insurance for all the latter's employees unless and until such employees are covered by the protection afforded by the PROVIDER. The PROVIDER and his subcontractors shall maintain during the life of this Agreement Employers Liability Insurance. The following limits must be maintained: A. Workers Compensation Statutory B. Employer's Liability $100,000 each accident $500,000 Disease -policy limit $100,000 Disease -each employee If PROVIDER or its subcontractor claims to be exempt from this requirement, PROVIDER shall provide CITY proof of such exemption along with a written request for CITY to exempt PROVIDER, written on PROVIDER or subcontractor's letterhead. 6.6 PROVIDER shall also maintain Auto Liability and Directors and Officers insurance with limits reasonably acceptable to CITY during the term of this Agreement. 6.7 The CITY and the Fulton County Board of Education shall each be named as an additional insured and loss payee on all policies required by this Agreement. ARTICLE 7.0 Term and Termination 7.1 After a two (2) month trial period, the programs will be evaluated by the DEPARTMENT, and the remainder of this Agreement will either be terminated or continue in full force and effect. If at any time after the two (Z) month evaluation, program enrollment should fall below the required minimum, the PROVIDER will be allotted four (4) weeks to bring enrollment up to the required minimum. The programs will be reevaluated and execution or termination of the contract will be determined by the DEPARTMENT. 7.2 The term of this Agreement shall commence upon the date of execution hereof and shall remain in effect for a period of one (1) year from the date of execution of this Agreement by the CITY, unless terminated sooner as provided in this Article. Renewal of this Agreement beyond the one (1) year term shall require the mutual written agreement of the CITY and PROVIDER. 7.3 This Agreement may be terminated by the CITY for convenience upon giving of at least thirty (30) days prior written notice of termination to the PROVIDER at the PROVIDER's address set forth herein at the sole and exclusive discretion of the CITY. This Agreement may be terminated by the City immediately by written notice to PROVIDER upon any willful, reckless, or grossly negligent act or omission by PROVIDER or any of its officers, agents, employees, or volunteers. 7.4 This Agreement may be terminated by PROVIDER upon giving at least thirty (30) days written notice of termination to the CITY. 7.5 PROVIDER must notify the DEPARTMENT in writing of any program cancellations at least ten (10) business days prior to the scheduled cancellation. 7.5 CITY reserves the right to cancel or reschedule any of the PROVIDER's programs, in the case of scheduling conflicts or other emergencies, as determined by the DEPARTMENT. ARTICLE 8.0 Indemnification 8.1 PROVIDER agrees to indemnify and hold harmless the CITY and the FULTON COUNTY BOARD OF EDUCATION, their trustees, elected and appointed officers, agents, servants and employees, from and against any and all claims, demands, or causes of action of whatsoever kind of nature, and the resulting losses, costs, expenses, reasonable attorneys' fees, including paralegal fees, liabilities, damages, orders, judgments, or decrees, sustained by the CITY, the FULTON COUNTY BOARD OF EDUCATION, or any third party arising out of, or by reason of, or resulting from the will 7 full or negligent acts, errors, or omissions of the PROVIDER or its agents, officers, volunteers or employees. 8.2 The Parties understand and agree that the covenants and representations relating to this indemnification provision shall survive the term of this Agreement and continue in full force and effect as to the PROVIDER's responsibility to indemnify. ARTICLE 9.0 Americans With Disabilities Act 9.1 PROVIDER shall not discriminate against any person in its operation and activities in its use or expenditure of the funds or any portion of the funds provided by this Agreement and shall affirmatively comply with all applicable provisions of the Americans With Disabilities Act ("ADA"), in the programs while providing any services funded in whole or in part by the CITY, including Titles I and II of the ADA and all applicable regulations, guidelines, and standards. 9.2 PROVIDER's decisions regarding the delivery of services under this Agreement shall be made without regard to or consideration of race, age, religion, color, gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation, or any other factor which cannot be lawfully or appropriately used as a basis for delivery of service. ARTICLE 10.0 Miscellaneous 10.1 No modification, amendment, or alteration of the terms and conditions contained shall be effective unless contained in a written document executed with the same formality and equal dignity herewith. 10.2 This Agreement is non -transferable or assignable, and PROVIDER agrees not to transfer or assign the performance of services called for in the Agreement. 10.3 This Agreement sets forth the full and complete understanding of the Parties as of the effective date, and supersedes any and all negotiations, agreements, and representations made or dated prior to this Agreement. 10.4 The PROVIDER shall pay reasonable attorney's fees to the City should the City be required to incur attorney's fees in enforcing the provisions of this Agreement. 10.5 Time is of the essence of this Agreement. 10.5 Each of the individuals who executes this Agreement agrees and represents that he is authorized to execute this Agreement on behalf of the respective entity. Accordingly, the City and PROVIDER both waive and release any right to contest the enforceability of this Agreement based upon the execution and/or approval thereof. 10.7 It is the policy of City that unauthorized aliens shall not be employed to perform work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the PROVIDER shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and "D" that it and its subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perform work on the City contract to ensure that no unauthorized aliens will be employed. The City Manager or his/her designee shall be authorized to conduct an inspection of the PROVIDER's and its subcontractors' verification process to determine that the verification was correct and complete. The PROVIDER and its subcontractors shall retain all documents and records of its verification process for a period of three (3) years following completion of the contract. This requirement shall apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. Compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 is mandatory. PROVIDER's compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300- 10-1-.02 shall be attested by the execution of the contractor's affidavit attached as Exhibit "C .15 Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to O.C.G.A. § 16-10-71), a form of which is attached hereto as Exhibit "E", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A. § 50-36-1). 0j IN WITNESS OF THE FOREGOING, the Parties have set their hands and seal the day and year first written. above. CITY: ATTEST: SUDIE GORDON, CITY CLERK WITNESS: BY: BY: JOE LOCKWOOD, MAYOR EDWARD MUNSTER, PRESIDENT [AFFIX CORPORATE SEAL] 10 EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals_ Use one farm per program. Name of Program: Y Babysitting Participant Ages: 10-17 Day/s of the week program is offered: one Saturday a month Time of Program: 9:00 am to 4:00 pm Program Dates: starting August 2012 to July 2013 Program Fee: Resident: $70.00 Non Resident: $105.00 per class Program Enrollment: Minimum 4 _ Maximum: 10 Materials to be supplied by participants: Snacks, drink and lunch Materials to be supplied by PROVIDER: Participant Manual along with all supplies needed to run the program will be provided by the provider. Materials to be supplied by the City of MILTON: Facility (rent _cost _to be paid by the provider) w Additional Program Requirements: PROVIDER (s)Name. Ed_Isakson/Alpharetta Family YMCA Address: 3655 Preston Ridge Road City/State/Zip Code: Alpharetta, GA 30005 Phone Number: (Day) 770-664-1220(Evening) 770-664-1220 (E-mail): kimn@ymccatlant.org (Fax) 770-664-0337 Minimum Reauirements: 1,000,000 General Liability Insurance Office Use Only. Program Rate:$ # of programs in Session: ii" Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form_ per program. Name of Program: Y Jr. CPR Participant Ages: 10-17 Day/s of the week program is offered: one Saturday a month Time of Program: 1:00 pm to 4:00 pm Program Dates: starting August 2012 to July 2013 Program Fee: Resident: $25.00 Non Resident: $37.50 per class Program Enrollment: Minimum 4 Maximum: 10 Materials to be supplied by participants: Must take Babysitting course first. Snacks, drink and lunch. Materials to be supplied by PROVIDER: Participant Manual along with all supplies needed to run the program will be provided by the provider. Materials to be supplied by the City of MILTON: Facility (rent cost to be paid by the provider) Additional Program Requirements: PRCVIDERCOName: Ed lsakson/AI hhaaretta Family YMCA Address: 3655 Preston Ridge Road City/State/Zip Code: Alpharetta, GA 30005 Phone Number: (Day) 770--664-1220(Evening) 770-664-1220 (E-mail): kimn@ymccatlant.org (Fax) 770-664-0337 Minimum Reauirements: 1,000,000 General Liability Insurance Office Use Only. Program Rate:$ # of programs in Session: Fee/Program: I 5 i EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals_ Use one form per program. Name of Program: Y Jr. World of Fun Participant Ages: 5-12 Day/s of the week program is offered: Tuesdays Time of Program: 3:30 pm to 4:30 pm Program Dates: starting August 2012 to May 2013 Program Fee: Resident: $75.00 Non Resident: $112.50 per class per six week session Program Enrollment: Minimum 7 Maximum: 15 Materials to be supplied by participants: Materials to be supplied by PROVIDER: Recreational equipment provided to promote physical fitness and social skills for special need individuals. All supplies needed to _run the program will be provided by the provider. Materials to be supplied by the City of MILTON: Facility (rent cost to be paid by the provider) Additional Program Requirements: Parent/Guardian must complete child special needs evaluation form before participating_in_program. PROVIDER(`s}Name: Ed Isakson/Alpharetta Family YMCA Address: 3655 Preston Ridge Road City/State/Zip Code: Alpharetta, GA 3000S Phone Number: (Day) 770-664-1220(Evening) 770-664-1220 (E-mail). kimn@ymccatlant.org (Fax) 770-664-0337 Minimum Reouirements: 1,000,000 General Liability Insurance Office use only: Program Rate:$ # of programs in Session: 7 r Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one farm per program. Name of Program: Y Book Club Participant Ages: 18+ Day/s of the week program is offered: 1St Friday of the month Time of Program: 10:30 am to 12:00 pm Program Dates: starting September 2012 to May 2013 Program Fee: Resident: Free Non Resident: CDM residents only Program Enrollment: Minimum Maximum: Materials to be supplied by participants: book of the month Materials to be supplied by PROVIDER: Volunteer to lead grou Materials to be supplied by the City of MILTON: Facility (rent cost to be paid by the provider Additional Program Requirements: PROVIDERCOName: Ed Isakson/Alpharetta Family YMCA Address: 3 655 Preston Ridge Road City/State/Zip Code: Alpharetta, GA 30005 Phone Number: (Day) 770-664-1220(Evening) 770-664-1220 (E-mail): kimn@ymccatlant.org (Fax) 770-664-0337 Minimum Requirements: 1,000,000 General Liability Insurance Office Use Only. Program Rate:$ # of programs in Session: S Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: Y Cake Decorating Participant Ages: 18 + Day/s of the week program is offered: 1 day a month Time of Program: 10:00 am to 11:00 am Program Dates: starting August 2012 to July 2013 Program Fee: Resident: $12.00 Non Resident: $19.50 per class or Three classes Resident: $35 Non Resident: $52.50 Program Enrollment: Minimum 3 Maximum: 15 Materials to be supplied by participants: Cake decorating kit Materials to be supplied by PROVIDER: Instructor's supplies will be provided by the provider. Materials to be supplied by the City of MILTON: Facility gent cost to b_p_paidL by the provider) Additional Program Requirements: PROVIDER Cs) Name: Ed Isakson/Alpharetta Family YMCA Address: 3655 Preston Ridge Road City/State/Zip Code: Alpharetta, GA 30005 Phone Number: (Day) 770-664-1220(Evening) 770-664-1220 (E-mail): kinin@ymccatlant.org (Fax) 770-654-0337 Minimum Reauirements: 1,000,000 General Liability Insurance office Use Only.- Program nly: Program Rate:$ # of programs in Session: Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program, Name of Program: Y Parents Morning Out Participant Ages: 2 1/2 - Day/s of the week program is offered: Monday/Wednesday Time of Program: 9:00 am to 1:00 pm Program Dates: August 2012 to May 2013 (follows Fulton County School schedule Program Fee: Resident: $51.00 Non Resident: $76.50 per week Program Enrollment: Minimum 8 Maximum: 20 Materials to be supplied by participants: Snacks, drink and lunch Materials to be supplied by PROVIDER: All supplies needed to run the program will be ,provided by the provider — arts & crafts, books, outside equipment, toys, etc.. Materials to be supplied by the City of MILTON: Facility (rent cost to be paid by the provider Additional Program Requirements: PROVIDER Cs) Name: Ed Isakson/Alpharetta Family YMCA Address: 3655 Preston Ridge Road City/State/Zip Code: Alpharetta, GA 30005 Phone Number: (Day) 770-664-1220(Evening) 770-664-1220 (E-mail): kimn@ymccatlant.orq (Fax) 770-664-0337 Minimum Requirements: 1,000,000 General Liability Insurance Office Use Only. - Program Rate:$ # of programs in Session: S Fee/Program: 1) This Request Is For: (Check onlyone) Q Employment o Military ❑ Licensing o Personal Use a Other Use Not Listed (E) * International Travel n Firefighters Employment (E) * Prospective AdoptivelFoster Parents {E + Nate & 2 copies} * Employment Working With The Elderly (N) * Employment At A Child Care Facility (W) X Volunteer working with Children (W) o Employment Working With The Mentally Ill (m) • Police Ride Along Request (C) o Police Department VendorlCon tractor {C) 2) A History is Requested On The Following Person: Name: Social Security Number: Fara Sex - kiddie Race: o White o Bek oftan o American Indian o Unknawn/bther Date Of Birth. Phone Number: - - 01W y— El Check h Request is For Yourself And Proceed To Section 5 At The Bottom Of This Page. 3) Person Requesting Criminal History: Name: City of MiltonlCompany Name (TBD) Address: 13000 Deerfield Parkway Suite 107 Phone: 678 242 2500 City!State,'Zip: Milton, GA 30004 d) Consent: This portion is to be used if the person requesting the criminal history is different than whom the criminal history is being inquired on (sections 11 & III above are not the same person). Third party notary is required, I hereby give my consent for my crimcal history to be nun and for the move named persm m sectton Elf to have access to it. MMI Seal. - t cv� n� 5) In making this request, I agree #hal the City of Mco Police Department, its employees, heirs. trustees. etc.. std in no way be heM at tMA for the use or misuse of this record. A photocopy of Utt release vrill be placed on ifle and is valid as an original hereof, even "h ase photocopy does not contain an onginal "nature, lr=mp;e� requests %Mll be denied. This report Is crosWered accurate at time of inquiry and may change at anytime. Qfhcial Use Only— fo Not Ma* Below This Line WNW 5& 11 Operator ARM Bate Submitted i Inquiry date I—/- 11 1 EXHIBIT "C" STATE OF GEORGIA CITY OF MILTON CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-.08 in the form attached hereto as Exhibit "D." Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perform such service. EEV l Basic Pilot Program User Identification Number BY: Authorized Officer or Agent Date Young Men's Christian Association of Metropolitan Atlanta, Inc. Title of Authorized Officer or Agent of Contractor Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF , 201 Notary Public My Commission Expires: 12 STATE OF GEORGIA CITY OF MILTON EXHIBIT "D" SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with Young Men's Christian Association of Metropolitan Atlanta, Inc. on behalf of the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. EEV 1 Basic Pilot Program User Identification Number BY: Authorized Officer or Agent Date [INSERT SUBCONTRACTOR NAME] Title of Authorized Officer or Agent of Subcontractor Printed Name of Authorized Officer or Agent SUBSCRIBER AND SWORN BEFORE ME ON THIS THE DAY OF , 201 Notary Public My Commission Expires: 13 EXHIBIT "E„ SAVE Affidavit By executing this affidavit under oath, and as an applicant for a public benefit, as referenced in O.C.G.A. § 50-36-1, from the City of Milton, the undersigned applicant verifies one of the following with respect to my application for a public benefit: 1) 1 am a United States citizen. 2) 1 am a legal permanent resident of the United States. 3) 1 am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verifies that he or she is 1$ years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 50-35-1(e)(1), with this affidavit. The secure and verifiable document provided with this affidavit can best be classified as: In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute. Executed in SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF , 20 NOTARY PUBLIC My Commission Expires: (city), (state). Signature of Applicant Printed Name of Applicant 14 City of Milton 13000 Deerfield Parkway Suite 107C Milton, Georgia 30004 To: Honorable Mayor and City Council Members From: John Rebar, Parks and Recreation Director Submission Date: April 25, 2012 Meeting Date: May 7, 2012 Agenda Item: Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Off Broadway Expressions Background: The Parks and Recreation Department is eager to continue offering programs and additional services to the citizens of Milton. Many of these programs may be offered by outside providers through an agreement with the City of Milton based on a submitted program proposal rather than offering these programs through a paid independent contractor or a paid employee of the City. Discussion: The Parks and Recreation Department recommends entering into agreement with Off Broadway Expressions to provide miscellaneous dance programs for our residents and visitors. Programs may include: Adult Dance After School Dance Cotillion Youth Dance Dance Recital Dance-A-Thon Summer Dance Camp Talent Fashion Show A commission of 30% of all registration fees will be paid to the City of Milton two weeks following the end of registration. Non-resident fees will be collected by the provider and paid to the City at a rate of 50% more. Legal Review: Contract Template - Paul Higbee, Jarrard & Davis on February 23, 2012 Attachments: A Parks and Recreation Department Agreement between the City of Milton and Off Broadway Expressions. CITY OF MILTON PARIES & RECREATION DEPARTMENT AGREEMENT FOR OUTSIDE PROVIDERS THIS IS AN AGREEMENT, made this day of , 2012, between: THE CITY OF MILTON, a municipal corporation organized and operating under the laws of the State of Georgia, with a business address of 1' 000 Deerfield Parkway, Suite 107 A. MILTON, Georgia 30004, hereinafter referred to as the "CITY." and OFF BROADWAY EXPRESSIONS hereinafter referred to as "PROVIDER". CITY and PROVIDER may hereinafter collectively be reFerred to as -the PdrliVS". In consideration of the mutual obligations of the Parties and for good and valuable consideration, the adequacy and receipt of which are hereby acknowledged, the Parties agree as follows: ARTICLE IA PROVIDER's Services and Responsibilities 1.1 PROVIDER shall conduct services generally described as Dance Camp & Dance Classes at the following location: Bethwell Community Center, 2595 Hope",ell Road, Milton GA 30004. 1.2 The PROVIDER's services shall be performed during the days and hours described in Exhibit "A," attached hereto and incorporated herein by reference. 1.3 The PROVIDER and The Director of the Parks & Recreation Department or his designee, hereinafter referred to as the "DEPARTMENT", will agree upon program schedules. PROVIDER agrees to submit a Program Request Form to the Coordinator for each program: being proposed eight (8) weeks prior to the beginning of each session. 1.4 The fees charged to each participant will be as described in Exhibit "A" for residents of MILTON and a surcharge of 50% more for port -residents of MILTON, The entire balance of this surcharge for non-residents shall be paid to the CITY. 1.5 The PROVIDER warrants to CITY that it is not insolvent, it is not in bankruptcy proceedings or receivership, nor is it engaged in or threatened with any litigation or other legal or administrative proceedings or investigations of any kind which would have an adverse effect on its ability to perfoi ni its obligations under this Agreement, 1.6 The PROVIDER agrees that it shall he solely responsible for all casts and/or expenses associated with, or as a result of its operation under this Agreement. The PROVIDER stipulates and certifies that it is qualified to provide the programs it is hired to provide, maintains the education and required licenses or permits necessary to provide the programs, and shall continue to maintain such licenses or permits during the term of this Agreement. 1.7 This Agreement is considered a non-exclusive Agreement between the Parties. The CITY shall have the right to purchase the same kind of services to be provided by the PROVIDER from other sources during the term of this Agreement. The PROVIDER is not precluded from providing the same or similar services for other parties so long as such other engagements do not interfere with the PROVIDER'S provision of services to the CITY. 1.8 The DEPARTMENT must approve any promotional material, flyers, and posters advertising the programs prior to its release. The following content and topics shall specifically he prohibited.- sexually explicit tuaterials, profatrity, child pornography, alcoholic beverages, tobacco products, adult movies, adult booklvideo stores, adult eirtertainnrent establishneenis, massage parlors, pawn shops, and tattoo parlors or shops. 1.9 The PROVIDER shall not promote any privately owned business in a CITY park/facility or solicit any participant in a CITY park/facility activity for any privately owned business. The PROVIDER may not use said facilities to conduct personal business including workshops, clinics, seminars, camps, or any other activities that are outside the scope of service described in (Exhibit "A"'). It is further understood that such action(s) may result in immediate termination of the Agreement and the forfeiture of all compensation due to the PROVIDER. 1.1 0 The PROVIDER shall abide by the policies, pmcedures, riles and regulations of the DEPARTMENT, the CITY, and the FULTON COUNTY BOARD OF EDUCATION as promulgated from time to time. PROVIDER understands and agrees that the DEPARTMENT shall have first nrioriO for use of CITY facilities, notwithstanding any other provisions of this Agreement 1.11 All assistants, substitutes, and subcontractors utilized by the PROVIDER must have prior written approval of the DEPARTMENT. 1.12 PROVIDER shall provide necessary supervisory personnel to ensure that the participants of the programs obey all applicable policies, procedures, Rules and Regulations. 1.13 The DEPARTMENT or CITY may require that the PROVIDER not be permitted to utilize specific assistants, substitutes, or subcontractors of PROVIDER who have failed to follow any policies, procedures, rules or regulations applicable to the use of the facility. 1.14 Although the CITY shall not. control the PROVIDER's techniques, methods, procedures, or sequence of instruction, the PROVIDER will comply with the CITY's and DEPARTMENT's policies, rules, regulations and procedures, as well as those of the FULTON COUNTY BOARD OF EDUCATION, and small not interfere with their 2 operation, nor harm or damage the equipment or facilities afforded to PROVIDER for his/her programs, nor otherwise disrupt the other on-site activities being offered at such public facilities. 1.15 The PROVIDER also acknowledges that he or she is primarily responsible for the conduct of the participants in all programs under the PROVIDER's charge. 1.16 If the PROVIDER will be providing services directly with minor children without parental supervision, the PROVIDER shall, prior to commencing services under this Agreement, comply with the CITY's policy regarding criminal background screening. The CITY will furnish the PROVIDER with a background release form (Exhibit "B") for all the provider's counselors, coaches, volunteers, subcontractors, employees or any other individuals that will corse in Contact with a child, at the PROVIDER's sole expense. A Consent and Release Form to conduct a criminal background must be executed by any of PROVIDER's employees or any individual who will come in contact with a child at the CITY through PROVIDER or at PROVIDER's direction, such force authorizing the CITY to conduct a search of each such individual's criminal background. The result of such inquiry may be deemed acceptable by the CITY in its sole and complete discretion, and the CITY may reject any individual from participating in any program based upon such results. If the PROVIDER has recently had a background screening conducted by another agency, the CITY, at its sole discretion, may accept that background screening and waive the requirement o, f a new background screening. PROVIDER and its employees must also execute a Waiver and Release of Liability holding the CITY and FULTON COUNTY BOARD OF EDUCATION harmless. 1.17 The CITY shall require all participants in all programs to sign a Waiver and Release of Liabi lity. ARTICLE 2,0 Eguipment & Materials 2.1 All program materials and equipment needed or pertaining to the above stated programs will be provided by the PROVIDER at his/her own cost and expense. However, PROVIDER may require participants to obtain certain materials required in the programs by providing a list of such materials (with. approximate costs) to the participants. If PROVIDER makes such materials available to participants, they must be sold at PROVIDER's cost. All equipment provided by the PROVIDER shall be used in strict accordance with equipment manufacturer's instructions and in accordance with all applicable laws. PROVIDER shall coordinate storage of goal posts with the principal of the school located at the facility. 2.2 The sale of merchandise is restricted to those materials utilized in and for the programs. Fundraising activities conducted by the PROVIDER will not be permitted. The PROVIDER shall obtain the CITY's approval of any merchandise to be sold prior to its distribution or sate. 3 2.3 The CITY will provide no storage space to the PROVIDER, unless otherwise mutually agreed upon in a separate written agreement. 2.4 Any supplies or equipment left at the facility will be the responsibility of the PROVIDER. The CITY will not be responsible for any lost, stolen, or broken equipment or supplies. 2.5 The PROVIDER shall inspect the premises and equipment offered to him/her for his/her proposed activity and if he or she finds anything wrong with the premises or equipment before cacti program commences that cannot be corrected immediately by the DEPARTMENT, the program shall be canceled and the matter reported to the DEPARTMENT for correction. If the PROVIDER elects to held his/her programs in the facility provided, it will be presumed that the PROVIDER has inspected the premises and facilities and equipment provided for such programs and has accepted same as being safe and suitable for the use intended. ARTICLE 3.0 Program Sire Minimums: 3.1 ACTIVE: Program sizes shall meet the minimum numbers of participants for each program as designated in Exhibit "A." ARTICLE' .!_U Compensation and Method (if Pavrnent 4.1 In consideration of the releases and indemnities contained herein and of the PROVIDER's services in connection with the programs and activities described herein, the CITY shall be entitled to 30% of the registration fees paid by all program participants to the PROVIDER, and the PROVIDER shall be entitled to 70°/o of such fees paid, exclusive of the 50% non-resident surcharge. The 50% non-resident surcharge is fully payable to the CITY and shall not be included in PROVIDER's gross income calculation. PROVIDER shall be entitled to retain all non -registration fees paid by participants to PROVIDER. i.e. PROVIDER membership fees and casts for uniforms and pictures to participants. 4.2 The PROVIDER agrees to collect all fees from participants, and the PROVIDER agrees to provide CITY with schedules of fees to be charged to participants in conformance with Exhibit "A". It is agreed that the PROVIDER's sole obligation shall be to collect the fees from the participants and to remit the 30% of the fees collected as well as all 50% non-resident surcharge amounts to the CITY with a pay -out report of all monies collected. Payment will be made to the CITY within fourteen (14) business days of the end of each month or session or program, whichever occurs first. 4.3 It is the responsibility of the PROVIDER to pay all applicable local, state, and federal taxes associated with this Agreement, and to acquire and pay for all necessary permits, licenses, and insurance required for the execution of this Agreement. ARTICLE S.0 Indeneudent PROVIDER 5.1 This Agreement does not create an employeetemployer relationship between the Parties. It is the intent of the Parties that the PROVIDER is an independent contractor under this Agreement and not a CITY employee for all purposes, including but not limited to, the application of the Fair Labor Standards Act minimum wage and overtime payments, Federal Insurance Contribution Act, the Social Security Act, the Federal Unemployment Tax Act, the provisions of the Internal Revenue Code, The State: Workers Compensation Act, and the State unemployment insurance law. The PROVIDER shall retain sole and absolute discretion in the: judgment of the manner and means of carrying out PROVIDER's activities and responsibilities hereunder. The PROVIDER agrees that it is a separate and independent enterprise from the CITY, that it had full opportunity to find other business, that it has made its oven investment in its business, and that it will utilize a high level of skill necessary to perforin the work required hereunder. This Agreement shall not be construed as creating any joint employment relationship between the PROVIDER and the CITY and the CITY will not be liable for any obligation incurred by PROVIDER, including but not limited to unpaid minimum wages or overtime premiums_ 5.2 PROVIDER warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the PROVIDER to solicit or secure this Agreement, and that it has not paid or agreed to pay any person, company, corporation, individual or firm any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of this provision, the CITY shall have the right to terminate the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover the full amount of such fee, commission, percentage, gift or consideration. ARTICLE 5.0 Insurance 6.1 PROVIDER shall not provide any service until all insurance required under this paragraph has been obtained and approved by the CITY. 6.2 Certificates of Insurance. Certificates of Insurance reflecting evidence of the required insurance shall be filed with the CITY prior to the commencement of this Agreement_ These Certificates shall contain a provision that coverages afforded under these policies will not be cancelled until, at least forty-five days (45) prior written notice has been given to the CITY. Policies shall be issued by companies authorized to do business under the laws of the State of Georgia. Financial Ratings must be not less than "A -VI" in the latest edition of `Best Key Rating Guide", published by A.M. Best Guide. 6.3 Insurance shall be in force until the obligations required to be fulfilled under the terms of the Agreement are satisfied. In the event the insurance certificate provided indicated that the insurance shall terminate and lapse during the period of this Agreement, then in that event, the PROVIDER shall furnish, at feast thirty (30) days prior to the expiration of the date of such insurance, a renewed Certificate of Insurance as proof that equal and like coverage for the balance of the period of the Agreement and extension thereunder is in effect. The PROVIDER shall not provide any service pursuant to this Agreement unless ail required insurance remains in full force and effect. 6.4 Commercial General Liability insurance to cover liability bodily injury and property damage. Exposures to be covered are: premises, operations, products/completed operations, and certain contracts. Coverage must be written on an occurrence basis, with the following limits of liability: $1,000,000 Combined Single Limit — each occurrence $2,000,000 Combined Single Limit — general aggregate $1,000,000 Personal Injury $1,000,000 Products/Completed Operations Aggregate PROVIDER shall have its insurer name the City of MILTON as an additional insured on its General Liability policy. 6.5 Worker's Compensation insurance shall be maintained during the life of this Agreement to comply with the statutory limits for all employees, and in the case any work is sublet, the PROVIDER shall require the subcontractor(s) similarly provide Workers Compensation Insurance for all the tatter's employees unless and until such employees are covered by the protection afforded by the PROVIDER. The PROVIDER and his subcontractors shall maintain during the life of this Agreement Employers Liability Insurance. The following limits must be maintained: A. Workers Compensation Statutory B. Employer's Liability $100,000 each accident $500,000 Disease -policy limit $100,000 Disease -each employee If PROVIDER or its subcontractor claims to be exempt from this requirement, PROVIDER shall provide CITY proof of such exemption along with a written request for CITY to exempt PROVIDER, written on PROVIDER or subcontractor's letterhead. 6.6 PROVIDER shall also maintain Auto Liability and Directors and Officers insurance with limits reasonably acceptable to CITY during the term of this Agreement. 6.7 The CITY and the Fulton County Board of Education shall each be named as an additional insured and loss payee on all policies required by this Agreement, ARTICLE 7.0 Term and Termination 7.1 After a two (2) month trial period, the programs will be evaluated by the DEPARTMENT, and the remainder of this Agreement will either be terminated or continue in full force and effect. If at any time after the two (2) month evaluation, program enrollment should fail below the required minimum, the PROVIDER will be allotted four (4) weeks to bring enrollment up to the required minimum. The programs will be reevaluated and execution or termination of the contract will be determined by the DEPARTMENT. 7.2 The term of this Agreement shall commence upon the date of execution hereof and shall remain in effect for a period of one (1) year from the date of execution of this Agreement by the CITY, unless terminated sooner as provided in this Article. Renewal of this Agreement beyond the one (1) year term shall require the mutual Written agreement of the CITY and PROVIDER. 7.3 This Agreement may be terminated by the CITY for convenience upon giving of at least thirty (30) days prior written notice of termination to the PROVIDER at the PROVIDER's address set forth herein at the sole and exclusive discretion of the CITY. This Agreement may be terminated by the City immediately by written notice to PROVIDER upon any willful, reckless, or grossly negligent act or omission by PROVIDER or any of its officers, agents, employees, or volunteers. 7.4 This Agreement may be terminated by PROVIDER upon giving at least thirty (34) days written notice of termination to the CITY. 7.5 PROVIDER must notify the DEPARTMENT in writing of any program cancellations at least ten (10) business days prior to the scheduled cancellation. 7.5 CITY reserves the right to cancel or reschedule any of the PROVIDER's programs, in the case of scheduling conflicts or other emergencies, as determined by the DEPARTMENT. ARTICLE 8.0 Indemnification $.1 PROVIDER agrees to indemnify and hold harmless the CITY and the FULTON COUNTY BOARD OF EDUCATION. their trustees, elected and appointed officers, agents, servants and employees, from and against any and all claims, demands, or causes of action of whatsoever kind of nature, and the resulting losses, costs, expenses, reasonable attorneys' fees, including paralegal fees, liabilities, damages, orders, judgments, or decrees, sustained by the CITY, the FULTON COUNTY BOARD OF EDUCATION, or any third party arising out of, or by reason of, or resulting from the will full or negligent acts, errors, or omissions of the PROVIDER or its agents, officers, volunteers or employees. r► 8.2 The Parties understand and agree that the covenants and representations relating to this indemnification provision shall survive the term of this Agreement and continue in full force and effect as to the PROVIDEWs responsibility to indemnify. ARTICLE 9.0 Americans With Disabilities Act 9.1 PROVIDER shall not discriminate against any person in its operation and activities in its use or expenditure of the funds or any portion of the funds provided by this Agreement and shall affirmatively comply with all applicable provisions of the Americans With Disabilities Act ("ADA"), in the programs while providing any services funded in whole or in part by the CITY, including Titles I and II of the ADA and all applicable regulations, guidelines, and standards. 9.2 PROVIDER's decisions regarding the delivery of services under this Agreement shall be made without regard to or consideration of race, age, religion, color, gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation, or any other factor which cannot be lawfully or appropriately used as a basis for delivery of service. ARTICLE 10.0 Miscellaneous 10.1 No modification, amendment, or alteration of the terms and conditions contained shall he effective unless contained in a written document executed with the same formality and equal dignity herewith. 10.2 This Agreement is non -transferable or assignable, and PROVIDER agrees not to transfer or assign the performance of services called for in the Agreement. 103 This Agreement sets forth the full and complete understanding of the Parties as of the effective date, and supersedes any and all negotiations, agreements, and representations made or dated prior to this Agreement. 30.4 The PROVIDER shall pay reasonable attorney's fees to the City should the City be required to incur attorney's fees in enforcing the provisions of this Agreement. 10.5 Time is of the essence of this Agreement. 10.6 Each of the individuals who executes this Agreement agrees and represents that he is authorized to execute this Agreement on behalf of the respective entity. Accordingly, the City and PROVIDED both waive and release any right to contest the enforceability of this Agreement based upon the execution and/or approval thereof. 10.7 It is the policy of City that unauthorized aliens shall not be employed to perform work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the PROVIDER shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and "D" that it and its subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perform work on the City contract to ensure that no unauthorized aliens will be employed. The City Manager or his/her designee shall be authorized to conduct an inspection of the PROVIDER's and its subcontractors' verification process to determine that the verification was correct and complete. The PROVIDER and its subcontractors shall retain all documents and records of its verification process for a period of three (3) years following completion of the contract. This requirement shall apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. Compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 is mandatory. PROVIDER's compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300- 10-1-.02 shall be attested by the execution of the contractor's affidavit attached as Exhibit iiC » Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to O.C.G.A. § 16-10-71), a form of which is attached hereto as Exhibit "E", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically (in compliance with the Uniform .Electronic Transactions Act). Contractor verifics that it is in complianec with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A. § So -36-1). E IN WITNESS OF THE FOREGOING, the Parties have set their hands and seal the day and year first written above. CITY: ATTEST: BY: SUDIE GORDON, CITY CLERK JOE LOCKWOOD, MAYOR WI ESS: PROVIDER: [AFFIX CORPORATE SEAL] 10 EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form_per_rop rram. Name of Program: Adult Dance classes Participant Ages: Any age Dayls of the week program is offered: Tuesday, Thursday, Saturday or Friday Time of Program: 5:00 & 6:00 to 6:00 & 7:00 Program Dates: May 2012 to May 2013 Program Fee: Registration Fee: $30 per month (4 classes) or $8 per class Program E=nrollment: Minimum 10 Maximum 30 Materials to be supplied by participants: Comfortable shoes and clothing Materials to be supplied by PROVIDER. Music Materials to be supplied by the City of MILTON: Space Additional Program Requirements: None PROVIDER ('s) Name: Macita St Germain-Regnier Address: 2969 Commonwealth Circle City/State/Zip Code: Alpharetta, GA 30004 Phone Number: (Day) 917-G57-4904 (Evening) 578 404 7570 (E -man): anncico(�Photmail.com (Fax) Minimum Req_*§pents: 1,000,000 General Liability Insurance Office use Only: Program Rate: $ # of programs in Session: S Fee/Program: EXHUBIT «A„ PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest This information will be used for consideration of program proposals. Use one form per program. Name of Program: Atter School Dance Participant Ages. 11 to 15 Day/s of the week program is offered: Monday - Friday Time of Program: TBD by the Recreation Dept. Program Dates: September 2012 to May 2013 Program Fee: $200 per semester ( 1 S classes) Program Enrollment: Minimum 10 Maximum 40 Materials to be supplied by participants_ Leotard, Ballet, Tap and or Jazz Shoes Materials to be supplied by PROVIDER: Music and casturne Materials to be supplied by the City of MILTON: Space Additional Program Requirements: None PROVIDER (`s) Name: Macita St Germain-Regnier Address: 2969 Commonwealth Circle City/State/Zip Code. Alpharetta, GA 30004 Phone Number: (Day) 917-557-4904 (E-mail ); anncico.(d�h-otmail.com Minimum Requirements: (Evening) 678-404-7570 (Fax) 1,000.000 General Liability Insurance Office Use Only.- Program nly:Program Rate: $_ it of programs in Session: Fee/Pragra m EXHIBIT "A„ PROGRAM_ REQUEST l�C]RM individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one formmer pmgram. Name of Program. Cotillion Participant Ages. 14 to 17 Day/s of the week program is offered: Monday - Saturday Time of Program: TBD by Recreation Dept, Program Dates: October 2012 to April 2013 Program Fee: $50 Program Enrollment: Minimum 1O Maximum 50 Materials to be supplied by participants: Dress, shoes for the cotillion Materials to be supplied by PROVIDER: Music, flowers, and gifts from sponsors Materials to be supplied by the City of MILTON: Space Additional Program Requirements: None PROVIDER ('s) Name: Maeita St Germain-Regnier Address: 2959 Commonwealth Circie City/State/Zip Code: Alpharetta, GA 30004 'hone Number: (Day) 917 657-4904 (Evening) 578 404 7570 (E-mail): anncicgCa)h tm*� .corn (Fax) Minimum Reg irements: 1,000,000 General Liability Insurance Office Use Only: Program Rate: $ # of programs in Session: S Fee/Program: EXHI BIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: Dance Classes Participant Ages: 4 to 16 Day/s of the week program is offered: Monday - Saturday Time of Program: TBD by Recreation Dept, Program Dates: September 2012 to May 2013 Program Fee: $200 per semester (15 classes) or $60 per month Program Enrollment: Minimum 10 Maximum 40 Materials to be supplied by participants: Leotard, Ballet, Tap and or jazz shoes Materials to be supplied by PROVIDER: Music and costume Materials to be supplied by the City of MILTON. Space Additional Program Requirements: None PROVIDER (`s) Name: Macita St Germain-Regnier Address: 2959 Commonwealth Circle City/State/Zip Code: Alpharetta, GA 30004 Phone Number: (Day) 917-657-4904 (Evening) 678-404-7570 (E-mail); arincic a7hatmail.cam (Fax) Minimum Requirements: 1,000.000 General Liability Insurance Office use Only. Program Rate: $� # of programs in Session: Fee/Progra rn: E,X111RIT "A" PROGRAM REQUEST, FORM Individuals interested in proposing their programs and services must complete and return this faint attached to the Letter of Interest. This in(ormation will be used fear consideration of program proposals. Use one form per program. Name of Program: Dance Recital Participant Ages: Those taking dance classes Day/s of the week program is offered: Friday and/or Saturday Time of Program: 5PM to 8PM Program Dates: May 2013 Program Fee: $50 Program Enrollment: Minimum 10 Maximum 30 Materials to be supplied by participants: Comfortable shoes and clothing Materials to be supplied by PROVIDER: Music Materials to be supplied by the City of MILTON: Space Additional Program Requirements: None PROVIDER (`s) Name: Macita St Germain-Regnier Address: 2969 Commonwealth Circle City/State/Zip Cade: Alpharetta, GA 30004 Phone Number: (Day) 917-657-4904 (E-mail); anncico@hotmail.com Minimum Requirements: (Evening) 678-404-7570 (Fax) Oa*fice Use Only: 1,000,000 General Liability Insurance Program Rate: 5 5 __ #t of programs in Session: Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for c0nsideratibR of program proposals. Use one form per. program. Name of Program: Dance -A -Then Participant Ages: Any age Day/s of the week program is offered: Monday - Saturday Time of Program: TBD by Recreation Dept Program Dates: April 2013 Program Fee: $50 Program Enrollment: Minimum 10 Maximum 100} Materials to be supplied by participants: Dancing shoes and water bottle Materials to be supplied by PROVIDER: Music and gifts from sponsors Materials to be supplied by the City of MILTON: Space Additional Program Requirements: None PROVIDER (`s) Name: Macita St Germain-Regnier Address: 2969 Commonwealth Circle City/State/Zip Code: Alpharetta, GA 30004 Phone Number: (Day) 917-657-4904 (Evening) 678--404-7570 (E-mail]: anncico.M hotrnail..corn (Fax} Minimum Requirements: 1,000.000 General Liability Insurance Office Use Only. Program Rate: $_ 5 # of programs in Session: Fee/Program, EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This Information will be used for consideration of program proposals. Use one form per program. Name of Program: Summer Dance Camp Participant Ages: 6 to 14 Day/s of the week program is offered: Monday - Saturday Time of Program: TSD by the Recreation Dept. Program Dates: Weeks of June 4, 11, 18, 25, 2012 Program Fee: $150 per week Program Enrollment: Minimum 10 Maximum 50 Materials to be supplied by participants: Leotard. Ballet and or jazz shoes Materials to be supplied by PROVIDER: Music and costume Materials to be supplied by the City of MILTON: Space Additional Program Requirements: None PROVIDER (`s) Name: Mac4a St Germain-Regnier Address: 2969 Commonwealth Circle City/State/Zip Code: Alpharetta, GA 30004 Phonc Number: (Day) 917-657-4904 (Evcning) 678-404-7570 (E-mail). anncicoCc]hotrnail.corn (Fax) Minimum Reauirements: 1.000,000 General Liability insurance Office Use Only., Program Rate: $ it of programs in Session: I Fee/Program: E:XHtBrr "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this fprm attached to the Letter of Interest. This information trill be used for cons0cratian of program proposals. Use one form per program. Name of Program: Talent Fashion Show Participant Ages: Any age Day/s of the week program is offered: Monday - Saturday Time of Program: TBD by Recreation Dept Program Dates: March 2013 Program Fee: $50 Program Enrollment: Minimum 10 Maximum 30 Materials to be supplied by participants: Shoes, cdothing, and make up Materials to be supplied by PROVIDER: Music;, and yifts frorn spunsurs Materials to be supplied by the City of MILTON: Space Additional Program Requirements: None PROVIDER (`s} Name_ Macita St Germain-Regnier Address: 2969 Commonwealth Circle City/State/Zip Cade: Alpharetta, GA 30004 Phone Number: (Day) 917-657-4904 (E-mails): anncico[0hot mail .Wm Minimum _Requirements: (Evcning) 678-104-7S70 (Fax) _._ Office Use Only. 1,000,000 General Liability Insurance Program Rate: $ S # of programs in Session: Fee/Prograrn: EXHIBIT "B" ti i City of Milton Georgia Criminal History Record Information Request and Consent Forret 1) Tris Request is Por: (check Onrronel * Employment � Military n Licensing 2 Personal Use a Other Use Not Listed (E) International Travel c Firefighters Employment (E) a Prospective Adoptive[Foster Parents (E + Note & 2wpr ) Li Employment Working With The Elderly (N) a Employment At A Child Care Facility (W) X Volunteer working with Children :3 Employment Working With The Mentally III (M) Police Ride Along Pequesi [G) a Police Deparifnem VendorfContrnOor {C} 2) A History Is Requested On The Following Person: Name: L-1 Fm v e 5oeial Security Number. - - Sex: Race: a White n Black a Asian u American Indian ❑ UnknowNDther Date Of Birth: Phone Number- � aw W - Check If Request N For Yourself And Proceed To Section 5 At The Bottom Of This Page_ 3) Person Requesting Criminal History: Name: City of MiltonlCompany Name (TBD) Address: '13660 DeerWd Parkway Suite 107 Phone- 6-18 242 2560 City,State/Zip. klilton, GA 30004 4) Consent: This portion is to be used it the person requesting the criminal history is different than whom the criminal history Is being inquired on (sections li K 111 above are not the sante person). Tdtrd party notaryis required. I hereby give fry Consent lot my Ominal Ndswy %o be nun aha for she abme named person in section ill 6o rare access to it. nao� y. Sell: 5) In maKing ints request 1 agree that the City of f'.10on Police f)epartmenl, its ernployees, heirs, trustees, etc., shall in no Wray be held at tart for the use or misuse of this retard. A photocopy of this release wit ve placed on fHe and is valld as an original hereof. even lhougn the photocopy does not contarn an original signature. Incomplete requests will be denied. Thts report is considered accurate at time of inquiry virnd may change ai anytime. Official We Only - 00 Not Mark Seiow This Line Operator ARM Results: Date Submitted (752068 56 Inquiry fate 11 t EXHIBIT "C" STATE OF GEORGIA CITY OF MILTON CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in ❑.C.G_A, § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-.08 in the form attached hereto as Exhibit "D." Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perform such service. EEV 1 Basic Pilot Pram User Identification Number IfY: Niltho�ed O gent Date 0ff-Broadway Expressions Title of Authorized Officer or Agent of Contractor / r� Prinied Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME OTJTHIS THE "'1 DAY OF 2012 2nmimission ublic ��':.; .ON W.. �'. Expires: Ito , -2-c>k�f : _ c _ : a tit : • : � f"• 1, �lll�i 12 STATE OF GEORGIA CITY OF MILTON EXM BIT "D" SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firrn or corporation which is engaged in the physical performance of services under a contract with Off Broadway Expressions on behalf of the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. EEV I Basic Pilot Pr ann�ser dentification Number t cer or Agent Date [INSERT SUBCONTRACTOR NAME] bmt f) ar f, 0).. Title of Authorized Officer ox gent of Subcontractor `� Printed Name of Authorised Officer or Agent all W- 41580N1A10,1IM&Wi11W BEFORE ME ON THIS TIJE DAY OF , 201-1- jNota�rl?ublic ,ommissinnExpires- 0.7.1 Le. ) b1'-- 13 EXHIBIT "E" SAVE Affidavit By executing this affidavit under oath, and as an applicant for a public benefit, as referenced in ❑.G.G.A. § 50-36-1, from the City of Milton, the undersigned applicant verifies one of the following with respect to my application for a public benefit: 1)_ 1 am a United States citizen. 2) 1 am a legal permanent resident of the United States. 3) I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by ❑.C_G.A. § 54-36-1(e)(1), with this affidavit. The secure and verifiable document provided with this atiidavit can best be classified as: In making the above representation under oath. I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of D.C.G_A_ § 16-10-20, and face criminal penalties as allowed by such criminal statute. Executed in 1rll E`Cz A,( -city), 6 F-0 q 6 S A (state). SUBSCRIBER AND SWORN BEFORE ME ON THIS THE DAY OF , 20 t Z 'NOTARY P OBLIC My Commission Expires: MARIBIEL ABARCA NOTARY PUBLIC Gwinnett County State of Georgia My Comm. Expires May 24, 2015 .- 5'nature o Applica - Printed Name of Applicant 14 Vince Green Allstate Agency 138 Marietta Hwy . Roswell, GA 30075 (0) 770-645-9010 (F) 770-642-5463 Date: 12/28/2011 To: Ms. Regnier(anncico@hotmail.com) Re. Certificate of Insurance From-- Chanel Bacoate u and we appreciate your business, CharnelBa ate to u Allsra ra ice Ageit anelbacoate&IIsta e om ACDRDT, CERTIFICATE OF LIABILITY INSURANCE "F¢11xa1' Vines Green Agency, Inc, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND 13$ Marietta Hwy 138 Marell, GONFERES No RIGHTS UPON THE CERTIFICATE HOLQER. THIS CERTIFICATE GA 30075 DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE PERIOD BY THE 77D -&4&9010 POLICIES BELOW - INSURERSAPrORMING COVERAGE Macita Regmer cUbla Off Broadway Expressions INSURcr7ti F&I ln3wa eommr%y 2969 Commonwealth Cir INSURER 8: _ Alpharetta, GA 30004 INSURERC: INS VRER❑ _. „_ , COVERAGES THF POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED- NOTWfi'HSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR O1HLK DOCUMENT VVITH RESPECT Td 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUICED UY r AID ;,}}lW& (haR YI POLICY EFFECTIVE I EXPIRATION LIMITS LTR TYPE OF INSURANCE POLICY NUMBER 6ATE (LgKMDIYY) OATS (MM10 GENERAL LAASILITY Ewl Mourrence w I ;7,Oi'{1,OW nrne•cial General LIeb1Ly I F,re UN1T1 Bge (Ary ono Bre] $5o, 000 ] Clakns e l ufa �Ocrar .. P.xson8[luwreaa LiaAlGty Exp IWry onepelscl? 87.Ojp A 443 30 70f3T12071 10rWQ011 i'0f5�,^31 &mv Iniury 31. 00.000 Gen'IAggro atYLimil�j ea Per. GenaalAggrnWe $2.000.01)0 �P° 7 11prcier. LJLoC Produch- UMP?OP►gg $2,0m,00D Any ) -A410 All Owned Autos S[hadugd A[Ms Hired Autos mm'id A'Jms L7edudr3le iielerAW11 Claims R1add $ AND EMPLOYERS' LIRBI TY RATION Dame insaruelor rEa;hacddkniV _... 3 Roddy Injury s (Per P-) Body Injury -- 5 ;Par accidar . . Ply Damage S (Fer —6deM) A :o Onry - "d1 acCkW $ Otber than Each a� 3 arlo ady AGG $ Ex�cn Dcurr�r_v 6 ,ag0egate S S ❑yvc 6taww.y Li•r it. E.L F.aOftclde-'l S E.L. Disvaa�-Each Ln,�layea S F I nZ— _ Peau A-,nt S CERTIFICATE HOLDER @4 B[HpONALINSURE0;INSURER LETTER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED City Of Milton BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURI=R WILL ENDEAVOR TO MAIL 30 S WR1TTEi9 NOTME TO THE CERTIFICATE HOLDER $11ED "O L , BUT r -AI 1 DO SO SHALL I -POSE NO DELIGATION OR LIA - 1TY F ANY VP N TME INSVREA, ITS AOENTS OR REPRESENTAM/E5. - . VINCENT RGRFt ?4 11 ,'' C❑ ❑ PORATiON 1988 City of Milton Business License Fry (Home Based Business) IN ACCORDANCE WITH THE PROVISIONS OF THE CITY OF MILTON CODE OF ORDINANCES, LICENSE is HEREBY GRANTED TO OPERATE, THI- 13US1NESS REFERENCED BELOW BUSINESS Off Broadway Expressions DBk LOCATED AT: 2969 Commonwealth Circle LICENSE #: BUS001313-12-201 # DATE ISSUED: December 02, 2011 DATE EXPIRES, December 31, 2012 Given under my hand this date of December 15, 2077 ad. Chris J. Lagerbloom City Manager POST IN A CONSPICUOUS PLACE City of Milton 13000 Deerfield Parkway Suite 107C Milton, Georgia 30004 To: Honorable Mayor and City Council Members From: John Rebar, Parks and Recreation Director Submission Date: April 25, 2012 Meeting Date: May 7, 2012 Agenda Item: Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Kim Saunders Yoga, LLC Background: The Parks and Recreation Department is eager to continue offering programs and additional services to the citizens of Milton. Many of these programs may be offered by outside providers through an agreement with the City of Milton based on a submitted program proposal rather than offering these programs through a paid independent contractor or a paid employee of the City. Discussion: The Parks and Recreation Department recommends entering into agreement with Kim Saunders Yoga, LLC to provide miscellaneous yoga classes for our residents and visitors. A commission of 30% of all registration fees will be paid to the City of Milton two weeks following the end of registration. Non-resident fees will be collected by the provider and paid to the City at a rate of 50% more. Legal Review: Contract Template - Paul Higbee, Jarrard & Davis on February 23, 2012 Attachments: A Parks and Recreation Department Agreement between the City of Milton and Kim Saunders Yoga, LLC CITY OF MILTON PARIS & RECREATION DEPARTMENT AGREEMENT FOR OUTSIDE PROVIDERS THIS IS AN AGREEMENT, made this day, of , 2012, between: THE CITY OF MILTON, a rntmicipal corporation organized and operating under the laws of the State of Georgia, Frith a business address of 13000 Deerfield Parkway-, Suite 107 A, MILTON, Georgia 30004, hereinafter referred to as the "CITY." and KIM SAUNDERS YOGA LLC hereivaticr referred to as "PROVIDER". CITY and PROVIDER may hereinafter collectively be referred to as "the Parties". In consideration of the mutual obligations of the Parties and for good and valuable consideration, the adequacy and receipt of which are hereby acknowledged, the Parties agree as follows: ARTICLE LQ ,PROVIDER's_Services _ and Responsibilities 1.1 PROVIDER shall conduct services generally described as Yoga Classes at the following location: I3ethwell Conummity Center. 2695 Hopewell Road, .Milton GA .30004. 1.7 The I'ROVIflFR's services shall be performed during the clays and hoi€rs described in Exhibit "A," attached hereto and incorporated herein by reference. 1.3 The PROVIDER and The Director of the Parks & Recreation Department or his designee, hereinafter referred to as the "DEPARTMENT", will agree upon program schedules. PROVIDER agrees to submit a Program Request Form. to the Coordinator for each program being proposed eight (8) weeks prior to the beginning r�, j' each .cession. 1A The .fees charged to each participant will be as described in Exhibit "A" for residents of MILTON and a surcharge of 501A more for non-residents of MILTON. The entire 'balance of this surchax e for non-residents shall be aid to the CI rY. 1.5 The PROVIDER warrants to CITY ilrat it is not insolvent. it is not ill bankruptcy proceedings or receivership, nor is it engaged in or threatened with any litigation or other legal or adluinistrativc proceedings or investigations of any kind. which .would have: an adverse effect on its ability to perfoma its obligations under this .Agreement. 1.5 The PROVIDER agrees that it shall be solely responsible (or all costs and/or expenses associated with., or as a result of its operation tinder this Agarecrrient. The PROVIDER stipulates and certifies that it is qualified to provide the programs it is hired to provide, maintains the education and required licenses or permits necessary to provide the programs, and shall continue to maintain such licenses or permits during the tenni of this Agreement. 1.7 This Agreement is considered a non-exclusive .Agreement between the Parties. The CITY shall have the right to purchase the same kind of services to be provided by the PROVIDER from other sources during the terin of this Agreement. The PROVIDED is not precluded from providing the same or similar services for other parties so long as such other engagements do not interfere with the PROVIDER'S provision of services to the CITY. 1.8 The DEPARTMENT roust approve any promotional material, flyers, and posters advertising the programs prior to its release. viae fello ing content and topics shall specifically be prohibited. sexually explicit materials, profan child pornography, alcoholic beverages, tobacco products, adrtlt movies, adult booklvideo stores, adult entertainment establishments, massage parlors, pawn shops, and tattoo parlors or shops. 1.9 The PROVIDER shall not promote any privately owned business in a CITY park/facility or Solicit any participant in a CITY park/facility activity for any privately owned business. The PROVIDER may not use said facilities to conduct personal business including workshops, clinics, seminars, camps, or any other activities that are outside the scope of service: described in (Exhibit "A"). It is further understood that such action(s) may result in irnmediate tonn.ination of the Agreement and the forfeiture of all compensation due to the PROVIDER. 1,111 The PROVIDED. shall abide by the policies, procedures, rules and regulations of the DEPARTMENT, the CITY, and the FULTON COUNTY BOARD OF EDUCATT0N as promulgated from time to time. I ROP7DER understands, and agrees that the DEPARTMENT'shaft haverrst rior' ar use a CITY arcilities rrat">ithstandin_Z an other provisions of this Agreement 1.11 All assistants, substitutes, and subcontractors utilized by the PROVIDER must have prior written approval of the DEPARTMENT_ 1.12 PROVIDER shall provide necessary supervisory personnel to ensure that the participants of the programs obey all applicable policies, procedures, Rules and Regulations. 1.13 The DEPARTMENT or CITY may require that the PROVIDER not be permitted to utilize specific assistants, substitutes, or subcontractors of PROVIDER who have failed to follow any policies, procedures, rules or regulations applicable to the use of the facility. 1.14 Although the CITY shall not control the PROVIDER's techniques, methods, procedures, or sequence of instruction, the PROVIDER will comply with the CITY's and DEPARTMENT's policies, rules, regulations and procedures, as well as those of the FULTON COUNTY BOARD OF EDUCATION, and shall not interfere vvith their 2 operation, nor harm or damage the equipment or facilities afforded to PROVIDER for his/her programs, nor otherwise disrupt the other on-site activities being offered at such public facilities. 1.15 The PROVIDER also acknowledges that he or she is primarily responsible for the conduct of the participants in all programs under the PROVIDER's charge. 1.16 If the PROVIDER. will be providing services directly with minor children without parental supervision, the PROVIDER shall, prior to commencing services under this Agreement, comply with the CITY's policy regarding criminal background screening. The CITY will furnish the PROVIDER with a background release form (Exhibit "B") for all the provider's counselors, coaches, volunteers, subcontractors, employees or any other iudividuals that will come in contact with a child, at the PROVIDER's svlu expense. A Consent mid Release Form to conduct u crimirzal background must be executed by any of PROVIDER's employees or any individual who will come in contact with a child at the CITY through .PROVIDER. or at PROVIDER's direction, such farm authorizing the CITY to conduct a search of each such individual's criminal background. The result of such inquiry may be deemed acceptable by the CITY in its sole and complete discretion, and the CITY may reject any individual from participating in any program based upon such results. If the.PROVIDER has recently had a background screening conducted by € pother agency, the CITY, at its sole discretion, may accept that background screening and waive the requirement of a new background screening. PROVIDER and its eraployees must also execute a Waiver and Release of Liability holding the CITY and F LTON COTJNTY BOARD OF EDUCATION harmless. 1.17 The CITY shalt require all participants in all programs to sign a Waiver and Release nl= Lia i lity. ARTICLE 2.0 Equipment & Materials 2.1 All program materials and equipment needed or pertaining to the above stated programs will be provided by the PROVIDER at his/her own cost and expense. However, PROVIDER may require participants to obtain certain materials required in the programs by providing a list of such materials (with approximate costs) to the participants. If PROVIDER makes such materials available to participants, they must be sold at PROVIDEWs cost. All equipment provided by the PROVIDER shall be used in strict accordance with equipment manufacturer's instructions and in accordance with all applicable laws. PROVIDER shall coordinate storage of goal posts with the principal of the school located at the facility, 2.2 The sale of merchandise is restricted to those materials utilized in and for the programs. Fundraising activities conducted by the PROVIDER will not be permitted. The PROVIDER shall obtain the C rl'Y's approval of any merchandise to be sold prior to its distribution or sale. 3 2.3 The CITY will provide no storage space to the PROVIDER, unless othervvise mutually agreed upon in a separate written agreement. 2A Any supplies or equipment lett at the facility 'mill be the responsibility of the PROVIDER. The C11'Y will not be responsible for any lost, stolen; or broken equipment or supplies. 2.5 The PROVIDER shall inspect the premises and equipment offered to him/her for hisflzer proposed activity aatd if he or she finds anything rmrong Nvith the promises or equipment before each program commences that cannot be corrected immediately by the DEPARTMENT', the program shall be canceled and the matter reported to the DUARTMENT for eorrect.ion_ IC the PROVIDER elects to hold his/her programs in the facility provided, it will bt;1]t'r;sUMcd that the PROVIDER has inslreQLcd Lhe prCrmsus and facilities and equipment provided for such programs and has accepted same as being safe and suitable .for the use intcnded. ARTICLE 3.0 Prot rata Size Minimums: 3.1 ACTIVE: Program sizes shall meet the rnL-iimum .numbers of participants for each program as designated in. E.xhibit "A." ARTICLE 4.0 Compensation and Method of Paw meat 4.1 In consideration of the rele4ises and 'indemnities contained heroin and of the. PROVIDER's services in connection with the programs and activities described herein, the CITY shall be entitled to 30% of the registration fees paid by all progra.rn participants to the PROVIDER, and the PROVIDER shall be entitled to 70% of such fees paid, exclusive of the 50% non-resident surcharge. The 50% non-resident surcharge is fully payable to the CITY and shall not be included in PROVIDER's grass income calculation. PROVIDER shall be entitled to retain all non -registration fees paid by participants to PROVIDER, i.e. PROVIDER mernbership fees and costs for uniforms and pictures to participants. 4.2 The PROV1lDFR agrees to collect all fees from participants, and the PROVIDER agrees to provide CITY With schedules of fees to be Charged to participants in conformance with Exhibit "AIIa It is agreed that the PROVIDER's sole obligation shall be to collect the fees from the participants and to remit the ail% of the lees collected as well as all 50% non-resident surcharge amounts to the CITYwith a pay -out report of all monies collected. Payment will be made to the CITY within fourteen (14) business days of the end. of each month or session or program, whichever occurs first. 4.3 It is the responsibility of the PROVIDER to pay all applicable local, state, and federal taxes associated with this Agreement, and to acquire and pay for all necessary permits, licenses, and insurance required for the execution of this Agreement. ARTICLE 5.0 :Independent PROVIDER 5.1 This Agreement does not create an employeelemploycr relationship 'between the Parties. It is the intent of the Parties that the PROVIDER is an independent contractor under this Agreement and not a CITY employee for all putpu s, including but not limited to, the application of the Pair Labor Standards Act minimum wage and overtime payments, Federal Insura.ncc Contribution Act, the Social Security Act, the federal Unemployment Tax Act, the provisions of the Internal Revenue Code, The State Workers Compensation Act, and the State uncrnployrncnt insurance law, The PROVIDER shall retain sole and absolute discretion in the judgment of the manner and ineans of carrying out PROVIDER's activities and responsibilities hereunder. The .PROVIDER agrees that it is a separate and independent enterprise from the CITY, that it had full opportunity to find gather business, that it has made its own investment in its business, and that it will utilize a high level of skill necessary to performm the work required hereunder. This Agreement shall not be construed as creating any joint employment relationship between the PROVIDER and the CITY and the CITY will not be liable for any obligation incurred by PROVIDER., including but not limited to unpaid minimum wages or overtime premiums. 5.2 PROVIDER warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the PP,0V1DFR to solicit or secnre this Agreement, andthat it has not paid or agreed to pay any person, company, corporation, individual or firm any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the aw=ard or making of this Agreement. For the breach or violation of this provision, the CITY shall have the right to terminate the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover the full amount of such fee, commission, percentage, gift or consideration. ARTICLE 6.0 Insurance 6.1 PROVIDER small not provide wiy service until all insurance required under this paragraph has been obtained and approved by the CITY. 6.2 Certificates of Insurance. Certificates of Insurance reflecting evidence of the required insurance shall be filed with the CITY prior to the commencement of this Agreement. These Certificates shall contain a provision that coverages afforded under these policies will not be cancelled until at least forty -rive days (45) prior written notice has been given to the CITY. Policies shall be issued by companies authorized to do business under the laws of the State of Georgia. Financial Ratings must be not less than "A -VI" in the latest edition of—Best. Key Rating tiuide", published by A.M. Best Guide. 6.3 Insurance shah be in force until the obligations required to be fulfilled under the terms of the Agreement are satisfied. In the event the insurrcttce certificate provided indicated that the insurance shall terminate and lapse during the period of this Agreement, then in that event, the PROVIDER shall furnish, at least thirty (30) days prior to the expiration of the date of such insurance, a renewed Certificate of insurance as proof that equal and like coverage for the balance of the period of the Agreement and extension thereunder is in effect. The PROVIDER shall not provide any service pursuant to this Agreement unless all required insurance remains in full force and effect. 6.4 Cammercial_General Liability insurance to cover liability bodily injury and property damage. Exposures to be covered are: premises, operations, products/completed operations, and certain contracts. Coverage must be written on an occurrence basis, with the following limits of liability: $1,000,000 Combined Single Limit — each occwTence $2z0G0,000 Combined Single Limit —general aggregate 51,000,0,00 Personal Injury $1,000,000 Products/Completed Operations Aggregate PRO VIDER shall have its insurer name the City oaf MILTON as an additional insured on its General Liability policy. 6.5 Worker's Compensation insurance shall be maintained during the life of this Agreement to comply with the statutory limits for all employees, and in the ase any work is sublet, the .PROVIDER shall require the subcontractor(s) similarly provide Workers Compensation Insurance for all the latter's employees unless and until such employees are covered by the protection afforded by the PROVIDER. The PROVIDER and his subcontractors shall maintain during the life of this Agreement Employers Liability Insurance. The following limits must bemaintained: A. Workers Compensation Statutory B. Employer's Liability $100,000 each accident $500,000 Disease -policy limit $100,000 Disease -each employee If PROVIDER or its subcontractor claims to be exempt from this requirement, PROVIDER shall provide CITY proof of such exemption along 1� ith a wTittm request for CITY to exempt PROVIDER, written on PROVIDER or subcontractor's letterhead. 6.6 PROVIDED shall also maintain Auto Liability and Directors and Officers insurance with 1.u -nits marionably acceptable to CITY during the term of this Agmeinent. 6 7 The CITY and the Fulton County Board of Education shall each be nanred as ars additional insured and lass payee on all policies required by this Agreement. ARTICLE 7.0 Term and Terminations 7.1 Amer a two (2) month trial period, the programs will be evaluated by the DEPARTMENT, and the remainder of this Agreement will either be terminated or continue in full force and effect. If at any time after the two (2) month evaluation, program enrollment should fall below the require minimum., the PROVIDER will be allotted four (4) weeks to bring enrollment up to the required minimum. The programs will be reevaluated and execution or termination of the contract will be determined by the DEPARTMENT. 7.2 The term of this Agrmineut shall ccarnmerice upori the dace of exeCutioa hereof and shall remain in effect for a period of one (1) year from the date of execution of this Agreement by the CITY, unless terminated sooner as provided in. this Article. Renewal of this Agreement beyond the one (I) year terart shall require the mutual written agreement of the CITY and PROVIDER. 7.3 This Agreement may be terminated by the CITY for convenience upon giving of at least thirty (30) days prior mitten notice of termination to the PROVIDER at the PROVIDER's address set forth herein at the sole and exclusive discretion of the CITY. This Agreement may be terminated by the City immediately by written notice to PROVIDER upon any willful, reckless, or grossly negligent act or omission by PROVIDER or any of its officers, agents, employees, or volunteers. 7.4 This Agreement may be terminated by PROVIDER upon giving at least thirty (30) days written notice of termination to the CITY_ 7.S PROVIDPR must notify the DEPARTMENT in writing of any program cancellations at least ten (10) business days prior to the scheduled cancellation. 7.6 CITY reserves the right to cancel or reschedule any of the PROVIDER's programs, in the case of scheduling conflicts or other emergencies, as determined by the DEPARTMENT. ARTICLE 8.0 Indemnification 8.1 PROVIDER agrees to indemnify and hold harmless the CITY and the FULTON COUNTY BOARD OF EDUCATION, their trustees, elected and appointed officers, agents, sen ants and employees, from and against any and all claims, demands, or causes of action of whatsoever kind of nature, and the resulting losses, costs, expenses, reasonable attorneys' fees, including paralegal fees, liabilities, damages, orders, judgments, or decrees, sustained by the CITY, the FULTON COUNTY BOARD OF EDUCATION, or any third party arising out of, or by reason of, or resulting from the will full or negligent acts, errors, or omissions of the PROVIDER or its agents, officers, volunteers or employees. 7 $2 The Parties understand and agree that the covenants and representations relating to this indemnification provision shall survive the term of this Agreement and continue in fia11 force and effect as to the .PRO VIDER's responsibility to indemnify. ARTICLE 9.0 Americans With Disabilities Act 9,1 PROVIDER shall not discriminate against any person ira its operation and activities in its use or expenditure of the funds or any portion of the funds provided by this Agreement and shall affirmatively comply with all applicable provisions of the Aruericans: With Disabilities Acct C'ADA" j$ in the programs while providing any services funded in whole or in part by the CITY, including Titles I and 11 of the ADA and all applicable regulations, guidelines, and standards. 9.2 PROVIDER's decisions regarding the delivery of services under this Agreement shall be made without regard to or consideration of race, age, religion, chlor, gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation, or any Other factor which cannot be lawfully or appropriately used as a basis for delivery of service. ARTICLE 10.0 eellancous 10.1 No modification, amendment, or alteration of the terms and conditions contained shall be effective unless contained in a written document execrated with the same formality and equal dignity herewith. 102 This Agreement is non -transferable or assignable, and PROVIDER agrees not to transfer or assign the performance: of services called for in the Agreement. 14.3 This Agreement sets forth the full and complete understanding of the Parties as of the effective date, and supersedes any and all :negotiations, agreements, and representations rnade or dated prior to this Agreement. 10.4 The PROVIDER shall pay reasonable attorney's fees to the City should the City be required to incur attorney's fees in enforcing the provisions of this Agreement. 10.5 Time is of the essence of this .Agreement. 10.6 Each of the individuals who executes this Agreement agrees and .represents that he is authorized to execute this Agreement on behalf of the respective entity. Accordingly, the City and PROVIDER both waive and release any right to contest the enforceability of this Agreement based upon the execution and/or approval thereof: 10.7 It is the policy of City that unauthorized aliens sha11 not be employed to perforin work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the PROVIDED shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and "D" that it and its subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perform work on the City contract to ensure that no unauthorized aliens will be employed. The City Manager or his/her designee shall be authorized to conduct an inspection of the PRO VIDER's and its subcontractors' verification process to determine that the; verification was correct and complete. The PROVIDER. and its subcontractors shall retain all documents and records of its verification process for a period of three (3) yeais following completion of the contract. This requirement shall apply to all contracts for the physical performance of services whew more than three (3) persons are employed can the City contract, Compliance with the requixeMents of O.C.G.A. § 13-10-9I and Rule 300-10-1-.02 is mandatory. PROVIDER's compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300- 10-1-.02 shall be attested by the execution of the contractor's affidavit attached as Exhibit 44f " Pursuant to O3 C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verities that it has, prior to executing this Agreement, executed a SAVE, Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to O,C.G.A.. § 16-10-71), a form of which is attached hereto as Exhibit "E", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prier to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electmnically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A, § 50 -3G -I). 9 IN WITNESS OF THE FOREGOING, the Parties have set their hands and seat the stay and year first written above. ATTEST: SUDiE GORDON, CITY CLERK f CITY: BY: JOE LOCKWOOD, MAYOR PROVIDER: BY: KIM SAUNDERS, PRESIDENT [AFFIX COR.PCF ATE SEAL] 10 EKIIIB ` "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form Der Drooram. Name of Program: Yoga Participant ,ages: 15 + Dayls of the Meek program is offered. T, VII, Th, Sat (will aidd Sunday workshops in the future) Time of Program Tues/Thurs 8:30 -- to 11:30 am & 6-7:30pm Sat 9 -- 12:30 (to be added in the future: Tues/ Thur 4prn -- kids/teens; Sunday workshops 2 x month) Program Dates: Program to run continuously for 4 weeks Program Fee: $10 per class for residents; $15 for non-residents Program Enrollment. Minimum 5 - Maximum 20 Materials to be supplied by participants: Yoga Mat Materials to be supplied by PROVIDER: Yoga Blocks, Straps Materials to be supplied by the City of MILTON. Meeting space Additional Program Requirements. Marketing support on City of Milton website PROVIDER (`s)Name: Kim Saunders Address: 830 Freernanwood Lane City/State/Zip Code: Milton, GA 30004 Phone Number: (404) 906-8233 (E-mail): kimsaunders@mindspr€ng.com Minimum Reciuirements: 1,000,000 General Liability Insurance 0froce use only, Program Rate:$ # of programs in Session: Fee/Program- EXHIBIT"B" B" City of Milton Georgia Criminal History Record information Request and Consent Form 1) This Request is For: fcn or r ) ❑ Employment a MMary o Ling a Perms U �i Other Lis& Not Listed {E} u International Trani u FireVter* Enylayment (Ei o Prospective Ado0i Fvstw Pawls (E - Iote d 2 3 o Employment Working With The Ekletiy tNi u Employrrraot At A Ch d Care FacO4 tM X Volum wonting with Children (W) * Empbyawt Workiq With The Mentally IN (M) is Poke RI& Along Request (t:) a Poles Depar'trrwnt VendorfGontrador lG} 2) A History Is Requested on The Fallowing Person: Marne. Social security, Numt7er --- ..._ Sex: Race: ❑ V&te a Atad o Asian o man Indian 3 t.kknown/C Cher Dole Of Birth: Phone Number,,----- 0 umber:0 Check If Request Is For Yourself And Prooeed To Becton 5 At The Mom Of This Pwje, 3) Person Requesting Crtrninal Hislory: Name: City of Nl toniCw"ny dame (T80) Address: 13000 field Parkway Suite 107 Phi . 678 24.2 2500 City€'Sia€efZip: Men, , GA 30004 4) Corte: This p€ rtim is to be used if the person requesiuq Me criminal history is different Inan whom the criminal history is being inquired on (smarts It & III stove are not ttte same person Y Third party notary is required. I hereat' rly a a MW f& my crimeui Y to be run and For tore above namea pwson in secuon I It to raave ACcC= tori. oaf: 51 In 01aaing anis request, I agree that Ute Gdy 0 MSDn PoNce DepaqmenL its exouyeei�, Heirs, trustees, r,., vhA 0 no way be tit at sl# Tor the use or misuse L% ihls Imo. A spy of Mn mkas., will be ptxed on lRe aN rs va 9 as an orig" rere4, e4en awgh the PAY dv�s > conn signaiur�. trscr�pt�te reqs I be s3enied. this report � c�tsid�r�ri a�a�a� at tgne of Inquwy and may div�ge at arqt . C]Moo € 0"4 - Dv NtA Aeark Be" P75 Lgx a5J2003 M Date SuLt ruitted € Inquiry Cate 1 1 I1 EXHIBIT "C" STATE OF GEORGIA CITY OF MILTON CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accurdance wilt die applivability previsions and deadlines established in O.C.G.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-9.1 on the Subcontractor Affidavit provided in Rule 300-10-01--.08 in the form attached hereto as Exhibit "D." Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perforin such, service. EEY / Basic P' of Prog User Identification Number 1 BY: Auth6rized Officer or Agent Date Kim Saurtdcui Yoga LLC Title of Authorized Officer or Agent of Contractor Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN E ORE ME ON T I5 THE DAY OF 20121 Notary Public My Co ssiun Expires: -Lott 12 1Z =PUE d�D I�or=u'ton CouaMy COMM. 5 STATE OF GEORGIA CITY OF M11LTON EXHIBIT "D" SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performnance of services under a contract with 1Kitirn Saunders Yoga LLC on behalf of the City of Milton has registered with and is participating in a federal work authorization prograi n, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. EEV I Basic Pin t Progntification Number BY:.A.utho ized Officer jr-A'-gent Date [INSERT SUBCONTRACTOR NAME] "Title of Authorized Officer or Agent of Subcontractor Printed game of Authorized Officer or Agent SUBSCRIBED AND SWORN EFORE ME ON TUIS THE DAY OF t� _, 201 Notary Public My Commission Expires -, Ice- la E " �1°iiTARD ARY PUBLIC y -State of Georgia xpires Feb. 1B, 2015 EXHIBIT "E" ,S V£ i ff-fda it By executing this affidavit wider oath, and as act applicant for a public bencf"it, as referenced in O.C.G-A. § 50-3b-1, frons. the City of Milton, the undersigned applicant 'verifies one of the following with respect to my application :for a publie benefit - 1) .................._ 1 am a United States citizen. 2) 1 am a legal permanent resident of the United States. 3) 1 am a qualified aliens or non-immigrant under the Federal :Immigration and Nationality Act with an alien nuintier issued by the Departwout of HVITICIall i Security Or caller federal immigration agency - My alien. number issued by the Department of Homeland Security or ether federal immigration agency is: The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as rewired by O_C.G.A. § 50-36-1(e)(1), with this affidavit. The secure and verifiable document provided with this affidavit can best be classified as: In malting the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation ofO.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute. Executed in SUBSCRIBED AND SWORN BEFORE ME O)PI THIS THE )PA,TJAY OF20 . 2 el - NOTARY PUBLIC My Commission Expir s: (city), (state). Signature of Applicant Printed Marne of Applicant IZAbELA A°l TARD NOTARY PUBLIC Fulton County - State of Georgia My Comm. Expires Feb. 16, 2015 14 ant nl No. 11089652 STATE OF GEORGIA Secretary of State Corporations Division 313 ''Lest Tower Z Martin Luther King, Jr, Drive Atlanta, Georgia 30334-1.530 CERTIFICATE OF ORGANIZATION 1, Brian P. Kemp, the Secretary of Mate and the Corporations Commissioner of the State of Georgia, hereby certify under the sca€ of my office that KIM SA NDERS YOGA, LLC a Domestic Limited Liability Company has been duly organized under the laws of the State of Georgia on 12105/2011 by the filing of articles of organization in the Office of the Secretary of State and by the paying of fees as provided by Title 14 of the Official Code of Gcorgia Annotated, WITNESS my hand and official seal in the City of Atlanta and the State of Georgia on December 5, 2011 r Brian P. Kerne Secretary of State Cofftrol No: 11089652 ❑ate Filed: 12!0512011 09:59 AM Brian P. Kemp Secretary of State Dcca 7 bcr 05, 2011 ARTI" ES OF ORGANIZATION FOR GEORGIA. LIMITED LIABILITY COMPANY The name of the Limited Liability Company is. Kim Saunders Yoga, LLC The principal mailing address of the Limited Liability Company is. 2595 Hopewell Rd Millen, GA 30004 The Registered Agent is.- Kimberly s:Kimberly Snow Saunders 8311 Freerrarnvood Lane Alphare": CA 30004 County: Fulton The name and address of each organizer(s) are: Kimberly Snow Saunders 2695 Hopewell Rd Milton, GA 30004 The optional provisions are: No optional provisions. 11- kVi' NESS WHEREOF, the undcrsigiied has executed these Articles of Organizz6on on the date set forth balow. sianature(s). Date; Attonwy-in-Fact, William Phalen Dmcmber 05, 2011 DATE cs,EeaMDf" rrp CERTIFICATE OF LIABILITY INSURANCE THIS CEMICAMIN IS ISSUER AS A MATTER OF INFOiRRATION Mat aNs3uaaarAt�g6Nlt, ONLY AND CONFERS NO RIGHTS UPO hI THC CEMFICATE xna€ eRaFe�Sudee29G HOLDER. THIS CEfMFICATE DOES NOT AMMEND, U(FEND OR +au anra3a cAsaset- ALTERTHE COVERAGE AFFORDED BYTHE POLICIM BELOW. Ili 7pas.7d 41- S.1wad17 lRRtta4, f 4 3M?]� COVERAGES PEL RPR G YHL KKfLWS OF IR4.SURANU:Lr316 ] SfrWW HAVE 8EEM i.SWIDDT-0 THE INSURED NAMED ABOVE FORTREPOLICYPERIOA INDICATED. NOTMTKSTAKINNZ ANY RE41VJIREMENT, TERM OR CON DIMON OF ANY #ONYMCT OR OTHER DOCULf IrNT WrrH QCT TO WHICH THIS CEN FILATE N MAY SE MM OR MAy PERTAIN, THE RjSk"r4CE RFFORMO 8Y THE poucles DeSaUMD HEREIN Is SUa jrr TO A.M THE TERMS, EXCLUSIONS AND COMMONS of SUCH POUC.IES.._AGGREGATE LINEITS SHOW�[.i�AY HAVE BEEN � BY PAID IIiLSR ADO'L POe1CYEFfEC[iYF ft'itl0'#OWLRA71Dil LTR l6N0 1YPEORIK4CIMIif.£ POiFGt'ia'JMdBR 0A7£tmumoj F'n" G4i'E LHYtII$ A x RAL.EfA8R,i7Y Pii?iCf ffa7&OGA I 04,R1418DxL tl4PAfB^2D1T C4CIOC7C1J 52s506AQ0 rieEht s Ea S:flDpoO X ERCLaL aI�eRAE uAliam CCCUR fE[ � MEO £7IO WW ax xra+i Sz.soD PE1tS'�Pt $ APrV PUURY $I,G4 AM X MOFMMNAq IAA94M qmE .;LktAGGRCGA UAW= I I F 3L-S-pOMPIOp AGG 54,Ooopro 6EH'L AG6stfGA'C� UwecY ApsVEi KR; I I{ 'c, >ADSECT LOC A AAFTOFN UfAW7Y 0W5 ttE051 HfiIF LMAFr .WV AVTO lOAIlY IIGU$Y �µ ALLOW19Sb AUrCY SCHEDUfSD wlSOS (Fu pe nl BOC1lY NiVR1' HIRED Au7dM NON-OWFIE7Al1T05 - fiRT=Wdcnty ._...F- fl$Ui''kYFT1 [ CdRA.EF i1A31LIT" R.FiUgLY-CA JLCCIDEH7 ^_ OYsl Y7" CAAcc I[ , LNY.:',:"O y..... € AUM 0:iY, DWL-i ;iMMXUAL1"UTY EACH OCOUIRNCE F.v4REGATL o(Y_:oR [;.v.'AR hA1.0 RET'1't^.Ot: eF+s EYaWnt�rrrl �slexu WRj'e�+.. a:eKfRl�Ern6EA l[ ii0cD7 ._..J - F. L. EACH ACGifsZKT £L Di3?�SF-IA AMPLOYFE i �rY INi1 E.L. OrSEASE ^ PP� El LUT 5yyam�,, dsa SF£e}PL Rov �RWifF71S5 mix { DLSORrrnm OF pPERT,T1oos j L*(,A gyW vEmo f =T40M ADDE1j SY ENDOMCKW IV90AL PROVISKNm P14 V0 VA00d .l rs jkv dt?1ft tt*f04& " t" a 4wvE0-add:6.. l'n5 &Rnt M V W)n mptIXjz to t he DpC,64"f 3f t;k fa o4 ingU KE weol f hit Fo oft frg"%I16 adck6"li iRu"gf'i sIe sa�l¢e� CERTTF"n HOLO) CANCE"'iON C.yofE6tW.t :3400 Deeri6efa Platy Ste 107 Mkk". GA 3emE. 3"our: Am up TKE A*w nexaeeo potxx* Oc pwCULE =AM THMCOF, Yxt YSCalM ;PSUACR Wta Cr1DEAVOR ID MAk = DAYS WMT,ft NO= TO 1HE CER'r:FCATE RRL a" "Am 70 THE Lt", BLIT vkwu ro DO ie SKM IRM -W no""GAT"om OR LL5 ILM OF AW KIND I)-41HE lfUWKR, tr-$14,W'S 6A N> CtETA'111flE-. R4 r xOK:L=D HLFKt! W :A311Tt ACO RD 25 (200/01.) CSS 1988-2009 ACCORD CQRPOAA'"`ION. All rights reServed. The ACORD name and lop are registered !narks of ACQ AD rCity of Milton IQLI� Business License (Home Based Burin sj IN ACCORDANCE WITH TETE PROVISIONS OF TSE CITY OF MILTON CODE OF ORDINANCES, LICENSE IS HEREBY GRANTED TO OPERATE THE BUSINESS REFERENCED BELOW BUSINESS: KIM S.AUNDERS DBA: LOCATED AT: 630 FREEMANVILLE LAME LICENSE #: BUS001329-12-2D11 GATE ISSUED: January 10. 2012 ©ATE EXPIRES: December 31, 2012 Given under my hand this date of January 10, 2012 ',#� qwz� Ghris J, Lagerbloorn Ci'y PAarnager POST IN A CONSPICUOUS PLACE. STATE OF GEORGIA BPJAN P. IM", Secreta -t of State Georgia Composite Board of PC, SW- and'�iF i Professional Counselor LICENSE NO. L.PCO04336 X mberly Snow Saunders 830 Freemanwood Lane A.Ipbztretta GAS. 30004 EXT DATE - 0913012012 Activt Above is yourwall gate iii to practice as a: ProfessiwW Counselor, SocW Worker or Marriage wd Fames Therapist in the State of Georgia. A pocket -sized license card. is Wow. %ensees are required to obmin 35 hours of continuing adticaaoo credits, with the exceptim of individuals licensed on or after October 1st, of the odd numbered year. Board Rule Chapter 135-9 specifies condau-mg education requirements. You should keep your own coutiuuiug education docrunutsta€ion ate, so Haat wben required upon the est oft` e- lard you can submit the documentation at renewal time. All forms and applications can Ile downleaded from the Boards web site atusf Ih.# Fleasc notify the Board in vntmg if you ktavc a name chanp (you or czange of addrew ismer%; a Composite Board of Professional %lam, &xiaal Woxkem&-MxTiage and Family Therapists 237 Coliseum DTive boon, GA 31217 Phone (478) 207-2440 Fax (478) 207-1410 ww &gwxtolb1counseior, lmbe;rly Snow Saunders 93-0 Freematrwood Lane Alpharetta GA 50004 'M YogaAflionce 0 lnteigrity. Diversity. Community_ � � ' EnLr�ricy. flirlrSi:y. Commun�xy. - fUndwfy.s, Saundem, RYT F July 12, 2011 � ' .Registry ID -1 47.2.10 Teacher -S inn- Sep 18,'2009 Kimberly $. Saunders. RYT 830 Freemanworxi Ln Primary Style: Hatha - Milton, GA 80004USA hear Kirnbetiy: Zh=k-you f�_``= ��- •; ,�,;r x�a AWa=e--Yomr --g;stratio„ 10 -mrd i!slo=ed in ftistariion Beniftts By metering, you've already taieen an important step to maintaining your professional creftility as a yoga teacher. Here are some ideas on how to use Yoga Alliance to expand your knowledge and experience as a teacher: • - Gredilsffidy Registration with Yoga Alliance enhances your credibility and integrity as a yop professional since our dFsignations are the premier forms of recognition for yoga teachers. The reostry provides glow recognition of your knowledge, 'training and experience to potential students and employers. Studio owners feel confident hiring you knowing that your trainir�u meets our standards and students can trust that they receive instruction from a qua lined teacher. Fmd Teaching OppottunWles. if you're looking for new teaching opportunities, find a registered school in yvr area via our website and introduce yourself to the owner. Drop in to Lake a skasz and inquire about opportunities in person. ldenttN QualityTrainiMo: ate a part of youragreernent with us, you will complete corMn Wing education every three years. You can start by looking for experienced registered yoga teachers gE-RYTsj 1 n your area to identify rrain1ngs eligible far contlnkuing education Credit. Let us know if we Can help Polish your Professional Image: You can use your RYT desigr�atjon foilovAng your name aintt can your marketing materials and website_ The public image you project as a yap teacher can Nelp stimulate new busing by referencing your quali-fications. Please visit our website, www.yogaaIlian€e.org, to check 0 u information on regiAer'ing, renewing arsd upgrades online and n" a k% -Q!tOdress`s-ye a rd {'ratze, -lir•: - . �--- integrity of yoga teacbars, Sincerely, Sohn Madhews President 1i01 Clorendon Ooulwecwd, 5udv 110, Adinglon, Virginia 22209 TOit-Freem,921YOGA ( 2) PhoneUTA82.3355 F=571A82.3VU www.yogoaiijurce.org Philadetphia Indemnity Insurance Company one Bala N� aza, Suite 100, Sala Cynwyd, Pennsylvania 99CO4 COMMON POLICY DECLARATIONS Policy Number: PHPK769478-000 Named Insured Fwd Mailing Address. Kim Saundra X30 Freemanwood Ln Mifton. GA 30004 - Producer. 6039 Maguire Insurance Agency, Inc. 27901 Puerts Real Suite 200 Mission Viejo, GA 9M1 - CPD -PLIC (01107) Policy Period From., 09/09MI 9 To: 091OW2012 at 1201 AM. standard Time at your maikrkg address shown abode Business Description: Fitness Club 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. PREMIUM Commer6al Property Coverage Part Commercial General Liability Coverage Pad $135.00 Commercial Crime Coverage Part Cors nvmal Intand marine coverage Fart Corrsrs erdal Auto Coverage Part comrneroal Stop Gap part Butisinessowners Workers C;vsnpen5atun Taxes/Fees/SurchargesTaxes/Fees/Surcharges $0.00 Total $0.00 FORM (S) AND ENDORSEMENT �Sj MAIDE A PART OF THIS POLICY AT THE TIME OF ISSUE Refer To Forms Sctmdule "Omits applicable Forms and Endorser nts if shown in specific Coverage PaWCoverage Form Declarations _.._.._ Countersignature bate Auii6iii d Representakive Fuesday WED 8:30 - bodyART yoga 10 - yoga level I* City of Milton Schedule Thursday Saturday Suva 8:30 - bodyART* 9 yoga - All* 10 - yoga level 2 * 11 - yoga * * workshops 2 x month 11-1 OR 1-3 pm ** 4 -'kids** 6 BA* 4 - teens** 6 -_. yoga** 6 yoga -all levels* Phase 1 * - start with i classes Phase 2 * - potentially add 4 classes - - workshops Descriptions: bodyART TM "The training of the future. Yin meets Yang in this class that blends cardio, yoga and strength -based principles. A blend of body and mind manifested as freedom of motion fluidly combines Cardio Interval Training and classical breathing techniques allowing you to be strengthened and stretched. Deep --work training releases tension in the body and returns it to the roots of what makes it an efficient and functional unlit. A total-body workout that emphasizes strength, cardio and flexibility. Level 1 — Good far new students or those desiring a moderate pace. You will learn basic poses, breathing techniques and correct alignment. Level 2 — Focus on strength, flexibility and stamina introducing more backbends, inversions and flowing sequences, Kids Yoga — Fun program designed to help children build strength, flexibility and concentration in a non-competitive environment. Yoga for Teens -- For those who want to work up a sweat, build muscles and get a break from their busy day, this class is for you? This class will improve strength, focus and confidence while also reducing stress. City of Milton 13000 Deerfield Parkway Suite 107C Milton, Georgia 30004 To: Honorable Mayor and City Council Members From: John Rebar, Parks and Recreation Director Submission Date: April 25, 2012 Meeting Date: May 7, 2012 Agenda Item: Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Overkill Volleyball Background: The Parks and Recreation Department is eager to continue offering programs and additional services to the citizens of Milton. Many of these programs may be offered by outside providers through an agreement with the City of Milton based on a submitted program proposal rather than offering these programs through a paid independent contractor or a paid employee of the City. Discussion: The Parks and Recreation Department recommends entering into agreement with Overkill Volleyball to provide miscellaneous volleyball programs for our residents and visitors. Programs may include: Youth Leagues Volleyball Camp Skills Clinics Adult League A commission of 30% of all registration fees will be paid to the City of Milton two weeks following the end of registration. Non-resident fees will be collected by the provider and paid to the City at a rate of 50% more. Legal Review: Contract Template - Paul Higbee, Jarrard & Davis on February 23, 2012 Attachments: A Parks and Recreation Department Agreement between the City of Milton and Overkill Volleyball. CITY OF MILTON PARKS & RECREATION DEPARTMENT AGItEEMLNT FOR ()UTSIDF P110V11)ERS T[IIS IS Ali AGREEMENT, madc this day of 2012, between: THE CITY OF MILTON. a municipal corporation organized and operating, under the laws cit the State oi'Georgia, with a business address of 13000 Deerfield Parkway, Suite 107 A, M1[,TON, Georgia 30004. hereinafter referred to its the "CITY." and OVERKILL VOLLEYBALL hereinalte°r rcl'erred to as "PROVIDI R". CITY and PROVIDER may hereinalter collectively be referred to as "the Parties'. In consideration of the ma.ttual obligations of the Parties and for goad and valuable consideration, the adequacy and receipt ol' which are hereby acknowledged- the Parties agree as lullu►�s- ARTICLE 1.0 PROIV l l) U.14's 5ervices.anti Rr,pon ibilities 1.1 PROVIDEK shall eoriduct scrv4xe, gLnentll% described as Volleyball C'anip & Volleyball Leagues at the follow -Ing location: l-iope►Nell Middle School- 13060 Coghttrn Road, Milton 6A 30004. Northwestern Middle School. 128115 Birmingham Ilwy, ;Milton t.iA '10004: Cu -burn IVoods [Aernentary School, 1 'ogo Co -burn Road. Milton G!1 '10004: and Btrrniiwh�irn halls I:leinentar% School_ 14965 Birmingham Hwy. Milton GA 30004. l.' The PROVIDER's services shall he perlornwd during the days and hours described in Exhibit -A," attached hcicio and 1twoi-1 oiated lieieltt b.V itlel-Uni e. l.3 Th, PRO VIDEIZ and 'I'lic Dffectur of the Parks &Recreation Departl7wnt or leis designee, hereinalier referred te► as the "-DI:P:►.RT1 vlENT-, will agree upon program se'he(ltale.. PROVII)rR agrees to sub►ruf a Prq rain l equesr Form to tlfe Coordinator fr)r each program being proposer! eight (8) F eeAs prior Co Me begitfffifng of each session. 1.4 l'he fees charged to cacti participalat Will be as described in Exhibit "A" for residents of MlL-I'ON and a surcharge of Sf".;, mord for rron-residents of MII: l'ON. The entire balance of thia surchar� tr�l_ n��it-r 5idents Sk�itll he pati to the L�I I Y. -� 1.7 'flae I-RC.)V11)1A ►► arrants to C ITY that it is not insolvent, it is not in bar&ruptc) proceedings or receivership, nor is it cm -!a, -ed in or threatened with any iitianon of other legal or adinlaistrative proceedings or investigations of any kind ►Nhich Mould have an adverse effect ora its ability to perform its oh€ons under this :agreement. the programs: and shall continue to 111aI111a111 such Iicenses or permits during. the tern? of this Agreement. 1.7 This Agreement is considered a noir-esclusi,.e Agreement between the Parties. The CITY shall have the right to purchase the same kind of services to be provided by the PROVIDFR from other sources during the term of this Agreement. The PROVIDER is not precluded from providing the same or similar services for other parties so long as such other engagements do not interfere with the PROVTDER'S provision of services to the CITY. I.8 The DEPART1YfEW must approve any promotional material, Ayers, and posters advertising the programs prior to its release. The following content and topics shall specifically be prohibited: sexually erplivit materials, profanity, child pornography, alcoholic beverages, tobacco products, adult naavies, adult boo lvidev stores, adult entertttitttnetat estrablishments, massage parlors, pawn shops, and tattoo parlors or shups. 1.9 The PROVIDER shall not promote any privately owned business in a CITY parklfacility or solicit any participant in a CITY parklfacility activity for any privately owned business. The PROVIDER may not use said facilities to conduct personal business including workshops, cynics, serrtanars, camps, or any other activities that are Outside the scope of service described in (Exhibit "A"). It is farther understood that such action(s) may result in tmrnediale terminauion of the Agreement and the forfeiture of all compensation due to the PROVIDER. 1.10 The PROVIDER shall abide by the policies, procedures, rules and regulations of the DEFARTMENI', the CITY, and the 1`tv1t.TON COiJNTY ,BOARD OF EDUCATION as protrnilgated from time: to time. I'ROVIDF_R understands and agrees that the DF.P,=ti?T-MEiVTstartll hatve it,,t jriorit ur ttsc u CITY iiciiities notwirltstandinu ana other provisions u 'th is Aareetnent 1.11 All assistants, substitutes, Wid subcontractors utilized by the PROVIDER must have prior written appro4al of the DCPARTMENT. 1.12 PROVIDER shall provide necessary supervisory personnel to ensure that the participants of the programs obey all applicable policies, procedures, Rules and Regulations. 1.13 The DEPARTMENT or CITY may require that the PRQVIDER not be permitted to utilize specific assistants. SUbS1111-1tes. ar subcontractors of PROVIDER who have fiile.d to fcolloW any policies, proiL:durc�, rules or ret)okttious applicable to the use of the f2cii ity. 1,14 :Although the CITY shall not control the PROVID R's techniques, methods, proQtedures, or sequence of instruction. the PROVIDER will comply with the C'ITY's and DEPAR IM ENT's policies, rules, N-Ulations and procedures, as well as those of the FULTON COUNTY BOARD OF EDUCATION. and shall not interfere with their 2 operation, nor harm or damage the equipment or facilities afforded to PROVIDER for his/her programs, nor otherwise disrupt the ether ori -site activities being ot1'ered at such public facilities. 1.15 The PROVIDER also acknowledges that he or she is primarily responsible for the conduct of the participants in all programs tinder the PROVIDER's charge. 1.15 If the PROVIDER will be providing services directly with minor children without parental supenision, the PROVIDER shall, prior to commencing services under this Agreement, comply with the CITY's policy regarding criminal background screening. The CITY will furnish the PROVIDER with a background release form (Exhibit "It") for all the provider's counselors, coaches, volunteers, subcontractors, employees or any other individuals that will come in contact with a child, at the PROVIDER"s sole expense. A Consent and Release. Form to conduct a criminal background must be executed by any of PROVIDER`s employees or any individual who will come in contact with a child at the CITY through PROVIDER or at PROVIDE:R's direction, such form authorizing the CITY to conduct a searc=h of each such individual's criminal back=ground. The result cel such inquiry may be deemed acceptable by the C1 I Y in its sole and complete discretion, and the CITY may rejec=t any individual from participating in any program based upon such results. i fire PROVIDER has recently had u background screening conducted by another agency, the CITY at its sole discretion, may accept that background .screening and waive the requirement of a new background screening. PROVIDER and its employees must also execute a Waiver and Release of Liability holding the CITY and FULTON COUNTY BOARD OF EDUCATION harmless, 1.17 The. CITY shall require all participants in all programs to sign a Waiver and Release of Liabilily. ARTICLE' 2.0 Equipment _& Materials 2.1 All program materials and equipment needed or pertaining to the above stated programs will be provided by the PROV lDEIZ at hiafher own cost and expense. However, PROVIDER may require participants to obtain certain materials required in the programs by providing a list of such materials (with approximate casts) to the participants. if PROVIDER makes such materials available to participants, they must be sold at PROVIDE -R's cost. All equipment provided by the PROVIDER shall be used in strict accordance with equipment marIutacturer's illSlrttCtions and in accordance: with all applicable 1aw-s_ PROVIDER shall coordinate storage of gnal pasts with the principal n the school located at the facility. 2.2 The sale of' rnerchandise is restricted to those materials utilized in and for the programs. Fundraising; activities conducted by the PROVIDER will riot be pennitted. The PROVIDER shall obtain the CITY's approval of any merchandise to be sold prior to its distribution or sale. 3 ?.? l'he Sale oL merchandise is restricted to those rllatcrl als III lli7C'il in and for the programs. Fundraising activities conducted by the PROVIDER will not be penliitted. The PR{]V[DI::R Shall cortin the UITY's approval of,.lrly merchandise to he sold prior to its di�tl'ihutiut7 or sale. ?.3 The CITY will protide no storage space to the PROVIDER, unless otherwise tnutualk a -reed upon in a scparatc written :t�rccn7ettt. ?.=i m Supplies or eyuipmem Ieft at the lactllty Rvill he the responsibility of the 11Rt)V11)ER. F lie C1 I Y xvill not be responsible 10r any lost, stolen. or broken eyuipn7ent or,applies. ?J 1 he 11KOVIDFR shall ivispect the prernisl~5 and equipment ot'Iered to Ili miller for hiklhQr proposed ;activity and il' lie or She finds anything �,�rong WiLh Ow premises or equipment before each program commences that cannot be corrected immediately by the DEPARTMENT- the pro -rani shall be canceled and the matter reported to the D1iPAR-1-VII:N'1' for correction. Ifthc PROVIDER c:lc:cts to hold hislher pro -rums to the laciilty provided, it %%.-[[I he presumed that the PROVIDER has iltspec:ted the prenrtisys and iatcilities and equipment prOVided tol- SUCK Ilrograms and ha." ac:ceptcd Sarno as being sale. and suitatble for the use Intended. AIt'1.1ULE 3.11 Proeram Size [ininiums: 3.1 ACTIVE: Program sizes shall Inert the 1311t71ntt1111 IZul77bcrs of patilelpants for each pro-ratn as designated in Exhlbit "A. AItTi01- 4.0 Compensation and Method tol' Pavnient 4.1 In cods-Ideimion of the relcascs and 111de111111t1cs colitailled heleM 011(1 of flit PROVIDI-IR's services M eomicttlon �vah the programs and activities described her'eil7. the ('11 Y' shall he entitled to 30'i, of llic I-cgi,trallon ICes paid by all program participants to the PR'OV1D1-R.. and flit [IROV'IDL]k shill he entitled to 70°« of such tires p�Od. exclusive of the 70°/6 lion-reaident surcharge. The 5[]% norl-resident surCIMI" e iS fully payable to the (TI Y and shall nOt be Intituled in PRO VIDkk's gross inconlc caticuiatiojl. PROVIDER Shall be entitled to ivi mi all puid by pw.oii 1pants to PROVIDER. 1.t. PROVIDER membership tees aild rusts For unih)rms and pictures to part mixaa t s. 4-2 '['he PROVIDER agrees to collect all fees from participants, and the PROVIDER agrees to provide CITY with schedule~ of feats to be charged to participants in con 10ri-nance kith F%hihit "A". It 15 <11"reecI 111i11 lhc. PR()VII)I".l2'S sl-')) C, obIIgat ion sh:tl.1 be to collect Clic lec_s from the p-,articipams :and to reirilL the ')Q!,,, of the fees collected as iwll Its -,711 50%, non-resident surcharge alnouills to the CITY t,itl7 a pay -out report of all 4 4.3 It is the responsibility of the ?R0V[DI:R to pay all applicable local, state.; and federal taxes associated with this Agreelncnt, anis to accluire and lay for all necessary pemills. licenses, and insurance required lior the execution of this Agreement. ARTICLE 5.0 Independent PROVIDER 5.1 This Agreement does not create an employee/employer relationship betvveen the Parties. It is the intent of the Parties that the PROVIDER is an independent contractor under this Agreement and not a CITY ernp10yee for all purposes, including but not limited to, the application of the Fair Labor Standards Act minimum wage and overtime payments, Federal Insurance Contribution Act, the Social Security Act, the Federal Unemployment Tax Act, the provisions of the Intemal Revenue Code, The State Workers Compensation Act, and the State unen-tptoyment insurance law. The PROVIDER shall retain sole and absolute discretion in the judgment of the manner and means of carrying out PI-WVIDUR's activities and responsibilities hereunder. The PROVIDFR agrees that it is a separate and independent enterprise from the CITY, that it had full opportunity to trod other business, that it has made its own investment in its business, and that it will utilize a high level of skill necessary to perform the work required hereunder. This Agreement shall not be construed as creating any joint employment relationship between the PROVIDER and the CITY and the CITY will not be liable for any obligation incurred by PROVIDER, including but not limited to unpaid minimum wages or overtime premiums. 52 PROVIDER warrants that it has not employed or retained any company or person, other than a bona tide employee working solely for the PROVIDER to solicit or secure this Ac reement,and that it has not paid Or agreed to pay any person, company, C011101MIbdl, IL dWidUai 01. tiLLll ally 1CC. tiUJIIIL11S5JL]Jl, l]Cll'C11ULgC, gift, ur utlicr consideration contingent upon or resulting from the award or making of this Agreement. For the hL-each or violation of this provision, the CITY shall have the c-ight to tele urate the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover the full amount of such tee, commission, percentage, pili or consideration. ARTICLE 6.0 Insurance 6.1 PROVIDER shall not PrUL1& WIV 5C1"ViCC Lrnlil all irSuranCe required Linder this p,iragraph has been obiainl•d ,inn cipproked by th+: CFIN 62 Certificates- of Insurance_ Certificates of instlrnnce reflecting evidence Lel' the required insurance shall be tiled with the CITY prior to the commencement of this Agreement. 'These Cenificates shall contain a provision that coverages alrorded under these Policies writ not be cancelled until at !cast forty -t -1v days (45) prior writ en notice has beets given to the CITY. Policies shall be issued by companies aulhorired to do business Under 5 the laws ni'the State of, Georgia- FIna nclaI Ratings enlist he not less than "A -VI" in the latest edition of -'Best Key Rating Guide", published by A.M. Hest Guide. 6.3 Insurance shall be in force until the obligations required to be fulfilled under the terms of the Agreement are satisfied. In the event the insurance Certificate provided indicated that the insurance shall terminate and lapse during the period of this Agreement, then in that event, the PROVIDER shrill I'timish, at forst thirty (=30) days prior to the expiration of the date of such tnsurancc. a renevved Certificate of Insurance as proof that equal and like coverage for the balance of the period of the Agreement and extension thereunder is in effect. The PROVIDER shall not provide any service pursuant to this Agreement unless all required insurance remains in full force and effect. 6.4 Commercial General. Liability_ insurance to cover tiability bodily injury and property damage. Exposures to be covered are: premises. operations, products/completed operations, and certain contracts. Coverage must bre wntteii ort an occurrence basis, with the following limits of liability: $1,000,000 Combined Single Limit —each occurrence $2,000,000 Combined Single Limit — general aggregate $1,000,000 Personal Injury $1,000,000 Products/Completed Operations Aggregate PROVIDER shall have its insurer name the City cifMILTON as an additional insured on its General Liability policy. 6.5 Worker's Compensation insurance shall be "Aintained during the lite of this Agreement to comply with the statutory limits for all employees, and in the case any work is sublet, the PROVIDER shall require tile subcontractor(s) sn-nitarly provide Workers Compensation Insurance for all the latter`s entployee-s unless and until such employees are covered by die protection afforded by tho PROVIDER. The PROVIDER and his subcontractors shall -main€girt during the life of this Agreement Employers Liability Insurance, The following Ili -oils must be maintained, A. Workers Co€nlwnsation Statutory B. E;ntployer's Liability S 100.000 each ace idertt $500.000 Disease -policy lirrut $100,000 Disease -each employee If PROVIDER or its subcontractor claims to be exempt from this requirement, PROVIDER shall provide CITY proof of such exemption along with a written request for CITY to exempt PROVIDER, written ort PROV[DE;R or subcontractor's letterhead. 6.6 PROVIDER shall also maintain Auto Liability and Directors and 011ic:ers insurance VWh i irrlits reasonably uc:c eptabl: to Cl I Y during the torn of this Agreement. 6.7 the CITY and the FLIftnrl Count% Board of Education shall each be named as an additional insured and loss payee oil all policies rCyuired by this Agreement. L AWFICLE 7.0 Term and Termination 7.1 Alter a two (2) month trial period, the programs will be evaluated by the DEPAWI'NAEN`I'. and the remainder of this Agreement will either be ternm€hated or continue in full torce and effect. If at any time after the two (2) month evaluation, program enrollment should fall below the required ininintuni. the PROVIDER will be allotted four (4) weeks to bring enrollment up to the required minimum. The programs will be reevaluated and execution or termination of the contract will be determined by the DEPARTMENT. 7.2 The to t -m1 of this Agrecrneut shall commence upon the date of execution hereon and shall remain in effect for a period of' one i i ] year from the date ofexecution of this Agreement by the CITY, unless terminated sooner as provided in this Article. Renewal of this ,Agreement beyond the one (I) year term shall require the mutual written agreement of the CITY and PROVIDER. 7.3 This Agreement may be terrninated by the CITY for convenience upon giving of at least thirty t 30) days prior written notice of termination to the PROVIDER at the PROVIDER's address set forth herein at the sole and exclusive discretion of time CITY, This Agreement may be terminated by the City immediately by written notice to PROVIDER upon any willtul, reckless, or grossly negligent act or omission by PROVIDER or any of its officers, agents, employees, or volunteers. 7.4 This Agreement may be terminated by PROVIDER upon giving at least thirty (30) days written notice of termination to the CITY. 7.5 PROVIDER must notify the DEPARTMENT in writing of any program cancellations at least ten (10) business days prior to the scheduled cancellation. 7.6 CFl`Y reserves the right to cancel or reschedule any of the PROVIDER's prograuts, ill the case of schedulilig C011fliLts Or otfiri eineigencies, as deiennEned by Lhe DEPARTMENT. ARTICLE 8.0 Indcmuifiratiork 8.1 PROVIDER agrees to indemnify and hold harmless the ary and the FULTON COUNTY BOARD OI-' EDUCATION, their trustees. elected and appointed officers, agents, servants and employees, from and against any and all claims, demands, or causes of action of whatsoever !find of nature. and the resulting, musses. costs, expenses, reasonable attorneys' fees. inctuding paralegal fees, liabilities, damages, orders; judgments, or decrees, sustained by the CITY, time FULTON COUNTY BOARD OF EDUCATION, or any third party arising out of', or by reason of, or resulting front the will full or negligent acts, errors, or onmissions of the PROVIDER or its agents, officers, volanteem or employees. T 8.2 The Parties understand and agree that the covenants and representations relating to this indetnnit€ration provision shell suMve the term of this Agreerttent and continue in full force and effect as to the PROVIDEWs responsibility to indemnify. ARTICLE 9.0 Americans With Disabilities Act 9.1 PROVIDER shall not discriminate against any person in its operation and activities in its use or expenditure of the binds or any portion of the funds provided by this Agreement and shall affirrrratilely comply with all applicable provisions of the Americans With Disabilities Act ('-ADA"), i« the prograrrts white providing any services funded in whole or in part by the Cl t'Y. including Titles I and 11 of the ADA and all applicable regulations, guidelines, and standards. 9.2 PROVIDER's decisions regarding (lie delivery of services trader this Agreement shall be made wkthout regard to or consideration of race, age, rehgion, color. gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation, or any other factor which cannot be lawfully or appropriately used as a basis for delivery of service. AR-11C:LE 10.0 Miscellaneous 10.1 No modification, amendment, or alteration ofthe terms and conditions contained shall k, effective unless contained in a written document executed with the same formality and equal dignity herewith. 10.2 This Agreement is non -transferable or assignable, and PROVIDER agrees not to wino er or assign the pe1t'ur111W1ce of'serti ices called .for in the Agreement. 10.3 This Agreeinent sets fbah the fall and complete anderstanding of the Pasties as of the effective date, and Supersedes any and all negotiations, agreements, and representations made or dated prior to this Agreemcnt. 10.4 The PROVIDER shall pay reawnable attorney's fees to the City should the City be required to incur attorney's fees in enforcing the provisions of this Agreement. 10.5 Time is . f the essence of this Agreement, t0.6 Each of the individuals who executes this Agreement agrees and represents that he is authorized to execute this Agreement on behalf of the respective entity. Accordingly, the Cit} mid PROVIDER both waive and release any right to contest the enforceahility aI'this Agree-meriL based upon the execution and/or approval thereof. 8 10.7 It is the policy ol'C'ity that unauthorifed aliens shill not be employed to perforin work on City contracts involving the physical performance of services. 'Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the PROVIDER shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and -'I)" that it and its subcontractors have within the previous twelve (12) month period conducted a verification of the social security :lumbers of all employees who will perform ~murk on the City contract to ensure that no unauthorized aliens will be emploved. The City I'vlanager or his/her designee shall be authorized to conduct an inspection of the PROVIDER s and its subcontractors' verification process to determine that the verification was correct and complete. The PROVIDER and its subcontractors shall retain all docurrtents and records of its verification process for a period of three (3) years following completion of the contract. This requirement shalt apply to all contracts for the physical performance of services where more than three #3) persons are employed on the City contract - Compliance with the requirements of O.C.G.A. § 13-t0-41 and Rule 300-10-1-.02 is mandatory. PRO VIDER 's conipiiance with the req iulremcnts ofQ.C.G.A_ § la -10-91 and Rule 300- 10-1-,02 shaft be attested by the execution of the contractor's affidavit attached as Lixhibit -,C,,, Pursuant to O.C.G.A. y 50 36 1, the City must obtain a SAVF. Alfida it and a secure and verifiable document evidencing the Coiaraf:tor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal pcaalt, -of false swearing pursuant to O.C.G.A. § 16-10-7 1), a forin of which is attached hereto as Exhibit "E", and submitted such affidavit to the City itt person, eleetronjcally, or by mail. Further. Contractor verifies that it has, .prior to executing this Agreement, submitted a secure and verifiable docuinent_ evidencing the Contractor's legal status, to the City either in person or electronically (it' cottlpliatice with the Uniform Flectronic Transactions Alt). Contractor verifies that it is in compliance with the Residency Status of ars Applicant for Public Benetit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A. § 59-36- 1). L•f IN WITNESS OF TFIF- FORFG01N'G, the Parties have set their hands and seal the day and year first written above. A,rTk:s,r., SUDIE GORDON, CITY C:LLRK WITNESS: 4fal{A fl kt mkA CITY: BY: JOE LOCK1' OOD, MAYOR PROVInF.11- BY: ILIA Y l; 5 115, Ply Sllll~I 1' [AFFIX CORPORA FE SEAL] MARL L ABARCA NOTARY pUSLIC Gwinnett County Stitte tit Georgia My Comm. Expires May 24.2015 10 --zo kn- -z6• F,XHIBIT -C" STATE OF ( LORCIA CITY OF MILT0N C NTRACT(R A FFID VIT ND ACRES NT By executing this affidavit, the undersigned contractor verities its compliance with O-C.G.A. § 13-10-91, stating affinrtatively that the individual, firm, or Corporation which is contracting with the City of lV111ton has registered with and is participating in a federal work authorization prograan, in accordance with the applicability provisions and deadlines established in O.C.G.A. 13-1D-91. The undersigned further agrees that, should it employ or contract with any subcontractor{s} in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. 3 t3-10-91 oil the Subcontractor Affidavit provided in Rule 300 -10 -U1 -.Q$ in the Form attached hereto as Exhibit "D.-' Contractor further agrees to ntaintain records of such compliance and provide a copy of each such verification to the City of N111ton at the time the subcontractor(s) is retained to perform such service. l_1.;V I Basic Pilot Program User Identification Number IW, ALlthoriLed Officer or Agent Date: _ Overkill Volleyball _ Title of Authori7.ed Officer or A,,ent of Contractor rXet -14, -C 41e- dj' , - 1-e 1; i I I ?, 0 �,/ C, Printed Nance of Authorized Officer or Aactit Si.ii3S('Rf1.3LD AND SWOIt:V BEVOR- ME ON THIS THE Notaffv Publict NI) C' rrtm i scion l i res: _ MARIBLL ABARCA NOTARY PUBLIC Gwinnett County State of Georgia My COMM. Expires May 24, 2015 I) STATE OF GEORGIA CITY OF MILTON SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-1.0-91, stating affirruatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with Overkill Volleyball on behalf of the City of Milton has registered with and is panicipating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. EEV / Basic Pdut Progrant User Identification Dumber t� BY: Authorized Officer or Agent Date T [INSERT SUBCONTRACTOR NAME] �&- "Z,-- -- Title of Authorized Officer or Agent of Subcontractor 1 7 4,4 ?'/,�d Printed Name of Autttorized Officer or Agent SUBSCRIBED AND SWORN BF ORE ME ON THIS THE yoff• /� _ �, 201Z Public My Cdnunission ExpAs: MAAIBEL ARARCA NOTARY PUBLIC Gwinnett County State of Georgia My Comm. Expires May 24, 2015 PROGRAM REQUEST FORM Indlvidrual5 interested iri proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals'.. Use one form_p4er pro �7gram. Name of Program: n,i Ty l L Participant Ages: Day/s of the week program is offered: f ] Y t T7` 1 Sat- SVY Time of Program: Prog[ am Dates: to T Program Fee: 3 Program Enrollment: Minimum�Maximumi�5-0 Materials to be supplied by participants: r+- 'act ri"�� Mate.rFa Is to be. supplied by PROV IDER: loo t I S _ ra � L r n (fi - s. Materials to be supplied Additional Program Requirements: by the City of MILTON- PROVIDER 4`s}Name: Address: l--1 Oc�l City/Slate/Zip Cade: . 3o3 _.�•_: ; Phone Number: ( Day) � � � � � (Evening) (Fax) Minimum Requirements: l 1.000,000 General Liability Insurance Orme Use only. Program Rate:i # of programs in Session: Fee/Prograrn: S EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their prograrns and survices mist complete and return this form attached to the Letter of Interest This information will be used for consideration of program proposals_ Use one- form _per__pragram. Name of Program: Participant Ages: r� ~ CO Day /s of the week program is offered: G I - �t , .�� of Time of Program: Program Dates: Program Fee: Program Enrollment. Minimum Maximum _ V . 11 -- Materials to be supplied by participants: �/ � y -al� �o iflr5 Materials to be supplied by PROVIDFR Materials to be supplied by the City of MILTON: Additional Program Requirements: O�NYyt GA _ Vv C C via vt PROVIDER ('s)Name: E (� ' jr 0-fWQ Address: City/State/Zip Code: i yt Phone Number: (Day) 8 j �{Evening} (E mail)-. 0' (Fax) Minimum Requirements: 1,000.000 General Liability Insurance Office Use Orly. P;Utrdff! Rdte-$_ S E) it of programs in Session: Fee/Program : EXR181T "A" PROGRAM REQUEST FORM lndrviduals interested in proposing their programs and services must r_ompiFrP and return th►s form attached to the Letter of Interest. ibis information W/j/ be used for consideration of program proposals. Use one form per program. Name of Program: --- - Participant Ages: Day / s of the week program is offereU 7 Time of Prograrn: Program Dates: Program Fee - Program Enroilment: Minimum Materials to be supplied Oy participants: Matertais to tae suppioea r)y PROVIDER: to Maximum Materials to be supplied by the Additional Program Requirements-. city of MILTON: PROVIDER ('s)Name: Address: City/State/Zip Code: Phone Numbers (Day) (Evening) Minimum Re uiCE'rrieTltS- 1,000,000 General Liability Insurance (Fax) OAce use Only: Program Rate 5 9 of programs in Session: S Fee/program EY111131,1- -All PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return tins form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per prnram. Name of Program: 1%C 1 i 1 l 1�jL t[ fi Participant Ages: Day/s of the week program is offered: AAO n -1� l� i -_cc. ,,Tnl 'L) Time of Program: Program Dates: Program Fee: "J'- I l Program Enrollment: Minimum -4 d to to MaximumI-J L Materials to be supplied by participants: �i �X Aa%i�',�' bof LL-, Materials to be supplied by PROVIDER: _baklIs ba I � C-- rf S. Materials to be suppliec1 Additional Program Requirements: by the City of MILTON: PROVIDER ('s)Narne: Address: ) I 0 � amLl W"u V) n () Ic- 1) r City/State/Zip Code: Phone Number: (Day) �� r (Evening) a_ L]Y; (Fax) Minimum Requirements: 1,000,000 General Liability Insurance OfFtce Us& Only: Program Rate:$ # of programs in Session: Fee/Program: S ACCORD:, CERTIFICATE OF LIABILITY INSURANCE DATE jMWDD1YYYYl -3SL1ED OR MAY FFRTAIN IFIE •r1SuRA.NCE AFFORL)6D 6Y T rlL P OL !IES ' FSO <:lsE:. .ERLIN IS SUBJECT FOA— THE TERMS EXCLUSIONS AND CONDITIONS OF 04/2 &2012 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 POLICIES BELOW. TIIIS GERTirSCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) trust be endorsed, If SUBROGATION IS WAIVED, subject to the terms and condition* of the policy, certain policies may require an endorsement. A atatoment on thin certificate does not confer rights to the certificate holder in lieu of sucil endorsements . PRODUCER CCNTACTtYAME: '08s -z; Me= Unde'wribn K8K InsUra i1ce Group s.' QC PHONE: (A,C, No. Cm), [5�-5+'SD-iSDa'I FAX. JAiC, Noy. �ijd-459-.i99U 1712 Magriavex Way E-MAIL ADDRESS: KK kiaa%Merchandisin94itkaiidkirisurance eons - FoO VVayne IN 46dO4 PRDDiICER CU S76MER !D R' INSUFW-D _ IN 3ORFFi 5 AFFORIA No GOVERAGE IHiUG Ic Overklli Youth Volleybali Inc INSURER A ' NatianVnde Mutual Insurance Carrlparl 3787 ] 709 5u mmerhrUok Dei@ 4N5LIRER B. sanrsy Gpritup [GA 30350 INSURLU C: -- A Member of the Sports. Leisure & EIIteiIa!flr1ierlk RFG ..:aru o. THIS IS TDCERTIFY THAT 7hE POLICIES OF L,STE❑ BEL L'P:.-IA':L —_:; 1•. .. .:,. U 'HE INURED Nn4d4E❑ ABOVE FOR THE POLICY PERIOD INDICATED. IMT KOTHSTrANDiNG ANY REQUiREMFNT• TERM OR CONDITION OF AN-.CCNT�<:,i: ! ;,kms �1• MLR E)OCUMENT '•P7 rFt RESPECT TO �(VHICH Tills CERTIFICATE MAYBE -3SL1ED OR MAY FFRTAIN IFIE •r1SuRA.NCE AFFORL)6D 6Y T rlL P OL !IES ' FSO <:lsE:. .ERLIN IS SUBJECT FOA— THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES �IkLIS SHOWN MAr I1A'vE BEEN ri_L7VC-;D Er -A.J INSR LTR TYPE OF INSURANCE -^ ADDL INSR SUBR YVYD ; POLICY EFF POLICY EXP POLICY NUMBER k1Mr00%YY' MM)OD1YY 1 _ LIMITS A GENERAL LIABILITY 6BRPGOOODO04992200^ 01191!2012 0110112913 EAC,rt CKCLJRRENGE S1 -000,0010 r X L�f+I W.ERCWL u�i+ER.it .:n�1LkTY '1 AHA F -D 1.2 01 AM � l7P.MAC F To RENT@Q $3QQ-DO •.'LA1MS.1I,t4EOG1CCLR PREMISES Ea=Uf1VIw-0 tai❑ Exp [Any one pwwni - $5.000 :.+FR.�r(i{UAl RAr51/tN,alliiY $1.�i]D,om 3ENERALAGCRECATE $3,000.0()C PRODUCT&CORPrnP koG CiEN L Ak;LRCZ.-A I E UP61 I i'Ert $1.000,OOC r L,C^ nPRo EcE _CrC I { PRCWESSiONAtwk $L!Tr $1.000.0[1 1 r _I Tr? PORT CIPALTS $1,000,00 A UASiLITY 6FIRPC,0000004992200 0110112012 01,"0112013 L:OWi:%ED SINGLE OMIT �AUTQMOSILE ANY A:JTQ € 12 01 AM EDF 4 12 01 APA to %xra iellrs -...-.� I I f3.0LY r URV (F'tlr p&fskti _ ._. ..... •'. I' - - .!' ....... LC; DILY INJkJRY rPer aCGWnt) - PRoPEA rY C)A7It GE; I UMBRELLA LIAROCC.JR EAC. i GCC:L� ENCCE EXCESS L3AB 1CLAI MS-POIALA- isCiK�."rFf ..tU-. it"L' i WORKERS COMPENSATIONNIA .AC STATU - AND EMPLOYERS' LiABL1TY Y + N 7pRr 4 7 I'Gr-ER alar g13L:T.^, FijnfF1P17HThE Rf F L ZACre ACCQEN1 E;iECV rlVVE O OFF 1 L'.�tiA1E 6di3EH EXCLUDEIr E.L. OiSEASE - EA EMPLOY EE -.. . (Mandatory irk AlhI - It has te ❑Ea'CR,PNON OF OPERAI,+3hS tlr*•ur E.L PlSEA5F - POLIi:Y LIMIT A SIEDECALPAYMENTS FOR F-AFTI0:P.-.'4T3 6BRPGO000004992200 GT1C 112l)12 0110V2013 PR AARY MEDICAL 12 D T ANI EDI 12 01 ANT EXCESS MtDiCAI S75 {NIC DESCRIPTION OF OPE RATION$- Z LOCATIONS! VEHICLES+Attach ACORO 101. Addftional kema6Ls Schedule. if more space is require[I Spulttsr VUiley041; Age ks� '2 ano unclor 13-15. 1ti-19 The Certificate holder is a::Ued as an adUitbrial insured. truI on iy wIlh res acs To the iIatAiE y a n s I nq DuI o theoperations of the Insured named above ' >�VSVCR CArNCELLAIiON [Lily Of rVilltlYl SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 130440 Deerfield PKwy THE EXPIRATION LATE THEREOF, NOTICE WILL BE DELIVERED IN Meson. GA 30004 ACCORDANCE WITH THE POLICY PROVISIONS. {OwnerfLessor of PFemisesl AUTHORIZED REPRESEfZTATIYE COVerage 1s un+y extended to U S events arm acrsvitieg " NC)TiCF TO TFXAS INSUREDS The Insurer far Ine purchasing gFOLlp may nOt be! SUOJeCi to 311 the ir'!sU J ICE° Taws and regLflations of the State of Texas ACORD 25 (2009rp9) The ACORD narne and logo are registered marks of ACORD a 1933.2009 ACORD CORPORATION_ All rights reserved- ACORD,,. CERTIFICATE OF LIABILITY INSURANCEDATE (MMI)MYYYI 04J2312012 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 13Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sy, AUTHORIZED REPRESENTATIVE Oft (PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) roust beendorsed. If SUBROGATION IS WAIVED, subject to the WIMb 411111 1L;QI1 iiliulll of tilt VWIILy, 4elt4lll liuiiciea iildY 1L'yuiie aII VlldulS-Umuill, A 5ldLviP;eiit vn Lhis Cu1106(oCklu LIQUb IIIJI LU111ef rights LV ill:: certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAUIE: klae i5 Merch Lltine"vrltin it3,R Inst. ranee Group Ilio one. {auc, No. exp: 888-530-80141 Ax: sArC, Na)' _2130-4_59.5995_ 1712 Magnavox Way E-MAIL ADDRESS KK A, 1assMerchal-4isin kandklnsurance com Fort Wayne IN 46804 PRODUCER CUSTorMER ID Y: Iverk ill Youth Volleyball Inc 709 Sumrllerbrook Drie andy Springs GA 30350 . Ivlernber of the Sports. Leisure & Erltertair dent RF (3 R A Nationwide Mutual insurance Com pa Ut B— ER D:...._— C'nVrRAr.FR f- F; OTI610 ATC RlI iRA Q G o• iA.Yl ria 7a7CZ ac�nclnu u�,sao�a_ I'J i Mrs I Ir• x �Iao r -c � C:LIi.FCS ::r• INSUrit..,r L.:, I t..+ ❑LL: r. --::•: L e�_-v aSLLJ I'.-; E hL IH i;�lr;F.itD A8U•.L I- UR I HL- PO UCY PER1Q0 iNDICA € ED. NOTV'ATHS-ANDONG AN +.• REOu:ACMENT TERM OR CQNDIT:CN OF A41 C04TRACT C QTnER GOCUME.NT ',h1T-, RLSrwCT fC-)''AHICH tHIS CERTIFICATE MAY BE 3SSuED OR MAA PERTAoN TriE NS_kAI4E.AFFLIR[;E_7 Br i rSE_ PO -I IC_$ DLSCn UL L' I: srLNN IS 508JECF r ,ALL THE TERMS EXCLUSIONS A"Q CONDITIONS OF SUCII POLICIES. LIMITS SH7'Ah hint r1A'VE 3c FN RE17uCEU 3' PA.D =_+WS. N$ LTR' TYPE OF INSURANCE AOOL SUBR WVD POLICY IvuM BER ' 6BRPGO000004992200 j POLICY EFF jMtdlDDIYY POLICY Exp MNVDDrYY LIMAS A ,w _ _ GENERALLIAMLM W-� Olfi) 112012 0110112013 E1CrIDCC.IRRENCL $1.i}OC.DEI[. X c:uluh7Elx[ 1„I :WNERA.L i:rniLJY C PINS -LA nD E , 177 �^ k :2 C1 ANI COT 12 01 AM • L. $300.00 PR Eid 1SE5 1 Eu w;;:ul rer�- ME 0 ExF' u;rif win Pelxvr; 55,6017 PEAU. -w :_a AL1-,n:.;ukr 84,000,0 :iENER4L AGt3RF. G. '"F $3,00000 ;'GGRESA:E UMIT.:PFi•:F5 PEP �PSlLi4T -PRO ECT F_]L-I. $7,000,044 j ll Ili r`1(:�- t->_7I"i iAL LrY �1 D09,D>7C SSI [ '_AL LtA@ r :• W�..F-'C:PA,.F:-t- $1.000.000 A jAUTOMO61LE LIABILITY 6BRPGO0 006499220D 01101/2412 k'2 01 AM EOTE EE 011011201'3 12 01 AM O 1u SINEC SiNc� L_M T $1 000,00C .� ^cclu Rd.: •r�i �t' HC1L7ii'! Jiiv per penw11 ANY r... -l1 ALS. 'J r�Eti.4iiTQ$ F300 r N.: ikR'•A j%r ar_l:[dEl 10t SCIaEI]riL£DTYIT3S � ...»_. PRG�EYIv i�EA1AGl7 Poo xwrnt }. X I x -1wL Au 4 i :J[:w-�rr:EO atirps i i X .NII Pn aad verve in •+avail _ - --- - - - t1MBRELLA UA6 OCCiR FAC Ii OCSURRENCE EXCESS LIAR CLAS MS-IAAD6 ? OC REO sT E DE1D,;CTi8LE .._.... _.. _, (WORKERS COMPENSATION AND EMPLOYERS UASLnY YtFv AN I EAE rk 1VE OFRC°S n1=:=:- ,•:_.. �t�LECV7IVE QFFCEwi+,tEl: �_ _� N i q •7yC �!A'. : `-�r."ER iTvRY _!!R7T$ _ _ _ EL EACr^>•..`C:1)Etr 4 ✓= L DISE LSE - iA i'MPL;]!EI EnC1.•,C£CY+ �llM1anpaiory m fyHl r r rea xaa�oc.•' •ua !G, R.FTIv1 OF ;•'E+w I_ —e,e .;n ' E.L. UISEnSE -PLL:, Y rsN.I I A MED C A �AYWE,'Jti "Of: ��RTICiP+1'v73 6BRPG0000004992200 0110 1;2012 0%G112fi13 r-RWARY IJEAiCAi- '1.J'. AM ED i 12.0'. Am EXCESS MEDvCAL $25,000 0£SCRIPTI4N OF OPEPATION LOCA KSfVE[iICLESIAttachACORD101,AdditioisaiI Rvmarks Schedule, rr nwm space m required) Sport(s) Volleyball Age;s): 12 and under. 13-15. 15-19 the certificate liGldef is added as an add0onal insured. but only with respect to the liability arising out of the O erations of the msufeci named anove 4r+iti �+G LLN I NUN Fulton County SCI}DOIS SHOULD ANY OF THE ABOVE DESCHIBED POLICIES BE CANCELLED BEFORE Go Search 785 Clevel'al;d Ave S4"J THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Atlanta GA 30315 ACCORDANCE WITH THE POLICY PROVISIONS. {C7vv11lrsL S5of of Prtfill$L5: AJT31GRiZED REPRESENTAT IVE Coverage .s only extended to U 5 eVenls and aetwille; NOTICE 1-C TEXAS INSUREOS 1 -he kisurer for the Purohds;ng group Way Out tie subject to all the Insurance laws and regulations of the State of Texas ACORD 25 (2009iD9j The ACORD name and logo are registered marks of ACORD J 1989-2009 ACORD CORPORATION. AH rights fesefved. 2011 SANDY . v �PRINGS License Number 11-C}ikl[?7123 Expir}a�tion] Date L]L°LNrIlber 31, 2��1 BUSINESS OCCUPATIONAL September21,21, 2011 TAX CERTIFICATE lee Class Account I\utllbt.r 15 U0139801Ll( ��tller r�r1Iu5L°ilicrll �� lies lncliLytl'i�� ENOj I RANSF IZAK E) NAICs Cade 713990 FOR OPFR.A ION IN THE CITY OF SANDY Si'}Zi;V(,S, GE[3IZL'•ti� SUBI (I.NEhf[; RE51itICIIC} fS ANDA1J_!71 Ftf i2C'U1]f;5 AND ELFS� i.L i lc r�S: IF 1 tKt: �t:�YC7}i A_'ti13C['iZ' C[]i1:�L:f� C71�'f}{E �1='� L!i• 5:11�t�1� Sf�IZlt�C,t. t.IC'kNSE IS A MEW PRI VII.FGt S4J8j1 f f 1 LSF kE b kt:t ANN ANNI.II11:0. AND IS ti(iBIECI M AN V 7Lik I iI; Z2 1J(I 11 4.."a'L.1 S , V! 0( -, 1 A ) ht Issued I3y:�t `1 4,L2 Michael Casey, City Clerk — City of Sandy Springs 7840 Roswell Coad Sandy Sprinc,S, Geurgia 30350 Valid for Business Shown Below only: SUS] \ESS AD DRESS - 1'70 K] 5LiL1tI1lL'rUrU��k f.7r "Jt)dy Spc'Lligs Ga 30350 MAf1,1NC AUEMI-;s: 0verl.111 Volleyball 1Y09 skim l erbrook i]r Sindv Springs Ga 30330 MUST 13F- POS FED IN A CONSPICUOUS LOCATION :ontror No 1106$702 STATE OF GEORGIA Secretary of State Corporation Division 315 West Tower #2 MV :trtiu Luther King, Jr. ❑r. Atlanta, Georgda 303J4-1531) CERTIFICATE OF INCORPORATION t, Brian P. Kemp, die S -c r Jary ul' Srat,-- atui tine Corporations Comm issrotter o1, the Stale Uff;eorola. here -b,, certif% under the s�:al of my office that Overkill Volleyball Inc. a i3tmiestic'Pott-Profltt Corporation has beim duly incorporated urrder the la4vs of'tito State ofGeurgia Oil -Se ptctttber9, 2011 by the filirtg ofartie.10; of incorporation 'it the Office of the Secretary of State and by the paying of tees as provided by I i tte 14 of Tho Official Code of0corgm latrtotated. WITNIESS my hand and official seal ofthc City of Atlanta acid the State OrGoorgia on September 9, 2011 3 s w 408m, i Brian P. Kamp Secre'tauy of State mo IRS INRNNAi REVS-NLTE S-ERVICT7EAS-MY TE CiNCINNXTI OH 4Sy59-v+2' GVERKII L VOLLE~f2ALL: 1709 SUMMEF.BROOK OR SANDY SPRINGS, CA 30350 Date of this notice: GS -31-2011 Employer Identification Number: 4-5-3130514 Form; SS -4 Number of this notice: CF 575 A For assistance you may call us at: 1-800-029-4933 IF YOU 'WRITE, ATTACH 7HE ST-LJ8 AT 7HE = 4F THIS NO-11Cc., LSF: ASST(;3+FFi7 YOU AN FM1PTf)YF'R T-)FN,TTFTC A^Tr1N, N TTKRFR Tfnark you for applying for an Employet Identification Number {EIN}. We assigned you 21N 45-3134514. This EIN will iden[rfy you, your business accounts, tax returns, and docurnents, even if you have no etnp UyeeB. ?lease keep this notice in your permanent records. When filing tax documents, payments, and related correspondence, it is very important beat you use your EIN and complete name and address exactly as shown above. Any variation may cauEe a delay in processing, reeu.lt to iLlcorrect informatiar_ in your account, or cvcn cause you to be assigned more than. one EIN. If the information is not correct as shown above, please make the correction•, using the attached tear orf stub and return it to us - Based on the ir-fo_mation received from you or your representative, you must file the f.ol'_owing form(s) by the daceis; shown. Fo-m t_20 03!15/2012 2L yua t:nvc� vi Lhe due date fs3 shown, you cart tail us at tate phone number or write to us at the acid.ress shown at the top of this notice_ If you need help in determining your anm;al accounting period ;tax year), see 2ublicatior. 538, Accour ezng Periods and Mechads . We assigned you a tai classification based or Information, obtained from you or your representa[ive. It is not a lega- determination of your tax classiEicarior,, and is not biLsuing on the IRS. If yo --i want a legai determinar_-ton of your tax classification, you may =acraest a private -Latter ruling Erorn the IRS under tite guidelines in Reveriue Procedure 2if{14-1 k -K-6. 1 (or sulOQ2"sed?1g Xevenue Procedure Tor rile year at 13sue). Nate Certain tax classification elections can be requested by fiwing Form 8832, Entity Classification Election. See Fora 883-2 and its instructions for additional information, IMPORTANT INFORMATION FOR S CORPORATION ELECTION - It you intend to elect co file your .Pturn as a small business corporation, an election to file a Form 1120-5 must be mane: wit sir, certain timeframes and tate corporation must meet certain tests_ All of tris iriformation is included in the instructions for Form 25-33, Elect4on by a Small Business Co*poraLiQn, (lits Utiv ONLY) -315A Ud-31-20-il OVER S 9999999999 SS -4 If you are required to deposit for enri3Toymert taxes (Norms 941, 943, 940, 944, 945, CT -1, or 1042), excise taxes (Form 726), or income taxes (Forth 1120), you will receive a Welcome Package shortly, which includes insnract:ions for making your deposits electronically through the Electronic Federal Tax Payment System (EFTPS). A Personal Identification ?lumber (?IN) for EF:'PS will also be sent to you under separate cover_ Please activate the PIN once you receive it, even if you have requested the services of a tax professional or renresentarive_ For mare infonnarion about EF'PPS, refer to Ps.Wlication 956, Electronic Choices to Pay All Your Federal Taxes. If you need to make a deposit immediately, you will neea to make arrangements with your Financial InstiLUtiaii to complete a wire transfer_ he TRS is c0auldtted to helpir_g all taxpayers comply with `heir tax filing Obligations, If you reed help compietir:g your- returns or meeting your tax ooiigations, Authorized e -file Provide Ys, such as Reporting Agent -s 1payroll service providers) are available to assist you, Visit th:e IRS Web site at: www. ixs.gov for a list of comparIies that offer IRS a -file for business products and services_ The list provides addresses, telephone numbers, and '_inks to their Web si,_es. To obtain tax form:, and pablications, including those referenced in this notice, visir nt;r wph ai rP a r ww.w i rs gcnv Tf ynsj ran nor have arcess to r!je 7:nt ernes , ^a.11 1-800-825-3675 ;TI'Y/TDD 1-800-829-4059} or visit your local IRS office. rXPaRTnz+rr B.EDaaNiDRRS * Keep a copy of this notice in your permanent records. This notice is issued only one time a=d the IRS will not be able to generate a duplicate copy for you_ Use this EIN and your name exactly as they appear at the top of this notice on all your federal tax form,:_ Refer to this EIN on your tax -related Correspondence and documents - If YOU nave questions about your Eli+), yes car_ call us at the phone n-wnber or write to us at the address shown ae the too of this notice. If you write, Please tear oft the scut at the bottom. of this notice and send it along with your tetter. It you do not head to write us, do not complete and return the stub. 'Thank you for your cooperation. Keep this part for your records. CP 575 A (Rev. 7-2007) Return this part with any correspondence so we may identity your account. ?lease correct any errors in your name or address. CP 575 A 9999999999 Your Telephone Numne�- Best Time to Call BATE OF THIS NOTICE: 0p-31-207.1 4 1 EMPLOYER IDENTIFICATION' XTMER: 45-3130514 FORM 7 SS - 4 NOBOD INTERNAL F2 ?97T SERVICE OVERK VGLLEf3A,: CDNCTVNATL p_3 45999-M23 1709 S[IPf,NiERBROOK DR I,I..I.I.I.I.I..I.I,.I.I,,II...II,..,jI,hIIII.IjhI SAV'Gy 3PPINGS, GA 30350 Control No, 11069102 Date Filed: 0910513011 02:48 PM Brian P. Kemp Secretary of State Articles Of Incorporation For Georgia Non -Profit The name of the corporation is: Overkill Volleyball Inc The corporation is organized pursuant to the Georgia Nonprofit Corporation Code. The principal mailing address of the non-profit: 1709 SummerbrooK Ck Sandy Springs, GA 3031iIJ The Registered Agent is. Ileana Yustis 1709 Surnmerbrook Dr Sandy Spi ii Kjs, GA 30350 County: Fulton The narne and address of each incorporator(s) is: Ileana Yusiis Ileana Barrios 1709 Summerbrook Car. 2979 Manitoba Lane Sandy Springs, GA 30350 Marletta, GA 30052 The corporation will not have members. The optional provisions are: No opbonai provisions. IN WITNESS WHEREOF, n`e undersignea naS executed these Articles of Incorporation on the date set fortri below Signature(s): pate: Incorporator, Ileana Yustis 09109/2019 [a:Xl[[BIT "B" City of Milton zQ Georgia Criminai History Recoru Information Request and Consent Form 1) This Request Is For: lcnece or y otat Employment �j Military : Licensing Perso€ial Use Other Use INot misted f E i ;a Internabanal Travel cj Firefighters Empicippant t E I a €'rospeetive Adul itivelFoster Parents iE _ yore 3 2 *opesl u Eiapluyrwe,ol VVviking Wild Thu Elklerly (N) D Employment At A Ghild Care Facility tthl X Vo€unleer work;nq with Children (W) Li Employment working With The dentally III tfmy Ll Palace RNdrs Alone Ri�yuest (C1 _.� Puiu a f3epartmen( VendufjConlractor (c) 2] A History Is Requested on The f=ollowing Person: i:amo sr,C,al Security IN umber _ . x Race- L White J Black LaAsian ;� Amenwn Indian j UnknownlOther Date of Birth" Phni to. NO tmhpr - - El Check If Request Is For Yourself And Proceed To Section 5 At The Bottom Of This Page. 3j Person Requesting Criminal History: NAn� City of Milton,Company Nam& JRF)j Address 13000 Deerfeid Nrkwav Suite 107 Pthof* 678, 242 2500 City,StatesZrp. Minton, GA 30001-4 4y Consent: ihls potion is to t>e used ,f the persolz rayuestii143 Ln8 Cri€nii tai h€st(xy i5 drtferent than whom the Criminal history is being inquired 0€1 €yeCIIU)s if & lir aDo,ie a€e, riot [he sante person) rhifd party notary is required r r:Breov jrrra my con5,ac;w eny ci[nldlai Riihk-f 1,D U*� IWC 3Ft3 1of'lie 41]04e nar.ell pefsm rn wcC xmI 3,-, u] fl}: e? access Io +1 :a• 0� 51 In a-exing ihtis request,1 ayteµ tnat me city or &Ulan PoitCe i)eparirnent, its ernplvyees. heirs, trustees, etc., slum in w way be rlew at faafi for the use or mrsuse of [his record. A pnClccepy of mos rek-.ase ml be piaecaa on Ott an0 :s vaNd as 2n origmal herec4. evtn T101.39h the photocopy does nal evnn.n an orgff al sic)[rlaturr €inf'syi:ltdr!e regfiesis .viii be denaeC This repon rs cvnsiaeveu accura€e 41 gii7e Ul p1gUIF]r anis iI W]r C11:0 Kjt iii .VY,il'i It O lai Use UR IV — Ja N01 MafA Be4o* N.LS Lne Re -Suits J �dZooa 56 0 Operator ARN Date SutTrf Med Inquiry pate 1 1 12012,SANDY SPRINGS License Number 12-00007I23 Expiration Date izw Date Issued December 31, 2012 BUSINESS OCCUPATIONAL January 05, 2012 TAX CERTIFICATE Fee Class Account Number � � Ont All Other Amusement & Rec Industries (NOT TRANSFERABLE) NAICS Code 713990 FOR OPERATION IN THE CITY OF SANDY SPRINGS, GEORGIA SUBJECT TO ZONING RESTRICTIONS AND ALL OTHER CODES AND RESOLUTIONS OF THE MAYOR AND CITY COUNCIL OF THE CITY OF SANDY SPRINGS, GEORGIA. THIS LICENSE 1S A MERE PRIVILEGE SUBJECT TO BE REVOKED AND ANNULLED, AND IS SUBJECT TO ANY FURTHER ORDINANCES WHICH MAY BE ENACTED, Issued By: Michael Casey, City Clerk City of Sandy Springs 78510 Roswell Road Sandy Springs, Georgia 30350 Valid for Business Shown Below Only: BUSINESS ADDRESS: Overkill Volleyball 1709 Surnmerbrook Dr Sandy Springs Ga 30350 MAILING ADDRESS: Overkill Volleyball 1709 Summerbrook Dr Sandy Springs Ga 30350 MUST BE POSTED IN A CONSPICUOUS LOCATION Copy of Personal Identification Documents Held in City Clerk’s Office City of Milton 13000 Deerfield Parkway Suite 107C Milton, Georgia 30004 To: Honorable Mayor and City Council Members From: John Rebar, Parks and Recreation Director Submission Date: April 25, 2012 Meeting Date: May 7, 2012 Agenda Item: Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Sperber Music Background: The Parks and Recreation Department is eager to continue offering programs and additional services to the citizens of Milton. Many of these programs may be offered by outside providers through an agreement with the City of Milton based on a submitted program proposal rather than offering these programs through a paid independent contractor or a paid employee of the City. Discussion: The Parks and Recreation Department recommends entering into agreement with Sperber Music to provide miscellaneous music programs for our residents and visitors. Programs may include: Summer Music – Movement Camp Mini Musicians Summer Camp Mini Musicians A commission of 30% of all registration fees will be paid to the City of Milton two weeks following the end of registration. Non-resident fees will be collected by the provider and paid to the City at a rate of 50% more. Legal Review: Contract Template - Paul Higbee, Jarrard & Davis on February 23, 2012 Attachments: A Parks and Recreation Department Agreement between the City of Milton and Sperber Music. CITY OF MILTON PARKS & RECREATION DEPARTMENT AGREEMENT FOR OUTSIDE PROVIDERS THIS IS AN AGREEMENT, made this day of , 2012, between: THE CITY OF MILTON, a municipal corporation organized and operating under the laws of the State of Georgia, with a business address of 13000 Deerfield Parkway, Suite 107 A, MILTON, Georgia 30004, hereinafter referred to as the "CITY." and SPERBER MUSIC hereinafter referred to as "PROVIDER". CITY and PROVIDER may hereinafter collectively be referred to as "the Parties". In consideration of the mutual obligations of the Parties and for good and valuable consideration, the adequacy and receipt of which are hereby acknowledged, the Parties agree as follows: ARTICLE 1.0 PROVIDER's Services and Responsibilities 1.1 PROVIDER shall conduct services generally described as Music Camp & Music Classes at the following location: Bethwell Community Center, 2695 Hopewell Road, Milton GA 30004, 1.2 The PROVIDER's services shall be performed during the days and hours described in Exhibit "A," attached hereto and incorporated herein by reference. 1.3 The PROVIDER and The Director of the Parks & Recreation Department or his designee, hereinafter referred to as the "DEPARTMENT", will agree upon program schedules. PROVIDER agrees to submit a Program Request Forma to the Coordinator for each program being proposed eight (8) weeks prior to the beginning of each session. 1.4 The fees charged to each participant will be as described in Exhibit "A" for residents of MILTON and a surcharge of 50% more for non-residents of MILTON. The entire balance of this surcharge for non-residents shall be paid to the CITY. 1.5 The PROVIDER warrants to CITY that it is not insolvent, it is not in bankruptcy proceedings or receivership, nor is it engaged in or threatened with any litigation or other legal or administrative proceedings or investigations of any kind which would have an adverse effect on its ability to perform its obligations under this Agreement. 1.6 The PROVIDER agrees that it shall be solely responsible for all costs and/or expenses associated with, or as a result of its operation under this Agreement. The PROVIDER stipulates and certifies that it is qualified to provide the programs it is hired to provide, maintains the education and required licenses or permits necessary to provide 1 PROVIDER stipulates and certifies that it is qualified to provide the programs it is hired to provide, maintains the education and required licenses or permits necessary to provide the programs, and shall continue to maintain such licenses or permits during the term of this Agreement. 1.7 This Agreement is considered a non-exclusive Agreement between the Parties. The CITY shall have the right to purchase the same kind of services to be provided by the PROVIDER from other sources during the term of this Agreement. The PROVIDER is not precluded from providing the same or similar services for other parties so long as such other engagements do not interfere with the PROVIDER'S provision of services to the CITY. 1.8 Tire DEPARTli2-ENT must approve any promotional material, flyers, and posters advertising the programs prior to its release. The following content and topics shall specifically be prohibited: sexually explicit materials, profanity, child pornography, alcoholic beverages, tobacco products, adult movies, adult booklvideo stores, adult entertainment establishments, massage parlors, pawn shops, and tattoo parlors or shops. 1.9 The PROVIDER. shall not promote any privately owned business in a CITY park/facility or solicit any participant in a CITY park/faciiity activity for any privately owned business. The PROVIDER may not use said facilities to conduct personal business including workshops, clinics, seminars, camps, or any other activities that are outside the scope of service described in (Exhibit 'W'). It is further understood that such action(s) may result in immediate termination of the Agreement .and the forfeiture of all compensation due to the PROVIDER. 1.10 The PROVIDER shall abide by the policies, procedures, rules and regulations of the DEPARTMENT, the CITY, and the FULTON COUNTY BOARD OF EDUCATION as promulgated frorn time to time. PROVIDER understands and a Tees that the DEPARTMENT shall have first Priorityor use v CITY acilities netwithsta►idin are other provisions of this Agreement 1.11 All assistants, substitutes, and subcontractors utilized by the PROVIDER must have prior written approval of the DEPARTMENT_ 1.12 PROVIDER shall provide necessary supervisory personnel to ensure that the participants of the programs obey all applicable policies, procedures, Rules and Regulations. 1.13 The DEPARTMENT or CITY may require that the PROVIDER not he permitted to utilize specific assistants, substitutes, or subcontractors of PROVIDER who have failed to follow any policies, procedures, rules or regulations applicable to the use of the facility. 1.14 Although the CITY shall not control the PROVIDER's techniques, methods, procedures, or sequence of instruction, the PROVIDER will comply with the CITY's and DEPARTMENT's policies, rules, regulations and procedures, as well as those of the FULTON COUNTY BOARD OF EDUCATION, and shall not interfere with their operation, nor harm or damage the equipment or facilities afforded to PROVIDER for his/her programs, nor otherwise disrupt the other on-site activities being offered at such public facilities. 1.17 The PROVIDER also acknowledges that he or she is primarily responsible for the conduct of the participants in all programs under the PROVIDER's charge. 1.15 If the PROVIDER will be providing services directly with minor children without parental supervision, the PROVIDER shall, prior to commencing services under this Agreement, comply with the CITY's policy regarding criminal background screening. The CITY will famish the PROVIDER with a background release form (Exhibit "B") for all the provider's counselors, coaches, volunteers, subcontractors, employees or any other individuals that will come in contact with a child, at the PROVIDER's sole expense. A Consent and Release Form to conduct a criminal background must be executed by any of PROVIDER's employees or any individual who will come in contact with a child at the Crl'Y through PROVIDER or at PROVIDER's direction, such form authorizing the CITY to conduct a search of each such 'individual's criminal background. The result of such inquiry may be deemed acceptable by the CITY in its sole and complete discretion, and the CITY may reject any individual from participating in any program based upon such results. If rhe PROVIDER has recently had a background screening conducted by another agency, the CITY at its sale discretion, may accept that background screening and waive the requirement of a new background screening. PROVIDER and its employees must also execute a Waiver and Release of Liability holding the CITY Olid FULTON COUNTY BOARD OF EDUCATION harmless. 1.17 The CITY shall require all participants in all programs to sign a Waiver and Rcicasc of Liability. ARTICLE 2.0 Enuipment & Materials 2.1 All program materials and equipment needed or pertaining to the above stated programs will be provided by the PROVIDER at his/her own cost and expense. However. PROVIDER may require participants to obtain certain materials required in the programs by providing a list of such materials (with approximate costs) to the participants. If PROVIDER makes such materials available to participants, they must be sold at PROVIDER's cost. All equipment provided by the PROVIDER shall be used in strict accordance with equipment manufacturer's instructions and in accordance with all applicable laws. PROVIDER shall coordinate storage of goal posts with the principal of the school located at the facility. 2 The sale of merchandise is restricted to those materials utilized in and for the programs. Fundraising activities conducted by the PROVIDER will not be permitted. The ?.3 The CITY will provide no storage space to the PROVIDER, unless otherwise mut€tally agreed upon in a Separate written agreernerit. 2.4 Any supplies or equipment left at the facility will be the responsibility of the PROVIDER. The CITY will not be responsible for any lost, stolen, or broken equipment 01' supplies. 2.5 The PROVIDER shall inspect the premises and equipment offered to him/her for his/her proposed activity and if he or she finds anything wrong with the premises or equipment before each program commences that cannot be corrected immediately by the DEPARTMENT, the program shall be canceled and the matter reported to the DEPARTMENT for correction. If the PROVIDER elects to hold his/her programs in the facility provided, it will be presumed that the PROVIDER has inspected the premises and facilities and equipment provided for such programs and has accepted same as being safe and suitable for the use intended. ARTICLE 3.0 Proaraw Size Minimums: 3.1 ACTIVE. Program sires shall meet the minimum numbers of participants for each program as designated in Exhibit "A." ARTICLE 4.0 Compensation and Method of Pavment 4.1 In consideration of the releases and indemnities contained Herein and of the PROVIDER's services in connection with the programs and activities described herein, the CITY shall be entitled to 30% of the registration fees paid by all program participanis to the PROVIDER, and the PROVIDER shall be entitled to 70% of such fees paid, exclusivv, € f the 50% non-resident surcharge. The 50% nan-resident surcharge is fully payable to the CITY and shall not be included in PROVIDER's gross income calculation. PROVIDER shall be catiticd to retain all non -registration fees paid by participants to PROVIDER, i.e. PROVIDER membership fees and costs for uniforms and pictures to participants. 4.2 The PROVIDER agrees to collect all fees from pailicipants, and the PROVIDER agrees to provide CITY with schedules of fees to be charged to participants in conformance with Exhibit "A". It is agreed that the PROVIDER's sole obligation shall be to collect the fees from the participants and to remit the 30% of the fees collected as %veli as all 50% nom -resident surcharge ainowits to the CITY with a pay -out report of all monies collected. Payment will be made to the CITY within fourteen (14) business days of the end of each month Or session orPrngraM. whichever occurs first. 4.3 It is the responsibility of the PROVIDER to pay all applicable local, state, and federal taxes associated with this Agreement, and to acquire and pay for all necessary permits, licenses, and insurance required for the execution of this Agreement. ARTICLE 5.0 Independent PROVIDER 5.1 This Agreement does not create an employee/employer relationship between the Parties_ It is the intent of the Parties that the PROVIDER is an independent contractor under this Agreement and not a CITY employee for all purposes, including but not limited to, the application of the Fair Labor Standards Act minimum wage and overtime payments, Federal Insurance Contribution Act, the Social Security Act, the Federal Unemployment Tax Act, the provisions of the Internal Revenue Code, The State Workers Compensation Act, and the State unemployment insurance law. The PROVIDER shall retain sole and absolute discretion in the judgment of the manner and means of carrying out PROVIDER's activities and responsibilities hereunder. The PROVIDER agrees that it is a separate and independent enterprise from the CITY, that it had full opportunity to find other business, that it has made its own investment in its business, and that it will utilize a high level of skill necessary to perform the work required hereunder. This Agreement shall not be construed as creating any joint employment relationship between the PROVIDER and the CITY and the CITY will not be Diable for any obligation incurred by PROVIDER, including but not limited to unpaid minimum wages or overtime premiums. 5.2 PROVIDER warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the PROVIDER to solicit or secure this Agreement, and that it has not paid or agreed to pay any person, company, corporation, individual or firm any fee, commission, percentage, gift, or other consideration couthigent upon or resulting from the award or snaking of this Agreemerit. For the breach or violation of this provision, the CITY shall have the right to terminate the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover the full amount of such fee, commission, percentage, gift or consideration. ARTICLE 6.0 Insurance 6.1 PROVIDER shall not provide any service until all insurance required under this paragraph has been obtained and approved by the CITY. fi_? Certificates of insurance. Certificates of Insurance reflecting evidence of the required insurance shall be filed with the CITY prior to the mmmencement of this Agreement. These Certificates shall contain a provision that coverages afforded under these policies will not be cancelled until at least forty-five days (45) prior written notice has been 5 given to the CITY. Policies shall be issued by companies authorized to do business under the laws of the State of Georgia. Financial Ratings must be not less than `A -VI" in the latest edition of "Best Key Rating Guide', published by A.M. Best Guide. 6.3 Insurance shall be in force until the obligations required to be fulfilled under the terms of the Agreement are satisfied. In the event the insurance certificate provided indicated that the insurance shall terminate and lapse during the period of this Agreement, then in that event, the PROVIDER shall furnish, at least thirty (30) days prior to the expiration of the date of such insurance, a renewed Certificate of Insurance as proof that equal and like coverage for the balance of the period of the Agreement and extension thereunder is in effect. The PROVIDER shall not provide any service pursuant to this Agreement unless all required insurance remains in full force and effect. 6.4 Commercial General Liability insurance to cover liability bodily injury and property damage. Exposures to be covered are: premises, operations, products/completed operations, and certain contracts. Coverage must be written on an occurrence basis, with the following limits of liability: $1,000,000 Combined Single Limit — each occurrence $2,000,000 Combined Single Limit — general aggregate $1,000,004 Personal Injury $1,000,000 Products/Completed Operations Aggregate PROVIDER sliall have its insurer name the City of MILTON as an additional insured oil its General Liability policy. 6.5 Worker's Compensation insurance shall be maintained during the life of this Agreement to comply with the statutory limits for all employees, and in the case any work is sublet, the PROVIDER shall require the subcontractor(s) similarly provide Workers Compensation Insurance for all the latter's employees unless and until such employees are covered by the protection afforded by the PROVIDER. The PROVIDER and his subcontractors shall maintain during the life of this Agreement Employers Nahility Insurance. The following limits must be maintained: A. Workers Compensation Statutory B. Employer's Liability $100,000 each accident $500,000 Disease -policy limit $100,000 Disease -each employee If PROVIDER or its subcontractor claims to be exempt from this requirement, PROVIDER shall provide CITY proof of such exemption along with a written request for CITY to exempt PROVIDER, written on PROVIDER or subcontractor's letterhead. 6.6 PROVIDER shall also maintain Auto Liability and Directors and Officers insurance with limits reasonably acceptable to CITY during the term of this Agreement. 6.7 The CITY and the Fulton County Board of Education shall each be named as an additional insured and loss payee on all policies required by this Agreement. ARTICLE 7.0 Term and Terminatig 7.1 After a two (2) month trial period, the programs will be evaluated by the DEPARTMENT, and the remainder of this Agreement will either be terminated or continue in full force and effect. If at any time after the two (2) month evaluation, program enrollment should fall below the required minimum, the PROVIDER will be allotted four (4) weeks to bring enrollment tap to the required minimum. The programs will be reevaluated and execution or termination of the contract will be determined by the DEPARTMENT. 7.2 The term of this Agreement shall commence upon the date of execution hereof and shall remain in effect for a period of one (1) year from the date of execution of this Agreement by the CITY, unless terminated sooner as provided in this Article. Renewal of this Agreement beyond the one (1) year term shall require the mutual written agreement of the CITY and PROVIDER. 7.3 This Agreement may be terminated by the CITY for convenience upon giving of at least thirty (30) days prior written notice of termination to the PROVIDER at the PROVIDER's address set forth herein at the sole and exclusive discretion of the CITY. This Agreement may be terminated by the City immediately by written notice to PROVIDER upon any willful, reckless, or grossly negligent act or omission by PROVIDER or any of its officers, agents, employees, or volunteers. 7.4 This Agreement may be terminated by PROVIDER upon giving at least thirty (30) days written notice of termination to the CITY. 7.5 PROVIDER must notify the DEPARTMENT in writing of any program cancellations at least ten (10) busincss days prior to the scheduled cancellation. 7.6 CITY rescrvcs the right to cancel or reschedule any of the PROVIDER's programs, in the case of scheduling conflicts or other emergencies, as determined by the DEPARTMENT. ARTICLE 8.0 Indemnification 8A PROVIDER agrees to indemnify and hold harmless the CITY and the FULTON COUNTY BOARD OF EDUCATION, their trustees, elected and appointed officers, agents; servants and employees, from and against any and all claims, demands, or causes of action of whatsoever hind of nature, and the resulting losses, costs, expenses, reasonable attorneys' fees, including paralegal fees, liabilities. damages, orders, Judgments, or decrees, sustained by the CITY, the FI LTON COUNTY INTY BOARD OF EDUCATION, or any third party arising out of, or by reason of, or resulting from the will 7 full or negligent acts, errors; or omissions of the PROVIDER or its agents, officers, volunteers or employees. 8.2 The Parties understand and agree that the covenants and representations relating to this indemnification provision shall survive the term of this Agreement and continue in full force and effect as to the PROVIDER's responsibility to indemnify. ARTICLE 9.0 Americans With Disabilities Act 9.1 PROVIDER shall not discriminate against any person in its operation and activities in its use or expenditure of the funds or any portion of the funds provided by this Agreement and shall affirmatively comply with all applicable provisions of the Americans With Disabilities Act ("ADA"), in the programs while providing any services funded in whole or in part by the CITY, including Titles 1 and II of the ADA and all applicable regulations, guidelines, and standards. 9.2 PROVIDER's decisions regarding the delivery of services under this Agreement shall be trade without regard to or consideration of race, age, religion, color, gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation, or any other factor which cannot be lawfully or appropriately used as a basis for delivery of service. ARTICLE 10.0 Miscellaneous 10.1 No modification, amendment, or alteration of the terms and conditions contained shall be effective unless contained in a written document executed with the same formality and equal dignity herewith. 10.2 This Agreement is non -transferable or assignable, and PROVIDER agrees not to transfer or assign the performance of services called for in the Agreement. 10.3 This Agreement sets forth the full and complete understanding of the Parties as of the effective date, and supersedes any and all negotiations, agreements, and representations made or dated prior to this Agreement. 10.4 The PROVIDER shall pay reasonable attorney's fees to the City should the City be required to incur attorney's fees in enforcing the provisions of this Agreement. 10.5 Time is of the essence of this Agreement. 10.6 Each of the individuals who executes this Agreement agrees and represents that he is authorized to execute this Agreement on hehalf of the respective entity. Accordingly, the City and PROVIDER both waive and release any right to Contest the enforceability of this Agreement based upon the execution and/or approval thereof. 10.7 It is the policy of City that unauthorized aliens shall not be employed to perfcTral work on City contracts involving the physical performance ref ser -rices. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Oenrgia, unless the PROVIDER shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and "D" that it and its subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perforin work on the City contract to ensure that no unauthorized aliens will be employed. The City Manager or his/her designee shall be authorized to conduct an inspection of the PROVIDER's and its subcontractors' verification process to determine that the verification was correct and complete. The PROVIDER and its subcontractors shall retain all documents and records of its verification process for a period of three (3) years fallowing completion of the contract. This requirement shall apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. Compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 is mandatory. PROVIDER's compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300- 10-1-.02 shall be attested by the cxecutEon of the contractor's affidavit attached as Exhibit «C ,7 Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executin; this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to O.C.G.A. § 16-10-71), a form of which is attached hereto as Exhibit "E", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, subrnirted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A. § 50-35-1). 9 IN WITNF.SS OF THF FCIRFGOING, the Parties have set their hands and seal the day and year first written above. CITY: ATTEST: BY: SUDIE GORDON, CITY CLERK JOE LOCKWOOD, MAYOR PROVIDER: WI ESS: BY: KAR--EK DAWN CORNELL, PRESIDENT [AFFIX CORPORATE SEAL] 10 U`Tr���F k Ln �ii PROGRAM REQUEST FORPA Individuals ince tested hn proposing their programs at -7d se, ,picas must complete afld return tlris forth attached to the Letter of Oteresz. This infor a7ation Evil/ be vse':� far ionside- ration of pnogram pi-oposals. Use oma form Der pEoorairn. Name of Program: Isar tici aiti Ages: Day/s of the week program i's offered: y'. .-O, _ � f o Program Dates'.il l i to Dates'.-15") Program Fee: � ( - � >t •� _ � 1 �v , Program Enrollment- Minimum � Maximum F Materials to be supplied I)y participarnts; ' Materials to be supplied by PROVIDER: i7. .•�?-L ;Yr .`.Yi. C3c- r''i•- _7' .'i �'._�j '•i i ini Materials to be supplied by the City of MILTON: Additional Program Requirements: PROVIDER Address: -- - - - t c . 4, CitylstatefZip Code: i t Phoria Number: (Day) . ' y 7, j ' - (Evening) (E-mail): (Fax) Minimum Re uiremen#s: 1,DOO,000 General Liability Insurance Letter(s) of Recommendation Office Use Only: Program Rate:$_ 9 of programs in Session: Fee/Program: PROGRAM REQUEST FORM Individuais interested in proposing their programs and services must complete and return this fora attached to the Letter of Interest. This information+ will .he used for consideration of program proposals. Use one form far program. Larne of Program: +,1 ---- Participant Rt�a� {, �� - ' - ' � c -I; Dayis of the week program is offered _-14.,;:: t: Time of Program:.-::..__� _ .. - - to 12 - Program 'Program Dates- J .: G to P rngra m Free: Program Enrollment: Minimum � 5 _ Maximum, i•_ 4 (;_% Matp-rials to he suppl i�rS by participants:�(� �-,_� �----------- .. _ I. ,Materials to be supplied by PROVIDER: ._ 'i �f i .'r- ,� 1-y 4. -_ --tsa • [.� � i}I` [.i� " = r F t i.'_ �rF_.. �_ •�� � r i F •x� � •, Y; :�.. c , r mac_ r'.',T ! �r'... �... Materials to be supplied by the City of MIL-rON: _�- Additional Program Rpquirements: PROVIDER City/State/Zip wade: F! Phone, Number' (Day) . (_�_� ^ � < _ a_.. �;(Evening) (E-rnail): (Fax) Minimum Requirements: 1,000,000 General Liability Insurance Letter(s) of Recommendation Office Use Only. Program Rate:$_ S # of programs in Session: Fee/Prograrn: -EXHIBIT "A" PROGRAM REQUEST FOR10i Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest This information will be used for consideretion cif program proposals. Use 0ne'Mer ro�r°am. Name of Program: Participant Ages-: Dayls of the'week program is offered: Tirne of Program- Program rogram Program bates: 7 . { toy ; ao4+f. I0 rn 14&r. Z $ i Zo 3 ( 12 wrr.r„ics') Program Fee: ! A- 41 e1 �5� Program Enrollment- Minimum Maximum r_ Materials to be supplied by participants: Materials to be supplied by PROVIDER: Materials to be supplied by the City of MILTON: Additional Program Requirements: PROVIDER Cs)Nsnie: r Address: f 7 w CitylState[ ip Code. �� F 1 M� • . { = Phone Number; (Day) i - :z � _ � _ L ; .T (Evening) (E-mail): Minimum Requirements: 1,000,000 General Liability insurance Letter(s) of Recommendation (Fax) -_ Office Use Only: Program Rate'$— # of programs in Session: Fee;Program: EXHIBIT "C" STATE OF GEORGIA CITY OF MILTON CONTRACJEOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor ,verifies its compliance -with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O_C.G.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-.08 in the form attached hereto as Exhibit "D." Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perform such service. EEV Basic Pilot Program User Identification Number Authorized Officer or Agent Date Sperber Music ()Wn l p `i" ,JSP 1"t U s" C_ Title of Authorized Officer or Agent of Contractor (PCAJELC Printed Name of Authorized Officer or Agcnt SUBSCRIBED AND SWORN BEFO MEQ THIS, E �AY aF I� A _ 1 NotaLy Public v U. MCommission Expires: X1-4-) ---1, 12 STATE OF GEORGIA CITY OF MILTON EXHIBIT "D" SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of sen°ices under a contract with Sperber Music on behalf of the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. EEV f Basic Pilot Program User Identification Number 1� Authorized Officer or Agent hate [INSERT SUBCONTRACTOR NAME] + c. Title of Authorized Officer or Agent of Subcontractor eve �. C -.•� [ Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEF RE ME ON HIS THE - DANF 1 , 2Q1,. Notary Pu c My Comnussion Expires: d 13 J 1 L 1. % >j gyp ►''-.r r�ei -,r ' NGpjo a� za� io '%V AS sy�r4C ,♦�����its `rte EXHIBIT "E" SAVE Affidavit By executing this affidavit under oath, and as an applicant for a public benefit, as referenced in O.C.G.A. § 30-36-1, from the City of Milton, the undersigned applicant verifies one of the following with respect to my application for a public benefit: 1) I am a United States citizen. 2..) 1 am a legal permanent resident of the United States. 3) 1 am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal imntigralion agt�nc;y is.- The s: The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by 0.C.G.A. § 50-36-1(e)(I), with this affidavit. The secure and verifiable document provided with this affidavit can best be classified as: In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G_A. § 16 10 20, and face criminal penalties as allowed by such criminal statute. Executed in TD h!5 r :. Vic.. (city), or- '.o,- (state). D ce� S* nature of Applicant SUBSCRIBED AND SWORN " h. C -d! Printed Name of Applicant 14 DATE IMMMDTYYYYI CERTIFICATE OF LIABILITY INSURANCE 0412312012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAT10M ONLY AND CONFERS NO RIGHTS UPON THE CERi11FICATE HOLDER. TWS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EJCTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE Of INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT. It the certificate holder is an ADOMONAL INSURED. the policy(tes) must be endorsed. It SUBROGATION 15 WAIVED, subject to the terms and conditions Of the policy, certain poticles may require an endorsement. A Statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Scat Ralston NAMECr .3CDit Ralston PHr N 7.� 4 -1QQD AIC Nol.. .� Stale Farm Insurance ��AIL 0415 Marietta HwHwyADnRess scat[ scottraiston.com Roswell, GA 30075 iNSUREP451 AFFORDING COVERAGE NAIC 0 INSURER A: State Farm Fire and Casuals Com a n 5143 FNsUltIEn Karen Cordell dba Sperber Music INSURER B: 12:772 Donegal Ln INSURER C: MILTON GA 30004-6106 INSURER t) INSURER P $14SURER F- r-Forirrrnrr= ui IT1rGFA• RESniSION NUMBER - THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 6FJ_OW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POIJCY PERIOD INDICATED, I+IOTWTHSTANMNG ANY REOUIRENIENT, TERNS OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIRED HEREIN IS SUBJECT TO ALL THE TERINS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIPATS SHOWN MAY HAVE BEEN REDUCE© BY PAID CLAJMS. !NSR I LTR TYPE OF INSBFL4NCE 1 ImsR 5 eR POLICY NUMBER FF PM.,.YYY1 Ex f Mlti U N TS GFRERAL U14EIIJTr x CO MERCIALGENeRALLIASILITY CLAIMSAADE F OG'WJA I !E] 11-1847-D-23 I 041!+012012 041x012013 EACH 0CCVRRENCE 1,[3[90,490 PREMISES rEA oDW". ee S APED FxP fAfrV ane Peraan E 5,606 ,.. PERSONAL & AOL+ NMY Is .'000.0" e GENERAL AGGREGATE is 2,1000.060 GEN'LAGG.REGATELIMIT APPLIESFER: X POUCY PRO• Loc PRODUCTS-COMPIOPAGG S I,064,ODU E ADTVMOOILE UAINGTY �ANY AUTO ALL OA NEO SCHEWLED AUTOS kr, 05 HER Al1TOS NON-OWKED AUTOS En ec !3 SINGLE LIMIT S BODILY INJIJRY (Per Qemw, - y SOCALY INJURY (Per acr dM] S r?7tY DF:M s .... _.._ a I .. UMBRELLA UAS EXi7ES5IJA8 DCOUR CtA3#SSE EACH OCCLatRENCE -.-- AGGREGATE I S OED RETENTION $ 3 WOI?KG 06 COMP EN9 WTION AND EMPLOYERS' UA BIL.F tY Alii' PROPRIFTORIPART)EEReEXEOVTkVE Y� E,4 OFFICEJARER EKCLUDE07 FtLLL..--���# j IRand wry In HR1 it [I yea, do crlbe 'cwnDEES-aPZIPTION LIE: I R 1 A T -k E.L. EACH ACCIDENT � S �` E.DISEASE - EA EMPLOYEE S E,u L. D15E65E -POLICY L7HrIT 15 evser:ess Wt>`I' iiy DESCMPTION 4F OPERATIONS! LOCATIONS I VEHICLES IAMach ACORD Ial, A IdIiions1 Ra iks SGNa d0m, N mom ape ce Is rvqulred) Music teacherfinslructor H Additional Insured: City of Milton 13000 Deem -told Pkwy, Suite 1107 Milton, GA 30004 ACORM 25 (2010106) 5HO11LO ANY OF THE ASO VE DESCRIBED POLICI ES BE CANCELLED BEFORE THE EXPIRATION DATE THERCOF, NOTICE WILL BE OFOVETRED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORrdkO b 1988-200 ACORO CORPO RATI014. All rights reserved. Tha ACOR:D dame anti logo are registered marks o ACORt7 1001466 132$48,7 03-01-2012 i City of Milton Business License (Home Based Business) IN ACCORDANCE WITH THE PROVISIONS OF THE CITY OF MILTON CODE OF ORDINANCES, LICENSE IS HEREBY GRANTED'] 0 OPERATE THE BUSINESS REFERENCED BELOW BUSINESS: Sperber Music DBA: LOCATED AT: 127722 Donogal Lane LICENSE 4: BUS002019-04-2012 DATE ISSUED: April C5, 2012 HATE EXPIRES: December 31, 2012 Given under my hand this date of April 05, 2012 vi:]1 h•S'o *iayEC POST 114 A CONSPICUOUS PLACE fAIRSDEPART"'T Off' THE TREAsmy ETrEF2NAL RIETENUE SERV?CE CINCINNATI OH 45999-0023 KAREN DAWN CORN= SPERBER MUSIC 2025 COBBLESTONE CTR ATE ATLANTA, GA 30315 Date of this notice. 02-25-2011 Employer Identification Number_ 27-5149458 Porn: SS -4 Number of this notice: CP 575 G For assistance you may call us at, - 1 -800 -B29 -4933 t:1-800-829-4.933 IF YOU WRITE, ATTACH. THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN Z�i LQYEER IDEl3TIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN]. we assigned you EIN 27-5149458. This EIN will identify you, your business accounts, tax returns, and documents, even it you have no erVloyees. Please keep this notice in your permanent records. when filing tax documents, payments, and related correspondence, it is very important that you use your SIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one EIR. If the informi5tion is not correct as shown above, please make the correction using the attached tear off stub and return it to us. A limited liability company (LLC) may file Form 8832, Entity ClassifiCativn Election, and elect to be classified as an association taxable as a corporation_ If the LLC is eligible to be treated as a corporation that meets certain tests and it will be electing S corporaLloxa status, it must timely file VQrm 2553, Election by a Sabxll Bus-b2e0s Corporation. The IZ C will be treated as a corporation as of the effective date of the 5 corporation election and does not reed to file Form 8832. To obtain tax forms and publications, including those referenced in this notice, visit our Web site at www.irs.gov. If you do not have access to the Internet, call 1.800-829-3675 (TTY/TDD 1-800-829-4459) or visit your local IRS office. * Keep a copy of this notice in your permanent records. This notice is issued only one time and the IRS will not be able to generate a duplicate copy for you. * Use this EIN and your name exactly as they appear at the 'top of this notice on all your federal tax forms. * Refer to this EIN on your tax -related correspondence and documents. If you have questions about your EEN, you can call us at the phone number or write to us at the address shown at the top of this notice. If you write, please tear off the stub at the bottom of this notice and send it along with your letter. If you do not need to write us, do not complete and return the stub. Thank you for your cooperation. (TRS USE ONLY) 575G 02-25-2011 CORN C 9999999999 SS -4 Y,eep this part for your records. CP 575 G (Rev. 7-2007) Return this part with any correspondence so we may identify your account. Please correct any errors in your name or address. CP 575 G 9999999999 Your Telephone Number Best Time to Call DATE OF THIS NOTICE: 02-25-2011 ( } _ RMPT-OYRIR IDENTIFICATION NU4EMZ! 27-S149458 FORMt SS -4 NOBO-7 INTERNAL REVE2YUE SERVI CE F 20 M DAWN CQP,NBLL CINCINNATI OH 45999-0023 SPERBER MUSIC III11.111. Fit l,LIII IJI19.l31111111111At11 2025 COB=STON-E CIu NE ATL -A=A, GA 303-19 City of Milton 13000 Deerfield Parkway Suite 107C Milton, Georgia 30004 To: Honorable Mayor and City Council Members From: John Rebar, Parks and Recreation Director Submission Date: April 25, 2012 Meeting Date: May 7, 2012 Agenda Item: Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Eric Snow Sports Background: The Parks and Recreation Department is eager to continue offering programs and additional services to the citizens of Milton. Many of these programs may be offered by outside providers through an agreement with the City of Milton based on a submitted program proposal rather than offering these programs through a paid independent contractor or a paid employee of the City. Discussion: The Parks and Recreation Department recommends entering into agreement with Eric Snow Sports to provide basketball camp for our residents and visitors. A commission of 30% of all registration fees will be paid to the City of Milton two weeks following the end of registration. Non-resident fees will be collected by the provider and paid to the City at a rate of 50% more. Legal Review: Contract Template - Paul Higbee, Jarrard & Davis on February 23, 2012 Attachments: A Parks and Recreation Department Agreement between the City of Milton and Eric Snow Sports. CITY OF MILTON PARKS & RECREATION DEPARTMENT AGREEMENT FOR OUTSIDE PROVIDERS THIS IS AN AGREEMENT, made this day of , 2012, between: THE CITY OF MILTON, a inunicipal corporation organized and opeYating under the lar, s of the State of Georgia, with a business address of 13000 Deerfield Parkway, Suite 107 A, MIfJON, Georgia 30004, hereinafter referred to as the "CITY." and ERIC SNOW SPORTS hereinafter referred to as "PROVIDER". CITY and PROVID1 R may hereinafter collectively be referred to as 'the Parties". In consideration of the mcitual obligations of the Parties and for gond and valuable consideration, the adequacy and receipt of which are hereby acknowledged, the Parties agree as follows: ! WFICLE 1.11 PROVIDER's Services and Responsibilities 1.1 PIZOVII)E'R shall conduct services generally described as Basketball Sarni,1xcr Camp at the following location: Northwestern Middle School, 12805 Birmingham I lwy, Milto_i CiA 30004. 1.2 The PROVIDER's services shall be performed during- the clays and hours described in Exhibit "A," attached hereto and incorporated herein by reference_ 1.3 The PROVIDER and The Director of the Parks & Recreation Department or his designee, hereinafter refect red to as the "DEPARTMENU', will agree upon prugratn schedules. PROVIDER agrees to submit a Program Request Furor to die Coordinator for eacla prograni being proposed eight (8) weeks prior to the beginning of each session. 1.4 The fees charged to each participant ;will be as described in Exhibit "A" for residrnts of MILTON and a surcharge of 50-%- snare for noti-residents of MILTON_ The entire balance of this surcharge for tion-r4sidents shall be Mid to the CITY_ 1.5 The PROVIDER marrmits to CITY that it is not insolvent, it is not in bankruptcy pro eedings or receivership, nor is it engaged in or t veatened with any litigation or other legal or administrative proceedings or investigations of any kind which would have an adverse effect on its ability to perforin its obligation, under this Agreement. 1.6 The PROVIDER a-rees that it shall be stalely responsible for all costs tndA)r expenses associated with, or as a result of its operation under this Agreement. The PROVIDER stipulates and cert:fzes that it is qualified to provide the prod;=rams it is hired to provide, inaititains the education and required licenses or perinits neecssary to provide the programs, ar d shall continue to maintain such licenses or permits during the term of tais Agreement. U 1.7 This Agreement is considered a non-exclusive Agreement bcMven the Parties. The CITY shall have the right to purchase the same kind of services to be prov;ded by the PROVIDER from other sources during the terra of this Agreement. The PROVIDER is riot precluded from providing the same or similar services for other parties so long as such other engagements do not interfere with the PROVIDER'S provision of services to the CITY. 1.8 The DEPARTMEW must approve any promotional material, flyers, and porters advertising the programs prior to its release. The following content arra topics shall specr_'fcally fie proloibited: sexually e-rplicitmaterials, profanity, ch ild p orn og raphy, alcoholic beverages, tobacco products, adult movies, adult boowvideo stores, adult entertainment establishmeats, massage parlors, pawn strops, and tattoo parlors or shops 1.9 The PROVIDER. shall not promote any privately owned business in a CITY park/facility or solicit any participant in a CITY park/facility activity for any privately owned h►isine5s. The PROVTDFR may not n_ce said Facilities to conduct personal hu;iness inclu6ing workshops, clinics, seminars, camps, or any other activities that are outside the scope of service described in (Exhibit "A"). It is further understood that such action(s) may result in immediate termination of the Agreement and the forfeiture of all compensation due to the PROVIDER. 1.10 The PROVIDER shall abide by tha policies, procedures, rules and regulations of the DEEPARTMENT, the CITY, and the FULTON COUNTY BOARD OF EDUCATION as promulgated from time to time. PROVIDF_R understands_ and agrees that the DEPARTA[ENTshallhave Cirst vrioritE or use of CITY facilities, notwithylanding an other provisions rr f thi► Agreement 1.11 All assistants. substitutes, and subcontractors utilized by the PROVIDER must have prior written approval of the DEPARTMENT. €.12 PROVIDER shall provide necessary supervisory personnel to ensure that the participants of the programs obey all applicable polities, procedures, Rules and Regulations. 1.1') The DEPARTMENT or CITY may require that the PROVIDER not be permitted to utilize specific assistants, substitutes. or subcontractors of PROVIDER who have failed to follow any policies, procedures, ;ales or regulations applicable .o the use of the facility. 1.14 Although the CITY shall not control the PROVIDER'S .echniques, methods, procedures, or sequence of instruction; the PROVIDER will comply with the CITY's and DEPARTMENT's policies, rules, regulations and procedures: as well as those of the FULTON COUNTY BOARD OF EDUCATION, and shall not interfere with their 2 UperatiO11, iwr li:zn.1i csr da2riagU Clic equipnnent Or facilities of vrded to PROVIDER fur his/her programs, nor otherwise disrupt the other on-site activities being offered at such public facilities. 1.13 The PROVIDER also acknowledges that he or she is primarily responsible for the conduct of the participants in all programs under the PROVIDER -s charge. 1.16 If the PROVIDER will be providing services directly with minor children without parental supervision, th-. PROVIDER shall, prior to commencing services under this Agreement, comply with the CITY's policy regarding criminal background screening. The CITY will furnish the PROVIDER with a background re ease fonn (Exhibit "B") for all the provider's counselDrs, coaches, volunteers, subcontractors, ernplcyees or any other individuals that will come in contact with a child, at the PROVIDER's sole expense. A Consen_ and Release Form to conduct a criminal background must be executed by any of PROVIDER's employees or any individual who will come in contact with a child at the CITY thruLgh PROVIDER or at PROVIDER's direction, such form authorizing the CITY to conduct a search of each such individual's criminal background. The result of such inquiry may be deemed acceptable by the CITY in its sole and complete discretion, and the CITY may reject any individual from participating in any program haled upon such results_ ftho PROVIDER hav recently had a background screening conducted by another agency, the CITY, at its sale discretion may accept that background screening and waive the requirement of a new background screening. PROVIDER and its employees must also execute a Waiver and Release of Liability holding the CITY and FULTON COUNTY HOARD OF EDUCATION harmless. 1.17 The CITY shall require all participants in all programs to sign a Waiver and Release of Liability. ARTICLE 2.0 Equipment & Materials 2.1 All program materials and equipment needed or pertaining to the above stated programs will be provided by the PROVIDER at his/her own cost and expense. However, PROVIDER may require participants to obtain certain materials req' -fired in the programs by providing a list of such materials (with approximate casts) to the participants. If PROVIDER makes such materials available to participants, they must be sold at PROVIDER's cost. All equipment provided by the PROVIDER shall be used in strict accordance with equipment manufacturer's instructions and in accordance with all applicable laws. PROVIDER shall coordinate storage of goal posts with the principal of the school located at the facility. 2.2 The sale of merchandise is restricted to those materials utilized in and for the programs. Fundraising activities conducted by the PROVIDER will not be permitted. The PROVIDER shall obtain the CITY's approval Df any merchandise to be solei prier to its distribution or sale. 3 2 . 3 The CITY will provide no storage spate to the PROVIDER, unless otherwise mutually agreed upon in a separate ,.vrritten agreement. _'. Am' supplies or ecluipinc��t Icn at tkie facility will he the responsibility of the PROV1DElt. Bete C1fY will not be responsible for any lost, stolen, or broken equipment or supplies. 2.5 The PROVIDER shall inspect the premises and equipment offered to hint/her for his/her proposed activity and if he or she finds anything wrong with the premises or equipment before each program commences that cannot be corrected immediately by the I]EPARTTENT, the program shall be canceled and the ma to reported to the DEPARTMENT for correction. If the PROVIDER elects to hold His/her programs in the facility provided, it will be presumed that the PROVIDER has inspected the premises and facilities and equipment provided for such programs and has accepted same as being sale and suitable for the use intended. ARTICLE 3.0 Program Size Minimums - 3.1 ACTIVE: Program sizes shall meet the minimum numbers of participants for each program m designated in Exhibit "A." ARTICLE 4.0 Compensation and Method of Pavrrrent 4.1 In consideration of the releases and indemnities contained herein and of the PROVIDER'S services in Connection with the programs and activities described lxereir., the CITY shall be entitled to 30% of the registration lees paid by all program participants to the PROVIDER, and the PROVIDER shall be entitled to 70% of such fees paid, exclusive of the 50% non-resident surcharge. The 50% non-resident surcharge is fully payable to the CITY and shall not be included in PROVIDER's gross income ealculatiol.. PROVIDER shall be entitled to retain all non-re�clistration fees paid by participants to PROVIDER. i.e. PROVIDER membership lees and costs for uniforms and pictures to participants. 4.2 The PROVIDER agrees to collect all fees fiotn participants, and the PROVIDER Agrees to provide CI'T'Y with schedules of fees to be charged to participants in conformance with Exhibit "A". It is agreed that the PROVIDER's sole obligation shall be to collect the fees froth the participants and to rernit the 30% of the fees collected as -a-ell as all 50% non-resident surcharge amounts, to the CITY with a pay -out report of all :ponies collected_ Payment will be made to the CITY vv'l:hin fourteen (14) business days of the end of each month cr session or prow,,_ hichnver occurs first_ 4 4.3 It is the responsibility of the PROVIDER to pay all applicable local, state, and federal taxcs associated with this Agreement, and to acquire and pay for a1; necessary permits, licenses, and insurance required for the execution of this Agreement. AR-11CLE 5.0 Independent PROVIDER 5.1 This Agreement does not create an employee/employer relationship between the Parties. It is the intent of the Parties that the PROVIDER is an independent contractor under this Agreement and not a CITY employee for all purposes, including but not limited to, the application of the Fair Labor Standards Act minimum wage and overtime payments, Federal lnsuaraice Contribution Act, the Social Security Act, the Federal Unemployment 'fax Act, the provisions of the Internal Revenue Code, The State Workers Compensation Act, and the State unemployment insurance law_ The PROVIDER shall retain sole and absolute discretion in the judgment of the manner and means of carrying out PROVIDEWs activities and responsibilities hereunder. The PROVIDER agrees that it is a separate and indepeade.nt enterprise from the CITY, that it had full opportunity to find other business, that it has made its own investment in its hz.zsiness, and that it will 11tili7e a high level of skill necessary to perforin the work required 1 ereunder. This Agreement shall not lbe construed as creating any joint employment relationship between the PROVIDER and the CITY and the CITY will not be liable for any obligation incurred by PROVIDER, including but not limited to unpaid minimum wages or overtime premiums. 5.2 PROVIDER wurrants that it has not employed or retained any company or person, other titan a bona fide employee working solely for the PROVIDER to solicit or secure this Agreement, and that it has not paid or agreed to pay any person, company, corporation, individual or firm any fee, commission, percentage, gift, ur other consideration coilthigent upon or resulting froze the award or making of this Agreement. For the breach or violation of this provision, the CITY shall have the right to terminate the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover tate full amount of such fee, commission, percentage, gift or consideration. ARTICLE 6.0 Insurance 6.1 PROVIDER shall not provide any service until all insurance recuired under this paragraph has been obtained and approved by the CITY. 6.2 Certificates of Insurance. Certificates of Insurance reflecting evidence of the required insurance stall be fled. 'With the CITY prior to the commencement of this Agreement_ These Certificates shall contain a provision that coverages afforded under these policies will not be cancelled until at least forty-five days (45) prior written notice has been given to the CITY. Policies shall be issued by companies authorized to do business under 61 the laws of the State of Georgia. Financial Ratings must be not less than "A -VI" in the latest edition of " Best Key Rating Guide", published by A�--,\ . Best Guide. 6.3 Insurance shall be in force until the obligations required to be fulfilled under the terms of the Agreement are satisfied. In the event the insurance certificate provided indicated that the insurance shall terminate and lapse during; the period of this Agreement, then in that event, the PROVIDER shall ftunish, at least thirty (30) days prior to the expiration of the date of such insurance, a renewed Certificate of Irsurance as proof that equal and tike coverage for the balance of the period of the Agreement and extension thereunder is in effect_ The PROVIDER shall not provide any service pursuant to this Agreement unless all required insurance remains in full force and effect. 6.4 Commercial General Liability insurance to cover liability bodily injury and property damage. Exposures to be cowered are: premises, operations, products/completed operations, and certain contracts. Coverage must be written on an occurrence basis, with the following; limits of liability $1,000,004 Combined Single Unit — each occurrence $2,000,000 Combined Single I-nit—general aggregate $1,000,000 Personal Injury $1,000,000 ProducLs/Completed Operatinn., Aggregate PROVIDER shall have its insurer name the City of MILTON as an additional insured on its General Liability policy. 6_5 Worker's Compensation insurance shall be mai:-itained during the life of this Agreement to comply with the statutory limits for all employees, and in the case any work is sublet, the PROVIDER shall require the subcontractor(s) similarly provide Workers Compensation Insurance for all the latter's employees unless and until such employees are cowered by the protection afforded by the PROVIDER. The PROVIDER and his subcontractors shall maintain during the life of this Agreement Employers Liability Insurance. The following limits must be maintained: A. Workers Compensation Statutory B. Employer's Liability $100,000 each accident $5,00,000 Disease -policy limit $100,000 D isease-each employee If PROVIDER or its subcontractor claims to be exempt from this requirement, PROVIDFR shall provide CITY proof of such exemption along with a written request for CITY to exempt PROVIDEER, wrincrt on PROVIDER or subcontractor's letteriead_ 6.6 PROVIDER shall also maintain Auto Liability and Directors and Officers insurance with limits reasonably acceptable to Cl'I'Y during the term of this Agreement_ 6.7 The CITY and the Fulton County Board of Education shall each be named as an additional insured and loss payee on all policies required by this Agreement. ARTICLE 7.4 Term and Termination 7.1 After a two (2) month trial period, .he programs rill be evaluated by the DEPARTMENT. and the remainder of this Agreement will either be terminated or continue in full farce and effect. If at any time after the two (2) month evaluation, program enrollment should fall below the required minimum, the PROVIDER will be allotted four (4) weeks to bring enrollment up to the required minimum. The programs will be reevaluated and execution or termination of the contract will be determined by the DEPARTMENT. 7.2 The term of this Agreement shall commence upon the date of execution hereof and shalt remain in effect for a period of one (1) year from the date of execution of this AgreeEnent by the CITY, unless terminated sooner as provided in this Article. Renewal of this Agreement beyond the one (1) year term shall require the mutual written agreement of the CITY and PROVIDER. 7.3 This Agreement may be terminated by the CITY for convenience upon giving o at least thirty (30) days prior written notice of termination to the PROVIDER at the PROVIDER's address set forth herein at the sole and exclusive discretion of the CITY. This Agreement may be terminated by the City immediately by written notice to PROVIDER upon any willful, reckless, or grossly negligent act or oraission by PROVIDER or any of its officers, agents, employees, or volunteers. 7.4 This Agreement may be tcrminatcd by PROVIDER upon giving at least thirty (30) days written notice of tern- ination to the CITY. ".5 PROVIDER must notify the DEPARTMENT in writing; of any program cancellations at least ien (10) business days prier to the scheduled cancellation. 7.6 CITY reserves the right to cancel or reschedule :any of the PROVIDER's programs, in the case of scheduling conflicts or other emergencies, as determined by the DEPARTMENT. ARTICLE 8.0 Indemnification 8.1 PROVIDER agrees to indemnify and hold harmless the CITY and the FULTON COUNTY BOARD OF EDUCATION, their trustees, elected and appointed of leers, agents, servants and employees, from and against any and all claims, demands, or causes of action of whatsoever kind of nature, and the resulting losses, costs, expenses, reasonable attorneys' fees, including paralegal fees, liabilities, damages, orders, judgments, or decrees, sustained by the CITY, the FU7LTON COUNTY BOARD OF EDUCATION, or any third parry arising out of, or by reason of, or resulting from the will full or negligent acts, errors, or omissions of the PROVIDER or its agents, officers, volunteers or employees. 7 8.2 The Parties understand and agree that the covenants and representations relating to this indemnification provision shall survive the ternr of this Agreement and continue in full force and effect as to the PROVIDE -R's responsibility to indemnity. ARTICLE 9.4 Americans With Disabilities Act 9.1 PROVIDER shall not discriminate against any person in its operation and activities ir its use or expenditure of the funds or any portion of the funds provided by this Aeteement and shall affirmatively comply with all applicable provisions of the Americans With Disabilities Act ("ADA"), in the programs while providing any services funded in whole or in part by the CITY, including Titles I and 11 of the ADA and all applicable regulations, guidelines, and standards. 9.2 PROVIDER's decisions regarding the delivery of services under this Agreement shall be made without regard to or consideration of race, age, religion, color, gender, sexual orientation, national oritsin, marital status, physical or mental disability, political affittiation, or any other factor which cannot be lawfully or appropriately used as a basis fur detivery of service. ARTICLE 1.0.8 Miscellaneous 10.1 No modification, ainendmcnt, or alteration of the terms and conditions contained shall be effective unless contained in a written document executed with the same formality aad equal dignity herewith. 10.2 This Agreement is non -transferable car assignable, and PROVIDER agrees not to transfer or assign the performance of services called For in the Agreement. 10.3 This Agreement sets forth the full and complete understanding of the Parties as of the effective date, and supersedes any rnd all negotiations, agreements, and representations made or dated prior to this Agreement. 10.4 The PROVIDER shall pay reasonable attorney's fees to the City should the Cit} be required to incur attorney's fees in enforcing the provisions of this Agreement. 10.5 Time is of the essence of this Agreement. 10.6 Each of the individuals who executes this Agreement agrees and represents that he is authori7cd to execute this Agreement on behalf of the respective entity. Accordingly, the City. and PROVIDER both waive and release any right to contest the enforceability of this Agreemen: based upon the execution andor approval thereof : E:l 10.7 It is Lite policy of City that unauthorized aliens shall not be employed to perform work on City contracts involving the physical performance of services. Therefore. the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the PROVIDER shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and "D" that it and its subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perform work on the City contract to ensure that no unauthorized aliens will be employed. The City Manager or his/her designee shall be authorized to conduct an inspection o: the PROVIDER's and its subcontractors' verification process to determine that the verification was correct and complete. The PROVIDER and its subcontractors shall retain all documents and records of its verification process for a period of three (3) years following Completion of the contract. This requirement shall apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. Compliance with the requirements of O.C.G.A_ § 13-10-91 and Rule 300-10-1-.02 is mandatory. PROVIDER's compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300- 10-1-.x2 shall be attested by the execution of the contractor's affidavit attached as Exhibit Pursuant to O.C.G.A. § 50-36-1, the City must obtair: a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the C-)untiy each time that Contractor obtains a public benefit, including any contract, from the City_ Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit to be sworn under oath under criminal pciialty of false swearing pursuant to O.C.G.A. § 16-10-71), a form of which is attached hereto as Exhibit "F", and submitted such aflidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically (in compliance with the Uniform Electronic ransactions Act). Contractor verifies :hat it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Cieorgia Security and Immigration Compliance Act (O.C.G.A. § 50-36-1). 9 IN WITNESS OF THE FORIEGOING, die Parties have set their hwidl ; mid seal the day and year first written above. CITY: ATTEST. BY: SUDIE GORDON, CITE` CLERK JOE LOCKWOOD, MAYOR PROVIDER- WITNESS - BY: ERIC SNOW, PRESIDENT - --- --- --- [AFFIX CORPORATE SEAL] 10 EXHIBIT `.A" PROGRAM REQUEST FORM Individuals interested tit proposing their programs and services must complete and return t171s form attached to the Letter of Interest. This information will be used for consideration of program proposals.Use_one form per pracLram. Name of Program: Eric Snow Sports Partic:ipanl Ages: So sand Girls 7-14 Day/s of the week program is offered: Monday through Friday Time of Program: 9.00 am to 2:30 pm Program Dates: to Program Fee: $200 early registration/$225 Walk Ups Program Enrollment: Minim.►m 40 Maximum 80 Materials to be sipplied by participa-sts: Participants must wear comfortable shorts, shoes, and shirt. Bring a snack and lunch daily, along with a positive attitude and a SMILE! Materials to be supplied by PROVIDER: Basketball Training, Sports Authorit Discount coupons Powerade promotional items and more. Concessions will be available cif allowed by School) Materials to be supplied by the City of MILTON - Additional Program Requirements: EXHIBIT "C" STATE OF GEORGIA CITY OF MILTON CONTRACTOR AFFIDAVITA NI) AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractors) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor AtUdavit provided in Rule 300 -10 -01 -.OR in the town attached hereto as Exhibit "D_" Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perform such service. EEV 1 Basic Pilot Program User Identification Number WLZ L (9 Z�2 BY: Authorized OfficerkLA6etit Bate Eric Snow Sports Title of Authorized Officer or Agent of Contractor Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE DAY OF _i -1Z_ ��. 201 chary Public My C'cir mk%ion Expires_ �P� ,TT!`��•f,,, Wo. Lam-( 12 STATE OF GEORGIA CITY OF MILTON EXHIBIT "D" SUBC ONTRACI'OR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with Eric Snow Sports on behalf of the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. EEV 1 Basic Pilot Program User Identification Number BY: Authorized Oftteer or Agent Date [INSFRT ST JRC'CINTRACTOR NAME] "Title of Authorized Officer or Agent of Subcontractor K.{ (�' 6 t" Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN rBIs yEFOR , Mi: ON TI TI I ,/_- DAY 4FWg JZ- 1201.-P— I, Notary 2Q1.-P— Notary Public My Commission Expires: 13 EXHIBIT "E" SAVE Affidavit By executing this affidavit under oath, and as an applicant fur a pudic benefit, as referemmd in O.C.G.A. § 50-36-1, from the City of Milton, the undersigned applicant verifies one of the following with respect to my application for a public benefit: I ) I am a United States citizen. 2) I am a legaI permanent resident of the I Inited States. 3) 1 am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an a:ien number issued by the Department of Ilonietand Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verities that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C,G.A. § 50-36-t(ex1), with this affidavit. The secure and verifiable document provided with this affidavit can best be classified as: In making the above representation under oath, i understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C_G_A_ § 16-10-20, and face criminal penalties as allowed by such criminal statute_ Executed in (city), (state). a _ Signature °of Applicant Printed Name ofAppl:cant SUBSCRIBED AND SWORN BEFORE ME ON THIS THE '`„�~a,uusnun,r�n��i ,2S DAY OF �� 24!-.��``' p.N .............. /V;''Frr. ,� J WIRES OTARY PUBLIC AprilS{� Of9A My Commission E:Rires.,o og �.T .• 14 Control No. 08013747 STATE OF GEORGIA Secretary of State Corporations Division 315 West Tower 92 Martin Luther King, Jr. Dr. Atlanta, Georgia 30334-1530 CERTIFICATE OF ORGANIZATION 1, Karen C Handel, tate Secretai-v of State and the Corporations Cornmissioner of zhc State of Georgia, hereby certify under the seal of my mice that .ERIC SNOW ENTERPRISES, LLC a Domestic Limited Liability Company has been duly organized under the lawi of the State of Georgia on OM.512009 by the filing of articles of organization in the Office of the Secretary of State and by the paying of fees as provided by Title 14 of the Official Code of Georgia Annotated_ WITNESS my 1 --and and official seal in the City of Atlanta and the State of Georgia on February 25, 2009 4 Karen C Handel 'SccretatA- of Stab Control No: 00013747 Date Filed: 11112512M 111:06 AM }farm C Handel Secretary of State Februan, 2009 ARFICLES OF ORG-AN17-kTION FOR GEORGIA LIMFrED LIABILITY COMP NY The name of the Limited Liability Company is: Eric Snow Enterprises, LLC The principal mailing address of the Limited Liability Company is: 5665 Manta High -way; Suite 103-3701 A'phare`ta, GA 30JO4 The Registered Agent is: Valerie Sailun 1170 PLIEIL't TeU Sir eel NE , S.rite 1900 Atlanta, GA 30305 County: The name and address of each organizer(s� are: Alexis Summers 1170 Peachtree Street rdE Suite 1900 Atlanta, GA 30309 The optional provisions are: No optional Provisions - NT Wj7NT SS 1VH FRF0K the undersigned has executed these Articles ofOrganization ori --he data aet forth below. Signatures}: irate: Orwani7er, Alexis Summe-s I<cbrua}-,3, 2CA-0 A!20RD-, CERTIFICATE OF LIABILITY INSURANCE GAO DQzaI24��1at2012 Yy [HIS CLR11FICA-tE IS MUhi] AS A MATTER OF iNFUKMA ZION ONLY ANL} GONi•tHS NO RIUHTS !)PUN 1 Hh Cl=ttl IFLGAI E HOLDEN. I HILI' CFRTIFiCATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTFND CR ALTFR THI= (-OVFRAGF AFFORAFn RY THF Poi.iCIF$ m C]Ld_ THIS CERTIFICATE OF INSURANCE DOES NCT CONSTITUTE A CONTRACT BET'JVEEN THE ISSUING INSUREMR(Sf, AUTHORt7&D REPRESEN I A-1 IVE OR PROIJUCER, AND rHE GER I lir ICA tE HOLUhR. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policytiosj must be ondomed. If SUBROGATION IS WAIVED, subjoctto the terms and conditions of the policy, certain policies may require an endorsement. A Statement o" this certificate does not confer rights to the certificate holder in lieu of such andarsemont s . PRODUCER CONTACT N"r- Caroline Floret _ PHONE:(A1C, No -Ext): 8OD-955-1991 FAx (Arc. No)- 913-.32?..3201 Summit America EMAIL AOOMS= roram samm:america-ins.com 7400 CDIIege Blvd. Ste 100 Overland nark Kan�a3 66210 PRODUCER CUSTOMER IDO: INSURER(SIAIPPORDINGnOtEFtA"E WSURED Erie Snow Elterprisas INSURER A: AatianwMie tslutual Insurance Company 3787 DBA: Ga. Spartans - Eric Srimm Spa -is iNSDRE313: rlesDRE� c: 12463 Crabapple Road. #337 Alpharetta, GA 34004 A Member of the 3ports, LeisuT� & Er:tertainment RPG INSURER C: rnvreAr_ce r'CATwy-A.TF k5jidIRFR- bYLmni7A74R REVISION NUMBER: I HIS IS TO CERTIFY THAT THE POLI ;IES OF iNSURANCE LISTED B-LIDNV HAVE BEEN ISSUED TOTHE iNSUkEC NAMED ABOVE `rOK THE POLICY PEREOr3 INMCAI ED. NO 1110 TT ISIANDING ANY hLQUIKEW-N I, 1 WRRi UH CON UII IUN U- ANY GUN I KPG t UR r31HL.R L)C)CUM N 1 WETH RESECT .{_J VVHICA THIS CERTIF CATE MAY 6E ISSUED OR WAY PERTAIN, THE INSURANCE AFFOFDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UNITS SHOWN MAY HAVE BEEN REDUCED BY PAIL; CLAIMS. INSR LTR TYPE OF INSURANCE APDL INSR SUPIR Y4VO POLICY liLUA6ER POLr+'Y EFF IAMN POLICY SHA 0 UNITS A GENE_HAL LIABIL11Y ^ _ __ 613RPG000000499:20U 02110/2612 02117/2013 ;-Ar;H 6;;CUHi{ENCc S-1,030,00 X CCSIMERCIhI C3Eh,:ZRI LIAHi41-1 2' 18 PM EDT 12'01 AM ]Ap1J C� TO RErtTED 5370,00 D3£IJISE.S Fa ixcurren- 7AcR Exp (Any ono pamwe $5.000 C: e,I.S15-4R0E x 10CCU:� ,IERSOti AL d ACV INJURY $1,000,3 i W --NERAL AGGREGATE $3,Dg0,4 f—EN'- P.CY�REGATE LIMIT Ar'r-LI=S PER YHC .-' I--GUPIrgUtl AUIJ $1,000,00C I PRf)FE3SI0NALVABILITY $1,U0D, �P3LrCY �r'FiOJEvT LCC LE OAf. -IAS TO t�AR7ICII'ANTB $1-OUO,OD A Al1TOa1081LE LIABILETY 613R'GCj0000D4992200 02110f2012 2:18 PM EDT 0211 D12013 12:01 AM 04 1N :1+S1"4 L L! .11 $1.333.33 BbP I LY INJURY ' Per oersx� ANY ALTO BODILY INJURY :Pei j=dar:l; tlLL'J:AVL sUT0S i SCFEDL'«ED XJTOS li PKOPER TY DJ4.iA Gt- (Pa- aeadanil _ ..-. - . X -1IRWAUTQ'- X NDN-C'.A'NECAIJTCS �( lint rr:ni d=d xN I Htr t, UMBRELLA UAB[�OOCLR EACH OCCURRENCE AGGREGA'E EXCESS LIAR :;:AIMS -WADE 0-;;JCTIBLE f E—ENTION WORKERS COMPENSATIOU AND EMPLOYERS' LIA6LJti %4.f A tiAC SFATU- ITORv UW.IT5 =SEA=HACCOENT ANYPROPRIE:T0;SHI:'iP-=:',1?1ERI EXE CLI I PIE OFF ICER"1 EPAE ER c7CCLS1D:Ct-' c'. L. R!.'. =ASE - LA r"1sSPF W E.L. DTS=ASE- POLICY L W INandatoT In KH1 If yes, doscinbe under DESCRIPTION OF OVERA71ONS beler A M=-DICALPAYVERTS =OR PART-C1;2nNTS 68RPG0000004992200 0211MM 02110=13 : ! EJMA3ty fFEU R -XCESS 11E 7CRL 5100. 2:18 Phi EDD 12-D1 AM DESCRIP ION OF OPERATIONS t L0CA71DNS t VENN LES (711ach ACORD 101. Addaiou�al Remam* Scfiedjle, to more apace is requrredi Sport(s): Rasketba!1 Agots): 12 and under. 13-15 The certificate holder is added as an additional insured. but onl with res ect to the iatAty arising aut of the operations of t1C insured named above. r'_FRTIFICATF HOLLER CANCELLATION r ION f lopewell Kddle School SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Or CANCELLCD 13CfOnC 130-'G Cngt:um Road THE EXPIRATION DATE THEREOF, NOTICE INiLL BE DELIVERED IN ph recta GA Al3ipharetta. GA 38494 0reniisesj ACCORDANCE WITH -HE POLICY PROVISIONS. AUTHDRIZED REP RES ENTA-nVE o�`✓t �A of Coverage is cnly extended to U.S. events and aativlhcs. " NO -ICF- TO TEXAS INSL REDS: The Insurer for the purchasing group may not be sTAiiect to all the insurance !avis and regulations of the State of Texas ACORD 25 (20091#91 The ACORD name and logo are registered marks of ACORD 0 1988-2009 ACORD CORPORATION. All rights reserved. A dRD->:�. CERTIFICATE OF LIABILITY INSURANCE QATE 104124?(Mht?ODi2 � THIS CERTIFICATE IS ISSUED AS A NATTER 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 EY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BFIWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERT1 KATE HOLLER. IMPORTANT: if the certificate holder is an ADDITIONAL. INSURED, the policy(ies) must be erdorsed_ If SUBROGATION IS WAIVED. subject to the terms and conditions of the policy, certain policies may "pulse an endorsement. A stater3ent on this cortificate does not confer rights to the cerLifil:ate huller in lieu of such endorsements . PRODUCER Summit America 14UUGotlege Ova. Ste 1UU CSverland Park Kansas 66210 CONTACT NAME CaraliW Flor@7 V PHONE:(AiC, W. EMM. 81OQ-9535-1991 AX: (AIG, No). 913.327-0201 P-MAILVDoPIESS; rams summitamerica-ins.com PRooLrcEa cusroM�n I3 x: � INSURED Eric Snow Enterprises DBA Go. Spartans, Eric Snow Sports 12480 Crabapple Read, #337 Alpharetta. GA 30004 A Member of the Sports, Leisure & Entertainment RPG INSURER 5 AFFORDINGCOVERAGE NAIG INSURERA: NationW-de Ivtutsal Insufance Gam an 3737 INSURER B: -~ INSURER C: I -'- INSURER 0 - COVERAGES CERTIFICATE NUMBER: W40176742 REVISION NUMBER: THIS tS TO CERTIFY THAT THE POLICIES OF INSUR-.vcE LISTED BELO%&) FAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR I IiE POLICY PERIOD INDICA I'Eu NOT%,MT11STAN DIN ANY RL'RJIrtEMF,NT, TERM OR CONDTION OF ANY CONTRPCT OR OTHER DOC UrJCNT WTH RESPLCT TO Wv itClI TI IIS CLRTI FICATE MAY L3C ISSU=D OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCFIeED HSREIK IS SUBJECT TO ALL THE TERMS- EXCtUSIONE ANO CONDITIONS OF SU[:H VULIU LS- LINT I,,SHU''"N MAY HAVE BEEN REDUCED BY PAID CL.A M5. INSR LTR TYPE OF INSURANCE .._._.._. Ao:)L INSR SURR ff WVQ I POLICY NUMBER. �- POLICY EFF -- �� � POLICY EXP "541. KNW UNITS A GENERAL LIAEPILI-Y 5BI. PGOODO004992200 02/10/2012 0?11012D13 `ACHOCCJRRENCE 31.004,4 X C -At: PPCIAI CZNFRAl I IARH 7N 2:18 PM EDT 12 01 AM ,ryy&1,kCE TO RENT_? S330.0 "EM15E.S CER ocMiTemw CLIIAS-!AAV,FTIOc 'JR V.EDEXP {A-tiyrilePerson) S5,000 PERSOVAL&ADVINwRY S1,C}Qf1.L}40 UEN--RAL A(4G$ GATE S3,004.00 .:E=1v'L AGC;H=GATE LJ MIT All F"IJ E$ PSR: PRODL-::TS COMP1oP AIG S1,O00,4D ntROJ2C7 n ac PROF tSSIGNA'-LIAa'L:TT' 51,004.00 Prlo:acY I LEGAL L'Aa T o aIART iCHIANTS S 1.000.0a A AUTOMORILE. LIABILITY 5BRPGO00000499220L) 02J1.0/2012 2:18 'M EUI 0211012013 12:01 AM G.^.0.1HI>3EU SIN ;Lt LIAAI l 511000,00 a tante BODILY INJURY (Pe- pdrsm) ANY AUI 0 AL_ DvgNED AJTOS BODILY INJURY (For a:,;,derrty — SC iEdJLEG AlJT05 PROPERTY DAMAGE 7! E�dE:Y1 x HIRE' uAW.OS---- x NON,OWNCIDAUTOD' }( I Not prewkxod wtile n KnfaziH UMBRELLA LIAB -;LR F,CH OCCJRR=vCE IAGOREGATE EXCESS LIATi CLAVJd4 MADE HW j RFT=N71ON 00RKERS CON PEN SATIflF7 AND EMFLOYERa LiABUTY Y i N NIA tic 5TATLJ- CiHtft TA Y ! EAIIFT$ E L EACP. ACCIOENT ANY PROP R.F70FSHIRPARTNCRI � :.)(EG:J1WL: ffif ICE" EMBER E.L UISE SE—EAEWILOYEF :xC_U_ED7 1101rrsdrruy In NR) I yes, desmbn un d+r E.L. DIS EASE — POLICY E)M IT :]CSCR; F�-ION CP� OPERAI IONS lj q r 7M EDICAL PAY ME N7S FO3PAR7iC:Pt�1T5 6BRPGO00)00499220a 02110!2012 02110/2013 fIRWARY MECIC4L � 2.15 PM ED- 12:01 AM IEXCESS MEDICAL S100,000 uLSLi N Wk—(w UPLKAIPUNS' LtWA IWM YtM L 0111& 1RY 7 , Addnior.ai Remarks Sanem e, it mcm space as rlgtireo) Sport(s)i: Basketball Age[s:: 12 and tinder, 13-15 The certificate holder is ad3Ed as 3n additional irsured. bul only with res ect to the liabilifY aftiN 00 of the aperati:ns of the insured naned above. City of [Milton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE: 13000 Deerieid Parkway, Suite 107 THE EXPIRATION DATE THEREOF, NOTICE WILL BE OELNERED IN Milton. CSA 3GO04 ACCOaDANOE WITH TtIC POLICY rROVISIONS. [Ovjner,`Le53Or of Premises) AUTHORIZED REPRESENTATIVE Coverage is only extended to U.S. events and activities. - NOTICE TO TEXAS INSUREDS: The Insurer to- the purchasing group may not be sLbject M all the insurance taws and mquiations of the State of Texas ACORD 25 (2009109) The ACCRD name and logo a•c registered marks of ACORD 07 1998-2009 ACORD CORPORATION. All rights reserved. ��-'� CERTIFICATE CSF LIABILITY INSURANCE E❑1.7e12412012 ; a4rz41zaiz THIS CERTIFICAI E IS RSSULD AS A MATTER 01- INI'C]KMA110H ONLY AND UONI-iRS NO RIGH 1 S UPON f HE CERT1FICA I Iz HOLUER. I HIS CERnFICATF DOTS NEST AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE CnVFRAGE AFFORnEn BY THE POL40ES BELOW - THIS CERTIFICATE OF INSURANCE DOES NOT CCNSTITUTE A CONTRACT BETIMEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTA I1VE 09 PKQL)UCt=H, A14D THE t;h i IP -ICA TE HOLLIEK. IMPORTANT: if the certificate holder is an ADDITTOHAL INSURED, the policy(las) must bo endorsed. If SUBROGATtON IS WAIVED, subject to the tonne and conditipns of the policy, certain policies Inay require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsementis . PRODUCER Sum -nit America 7400 College 131vd. Ste 103 Overland Park Kansas 06210 CONTACT NAM' Caroline Florez _ PHONE: JAMNa. Exly. 800-455-18°1 f..,._ FAX: IAt6, Not: 9137j77-0201 ~'— E•MAILADDRE SS: r Tar rs�sumrrniameriCa-ins-p7m PRO13UvE11 CUSTOMER 10 R: INSURED Eric Snow Enterprises DBA: Ga, Spartans - Erle Snow Sports 12460 Crabapple Road. 31;.'+37 Alpharetta, GA 30004 A Memm!c of ti -,c Sports, Leisure S Entertainment RPS R f FOROING COV9PAQV NACl INSURER A: Nationwide h ubiai insurance Company 3787 - — - - -- INSURER S. INSURER C: NSUPER o: COVERAGES CERTIFICATE NUMBER: M0176744 REVISION NUMBER -- THIS ES TO CERIiFY THAT THE POLICIES OF tNSUWNCE LISTED 13E LOW KAVE BEEN ISSUED TO THE INSURED NAMED ABOVE OR- THE POLICY PERIOD INRICAT ED. NOTWITHSTANDING ANY REr1UIL?ELI LN I . ILRM UR CON Di I1UN UI- ANY CUN I RAC i OR U ItiLR 1)UC LIMEN I AqI H RLSPL(:I IU VC"IGH I HIS CER I IFICAIE MAY BE ISSUED OR MAY PERTAIN. -HE INSURANCE AFFORDED By THE POLiC1ES DES CRI&ED HEREIN 13 SUBJECT TO ALL THE TER 1013, E=LUSkONS AND CONDITIONS OF SUCH POLICIES. LWITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS NS LTR TYPE OF INSURANCE APDL ENSR SUkIR 1NVR - POLICY NUMBER .. __ POLICY EFF PQLICYGXP (MM -DDM Limns A GENERAL LIABILITY 6BfRPGOCK)0004992200 02/1012012 O211S)!2O19 rel:*I VL:{;:iHit�':L:E I I,CC+O,{H] }( COVM FRC%ALOEh�- RAL _IABI T' (:L,i:N5 kEA.^,E CiCCi3i 2:18 FIM EDT 12:]1 RM DAMAGE TO REYTED-._ PREgrSES E=; ecorrence' MED EX. (Arsy we pa sur) 55,OgD PER SCNAL 8 ADV sN,iJRY $1.t 130,1}0 I GENEFAF iGGPECw iE S3.CL1fl,k A? i,WLGA rE LLMIi APr-LIFS PER. =O:.CYPROJECT LCC �rt:JIJlIC I SL'c7LIFti7V r i;G S1,C00,0 PROFESSIONAL JAOILIFr $1,tii3i],UL] LEGAL LIAR T0'�f 4rIC1i�2, A RUTOMOBILE UAWLIYY 6BRPGOOOM04992200 02110n012 2:18 PM ED` 0211WO13 12.31 AM COMB14ED SINGLE LtM1 S1.CQ0,0G 'Ea Ar4den1 BODILY SNJURY (Fe, ANvN.j1O .L OW%FD AUTOS SODr LY :N3i1RY Y=er acc 5�ni1 SCwUI-YJLE0 AUTOS PRCrr --- RTY GAnAGE j; HIR; D AFJTC7$ X Nt)N 0%NNEDi UTC1S X YO: p•avidcd �ehilc in :;:..n:ai UMBRELLA LIAB &--CI R FAC:H OCCURRrNCE EXCESS LIAB CI A: AS54A--7.0 H i A[•[;RCGATE D�cuc7lB�e � Rf`T�Pf}Iox 'WORRERSCOMPENSAT 10.1 AND EMPLOYERS' LIABLITY Y.i N ANY "RCFRIET0R$#iIP1PA3TNM C XCCL ri WE OF FI CERN EM3EH N/f tnC57A:'U- a7:ICr TC1RY :.I'-LS17� E.L. EAr'ii c•`.r€:�ErSr _w..,W.. DISEASE - zA Er: PLD EE EH: LL ELV (Mandatory in NH) r` yes. descriae under :ES�-RIFTION OFDp^AAT ETES We1w I E.:. DISEASE -IOU Y U MIT A .dEL)ICAI- PAYMENTS FOR 'ARTiOPANTS 6EIRP(,`0000304992200 02?'U:2G12 02110/2013 PRWA�tr NIEDIG.J_ 2:18 Ph1 EDT 12-01 AM --xcESS M-7,CAI- $100,0 EKrFTIQN OF PERATIONSI LOCAT*I4$ i VE -i LE (dIIacb ACORD 101, Additional Remarks Schedule, if mare space is requindE Sport(s)- 82sketbail Aga(s): 12 2nd under, 13-15 The Certificate holder is added as an addtional insured. uut on with respect to the liabdily arisin out of 1he operations of the ensured named above. +n��.cwt..rt nvn Fultorl County Schools SHOU_D ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED t3EFORL 786 Cleveland Ave. 5W THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN Atlanta, GA 30315 ACCORDANCE WITH THE PCY-ICY PROVISIONS, (OI'll'iedLess0, of Premisest AUTHORVED REPRESENTATIVE Coverage is only extended to U.S. events and actruitles. 140T'ICE TO TEXAS KSURECSS: The insurer ferule pLrcha-.wg group may not he subject to all the ins-urarce laws and regulations of Ihr: State Of Texas ACORD 25 (2009109) Tae ACORD name and logo are registered marks of ACORD 01988-2009 ACORD CORPORATION. All rights reserved. A 0RQr- CERTIFICATE OF LIABILITY INSURANCE DA LtMK.2pll THIS CERTIFICATE IS ISSUED AS A }HATTER or INFORMATION ONLY AND CONrr-RS NO RIGIIT.S UPON TILE CERTIFICATE IIOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING iNSUIREIR(S), AUTHORIZED REPRESENTATIVE QR PRODUCER, AND THE CLRT171CATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. if SUBROGATION IS WAVED, subjectto the terms and conditions of the policy, certain policies may require an oroorsement. A statement on this certificate does not confer rights to the certificate hvider in lieu Of such EndUrSCITWIIt . PRnn.ICER :CONTACT NAME Caroline Florez Summit America jPHONE (A1C_ No Ext)= 500-955-1991 Ax: (AJC, No i- 913-327-0201 7400 C,pliege blvd_ *1e100 E-MAIL ADDRESS: pr rams summtamenca-ins.cxrn Over.a Tid Park Kansas 66210 PRODUCER CUSTOM CR Ip a, INSURED INS URER(S) A FFORDING COVERAGE I NAIC F INSURERA:� Natioliwde i�iut.1SE IrISLrance Company 23787 Eric Snow Enterprises INSURER 15- DBA: Ca- Spartan; Eric Snow Sports 12460 Crabapple Road, #337 WSURER C: Alpharetta, GA 30004 h McPri Ser of the Spor[s, Leisure & E nterta :p ment RPG — — ......_.........-..�... . NSURER D: r^.f7Vi=RarSI~S CF R Ti Fir ATIF NII6MIRFR' Wnn176749 REVISION NUMBER - THIS 15 TO GER TfFY THAT THE POLICIES OF IKSIJzAN--L Lis f LD 3I=LCW HAVE BEEN ISSUED TO THE INSURED NAFd_ D ARUA FOrR TIDE POLICY P=RiOD INDICATED NOT' VITT ISTANDM3 ANY RrOUIREMCNT, -CRM 07t COIND.TION DEANY CONTRACT OR OTIIER 00CUM NT'+V1-:I REOPECT TD VA ii01 TI 115 CCRTKICATC RIAY DC ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN fS SUBJECT TO ALL THE TERMS, EXCLJSIONS AND CONDITEONS OF :;UUH PUL€L; LS LI1UI I S SHUNrN hrF.Y NAVE tittN NtLl;i{ tL HY i'AILJ [LAIN]. INSR LTR : 7YPe OF INSURANCE1NSR ADDL SU UR NJV D POLICY NunsSel¢ POLICY EFF POUCY EXP MM.�D,YY LJFiITB A GENERAL LFABILSTY GMIRP GONO004992200 0211W21)12 012117/;:013 Ei_:H l:C[:Ei17r�NCE $1,000,00 X ".nUMFfi0AI `:F NFRF.F l IA9111'rY 2:18 PIN EDT 12:11 AM D.AVAG-E TO R0,17M) s�3DO 00 F-Ett 3A��t�, E9 a:'llf'CNCE CI.AIA15-NACC [X-10"••C[Jr{ _ MEQ EXP [Arw otle Pefscr4 .. V_... .S.ri,l' H} PER!5C A L x AIN tNJURY $1 r0010 40 NE a G&rEGATE 53,061,00 PROD1-CTSCOMPIOP AGG $i mo,00 GI VL AGGK-GATE LNIT APP-OCS PER ?OUCY L]?R,7JECT "-OC; k PROFE3�1�lJALUA11ILITY 31,000,00. !` ;.LEGAL LIAP, TO PARTICIPANTS S7 .I1(H1..1Q, A AVTOMORILE LIA21LITY 66RPGO000004992200 02/1012012 2.16 3110 EDT 4211012(173 12:01 AM COMF31-qED$5JXgLE LIMIT $1,Q00,00 {La A—dm_ BO ULr MQLlRY (Per permn) ANY AUTO BOD. Lt INJURY (Pet aundent) ALL S 4FCLA EO A070S PFi.J€'PRTY OF.V t [ F4 -i accidertr? }( HIREQ ALTOS X NOI,-o.VKIDAJT7c X N3i xcvdea w'•,iie rn Havas: UMBRELtALIAR O--CLR ESC-iECCU-;Er.--E CC .?ESR ` _—...____.. _ EXCESS LIAR C_.,lNS-AACF _:EL7JGIESL6 .... WORKFn COMPENSATION AND FMF: LOYERS UABLITY Y Ifs, 1 AN" %R3F'R:ETORSF:•'I1':,RT�1ERi N/ k E.L. EF�H n.^_•::FsESti r E7CECUYF1(E ERCLL7EF ? E.L. DISEASE - EA 001 OYEF •7Manrlatory In Hit? f yes. ce_c+:f:z unser EA- 01SEASE - PCLICY LIMIT € A '%9E.D -"Al F ;Y SEN ^ =•Alf: rr^'e 3I:i:IP•=illy 6BRPGOG00004992200 0211G12312 02/10/2313 PRINJ&Y tlEDI^AL 2.1d PIN? EDT 12 C 1 AM cCESS MEDICAL g100 Op sultP> IDIA OE Pef:R IIons , Ur;A rluNS I IAnacn Acrrrtu 1u1, Addlpor,W Kernarrcs schedule, rt mere space is NquFrs Spod(s): Basketbal Age(s,: 12 and Udder, 13-15 The certificate holder is added as )n addrional insured, but onN Wrh respect to the liahili, arising out of the ❑ efatbns of the inso-ed nailed above. LGR IIrauA I C "LJLLJCR l.rtal<LGLLft IIVI{ Nortiwestem Middle Srho3l SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE 12805 Birmingham Hwy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Alpharetta. GA 30074 ACGORDANCL WMI TI IC POLICY PROVISIONS. (OvmodOassor of Premises) AUTHORIZED REPRESENTATIVE Coverage is only extended to Lf.3. everlta and activities. NOTICE TO TEXAS INSI.RLL)S' The Insurer (o.,the purrhasing group may not be sL-b=ec1 to a!l She insurance laves and requitaUons of the State of Texas ACORD 25 (2009109) The ACCRD name and logo are registered marks of ACORD Q 1988-2009 AvORD CORPORATICN. All rights reserved. City of Milton 13000 Deerfield Parkway Suite 107C Milton, Georgia 30004 To: Honorable Mayor and City Council Members From: John Rebar, Parks and Recreation Director Submission Date: April 25, 2012 Meeting Date: May 7, 2012 Agenda Item: Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Newtown Recreation Background: The Parks and Recreation Department is eager to continue offering programs and additional services to the citizens of Milton. Many of these programs may be offered by outside providers through an agreement with the City of Milton based on a submitted program proposal rather than offering these programs through a paid independent contractor or a paid employee of the City. Discussion: The Parks and Recreation Department recommends entering into agreement with Newtown Recreation to provide miscellaneous sports programs for our residents and visitors. Programs may include: Fall Flag Football Milton All Star Camp Milton Boys Lacrosse Camp Milton Flag Football Camp Milton Girls Lacrosse Camp Spring Boys Lacrosse Winter Youth Basketball A commission of 30% of all registration fees will be paid to the City of Milton two weeks following the end of registration. Non-resident fees will be collected by the provider and paid to the City at a rate of 50% more. Legal Review: Contract Template - Paul Higbee, Jarrard & Davis on February 23, 2012 Attachments: A Parks and Recreation Department Agreement between the City of Milton and Newtown Recreation. CITY OF MILTON PARKS & RECREATION DEPARTMENT AGREEMENT FOR OUTSIDE PROVIDERS THIS IS AN AGREEMENT, made this day of , 2012, between: THE CITY OF MILTON, a municipal corporation organized and operating under the laws of the State of Georgia, with a business address of 13000 Deerfield Parkway, Suite 107 A, MILTON, Georgia 30004, hereinafter referred to as the "CITY." and NEWTOWN RECREATION INC. hereinafter referred to as "PROVIDER". CITY and PROVIDER may hereinafter collectively be referred to as "the Parties". In consideration of the mutual obligations of the Parties and for good and valuable consideration, the adequacy and receipt of which are hereby acknowledged, the Parties agree as follows: ARTICLE 1.0 PROVIDER's Services and Res onsibilities 1.1 PROVIDER shall conduct services generally described as Basketball, Boys Lacrosse, Flag Football, & Summer Sports Camps at the following location: Hopewell Middle School, 13060 Cogburn Road, Milton, GA 30004; Northwestern Middle School, 12805 Birmingham Hwy, Milton GA 30004; Cogburn Woods Elementary School, 13080 Cogburn Road, Milton GA 30004; Birmingham Falls Elementary School, 14865 Birmingham Hwy, Milton GA 30004; Bethwell Community Center, 2695 Hopewell Road, Milton GA 30004; Bell Memorial Park, 15245 Bell Road, Milton GA 30004. 1.2 The PROVIDER's services shall be performed during the days and hours described in Exhibit "A," attached hereto and incorporated herein by reference. 1.3 The PROVIDER and The Director of the Parks & Recreation Department or his designee, hereinafter referred to as the "DEPARTMENT", will agree upon program schedules. PROVIDER agrees to submit a Programa Request Form to the Coordinator for each program being proposed eight (8) weeks prior to the beginning of each session. 1.4 The fees charged to each participant will be as described in Exhibit "A" for residents of MILTON and a surcharge of 50% more for non-residents of MILTON. The entire balance of this surcharge for non-residents shall be aid to the CITY. 1.5 The PROVIDER warrants to CITY that it is not insolvent, it is not in bankruptcy proceedings or receivership, nor is it engaged in or threatened with any litigation or other legal or administrative proceedings or investigations of any kind which would have an adverse effect on its ability to perform its obligations under this Agreement. 1 the programs, and shall continue to maintain such licenses or permits during the term of this Agreement. 1.7 This Agreement is considered a non-exclusive Agreement between the Parties. The CITY shall have the right to purchase the same kind of services to be provided by the PROVIDER from other sources during the term of this Agreement. The PROVIDER is not precluded from providing the same or similar services for other parties so long as such other engagements do not interfere with the PROVIDER'S provision of services to the CITY. 1.8 The DEPARTMENT must approve any promotional material, flyers, and posters advertising the programs prior to its release. The following content and topics shall specifically be prohibited: sexually explicit materials, profanity, child pornography, alcoholic beverages, tobacco products, adult movies, adult bookfvideo stores, adult entertainment establishments, massage parlors, pawn shops, and tattoo parlors or shops. 1.9 The PROVIDER shall not promote any privately owned business in a CITY park/facility or solicit any participant in a CITY park/facility activity for any privately owned business. The PROVIDER may not use said facilities to conduct personal business including workshops, clinics, seminars, camps, or any other activities that are outside the scope of service described in (Exhibit "A"). It is further understood that such action(s) may result in immediate termination of the Agreement and the forfeiture of all compensation due to the PROVIDER. 1.10 The PROVIDER shall abide by the policies, procedures, rules and regulations of the DEPARTMENT, the CITY, and the FULTON COUNTY BOARD OF EDUCATION as promulgated from time to time. PROT17DER understands and agrees that the DEPARTMENT shall have first priority for use o f CITY facilities, notwithstanding any other provisions of this Agreement 1.11 All assistants, substitutes, and subcontractors utilized by the PROVIDER must have prior written approval of the DEPARTMENT. 1.12 PROVIDER shall provide necessary supervisory personnel to ensure that the participants of the programs obey all applicable policies, procedures, Rules and Regulations. 1.13 The DEPARTMENT or CITY may require that the PROVIDER not be permitted to utilize specific assistants, substitutes, or subcontractors of PROVIDER who have failed to follow any policies, procedures, rales or regulations applicable to the use of the facility. 1.14 Although the CITY shall not control the PROVIDER's techniques, methods, procedures, or sequence of instruction, the PROVIDER will comply with the CITY's and DEPARTMENT's policies, rules, regulations and procedures, as well as those of the FULTON COUNTY BOARD OF EDUCATION, and shall not interfere with their K operation, nor harm or damage the equipment or facilities afforded to PROVIDER for his/her programs, nor otherwise disrupt the other on-site activities being offered at such public facilities. 1.15 The PROVIDER also acknowledges that he or she is primarily responsible for the conduct of the participants in all programs under the PROVIDER's charge. 1.16 If the PROVIDER will be providing services directly with minor children without parental supervision, the PROVIDER shall, prior to commencing services under this Agreement, comply with the CITY's policy regarding criminal background screening. The CITY will furnish the PROVIDER with a background release form (Exhibit "B") for all the provider's counselors, coaches, volunteers, subcontractors, employees or any other individuals that will come in contact with a child, at the PROVIDER's sole expense. A Consent and Release Form to conduct a criminal background must be executed by any of PROVIDER's employees or any individual who will come in contact with a child at the CITY through PROVIDER or at PROVIDER's direction, such form authorizing the CITY to conduct a search of each such individual's criminal background. The result of such inquiry may be deemed acceptable by the CITY in its sole and complete discretion, and the CITY may reject any individual from participating in any program based upon such results. If the PROVIDER has recently had a background screening conducted by another agency, the CITY, at its sole discretion, may accept that background screening and waive the requirement of a new background screening. PROVIDER and its employees must also execute a Waiver and Release of Liability holding the CITY and FULTON COUNTY BOARD OF EDUCATION harmless. 1.17 The CITY shall require all participants in all programs to sign a Waiver and Release of Liability. ARTICLE 2.0 Equipment & Materials 2.1 All program materials and equipment needed or pertaining to the above stated programs will be provided by the PROVIDER at his/her own cost and expense. However, PROVIDER may require participants to obtain certain materials required in the programs by providing a list of such materials (with approximate costs) to the participants. If PROVIDER makes such materials available to participants, they must be sold at PROVIDER's cost. All equipment provided by the PROVIDER shall be used in strict accordance with equipment manufacturer's instructions and in accordance with all applicable laws. PROVIDER shall coordinate storage of goal posts with the principal of the school located at the facility. 2.2 The sale of merchandise is restricted to those materials utilized in and for the programs. Fundraising activities conducted by the PROVIDER will not be permitted. The PROVIDER shall obtain the CITY's approval of any merchandise to be sold prior to its distribution or sale. 3 2.2 The sale of merchandise is restricted to those materials utilized in and for the programs. Fundraising activities conducted by the PROVIDER will not be permitted. The PROVIDER shall obtain the CITY's approval of any merchandise to be sold prior to its distribution or sale. 2.3 The CITY will provide no storage space to the PROVIDER, unless otherwise mutually agreed upon in a separate written agreement. 2.4 Any supplies or equipment left at the facility will be the responsibility of the PROVIDER. The CITY will not be responsible for any lost, stolen, or broken equipment or supplies. 2.5 The PROVIDER shall inspect the premises and equipment offered to him/her for his/her proposed activity and if he or she finds anything wrong with the premises or equipment before each program commences that cannot be corrected immediately by the DEPARTMENT, the program shall be canceled and the matter reported to the DEPARTMENT for correction. If the PROVIDER elects to hold his/her programs in the facility provided, it will be presumed that the PROVIDER has inspected the premises and facilities and equipment provided for such programs and has accepted same as being safe and suitable for the use intended. ARTICLE 3.0 Program Size Minimums: 3.1 ACTIVE: Program sizes shall meet the minimum numbers of participants for each program as designated in Exhibit "A." ARTICLE 4.0 Compensation and Method of Payment 4.1 In consideration of the releases and indemnities contained herein and of the PROVIDER's services in connection with the programs and activities described herein, the CITY shall be entitled to 30% of the registration fees paid by all program participants to the PROVIDER, and the PROVIDER shall be entitled to 70% of such fees paid, exclusive of the 50% non-resident surcharge. The 50% non-resident surcharge is fully payable to the CITY and shall not be included in PROVIDER's gross income calculation. PROVIDER shall be entitled to retain all non -registration fees paid by participants to PROVIDER, i.e. PROVIDER membership fees and casts for uniforms and pictures to participants. 4.2 The PROVIDER agrees to collect all fees from participants, and the PROVIDER agrees to provide CITY with schedules of fees to be charged to participants in conformance with Exhibit "A". It is agreed that the PROVIDER's sole obligation shall be to collect the fees from the participants and to remit the 30% of the fees collected as well as all 50% non-resident surcharge amounts to the CITY with a pay -out report of all 4 4.3 It is the responsibility of the PROVIDER to pay all applicable local, state, and federal taxes associated with this Agreement, and to acquire and pay for all necessary permits, licenses, and insurance required for the execution of this Agreement. ARTICLE 5.4 Independent PROVIDER 5.1 This Agreement does not create an employee/employer relationship between the Parties. It is the intent of the Parties that the PROVIDER is an independent contractor under this Agreement and not a CITY employee for all purposes, including but not limited to, the application of the Fair Labor Standards Act minimum wage and overtime payments, Federal Insurance Contribution Act, the Social Security Act, the Federal Unemployment Tax Act, the provisions of the Internal Revenue Code, The State Workers Compensation Act, and the State unemployment insurance law. The PROVIDER shall retain sole and absolute discretion in the judgment of the manner and means of carrying out PROVIDER's activities and responsibilities hereunder. The PROVIDER agrees that it is a separate and independent enterprise from the CITY, that it had full opportunity to find other business, that it has made its own investment in its business, and that it will utilize a high level of skill necessary to perform the work required hereunder. This Agreement shall not be construed as creating any joint employment relationship between the PROVIDER and the CITY and the CITY will not be liable for any obligation incurred by PROVIDER, including but not limited to unpaid minimum wages or overtime premiums. 5.2 PROVIDER warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the PROVIDER to solicit or secure this Agreement, and that it has not paid or agreed to pay any person, company, corporation, individual or firm any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of this provision, the CITY shall have the right to terminate the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover the full amount of such fee, commission, percentage, gift or consideration. ARTICLE 6.0 Insurance 6.1 PROVIDER shall not provide any service until all insurance required under this paragraph has been obtained and approved by the CITY. 6.2 Certificates of Insurance. Certificates of Insurance reflecting evidence of the required insurance shall be filed with the CITY prior to the commencement of this Agreement. These Certificates shall contain a provision that coverages afforded under these policies will not be cancelled until at least forty-five days (45) prior written notice has been given to the CITY. Policies shall be issued by companies authorized to do business under 5 the laws of the State of Georgia. Financial Ratings must be not less than "A -VI" in the latest edition of `'Best Key Rating Guide", published by A.M. Best Guide. 6.3 Insurance shall be in force until the obligations required to be fulfilled under the terms of the Agreement are satisfied. In the event the insurance certificate provided indicated that the insurance shall terminate and lapse during the period of this Agreement, then in that event, the PROVIDER shall furnish, at least thirty (30) days prior to the expiration of the date of such insurance, a renewed Certificate of Insurance as proof that equal and like coverage for the balance of the period of the Agreement and extension thereunder is in effect. The PROVIDER shall not provide any service pursuant to this Agreement unless all required insurance remains in full force and effect. 6.4 Commercial General Liability insurance to cover liability bodily injury and property damage. Exposures to be covered are: premises, operations, products/completed operations, and certain contracts. Coverage must be written on an occurrence basis, with the following limits of liability.. $1,000,000 Combined Single Limit — each occurrence $2,000,000 Combined Single Limit — general aggregate $1,000,000 Personal Injury $1,000,000 Products/Completed Operations Aggregate PROVIDER shall have its insurer name the City of MILTON as an additional insured on its General Liability policy. 6.5 Worker's Compensation insurance shall be maintained during the life of this Agreement to comply with the statutory limits for all employees, and in the case any work is sublet, the PROVIDER shall require the subcontractor(s) similarly provide Workers Compensation Insurance for all the latter's employees unless and until such employees are covered by the protection afforded by the PROVIDER. The PROVIDER and his subcontractors shall maintain during the life of this Agreement Employers Liability Insurance. The following limits must be maintained: A. Workers Compensation Statutory B. Employer's Liability $100,000 each accident $500,040 Disease -policy limit $100,000 Disease -each employee If PROVIDER or its subcontractor claims to be exempt from this requirement, PROVIDER shall provide CITY proof of such exemption along with a written request for CITY to exempt PROVIDER, written on PROVIDER or subcontractor's letterhead. 6.6 PROVIDER shall also maintain Auto Liability and Directors and Officers insurance with limits reasonably acceptable to CITY during the term of this Agreement. 6.7 The CITY and the Fulton County Board of Education shall each be named as an additional insured and loss payee on all policies required by this Agreement. ARTICLE 7.0 Term and Termination 7.1 After a two (2) month trial period, the programs will be evaluated by the DEPARTMENT, and the remainder of this Agreement will either be terminated or continue in full force and effect. If at any time after the two (2) month evaluation, program enrollment should fall below the required minimum, the PROVIDER will be allotted four (4) weeks to bring enrollment up to the required minimum. The programs will be reevaluated and execution or termination of the contract will be determined by the DEPARTMENT. 7.2 The term of this Agreement shall commence upon the date of execution hereof and shall remain in effect for a period of one (1) year from the date of execution of this Agreement by the CITY, unless terminated sooner as provided in this Article. Renewal of this Agreement beyond the one (1) year term shall require the mutual written agreement of the CITY and PROVIDER. 7.3 This Agreement may be terminated by the CITY for convenience upon giving of at least thirty (30) days prior written notice of termination to the PROVIDER at the PROVIDER's address set forth herein at the sole and exclusive discretion of the CITY. This Agreement may be terminated by the City immediately by written notice to PROVIDER upon any willful, reckless, or grossly negligent act or omission by PROVIDER or any of its officers, agents, employees, or volunteers. 7.4 This Agreement may be terminated by PROVIDER upon giving at least thirty (30) days written notice of termination to the CITY. 7.5 PROVIDER must notify the DEPARTMENT in writing of any program cancellations at least ten (10) business days prior to the scheduled cancellation. 7.6 CITY reserves the right to cancel or reschedule any of the PROVIDER's programs, in the case of scheduling conflicts or other emergencies, as determined by the DEPARTMENT. ARTICLE 8.0 Indemnification 8.1 PROVIDER agrees to indemnify and hold harmless the CITY and the FULTON COUNTY BOARD OF EDUCATION, their trustees, elected and appointed officers, agents, servants and employees, from and against any and all claims, demands, or causes of action of whatsoever kind of nature, and the resulting losses, costs, expenses, reasonable attorneys' fees, including paralegal fees, liabilities, damages, orders, judgments, or decrees, sustained by the CITY, the FULTON COUNTY BOARD OF EDUCATION, or any third party arising out of, or by reason of, or resulting from the will full or negligent acts, errors, or omissions of the PROVIDER or its agents, officers, volunteers or employees. 7 8.2 The Parties understand and agree that the covenants and representations relating to this indemnification provision shall survive the term of this Agreement and continue in full force and effect as to the PROVIDER's responsibility to indemnify_ ARTICLE 9.0 Americans With Disabilities Act 9.1 PROVIDER shall not discriminate against any person in its operation and activities in its use or expenditure of the funds or any portion of the funds provided by this Agreement and shall affirmatively comply with all applicable provisions of the Americans With Disabilities Act ("ADA"), in the programs while providing any services funded in whole or in part by the CITY, including Titles I and II of the ADA and all applicable regulations, guidelines, and standards. 9.2 PROVIDER's decisions regarding the delivery of services under this Agreement shall be made without regard to or consideration of race, age, religion, color, gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation, or any other factor which cannot be lawfully or appropriately used as a basis for delivery of service. ARTICLE 10.0 Miscellaneous 10.1 No modification, amendment, or alteration of the terms and conditions contained shall be effective unless contained in a written document executed with the same formality and equal dignity herewith. 10.2 This Agreement is non -transferable or assignable, and PROVIDER agrees not to transfer or assign the performance of services called for in the Agreement. 10.3 This Agreement sets forth the full and complete understanding of the Parties as of the effective date, and supersedes any and all negotiations, agreements, and representations made or dated prior to this Agreement. 10.4 The PROVIDER shall pay reasonable attorney's fees to the City should the City be required to incur attorney's fees in enforcing the provisions of this Agreement. 10.5 Time is of the essence of this Agreement. 10.6 Each of the individuals who executes this Agreement agrees and represents that he is authorized to execute this Agreement on behalf of the respective entity. Accordingly, the City and PROVIDER both waive and release any right to contest the enforceability of this Agreement based upon the execution and/or approval thereof. 8 10.7 It is the policy of City that unauthorized aliens shall not be employed to perform work on City contracts involving the physical perfonxnance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the PROVIDER shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and "D" that it and its subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perform work on the City contract to ensure that no unauthorized aliens will be employed. The City Manager or his/her designee shall be authorized to conduct an inspection of the PROVIDER's and its subcontractors' verification process to determine that the verification was correct and complete. The PROVIDER and its subcontractors shall retain all documents and records of its verification process for a period of three (3) years following completion of the contract. This requirement shall apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. Compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 is mandatory. PROVIDER's compliance with the requirements of O.C.G.A. § 13-10-9I and Rule 300- 10-1-.02 shall be attested by the execution of the contractor's affidavit attached as Exhibit «C." Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to O.C.G.A. § 16-10-71), a form of which is attached hereto as Exhibit "E", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A. § 50-36-1). 9 IN WITNESS OF THE FOREGOING, the Parties have set their hands and seal the day and year first written above. CITY: ATTEST: BY: SUDIE GORDON, CITY CLERK JOE LOCKWOOD, MAYOR PROVIDER: TNESS: BY: '► BRANDON ALLVN, PkESIDENT [AFFIX CORPORATE SEAL] 10 EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: Fall Flag Football Participant Ages: 6-11 (6yr. old, 7/8yr. old, and 9-11yr. old Day/s of the week program is offered: Weekday practices, weekend games Time of Program: Late afternoon/early even ing_practices , weekend games Program Dates: Mid. August — Mid. November Program Fee: $140 resident, $210 non-resident Program Enrollment: Minimum 11 _ Maximum 112 Materials to be supplied by participants: Mouth guard, black shorts, water bottle Materials to be supplied by PROVIDER: 2 team footballs, 12 player flags,_6 speed cones, uniform (jersey top only), and trophy Materials to be supplied by the City of MILTON: Access to fields Additional Program Requirements: Provider will provide all administrative support -- marketing (in conjunction with city), registration, team formation, rules, coaching _aids schedules, referees, trophv, and uniforms. PROVIDER (`s) Name: Newtown Recreation Address: 3000 Old Alabama Road Suite 104 City/State/Zip Code: Johns Greek, GA 30022 Phone Number: (pay) 678.2 97-2662 (Evening) (678) 850-3102 (E-mail): Brandon@newtownrec.com OR aril@newtownrec.com (Fax) 678-297-3920 Minimum Requirements: 1,000,000 General Liability Insurance Office Use Only: Program Rate:$ # of programs in Session: Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: Milton All Star Camp Participant Ages: 5-15 Day/s of the week program is offered: Monday, Tuesday, Wednesday, Thursday, Fries Time of Program: 8.30am to 11:30am Program Dates: June 11 to June 15 Program Fee: $135 resident, $202.50 non --resident Program Enrollment: Minimum 12 Maximum 84 Materials to be supplied by participants: Water bottle/drink, sun screen, small snack. Materials to be supplied by PROVIDER: All field equipment, balls,_ cones, lining, water cooler, first aid kit, name tags, and camp t -shirt. Materials to be supplied by the City of MILTON: Fields, access to bathrooms, runni water Additional Program Requirements: PROVIDER (`s)Name: Newtown Recreation Staff Address: 3000 Old Alabama Road Suite 104 City/State/Zip Code: Johns Creek, GA 30022 Phone Number: (Day) 678-297-2662 (Evening) (678) 860-3102 (E-mail): Brandon@newtownrec.com OR aris@newtownrec.com (Fax) 678-297-3920 Minimum Reauirements: 1,000,000 General Liability Insurance office use Only. Program Rate:$ # of programs in Session: Fee/Program: i 5 i PROGRAM DESCRIPTION Directed by Newtown Recreation Staff Campers will spend the week playing various games in several sports including: flag football, whiffle ball, capture the flag, pickle ball, and other fun and engaging games. All campers will receive a camp t -shirt. EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: Milton All Star Camp Participant Ages: 5-15 Day/s of the week program is offered: Monday, Tuesday, _Wednesday, Thursday, Friday Time of Program: 8:30am to 11:30am Program Dates: June 25 to June 29 Program Fee: $135 resident, $202.50 non-resident Program Enrollment: Minimum 12 Maximum 84 Materials to be supplied by participants: Water bottle/drink, sun screen, small snack. Materials to be supplied by PROVIDER: All field equipment, balls, cones, lining, water cooler, first aid kit, name tags, and camp t -shirt. Materials to be supplied by the City of MILTON: Fields, access to bathrooms, runnin water Additional Program Requirements: PROVIDER Cs)Name: Newtown Recreation Staff Address: 3000 Old Alabama Road Suite 104 City/State/Zip Code: Johns Creels, GA 30022 Phone Number: (Day) 578-297-2652 (Evening) (678) 860-3102 (E-mail): Brandon@newtownrec.com_OR aris@newtownrec.com (Fax) 578-297-3920 Minimum Requirements: 1,000,000 General Liability Insurance Office use Only. - Program Rate:$ # of programs in Session: Fee/Program: S 1 PROGRAM DESCRIPTION Directed by Newtown Recreation Staff Campers will spend the week playing various games in several sports including: flag football, whiffle ball, capture the flag, pickle ball, and other fun and engaging games. All campers will receive a camp t -shirt. EXHYB1T "A" PRO -GRAM_ REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest_ This information will be used for consideration of program proposals. Use one form per program. Name of Program: Milton Boys Lacrosse Camp Participant Ages: 7-15 Day/s of the week program is offered: Monday, Tuesday, Wednesday, Thursday, Friday Time of Program: 8:30am to 11:30am Program Dates: August 6 -August 10 Program Fee: $1.40 resident, $21.0 non-resident Program Enrollment: Minimum 14 Maximum 84 Materials to be supplied by participants: Water bottle, sun screen, small snack, stick mouth guard, helmet, arm pads, shoulder pads, and gloves Materials to be supplied by PROVIDER: Balls, cones, cages, extra_equipment for campers who need pear, camp t -shirt, shooting nets. first aid kid. and water cooler. Materials to be supplied by the City of MILTON: Access to fields, bathrooms, and running Additional Program Requirements: PROVIDER (`s}Name: Newtown Recreation Staff Address: 3000 Old Alabama Road Suite 104 City/State/Zip Code: Johns Creek, GA 30022 Phone Number: (Day) 678-297-2552 (Evening) (678) 860-3102 (E-mail): Brandon@newtownrec.com OR aris_@newtownrec.com (Fax) 678-297-3920 Minimum Requirements: 1,000,000 General Liability Insurance Office Use Only Program Rate:$_ S # of programs in Session: ree/Program: PROGRAM DESCRIPTION Directed by- Newtown Recreation Staff (current high school coaches, and former players) Campers will receive instruction from former high school and college players as well as current high school coaches. This camp is designed to help campers learn and develop various lacrosse skills and techniques through many fun drills and games. Camp will focus on stick skill development as well as game strategy and teamwork. Each camper will receive a camp t -shirt at the conclusion of camp. EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one farm er rorlram. Name of Program: Milton _Flag -Football Camp Participant Ages: 5-12 Day/s of the week program is offered: Monday, Tuesday, Wednesday, Thursday, Frida Time of Program: 8:30am to 11:30am Program Dates: June 18 to June 22 Program Fee: $135 resident, $202.50 non-resident Program Enrollment: Minimum 12 Maximum 84 Materials to be supplied by participants: Mouth guard water bottle/drink sun screen small Materials to be supplied by PROVIDER: Footballs, cones, flag belts, other training aids, water cooler, first aid kit, field lining, and camp t -shirt Materials to be supplied by the City of MILTON: Access to fields, bathrooms, running water Additional Program Requirements: PROVIDER (`s)Name: Newtown Recreation Staff Address: 3000 Old Alabama Road Suite 104 City/State/Zip Code: Johns Creek, GA 30022 Phone Number: (Day) 678-297-2662 (Evening) (678) 850-3102 (E-mail): Brandon@newtownrec.com OR aris@newtownrec.com (Fax) 678-297-3920 Minimum Requirements: 1,000,000 General Liability Insurance Office Use Only. - Program Rate:$ # of programs in Session: S Fee/Program: PROGRAM DESCRIPTION Directed by Newtown Recreation Staff Campers will spend the week playing games and learning the skills and fundamentals of flag football. ❑rills target specific techniques to work on both individual and team progression. Each camper will receive a camp t -shirt at the conclusion of camp. EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: Milton Girls Lacrosse Camp Participant Ages: 6-14 Day/s of the week program is offered: Monday, Tuesday, Wednesday, Thursday, Frida Time of Program: 8:30am to 11:30am Program Dates: July 16 -July 20 Program Fee: $140 resident, _$210 non-resident Program Enrollment: Minimum �1 2_Maximum 84 Materials to be supplied by participants: Water bottle/drink, sun screen, small snack, girls stick, mouthguard,_aoggles. Materials to be supplied by PROVIDER: Lacrosse balls, cones, cages, shooting nets, training aids, additional equipment for campers who need gear, water cooler, first aid kid, and camp t -shirt. Materials to be supplied by the City of MILTON: Access to fields, bathrooms, runnin water. Additional Program Requirements: PROVIDER (`s)Name: Newtown Recreation Staff Address: 3000 Old Alabama Road Suite 104 City/State/Zip Code: Johns Creek, GA 30022 Phone Number. (Day) 678-297-2662 (Evening) (678) 860-3102 (E-mail): Brandon@newtownrec.com OR aril a@newtownrec.com (Fax) 678-297-3920 Minimum Requirements: 1,000,000 General Liability Insurance Office Use Only., Program Rate:$ # of programs in Session: Fee/Program: I S C PROGRAM DESCRIPTION Directed by Newtown Recreation Staff (former high school and former and current college players, current high school coaches) Campers will learn and develop various lacrosse skills and techniques through progression based instruction. Newer players will focus on basic stick skills- throwing, catching, scooping, and cradling. More seasoned players will learn higher based skills- transition, shooting, team defense, and draw control. All players will receive a camp t -shirt at the conclusion of camp. EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form_per program. Name of Program: Spring 2013 Boys Lacrosse Participant Ages: 7-13 (7/8yr. old, 9/10yr. old, 11/12yr. old, 12/13yr. old boys lacrosse) Day/s of the week program is offered: Weekday practices, weekend games. Time of Program: Late afternoon /even inq practices, weekend games Program Dates: Late February — Mid. Ma Program Fee: 7/8yr. $165 residents, _$2.47.50__non-residpnts3__9/10yr-1_1/13yr. $180 residents, $270 non-residents, Program Enrollment: Minimum 40 Maximum 220 Materials to be supplied by participants: Water bottle, helmet, gloves, stick, mouth guard, arm pads, shoulder pads. Materials to be supplied by PROVIDER: Lacrosse balls, team uniforms (jersey and shorts), goalie equipment (stick, throat guard, chest protector), speed cones, training aids, and trophy. Materials to be supplied by the City of MILTON: Access to fields Additional Program Requirements: Provider will provide all administrative support - marketing (in „ conjunction with city), registrations team formation, rules, coaching_ aids, schedules referees tro h , and uniforms. PROVIDER (`s) Name: Newtown Recreation Address: 3000 Old Alabama Road Suite 104 City/State/Zip Code: Johns Creek, GA 30022 Phone Number: (Day) 678-297-2662 (Evening) L678) 860-3102 (E-mail).- brandon@newtownrec.com OR aris@newtownrec.com (Fax) 578-297-3920 Minimum Reauirements: 1,000,000 General Liability Insurance Office Use only, Program Rate:$ # of programs in Session: I S Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: Winter 2012/2013 Basketball Participant Ages: 6-12 (6 -shooters skill builder program, 7/8yr. old basketball, 9/10yr. old basketball, 11 /12yr. old basketball- each age group will have a boys ,and girls division) Day/s of the week program is offered: Weekday practices, weekend games {occasional weekday game near end of season Time of Program: Late afternoon /evening practices, weekend_ games Program Dates: Mid. November -- Mid. February Program Fee: $150 Program Enrollment: Minimum 24 Maximum 212 Materials to be supplied by participants: Water bottle/drink. Materials to be supplied by PROVIDER: Team basketballs, speed cones, basket or attachment if needed, scoreboard. Materials to be supplied by the City of MILTON: Access to basketball gym. Additional Program Requirements: Provider will provide all administrative support - marketing (in conjunction with city), registration, team formation, rules, coaching aids, schedules, referees, trophy, and uniforms. PROVIDER (`s) Name: Newtown Recreation Address: 3000 Old Alabama Road suite 104 City/state/Zip Code: Johns Creek, GA 30022 Phone Number: (Day) 678-297-2662 (Evening) (678) 860-3102 (E-mail): Brandon@newtownrec.com OR aris@newtownrec.com (Fax) 678-297-3920 Minimum Reauirements: 1,000,000 General Liability Insurance Office Use Only. Program Rate:$ # of programs in Session: 9 M Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: Fall Flag Football Participant Ages: 5-18 J6yr._ old; 7/8yr. old,_9-10yr. old, 11/12yr.old, 13/14yr. old, 15 /1 6vr_ ofd and 17/ 18vr. old Day/s of the week program is offered: Weekday practices, weekend games Time of Program: Late afternoon/early evening practices, weekend games Program Dates: Mid. November -- Mid. Februa Program Fee: $140 resident, $210 non-resident Program Enrollment: Minimum 11 Maximum 112 Materials to be supplied by participants: Mouth guard, black shorts, water bottle Materials to be supplied by PROVIDER: 2 team footballs, 12__player flags, 5 speed cones, uniform (jersey top only), and trophy Materials to be supplied by the City of MILTON: Access to fields Additional Program Requirements: Provider will provide all administrative support - marketing (in conjunction with city), registration, team formation, rules, coaching aids, schedules. referees. troohv. and uniforms. PROVIDER (`s) Name: Newtown Recreation Address: 3000 Old Alabama Road Suite 104 City/State/Zip Code: Johns Creek, GA 30022 Phone Number: (Day) 678-297-2662 (Evening) (678) 860-3102 (E-mail): Brandon@newtownrec.com OR aris@newtownrec.com (Fax) 678-297-3920 Minimum Requirements: 1,000,000 General Liability Insurance office Use Only: Program Rate:$ # of programs in Session: S Fee/Program: EXHI BIT "B" i City of Milton Georgia Criminal History Record Information Request and Consent Form 1) This Request Is For: (Check only one) * Employment o Military o Licensing o Personal Use o Other Use Not Listed (F) International Travel n Firefighters Employment (E) Li Prospective Adoptive/Foster Parents (E «Note & 2 copies) Employment Working With The Elderly (N) cr Employment At A Child Care Facility (w) X Volunteer waAing with Children (W) ❑ Employment Working With The Mentally III (M) u Police Fide Along Request (C) o Police Department VendortContraclor (C) 2) A History Is Requested on The Following Person: Name: Social Security Number. - Sex: Race.- o White a Blit o Asian o American Indian o Unknown/Other Date Of Birth: Phone Number: hk.�ffi 1)3�' rear E Check If Request Is For Yourself And Proceed To Section 5 At The Bottom Of This Page_ 3) Person Requesting Criminal History: genie: City of MiltonlCompany Name (TBD) Address: 13000 Deerfield Parkway Suite 107 Phone_ 678 242 2500 CitylState'Zip: Milton, GA 30004 4) Consent: This portion is to be used if the person requesting the criminal history is different than whom the criminal history is being inquired on (sections II & III above are not the same person). Third party notary is required. I hereby give my consent Ion my criminal history to be run and for the above named pion in sedan III to have access to it. Steal: mzwk a tsar 5) In making th€s request, I agree hat the City of t Iton Police Department, its employees. heirs, trustees, etc., shall in no way ne ?tell at fault for the use cr misuse of this record. A photocopy of the release will be iced on file and is vzdid as an original hereon, even though the photocopy does not contain an origMal signature. Inmmplete requests wilt be denied. Thts report is considered acctk'ate at time of inquiry and rroy change at anytime. Oftial Use Only - Do Not Mark Below This Line Operator ARIA Results: Date Submitted I G5(2WB 56 Inquiry pate f 11 EXHIBIT "C" STATE OF GEORGIA CITY OF MILTON CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-14-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor Affidavit provided in Rule 340-10-41-.08 in the form attached hereto as Exhibit "D." Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perform such service. EEV 1 Basic Pilot Program User Identification Number ?"/( -', A 1/1 -/ BV- Authorized O ice or Agent Date Newtown Recreation, Inc. Title" -'of Authorized Officer or Agent of Contractor Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN E-QRE ME ON T11IS THE � 241 �-- -f-DAY OF , Notary Publi tssion Expires: C • Irk rPUe� ► 6 ���+��.I.1111►► 12 STATE OF GEORGIA CITY OF MILTON EXHIBIT "D" SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with Newtown Recreation, Inc. on behalf of the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. EEV 1 Basic Pilot Prograg, User Identification Number TA 6 BY: AAorik4'6fficJ or Agent Date [77X;; CTOR NAME] Title of Authorized Office or Agent of Subcontractor �-a Alp, Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN RF� F 201 Notary PuRlic !1Expire V"I' 13 t� 4W EXHIBIT "E" SAVE Affidavit By executing this affidavit under oath, and as an applicant for a public benefit, as referenced in O.C.G.A. § 50-36-1, from the City of Milton, the undersigned applicant verifies one of the following with respect to my application for a public benefit: I ) I am a United States citizen. 2) I am a legal permanent resident of the United States. 3) I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C.G.A. § 50-36-1(e)(1), with this affidavit. The secure and verifiable document provided with this affidavit can best be classified as: In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute. ff � Executed in , eF '` (city), {state S' ature of Applicant SUBSCRIBED AND SWORN BEFORE ME N THIS it�AY OF 20 1 NOTA PUBLIC My CSgAmission Expires: &m le, Printed Name of Applicant 14 NEWTORE OP ID: SS AN?D* CERTIFICATE OF LIABILITY INSURANCE DA's`"' "' nar23M2 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATTVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURED($), 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 endorsemen s . PRODUCER 866-298-1 fifi8 Sitner-Henry Insurance Agcy888-739-7233 Customer Service Center 401 East Antletam St., Suite S MO 21740 Kenneth M Bird CONTACT NAME: P�HcaNI a I FAX �: —� ,��, e;>ewL ADDRESS:Hagerstom, INSURE 5 AFFORDING COVERAGE NAIC0 INSURER ; Brotherhood Mutual Insurance 13528 HGENERAL INSURED New Town Recreation, Inc 3000 Old Alabama Road 4104 .Johns Creek, GA 30022 INSURER B PRODUCTS - COMPIOP AGG S 3,0N,00 INSLIR£xc AUTOMIDGME UASn ny ANY AUTO ALL OWNED se"ZOULEO AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS WSURER D INSURER E CE9MSIINa� SINGLE LUAIT % !!SURER P: BpAiLV fNJURY (Pei' 0ccid&'1i) $ P pPERTY DAMAGE S Per sacident COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INUICATED. NOTMTHSTANDING ANY REQUIREMENT, TERM OR CQND)TlON OF ANY CONTRACT OR OTHER DOCUMENT WITH RE=SPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIE=S DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR !TR TYPE OF INSURANCE ADDISUSR POLICY NUMBER EFF 3Yi�FrID Yry POUC LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X IOMEAD321804 87/14111 mi OCCURRENCE S 1,000,0 GF TO RENTED ISE. S§Ea a rence $ 31.10,00 XP (Any one person $ 5,0I ONAL & ADV INJURY 5 1,000,0¢ HGENERAL AGGREGATE S 3,000,00 GENL AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMPIOP AGG S 3,0N,00 $ AUTOMIDGME UASn ny ANY AUTO ALL OWNED se"ZOULEO AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS CE9MSIINa� SINGLE LUAIT % BODILY rVJURY (Per person) S BpAiLV fNJURY (Pei' 0ccid&'1i) $ P pPERTY DAMAGE S Per sacident _ S UMBRELLALIABOCCUR EXCESS LIAB CLAIMS-WDE EACH OCCURRENCE S AGGREGATE $ DEC, 1 1 RETENTIONS $ WORKERS CgMPMEATION AND EMPLOYERS' LIABUJTY Y I N ANY PROPRIETOFJPARTHERlE1C1:CUT(VE ❑ pFFICERlMSHIBER EXCLUDED? (MwE dowy in NH) If yes. describe under DESCRIPTION OF OPERATIONS below NIA WC STATU- OTH- E.L EACH ACCIDENT S E1, DISEASE -FA EMPLOYEd i E.L DISEASE -POLICY LIMIT S I i DESCRIATIDN OF OPERATIONS 1 LOCATIONS I VEHICLES ]Attach ACORD 101, Additional Remarlm Schedule, Ir more "ce Is squire) City of Miltori is named as additional insured for use of City facilities. Coverage for additional insureds is strictly subject to all the terms of the policy. nCMr% rnATe unr rnco C 011tf`-RI I OTIf)H ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE: ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE: WILL BE DELIVERED IN City of Milton ACCORDANCE WITH THE POLICY PROVISIONS. 13()00 Deerfield Pkwy STE 107A Milton, GA 30004 AUTHORIZED REPRESENTATNE Kenneth M Bird y� / =- � C�7 , ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD NEwTORE OP ID: SS A4CC>MLY CERTIFICATE OF LIABILITY INSURANCE �"W2311 Y'`' 04/23/72 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 T14E POLICIES 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 866-298-1668 Bitner-Henry Insurance Agcy Customer Service Center 888-739-'1233 CDNTACT NAME: — pHDµE 'AX � � ,vc NO: 401 East Antietam St., Suite B Hagerstown, MD 21740 ADDRESS: Kenneth M Bird INSURER(S) AFFORDIHGCOVERAGE NAIC;9 EACH OCCURRENCE S 'I,DOo,DO IH SURER A: Brotherhood Mutual Insurance 113528 INSURED New Town Recreation, Inc 3000 Old Alabama Road #104 Johns Creek, GA 30022 INSURER B: pisuRERC : I GAMAGL 1-0 RLN] LD 07114M1 07!'14114 PREMISES Eaoommynca $ 300, INSURER D INSURER E . MISURER F: Ci1VFRAr%FS CERTIFICATENUMRER2 REVISION NLIMRE€ - THIS IS TO CERTIFY THAT THE AOLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IND#GATED. NOTWITHSTANDING ANY REQUIPEMENT, 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, EXCLUS[ONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. UlSR LTR TYPE OF INSURARCE Atlanta, GA 30354 AUTHORIZED REPRSSEWATnr£ POLICY HUNKER MPWDWOUCY EFF MPS Y P LIMrr3 GENERAL LIABILITY i EACH OCCURRENCE S 'I,DOo,DO A X COMMERCIAL GENERAL LZABILITY X 10MEA0321804 GAMAGL 1-0 RLN] LD 07114M1 07!'14114 PREMISES Eaoommynca $ 300, CLAIMS E j—XI OCCUR MED EXP 4My aye Peraonj S S'00 l PERSONAL &ADV INJURY $ 1,000,0 t GENERAL AGGREGATE $ 3,000,00 GEN'L AGGR E GATE UNIT APPLIES PER- PRODUCTS - COMPIOPAGG $ 3,000,00 POLICY PRO- 1 LOC I $ AUTOMOBILE I- AMLiTY COM81NED SINGLE L1Mrr Ea accident ANY AUTO j BODILY INJURY {Per pemm] $ ALL OWNED SCHEDULED j I BODILY INJURY (Per ac6dent) s AUTOSIF NO -OVI NED I PROPERTY DAMAGE S HIRED AUTOS AUTOS I(Per aDmdent UMBAPUA WAS OCCUR I EACHOCCJRRENCE $ AGGREGATE $ EXCESS LIAR C"tMg MADE J DED F I RETENTION $ $ WORKERS COMPENSAnON 1NC�TATU- I O]}I- AND EMPLOYTJt.S'LIAB1LRY Y� ANY PROPMETOIARTNERIF-XECUTIE E.L. EACH ACCIDENT $ pPZCENMEMSER EXCLUDED? NIR (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY uMIT $ µye$. dlesttiCA inFdOF DESCRIPTfCN OF OPERATiONSbeltry DESCRIPTION OF OPERArONS i LOCATIONS I VEHICLES IAttacn ACORD 101, Additlonal Remarks Schedule, if moa apace Is required] Fulton County Schools is nasa9d as additional insured for use of their facilities. Coverage for additional insureds is strictly subject to all the ter J0.8 of the policy. CAhJr`FI I ATInki (P 99$5-2010 ACOR L) CORPO ATIQN. AN rlgntS reSeIVW. ACORI7 2S (2010!05) The ACORD name and logo are registered marks of ACORD -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES M CANCELLED BEFORE Fulton County Schools THE EXPIRATION DATE THEREOF!, NOTICE WILL SE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 786 Cleveland Ave SE Atlanta, GA 30354 AUTHORIZED REPRSSEWATnr£ Kenneth M Bird 7 •�,...,-Y� rZr _ �rx--.moi (P 99$5-2010 ACOR L) CORPO ATIQN. AN rlgntS reSeIVW. ACORI7 2S (2010!05) The ACORD name and logo are registered marks of ACORD INTERNAL REVE3J SERV --CE C N NC Ii+TNATI . ON D to -,[SEP r- 03 _000 OLD ALABAPlA RD ItLPHAIZPTI'A, GA 3002-2 Dear Apr J. car. w DEPARTMENT -1 DF TEE: TREASURY LN k7 SERTELSFN 1D# -_.-L34n _2011°,ac W Telephone Numbem : P•awi is chari y status a Our 'eater dated. MAY 1999,.stated you would be exempt 'from Federal in rmay€r_der cC �rx 5DI [wi 13j of: the, ...<_._r�� Rei en-ue Code, and You would be tr ate^ at, a publ :c izharity �urinq am advance period. Based on ouz- records and on the iniortnau on dot: we are Pleased to confirm `hat yca are exempt under sect10n SC' iw} 3; of the Code, and you are classified as a public charity under the Code seat Won listed ir_ thy: heading of this tette--1 Public -a- on 557, Tax -Exempt st�a�us `ter Your Orr iza'tio, Pro -ides detailed inFor, atior; abou- yoar rights and responsibili es as an exempt organization. You may req yes t a copy by call firer the e r xsnber for d err s ; Uu} 3 -3 ZI oXtSt Or, z.s also av lab e or .._. b;..ernnt ire: Cite a iswv . iW-e.a3 . If you have gerzeral quest ons about erernpp'. organizations, please ca?? our toil -Free number shown in the headinq between 2.00 a,m. - 6.37 p.m. Easter:,. wime. Please keep to .W let—er it y, t,ur pez-manert records, S.inc.,e. rely yours, • � f � y Directc_-, Exempt: 3,aanaz&tions Rut nqs and Agreements Le—IterTG50 ]rlf^ri Brian P. Kemp Secretary of State Entity Control No. K838180 NEWTO JN RECREATION, INC. 3000 OLID ALA13AI A RD Suite 104 Johns Creek, GA 30022 STATE OF GEORGIA 2812 Corporation Annual Registration OFFICE OF SECRETARY OF STATE Annual Registration Filings P.O. Sox 23038 Columbus, Georgia 31902-3038 Information on record as -of: 12;00.00 AM Amount Due: $55.00 Amount blue AFTER April 1, 2012: $55.00 Each business entity registered at filed with the Office of Secretary of State is required to file an annual registration. Amount due for this entity is indicated above and below on the remittance form. Annual fee is $30. If amount is more than M. the total reflects amount(s) due from previous year(s) and any applicable late fee(s)- Renew by April 1, 2010ur Annual Registration must be postmarked by April 1, 2012. If your registration and payment are not postmarked by April 1, 2012, you will be assessed a $25-00 late filing penalty fee. For faster processing, we invite you to file your Annual Registration online with a credit card at www - eor iaco orations.or . The Corporations Division accepts Visa, MC, Discovor, American Express and ATMIDebit Cards with the Visa or MC logo for online filings only. Annual Registrations not processed online require payment with a check, certified bank aleck or money order. We cannot accept cash for payment. You may mail your registration in by submitting the bottom portion of this remittance with a check or money order payable to "Secretary of State". All checks roust be pro -printed with a complete address in order to be accepted by our offices for your filing. Absolutely, no counter or starter checks will be accepted. Failure to adhere to these guidelines will delay or possibly reject your filing. Checks that are dishonored by your bank are subject to a $30.00 NSF charge. Failure to horror your payment could result in a civil suit filed against you andinr your entity may be Administratively Dissolved by the Secretary of State. (See O. C.G.A. § 13-6-15 and Title 14, respectively.] Officer, address and Agent information currently of record is listed below. Please verify "county of registered office," If correct and complete, detach bottom portion, sign, and return with payment. Or, enter changes as needed and submit. Complete each line, even if the same individual serves as Chief Executive Officer, Chief Financial Offiicer, and Secmtary of the ccrperation. Note: Registered Agent address must be a street address In Georgia when;' the agent may be served personally. A mail drop or P.O. Box does not comply with Georgia law for registered office. P.O. Boxes may be used for principal office and officers' addresses. Any person autha dzed by the entity to do so may sign and file registration (including online filing), Additionally, a person who signs a document submits an electronic filing he or she knows is false in any material respect with the intent that the document be delivered to the Secretary of State for fling shall be qu7lty of a misdemeanor and, mon conviction thereof, shall be punished to the highest degree permissihie by raw. fO.C.G.A. § 14-2-129.1 Please return ONLY the original form below and applicable fee(s). For more information on Annual Registrations or to file online, visit www.neorulacoroorations.arg. Or, call 404-656-2817. PLEASE PRINT LEGIBLY. Current €nformat! on printed below. Review and update as needed. Detach or€ginaI coupon and return with payment. _.._ _.... ---. CORPORATION NAIVE _._.._.... - ADDRESS CITY .._......................._....._.......... STATE ZIP NEWrOWN RECREATION, SNC. 3000 OLD ALABAMA RD Johns Cr k GA 3G022 CEO: BRANDON ALLENam 3000 Odd Alaba Rd. Johns Creed( GA € 30022 — ._...._ _._.._ `. Gro tai Hebert ........... _......._.. 300G Odd Aabama Road Johns Crsek GA 30072 SEC Rkh McCann 3000 Old Alabama Road Johns Cree4c GA 3+0022 AOT NEVV70M RECREATION, INC 3000 Old AWN ma Rd Johns Creek GA 30022 IF 14SOVE JNFOlaMATION RAs CHRt GE5 TYPE OR PRINT CORRECTIONS BELOW: l CORPORATION ACIDRESS: CEO: CFO: ............... SEC: ACT: GA CERTIFY THAT I AM AUTHORIZED TQ SIGN THIS FORM AND THAT THE INFORMATION IS TRUE AN CORRECT. P.O. BOX NOTACCEPTABLEFOR REGfSTER�D AGENT'SADORESS COUNTY OF REGISTERED OFFICE: Fulton COUNTY CHANGE OR 0ORRECTION: AUTHORIZED SIGNATURE.: RATE' TCM Due: TITLE: EMAIL: $55.0n BR2G1 2012 Corporation Annuat RKWFatirn 126 K838180%9 0030004 NEWTOWNRECREATI4NINC7 201204017 0055004 *�Sft Brian P. Kemp Secretary of State Entity Control No. K838180 NEWTOWN RECREATION, INC. 3000 OLD ALABAMA RD Suite 104 Johns Creek, GA 30022 STATE OF GEORGIA 2012 Corporation Annual Registration OFFICE OF SECRETARY OF STATE Annual Registration Filings P.O. Box 23038 Columbus, Georgia 31902-3038 Information on record as of: 12:00:100 AM Amount Clue: $55.00 Amount Clue AFTER April 1, 2012: $55.00 Each business entity registered or filed with the Office of Secretary of State is required to file an annual registration. Amount due for this entity is indicated above and below on the remittance form. Annual fee is $30. 1f amount is more than $30, the total reflects amount(s) due from previous years) and any applicable late fee(s). Renew by April 1, 2018ur Annual Registration must be postmarked by April 1, 2012. if your registration and payment are not postmarked by April 1, 2€112, you will be assessed a $25.00 late filing penalty fes. For faster processing, we invite you to file your Annual Registration online with a credit card at www-georgiaaorporations.oro. The Corporations DMsion accepts Visa, MC, Discover, American Express and ATM/Debit Cards with the Visa or MCI for online filings only. Annual Registrations not processed online require payment with a check, certified bank check or money order. We cannot accept cash for payment. You may mail your registration in by submitting the bottom portion of this remittance with a check or money order payable to "Secretary of State"- All checks must be pre-printed with a complete address in order to be accepted by our offices for your filing. Absolutely, no counter or starter Checks will be accepted. Failure to adhere to these guidelines will delay or possibly reject your filing. Checks that are dishonored by your bank are subject to a $30,00 NSF charge- Failure to honor your payment could result in a civil suit flied against you andlor your entity may be Administratively Dissolved by the Secretary of State. (See O. C.G.A. § 13-x-15 and Title 14, respectively.] Officer, address and Agent information currently of record is listed below. Please verify "county of registered office." if correct and complete, detach bottom portion, sign, and return with payment. Or, enter changes as needed and submit. Complete each line: even if the same individual serves as Chief Executive Officer, Chief Financial Off oer, and Secretary of the corporation. Note: Registered Agent address must be a street address in Georgia where the agent may be served personally, A mail drop or P.O. Box does not comply with Georg la law for registered office. P.0- Boxes may be used for principal office and officers' addresses. Any person authorized by the entity to do so may sign and file registration (including online f€ting). Additionally, a person who signs a document submits an electronic filing he or she knows Is false in any material respect with the intent that the docua ent be delivered to the Secretary of State for filing shall be guilty of a misdemeanor and, upon conviction thereof. shall be punished to tete highest degree permissible by law, IO.C.G.A. § 14-2-129.1 Please return ONLY the original form below and applicable fee(s)- For more information on Annual Registrations or to file online, visit www.aeorctiaco=rations.org. Or, call 404-656-2817. PLEASE PRINT LEGIBLY, Current information printed below. Review and update as needed, Detach original coupon and return with payment. 60RP6 RATI N NAME ADDRESS CITY STATE Zip NEWTOWN RECREATION, INC. 30CM OLD ALABAMA RD Johns Creek GA 30022 CEO BRANDON ALLEN 3000 Otti Ala4ama Rd. Johns Creek GA 30022 CFO1 Bi Hebe�R _ 3000 Old Alabama Road Johns Creek GA 301322 SEC Rich McCann 340 Od Alabama Road Johns Creek GA 30022 AGT NEWTCbM RECREATICK, INC, 3000 Cid Alabama Rd Jvhns Creek GA 30022 IF ABOVE WORMATWC N I CHANGES TYPE OR PRINT CORRECTIONS BELOW: Ci3l POPATION ADOREM ClWo: CFO. l SEC: — AGT: GA CERTIFY THAT I AM AVTHORIZEta TO SIGN THI5 POR M ANO THAT THE INFORMATION IS TRUE AND CORRECT. P.O. BQXMQTACCEPTABLE FOR REGIS TEREO AGENT $ADD4ESS COUNTY OF REGISTERED OFFICE: POW COUNTY CHANGE OR CORRECTION: AUTHORIZED SIGNATURE: DATE: Total Due: TITLE: EMAIL: $55.00 BR2012012 Corporation Annual Registration 126 K838180%9 003[]004 NEWTOWNRECREATT4NINC7 2011204017 0055004 a non-profit youth athletic association Newtown Recreation EIN: 58-2424266 3000 Old Alabama Road Suite 144 Johns Creek, GA 30022 (678) 297-2662 Fax (678) 297-3920 "Serving the Community through Sports" City of Milton 13000 Deerfield Parkway Suite 107C Milton, Georgia 30004 To: Honorable Mayor and City Council Members From: John Rebar, Parks and Recreation Director Submission Date: April 25, 2012 Meeting Date: May 7, 2012 Agenda Item: Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Agape Academy LLC. Background: The Parks and Recreation Department is eager to continue offering programs and additional services to the citizens of Milton. Many of these programs may be offered by outside providers through an agreement with the City of Milton based on a submitted program proposal rather than offering these programs through a paid independent contractor or a paid employee of the City. Discussion: The Parks and Recreation Department recommends entering into agreement with Agape Academy LLC to provide miscellaneous tennis programs for our residents and visitors. Programs may include: Cardio Tennis Tennis After School (TAS) Private Lessons Holiday Round Robins Tournaments Camps A commission of 30% of all registration fees will be paid to the City of Milton two weeks following the end of registration. Non-resident fees will be collected by the provider and paid to the City at a rate of 50% more. Legal Review: Contract Template - Paul Higbee, Jarrard & Davis on February 23, 2012 Attachments: A Parks and Recreation Department Agreement between the City of Milton and Agape Academy LLC. CITY OF MILTON PARIS & RECREATION DEPARTMENT AGREEMENT FOR OUTSIDE PROVIDERS THIS IS AN AGREEMENT, made this m day of , 2012, between: THE CITY OF MILTON, a municipal corporation organized and operating under the laws of the State of Georgia, with a business address of 13000 Deerfield Parkway, Suite 107 A, MILTON, Georgia 30004, hereinafter- referred to as the "CITY." and AGAPE ACADAMY LLC hereinafter referred to as "PROVIDER". CITY and PROVIDER may ir.ereinafter collectively be referred to as "the Parties". In consideration of the mutual obligations of the Parties and for good and valuable consideration, the adequacy and receipt of which are hereby acknowledged, the Parties agree as follows: ARTICLE 1.0 PROVIDER's Services and Responsibilities 1.1 PROVIDED shall conduct services generally described as Tennis Classes & Tennis Camps at the following location: Hopewell Middle School, t306il Coghurn Road, Milton, GA 30004; and Northwestern Middle School, 12805 Birmingharn llwy, Milton GA 34004, 1.2 The PROVIDER's services shall be performed during the days and hours described in Exhibit "A," attached hereto and incorporated herein by reference. 1.3 The PROVIDER and The Director of the Parks & Recreation Department or his designee, hereinafter referred to as the "DEPARTMENT", will agree iipnn program schedules. PROVIDER agrees to submit a Programa Request Form to the Coordinator for each program being proposed eight (S) weeks prior to the beginning of each session. 1.4 The fees charged to each participant will he as described in Exhibit "'A" for residents of MILTON and a surcharge of 50% more for non-residents of MILTON_ The entire valance of this surcharge for non-residents_ shall be paid to the CITY. 1.5 The PROVIDER warrants to CITY that it is riot insolent, it is riot lir baukrrrptCy proceedings or receivership, nor is it engaged in or threatened with any litigation or other legal or administrative proceedings or investigations of any kind which would have an adverse effect on its ability to perform its obligations under this Agreement. 1.6 The PROVIDER agrees that it shall be solely responsible for all costs and/or expenses associated with, or as a result of its operation under this Agreement. The PROVIDER stipulates and certifies that it is qualified to provide the programs it is hired the programs, and shall t;ontinuu to maintain such licenses or permits during the terrll of this Agreement. 1.7 This Agreement is considered a non-exclusive Agreement between the Parties. The CITY shall have the right to purchase the same kind of services to be provided by the PROVIDER from other sources during the tern of this Agreement. The PROVIDER is not precluded from providing the same or similar services for other parties so long as such other engagements do not interfere with the PROVIDER'S provision of services to the CITY. 1.8 The DEPARTMENT must approve any promotional material, flyers, and posters advertising the programs prior to its release. The following content and topics shall specifically be prohibited. sexually explicit materials, profanity, child pornography, alcoholic beverages, tobacco products, adult movies, adult book video .stores, adult entertainment establishments, massage parlors, pawn shops, and tattoo parlors or shops. 1.9 The PROVIDER shall not promote any privately owned business in a CITY park/facility or solicit any participant in a CITY park/facility activity for any privately owned business. The PROVIDER may not use said facilities to conduct personal business including work%bops, clinics, seminars, camps, or any other activities that are outside the scope of service described in (Exhibit "A"). It is further understood that such action{s} may result in immediate termination of the Agreement and the forfeiture of all compensation due to the PROVIDER. 1.10 The PROVIDER shall abide by the policies, procedures, rules and regulations of the DEPARTMENT, the CITY, and the FULTON COUNTY BOARD OF EDUCATION as promulgated from time to time. PROWDER understands and agrees that the DEPARTMENT shall have first prioLity for use of CITY Lacilifies, notwithstt tyImi - any other provisions o -this Agreement 1.11 All assistants, substitutes, and subcontractors utilized by the PROVIDER must have prior written approval of the DEPARTMENT. 1.12 PROVIDER shall provide necessary supervisory personnel to ensure that the participants of the programs obey all applicable policies, procedures, Rules and Regulations. 1.13 The DEPARTMENT or CITY may require that the PROVIDER not be permitted to utilize specific assistants, substitutes, or subcontractors of PROVIDER who have failed to follow any policies, procedures, rides or regulations applicable to the use of the facility. 1.14 Although the CITY Shall not control the PROVIDE.R's technique, methods, procedures, or sequence of instruction, the PROVIDER will comply with the CITY's and DEPARTMENT's policies, rules, regulations and procedures, as well as those of the FULTON COUNTY HOARD OF EDUCATION, and shall not interfere with their FA operation, icor liarin or daruage the ecluipriLcrit or fatalities afforded to PROVIDER for his/her programs, nor otherwise disrupt the Other on-site activities being offered at such public facilities. 1.15 The PROVIDER also acknowledges that he or she is primarily responsible for the conduct of the participants in all programs under the PROVIDER's charge. 1.16 If the PROVIDER will be providing services directly with minor children without parental supervision, the PROVIDER shall, prior to commencing services under this Agreement, comply with the CITY's policy regarding criminal background screening. The CITY will fitmish the PROVIDER with a background release form (Exhibit "B") for all the provider's counselors, coaches, volunteers, subcontractors, employees or any other individuals that will come in contact with a child, at the PROVIDER's sole expense. A Consent and Release Form to conduct a criminal background must be executed by any of PROVIDER's employees or any individual who will come in contact with a child at the CITY through PROVIDER or at PROVIDER's direction, such form authorizing the CITY to conduct a search of each such individual's criminal background. The result of such inquiry may be deemed acceptable by the CITY in its sole and complete discretion, and the CITY may reject any individual from participating in any program based upon such result,,. 1f the PROVIDER has recently had a background screening conducted by another agency, the CITY, at its sole discretion, may accept that background screening and waive the requirement of a new background screening. PROVIDER and its employees must also execute a Waiver and Release of Liability holding the CITY and FULTON COUNTY BOARD OF EDUCATION harmless. 1.17 The CITY shall require all participants in all programs to sign a Waiver and Release of Liability. ARTICLE 2.0 Equipment & Materials 2.1 All program materials and equipment needed or pertaining to the above stated programs will be provided by the PROVIDER at his/her own cost and expense. However, PROVIDER may require participants to obtain certain materials required in the programs by providing a list of such materials (with approximate costs) to the participants. If PROWDER makes such materials available to participants, they must be sold at PROVIDER's cost. All equipment provided by the PROVIDER shall be used in strict accordance with equipment manufacturer's instructions and in accordance with all applicable laws. PROVIDER shall coordinate storage of goal posts with the principal of the school located at the facility. 2.2 The sale of merchandise iS restricted to those materials utilized in anrd for the programs. Fundraising activities conducted by the PROVIDER will not be permitted. The PROVIDER shall obtain the CITY's approval of any merchandise to be sold prior to its distribution or sale. 3 PROVIDER shall obtain the [TTY's approval of any merchandise to be sold prior to its distribution or sale. 2.3 The CITY will provide no storage space to the PROVIDER, unless otherwise mutually agreed upon in a separate written agreement. 2.4 Any supplies or equipment left at the facility will be the responsibility of the PROVIDER. The CITY will not be responsible for any lost, stolen, or brokcii cquiprncrxt or supplies. 2.5 The PROVIDER shall inspect the premises and equipment offered to him/her for his/her proposed activity and if he or she finds anything Nvrong with the premises or equipment before each program commences that cannot be corrected immediately by the DEPARTMENT, the program shall be canceled and the matter reported to the DEPAR'T'MENT for correction. If the PROVIDER elects to hold his/her programs in the facility provided, it will be presumed that the PROVIDER has inspected the premises and facilities and equipment provided for such programs and has accepted same as being safe and suitable for the use intended. ARTICLE 3.0 Prosiram Size Minimums: 3.1 ACTIVE: Program sizes shall meet the minimum numbers of participants for each program as designated in Exhibit "A." ARTICLE 4.0 Compensation and Method of Payment 4.l In consideration of the releases and indemnities contained herein and of the PROVIDER's services in connection with the programs and activities described herein, the CITY shall be entitled to 30% of the registration fees paid by all program participants to the PROVIDER, and the PROVIDER shall be entitled to 70% of such fees paid, exclusive of the 50% nota -resident surcharge. The 50% non-resident surcharge is fully payable to the CITY and shall not be included in PROVIDER's gross income calculation. PROVIDER shall be entitled to retain all non -registration fees paid by participants to PROVIDER, i.e. PROVIDER membership fees and costs for uniforms and pictures to participants. 4.2 The PROVIDER agrees to collect all fees from participants, and the PROVIDER agrees to provide CITY with schedules of fees to be charged to participants in conformance with Exhibit "A". It is agreed that the PROVIDER`s sole obligation shall be to collect the fees from/ the participants and to remit the 30% of the fees collected as well as all 50% non-resident surcharge arnounts to the CITY with a nay -out report of all monies collected. Payment will be nnade to the CITY within fourteen (14) business days of the end of each month or session or program, whichever occurs first. 4 4.3 It is the responsibility of the PROVIDER to pay all applicable local, state, and federal taxes associated with this Agreement, and to acquire and pay for all necessary permits, licenses, and insurance required for the execution of this Agreement. ARTICLE 5.0 Independent PROVIDER 5.1 This Agreement does not create an employee/employer relationship between the Parties. It is the intent of the Parties that the PROVIDER is an independent contractor under this Agreement and not a CITY employee for all purposes, including but not limited to, the application of the Fair Labor Standards Act minimum wage and overtime payments, Federal Insurance Contribution Act, the Social Security Act, the Federal Unemployment Tax Act, the provisions of the Internal Revenue Code, The State Workers Compensation Act, and the State unemployment insurance law_ The PROVIDER shall retain sole and absolute discretion in the judgment of the manner and means of carrying out PROVIDER's activities and responsibilities hereunder. The PROVIDER agrees that it is a separate and independent enterprise from the CITY, that it had full opportunity to find other business, that it has made its own investment in its business, and that it will utilize a high level of skill necessary to perform the work required hereunder. This Agreement shall not be construed as creating any joint employment relationship between the PROVIDER and the CITY and the CITY will not be liable for any obligation incurred by PROVIDER, including but not limited to unpaid minimum wages or overtime premiums. 5.2 PROVIDER warrants that it has not employed or retained any company or person, other than a bona tide employee working solely for the PROVIDER to solicit or secure this Agreement, and that it has not paid or agreed to pay any person, company, corporation, individual or firm any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of this provision, the CITY shall have the right to terminate the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover the full amount of such fee, commission, percentage, gift or co nsideration. ARTICLE 6.8 insurance 6.1 PROVIDER shall not provide any service until all insurance required under this paragraph has been obtained and approved by the CITY. 6.2 Certificates of Insurance. Certificates of Insurance reflecting evidence of the required insurance shall be filed with the CITY prior to the commencement of this Agreement. These Certificates shall contain a provision that coverages afforded under these policies will not be cancelled until at least forty-five days (45) prior written notice has been given to the C1 Y. Policies shall be issued by companies authorized to do business under the laws of the State of Georgia. Financial Ratings must be not less than "A -VI" in the latest edition of "Best Key Rating Guide", published by A.M. Best Guide. 6.3 Insurance shall be in force until the obligations required to be fulfilled under the terms of the: Agreement are satisfied. In the event the insurance certificate provided indicated that the insurance shall terminate and lapse during the period of this Agreement, then in that event, the PROVIDER shall furnish, at least thirty (30) days prior to the expiration of the date of such insurance, a renewed Certificate of Insurance as proof that equal and like coverage for the balance of the period of the Agreement and extension thereunder is in effect. The PROVIDER shall not provide any service pursuant to this Agreement unless all required insurance remains in full force and effect. 5.4 Commercial General Liability insurance to cover liability bodily injury and property damage. Exposures to be covered are: premises, operations, products/completed operations, and certain contracts. Coverage must be written on an occurrence basis, with the following limits of liability: $1,000,000 Combined Single Limit — each occurrence $2,000,040 Combined Single Limit — general aggregate $1,000,000 Personal Injury $1,000,000 Products/Completed Operations Aggregate PROVIDER shall have its insurer name the City of MILTON as an additional insured on its General Liability policy. 6.5 Workers Compensation insurance shall be maintained during the life of this Agreement to comply with the statutory limits for all employees, and in the case any work is sublet, the PROVIDER shall require the subcontractor(s) similarly provide Workers Compensation Insurance for all the latter's employees unless and until such employees are covered by the protection afforded by the PROVIDER. The PROVIDER and his subcontractors shall maintain during the life of this Agreement Employers Liability Insurance. The following limits must be maintained: A. Workers Compensation Statutory B. Employer's Liability $100,000 each accident $500,000 Discasc-policy limit $100,000 Disease -each employee If PROVIDER or its subcontractor claims to he exempt from this requirement, PROVIDER shall provide CITY proof of such exemption along with a written request for CITY to exempt PROVIDER, written on PROVIDER or subcontractor's letterhead. 6.6 PROVIDER shall also maintain Auto Liability and Directors and Officers insurance with limits reasonably acceptable to CITY during the terra of this Agreement. 6.7 The CITY and the Fulton County Board of Education shall each be named as an additional insured and loss payee on all policies required by this Agreement. ARTICLE 7.0 Term and Termination 7.1 After a two (2) month trial period, the programs will be evaluated by the DEPARTMENT, and the remainder of this Agreement will either be terminated or continue in full farce and effect. If at any time after the two (2) month evaluation, program enrollment should fall below the required minimum, the PROVIDER wild be allotted four (4) weeks to bring enrollment up to the required mininmurn_ The programs will be reevaluated and execution or termination of the contract will be determined by the DEPARTMENT. 7.2 The term of this Agreement shall commence upon the date of execution hereof and shall remain in effect for a period of one (1) year from the date of execution of this Agreement by the CITY, unless terminated sooner as provided in this Article. Renewal of this Agreement beyond the one (1) year term shall require the mutual written agreement of the CITY and PROVIDER. 7.3 This Agreement may be terminated by the CITY for convenience upon giving of at least thirty (30) days prior written notice of termination to the PROVIDER at the PROVIDER's address set forth herein at the sole and exclusive discretion of the CITY. This Agreement may be terminated by the City immediately by written notice to PROVIDER upon any willful, reckless, or grossly negligent act or omission by PROVIDER or any of its officers, agents, employees, or volunteers. 7.4 This Agreement may be terminated by PROVIDER upon giving at least thirty (3 0) days written notice of termination to the CITY. 7.5 PROVIDER Frust notify the DEPARTMENT in writing of any program cancellations at least ten (ID) business days prior to the scheduled cancellation. T6 CITY reserves the right to caricel or reschedule any of the PROVIDER's programs, in the case of scheduling conflicts or other emergencies, as determined by the DEPARTMENT. ARTICLE 8.0 Indemnification 8.1 PROVIDER agrees to indemnify and hold harmless the CITY and the FULTON COUNTY BOARD OF EDUCATION, their trustees, elected and appointed officers, agents, servants and employees, from and against any and all claims, demands, or causes of action of whatsoever kind of Mature, and the resulting lusses, coy ,ts, expurises, reasonable attorneys' fees, including paralegal fees, liabilities, damages, orders, judgments, or decrees, sustained by the CITY, the FULTON COUNTY BOARD OF EDUCATION, or any third party arising out of, or by reason of, or resulting from the will fall or negligent acts, errors, or omissions of the PROVIDER or its agents, officers, volunteers or employees. VA 8.2 The Parties understand and agree that the covenants and representations relating to this indemnification provision shall survive the term of this Agreement and continue in full force and effect as to the PROVIDER's responsibility to indemnify. ARTICLE 9.0 Americans With Disabilities Act 9A PROVIDER shall not discriminate against any person in its operation and activities in its use or expenditure of the funds or any portion of the funds provided by this Agreement and shall affirmatively comply with all applicable provisions of the Americans With Disabilities Act C ADR."), in the programs while providing any services funded in whole or in part by the CITY, including Titles I and 11 of the ADA and all applicable regulations, guidelines, and standards. 9.2 PROVIDER's decisions regarding the delivery of services under this Agreement shall be made without regard to or consideration of race, age, religion, color, gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation, or any other factor which cannot be lawfully or appropriately used as a basis for delivery of service. ARTICLE 10.0 Miscellaneous 10.1 No modification, amendment, or alteration of the terms and conditions contained shall be effective unless contained in a written document executed with the same formality and equal dignity herewith. 14.2 This Agreement is non -transferable or assignable, and PROVIDER agrees not to transfer or assign the performance of services called for in the Agreement. 10.3 This Agreement sets forth the full and complete understanding of the Parties as of the effective date, and superseders any and all negotiations, agreements, and representations made or dated prior to this Agreement. 10.4 The PROVIDER shall pay reasonable (attorney's fees to the City should the City be required to incur attorney's fees in enforcing the provisions of this Agreement. 10.5 Time is of the essence of this Agreement. 10.6 Each of the individuals who executes this Agreement agrees and represents that he is authorized to execute this Agreement on behalf of the respective entity. Accordingly, the City and PROVIDER both waive and release any right to contest the enforceability of this Agreement based upon the execution and/or approval thereof. 8 10.7 It is the policy of City that unauthorized aliens shall not be employed to perforin work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the PROVIDER shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and "U" that it and its subcontractors have within the previous twelve (1 2) month period conducted a verification of the social security numbers of all employees who will perforin work on the City contract to ensure that no unauthori2ed aliens will be employed. The City Manager or his/her designee shalt be authorized to conduct an inspection of the PROVIDER's and its subcontractors' verification process to determine that the verification was correct and complete. The PROVIDER and its subcontractors shall retain all documents and records of its verification process for a period of three (3) years following completion of the contract_ This requirement shalt apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. Compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 is mandatory. PROVIDER's compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300- 10-1-.02 shall be attested by the execution of the contractor's affidavit attached as Exhibit Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to O.C.G.A. § 16-10-71), a form of which is attached hereto as Exhibit "E", and submitted such affidavit to the City in person, electronically, or by nail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's Iegal status, to the City either in person nr electronically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A. § 50-36-1). IN WITNESS OF THE FOREGOING, thu Parties have wl tticir hwids and seat the clay and year first written abase. CITY: ATTEST: BY: SUD[E GORDON, CITY CLERK JOE LOCKWOOD, MAYOR PROV tID- WI S sr: AMY PA /-A NI K, P SI ENT [AFFIX CORPORATE SEAL] 10 EXH113YU "A" PROGRAM REQUEST FORM individuals interested in PI-OPOsiny their- prvyralr7s 010 seWices must caMplete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form _Re r program. Name of Program: Cardio Tennis Participant Ages: 18 and up Day/s of the week program is offered= Monday - Sunday Time of Program: TBD by Recreation [Dept. Program Dates: Year Round Program Fee: $15-$20 Program Enrollment: 6-12 per class Materials to be supplied by participants: Tennis rackets, water Materials to be supplied by PROVIDER: Tennis balls, cones, and other court equipment Materials to be supplied by the City of MILTON: NONE Additional Program Requirements. Access to Northwestern Middle School Courts and Hopewell Middle School Courts PROVIDER (`s)Name: Array Pazahanick Address: 13085 Morris Road, Apt 13004 City/State/Zip Code: Milton, GA 30004 Phone Number: (678) 333-5934 Phone Number: (678) 333-5934 (E-mail): amypazahanick@hotmail.com (Fax) Minimum Requirements: 1,000,000 General Liability Insurance Office Use Only. - Program Rate:$ # of programs in Session - 5 Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must canrpiete and returlr this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: Tennis After School (TAS) Participant Ages: 7-18 Day/s of the week program is offered. Monday- Thursday Time of Program: TBD by Rccrcation Dept. Program Dates: August 13 2012 -- May 23`J 2013 (15 week sessions) Program Fee: $100-$700 Program Enrollment: Minimum: 16 Maximum: 64 Materials to be supplied by participants: Tennis rackets, water Materials to be supplied by PROVIDER- Tennis balls, extra rackets, mini tennis nets, cones, and other court equipment Materials to he supplied by the City of MILTON- NnNE Additional Program Requirements: Access to Northwestern Middle School Courts and Hopewell Middle School Courts PROVIDER (`s)Name: Amy Pazahanick Address: 13085 Morris Road, Apt 13004 City/State/Zip Code: Milton, GA 30004 (E-mail): arnypazahanickaa, hotmail.com (Fax) Minimum Requirements: 1,000,000 General Liability Insurance office Use only: Program Rate:$ # of programs in Session: Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will he used for consideration of program proposals. Use one form per program. Name of Program: Camps Participant Ages. 7-18 Day/s of the week program is offered: Monday - Sunday Time of Program: TBD by Recreation Dept. Program Dates: ,lune 151, 2012 — May 31St 2013 Program Fee: $100-300 Program Enrollment: Minimum: 10 Maximum: 84 Materials to be supplied by participants: Tennis rackets, water Materials to be supplied by PROVIDER: Tennis balls, mini tennis nets, cones, and other court equipment Materials to be supplied by the City of MILTON: NONE Additional Program Requirements: Access to Northwestern Middle School Courts and Hopewell Middle School Courts PROVIDER (s)Name: Amy Pazahanick Address: 13085 Morris Road, Apt 13004 City/State/Zip Code: Milton, GA 30004 Phone Number: (578) 333-5934 (E-mail): amylpazahanick@hotmail.com (Fax) Minimum Requirements: 1,000,000 General Liability Insurance Office Use Only. Program Rate:$ 9# of programs in Session: Fee/Program: EXHIBIT �`A" PROGRAM REQUEST .FORM Individuals imerestecl iii piupusaay !{jeii ptugfams and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per pro ram. Name of Program: Tournaments Participant Ages: 7-18 Day/s of the week program is offered: Thursday - Sunday Time of Program: TBD by Recreation Dept. Program Dates: Juno 1"', 2012 — May 3V 2013 Program Fee: S40-60 Program Enrollment. Minimum: 16 Maximum: 84 Materials to be supplied by participants: Tennis rackets, water Materials to be supplied by PROVIDER. Tennis balls, mini tennis nets, cones, and other court equipment Materials to be supplied by the City of MILTON: NONE Additional Program Requirements: Access to Northwestern Middle School Courts and Hopewell Middle School Courts PROVIDER (`s)Name: Amy Pazahanick Address: 13485 Morris Road, Apt 13004 City/State/Zip Code: Milton, GA 30004 Phone Number: (678) 333-5934 (E-mail): a:mypazahanick hatmail.com (Fax) Minimum Requirements: 1,000,000 General Liability Insurance Office Use only. Program Rate!$ # of programs in Session: Fee/Program: EXIIIHIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest This information will be used for consideration of program proposals. Use one form per program. Name of Program: Holiday Round Robins Participant Ages. 7 -18 Day/s of the week program is offered: Monday - Sunday Time of Program: TBD by Recreation Dept. Program Dates: June 1y` , 2012 -- May 315 2013 Program Fee: $15-60 Program Enrollment: Minimum: 16 Maximum: 84 Materials to be supplied by participants: Tennis rackets, water Materials to be supplied by PROVIDP.R: Tennis halls, mini tennis nets, cones, and other court equipment Materials to be supplied by the City of MILTON: NONE Additional Program Requirements: Access to Northwestern Middle School Courts and Hopewell Middle School Courts PROVIDER (`s)Name: Amy Pazahanick Address: 13085 Morris Road, Apt 13004 City/State/Zip Code: Milton, GA 30004 (E-mail): amypazahanick@hotrnail.com (Fax) Minimum Requirements: 1,000,000 General Liability Insurance Office Use Onty_- Program Rate-.$ # of programs in Session: Fee/Program: EXJJIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and semces must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: Private lessons Participant Ages: All Day/s of the week program is offered: Monday - Sunday Time of Program: TBD by Recreation Dept. Program Dates: Year Round Program Fee: $70 per hour Program Enrollment: 1 Materials to be supplied by participants: Tennis rackets, water Materials to he supplied by PROVIDFR: Tennis balls, cones, and other court equipment Materials to be supplied by the City of MILTON: NONE= Additional Program Requirements: Access to Northwestern Middle School Courts and Hopewell Middle School Courts PROVIDER (`s)Name: Amy Pazahanick Address: 13085 Morris Road, Apt 13004 City/State/Zip Code: Milton, GA 30004 Phone Number: (678) 333-5934 Phone Number: (67$) 333-5934 (E-mail): amypazahanick@hotmail.carn (Fax) Minimum Requirements: 1,000,000 General Liability Insurance office Use only.- Program nly: Program Rate;$__. # of programs in Session: Fee/Program: EXHIBIT "B" f. City of Milton Georgia Criminal History Record Information IR Request and Consent Form 1) Thls Request is For: ;Check only ones o Employment a Military o Licensing o Personal Use ❑ Other Use Not Listed (E) © international Travel n Firefighters Employment {E} P rospective Adoptive/Foster Parents (E r Note & 2 copies) rs Employment Working With The Eldedy (N) a Employment At A Child Care Fa6lty (W) X Volunteer working with C hildren (M n Employment Working With The Mentally III (M) ii Police Ride Along request (C) 3 Police Department VendorlContractor (C) 2) A History Is Requested On The Fallowing Person; Name: Social Security Number -- r -M M41%. Sex: Race: o White ❑ Black o A9ian n American Indian iiUnknownlOther Date Of l3iiLtr- Phone Nurnt)er. - - NanM noir vw G Check If Request Is For Yourself And Proceed To Section 5 At The Bottom Of This Page. 3) Person Requesting Criminal History: Name: City of MiltonlCompany Warne (TBD) Address 1:3ii(]f) nf4:?fie1d Parkway Shite 107 Phone' 678 242 2500 City; State 'Zip: Milton, GA 30004 4) Consent: This portion is to be used if the person requesting the criminal history is different than whom the criminal history is lysing inquired on (sections 118 III above are not the same person). T"lrird partynwaryls required. I hereby give my consent for my crit vml history to be nm and for the above named person in section i I I to have access to A- �� ----•--�-------�-- .err+: .. ax Seal: 5) in making flits request, I agree that the City of Milton Police Department, its ernq"ees, heirs, trustees, etc., shati in no way W held at fault for the use or rrususe of this recnrd- A photocopy of this release will be placed on file and is vatid as an original hereof, even Mugli the photocopy does not contain an original signature Incomp$ete requests will be denied. This reportis considered accwate at time of inquiry and may change at anytime - pr CAri1J-W&V 012 Oficial Use Onjy - Da Hai Mark Below This Use Results: azrzoas 56 11 Operato AR N Date Submitted i 1 Inquiry Date 1 t EXHIBIT "C" STATE OF GEORGIA CITY OF MILTON CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G_A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C_G.A_ § 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-_08 in the form attached hereto as Exhibit "D." Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perform such service. FEV 1 as c. Pilot Progr serIdeLication Number BY: Authorized Offtcer r AgAt Date Agape adamy LLC I dz� Title of Au rized OiVicer or Agent of Contractor Printed Naiue of Authorized Off ccr or Agent SUBSCRIBED AND SWORN BEFW ME ON T I5 THE DAY OF 2012-., N y Public ommission Expires' _. -0. . L ...]-t)1 if 12 STA'T'E OF GEORGIA CITY OF MILTON EXHIBIT "D" SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor Verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with Agape Acadarny LLC on behalf of the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. EEV 4Ba#ic Pilot Prim User Identification Dumber BY Authorized Offi�6r or A&ht ]date [INSERT SUBCONTRACTOR NAME] r Title of Aut ori�icer or Agent of Subcontractor Printed Name of Authorized Officer or Agent SUBSCRIBED AND SWORN BEFORE ME ON THIS THE �5'-DAY OF _ 4" , 201,,E 0;+t4' otary Pu is ission Expires. 0 � . J&'.date - 13 EXHIBIT -E' SAVE Affidavit By executing this affidavit under oath, and as an applicant for a public benefit, as referenced in O.C,G.A. § 50-36-1, from the City of Milton, the undersigned applicant verifies one of the following with respect to my application for a public benefit: t) l am a United States citizen. 2} lam a legal permanent resident of the United States. 3} I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by O.C_G.A. § 50-36-1(e}(1), with this affidavit. The .secure: and verifiable document provided with this affidavit can best be classified as: In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, ar fraudulent statement or representation in an affidavit shall be guilty of a violation of a.C.G.A. § 16-10-20, and face criminal penalties as allowed by such criminal statute. Executed in SUBSCRIBED AND SWORN BEFORE MF N THOS THE Z�DAY OFQ6422 20 f Z. OT RY PUBLIC ommission Expires:bt (cit'), (state). Signature o 'Applicant Printed Name of Applic t 14 rcity of Milton Business License (Horne Based Business) IN ACCORDANCE WITH THE PROVISIONS OF THE CITY OF MILTON CODE OF ORDINANCES, LICENSE IS HEREBY GRANTEE] TO OPERATE THE BUSINESS REFERENCED BELOW BUSINESS: Agape AcadAmy LLC ❑BA: 10CATFn AT 13085 MORRIS ROAD #13004 LIC ENSE #: BUS001770-03-2012 ELATE ISSUED: March 20, 2012 ,Ww DAVE EXPIRES: December 31, 2012 Given under my hand this date of March 21, 2092 Chris J. Lagerb[oom City Manager POST IN A CONSPICUOUS PEACE CbRH CERTIFICATE OF LIABILITY INSURANCE °04109/2012 Yl PR011A RETS - I'.OMPK)P ACn 'HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS :ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTENT] OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. iil$ CERTIFICATE= OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED ,EPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, NPORTANT, If the certificate holder Is an ADDITIONAL INSURED, the policylles3 must be endorsed. If SUBROGATION IS WAIVED, subject to the arms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the ertificate holder in lieu of such endorsement s . )DUCER kw rT JENKINS & ASSOCIATES INC. RAN`. I�n Fy? Alter Nn' 12930 HIGHWAY 9 NORTH INSURER($;AFFORDING COVERAGE NA€C n AL.PHARETTA, GA 30004 PH: 770-754.4001 FAX: 770-754-4010 INSURER A: SCOTTSDALE INSURANCE JRED INSURER 8: AGAPE ACADAMY LLC 12850 HIGHWAY 9 INSURER C. SHITE 600-206 INBu13eR o: ALPHARETTA GA INSURERS: INSURER F_ )VERAGES CERTIFICATE NUMBER: 114528 REVISION NUMBER: 'HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED AROVE FOR THE POLICY PERIOD JDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS :ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, XCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN SPIOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. ADDL SUHR POLICY EFF POLICY EXP ---� TYPE OF 1NSURANCE _......_ INSR WVD POLICY NUMBER LIMITS GENERAL LIABILITY CGLI 1510 0$(091201 0aJ091201 a EACH OCCURRENCE $ 1.000.000 X COMMERCIAL GENERAL LLA8ILITY REWIESES EaF ente}� y 100,000 .... _� CLAIMS -MADE OCCUR I I MED EXP (Any one person) S __-- .1'i,(10l) 6PNv AGORPIGAT'F I EMIT APPI IFIL GFR- p�Icn E� —1 LOC. AUTOMOBILE LIABILITY ANY AUTO AUTOSwriED R A[}THosuLEO HIRE° AUTOS ��-�NEO UMBRELLA LIAR CGCUR EXCESS LIAt3 CLAMS -MAD. DED RETENTION E WORKERS COMP EHSAYIOFI AND EMPLOYERS' LIA81LrrY Y I N ANY PROPRIETORIPARTNER/lEXECUTtVE{ j NIA ❑I'"I"WIJtMSER EXCLIDED7 I� (Mandatory In NRI If Yes, desrntg under CAI P710N OFOPERATIONSI LCCAT€ONSI VEHICLES (Attach ACORD 101, Additlonal Remarks Schedule, if more space A required) .-RTIFICAT E HOLDER 1S LISTED AS ADDITIONAL_ INSURED CITY OF MILTON FULTON COUNTY SCHOOLS GENERAL AGGF2E_4ATE - S - - - 21 PR011A RETS - I'.OMPK)P ACn (E WEeE US UMI ROM Ly III JURY (Per pu,son) 50101LYINJURY(Peracc4NM i E PffOPE . 'P oraccdent S EACH OCCURRENCE AGGREGATE S 3 $ Is E.L. EACH ACCIDENT ; S E.L DISEASE - EA EMPLOYEE $ E.L.DISFASE-PCiL€CYLIIJIi7 S SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE FXPIRA71014 DATE THEREOF, NOTICE WILL BE DELIVERER? IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORVED REP RE$E 14TATIVE 0 1988-2010ACORD CORPORATION. All rights reserved. ORD 25 (2010105) The ACORD name and Ioga are registered marks of ACO RD Control No. 12026419 STATE OF GEORGIA Secretary of State Corporations Division 313 Vest Tower 2 Martin Luther King, Jr. Drive Atlanta, Georgia 30334-1530 CERTIFICATE OF ORGANIZATION I, Brian P. Kemp, the Secretary of State and the Corporations Commissioner of the State of Georgia, hereby certify under the seal of my office that AGAPE ACADAMY LIMITED LIABILITY COMPANY a Domestic Limited Liability Company has been duly organized under the laws of the State of Georgia on 0312312012 by the filing of ai ticks orfoi gattization is the Office of Lhe Sect clary of State and by the paying of fees as provided by Title 14 of the Official Code of Georgia Annotated. WITNESS my hand and official seal in the City+ of Atlanta and the State of Georgia on March 23, 2012 r ■ 1VUMMO B ian P. Kemp Secretary of State City of Milton 13000 Deerfield Parkway Suite 107C Milton, Georgia 30004 To: Honorable Mayor and City Council Members From: John Rebar, Parks and Recreation Director Submission Date: April 25, 2012 Meeting Date: May 7, 2012 Agenda Item: Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Core Physique, LLC. Background: The Parks and Recreation Department is eager to continue offering programs and additional services to the citizens of Milton. Many of these programs may be offered by outside providers through an agreement with the City of Milton based on a submitted program proposal rather than offering these programs through a paid independent contractor or a paid employee of the City. Discussion: The Parks and Recreation Department recommends entering into agreement with Core Physique, LLC to provide miscellaneous fitness programs for our residents and visitors. Programs may include: Kids Summer Boot Camp Core Physique Fitness Camp Core Physique Smart Core Kids Afterschool Program Teachers Boot Camp A commission of 20% of all registration fees will be paid to the City of Milton two weeks following the end of registration. Non-resident fees will be collected by the provider and paid to the City at a rate of 50% more. Legal Review: Contract Template - Paul Higbee, Jarrard & Davis on February 23, 2012 Attachments: A Parks and Recreation Department Agreement between the City of Milton and Core Physique, LLC. CITY OF MILTON PARKS & RECREATION DEPARTMENT AGREEMENT FOR OUTSIDE PROVIDERS THIS IS AN AGREEMENT, made this day of , 2012, between: THE CITY OF MILTON, a municipal corporation organized and operating under the laws of the State of Georgia, with a business address of 13000 Deerfield Parkway, Suite 107 A, MILTON, Georgia 30004, hereinafter referred to as the "CITY." and CORE PHYSIQUE hereinafter referred to as "PROVIDER". CITY and PROVIDER may hereinafter collectively be referred to as "the Parties". In consideration of the mutual obligations of the Parties and for good and valuable consideration, the adequacy and receipt of which are hereby acknowledged, the Parties agree as follows: ARTICLE 1.0 PROVIDER's Services and Responsibilities 1.1 PROVIDER shall conduct services generally described as Fitness Classes & Boot Camps at the following location: Hopewell Middle School, 13060 Cogburn Road, Milton, GA 30004; Northwestern Middle School, 12805 Birmingham Hwy, Milton GA 30004; Cogburn Woods Elementary School, 13080 Cogburn Road, Milton GA 30004; Birmingham Falls Elementary School, 14865 Birmingham Hwy, Milton GA 30004; Bethwell Community Center, 2695 Hopewell Road, Milton GA 30004; Bell Memorial Park, 15245 Bell Road, Milton GA 30004. 1.2 The PROVIDER's services shall be performed during the days and hours described in Exhibit "A," attached hereto and incorporated herein by reference. 1.3 The PROVIDER and The Director of the Parks & Recreation Department or his designee, hereinafter referred to as the "DEPARTMENT", will agree upon program schedules. PROVIDER agrees to submit a Program Request Form to the Coordinator for each program being proposed eight (S) weeks prior to the beginning of each session. 1.4 The fees charged to each participant will be as described in Exhibit "A" for residents of MILTON and a surcharge of 50% more for non-residents of MILTON. The entire balance of this surcharge for non-residents shall be paid to the CITY. 1.5 The PROVIDER warrants to CITY that it is not insolvent, it is not in bankruptcy proceedings or receivership, nor is it engaged in or threatened with any litigation or other legal or administrative proceedings or investigations of any kind which would have an adverse effect on its ability to perform its obligations under this Agreement. 1 1.6 The PROVIDER agrees that it shall be solely responsible for all costs and/or expenses associated with, or as a result of its operation under this Agreement. The PROVIDER stipulates and certifies that it is qualified to provide the programs it is hired to provide, maintains the education and required licenses or permits necessary to provide the programs, and shall continue to maintain such licenses or permits during the term of this Agreement. 1.7 This Agreement is considered a non-exclusive Agreement between the Parties. The CITY shall have the right to purchase the same kind of services to be provided by the PROVIDER from other sources during the term of this Agreement. The PROVIDER is not precluded from providing the same or similar services for other parties so long as such other engagements do not interfere with the PROVIDER'S provision of services to the CITY. 1.8 The DEPARTMENT must approve any promotional material, _flyers, and posters advertising the programs prior to its release. The following content and topics shall specifically be prohibited: sexually explicit materials, profanity, child pornography, alcoholic beverages, tobacco products, adult movies, adult book/video stores, adult entertainment establishments, massage parlors, pawn shops, and tattoo parlors or shops. 1.9 The PROVIDER shall not promote any privately owned business in a CITY park/facility or solicit any participant in a CITY park/facility activity for any privately owned business. The PROVIDER may not use said facilities to conduct personal business including workshops, clinics, seminars, camps, or any other activities that are outside the scope of service described in {Exhibit "A"}. It is further understood that such action(s) may result in immediate termination of the Agreement and the forfeiture of all compensation due to the PROVIDER. 1.10 The PROVIDER shall abide by the policies, procedures, rules and regulations of the DEPARTMENT, the CITY, and the FULTON COUNTY BOARD OF EDUCATION as promulgated from time to time. PROVIDER understands and agrees that the DEPARTMENT shall have firs tsriority for use of CITY facilities, notwithstanding any other provisions of dais Agreement 1.11 All assistants, substitutes, and subcontractors utilized by the PROVIDER must have prior written approval of the DEPARTMENT. 1.12 PROVIDER shall provide necessary supervisory personnel to ensure that the participants of the programs obey all applicable policies, procedures, Rules and Regulations_ 1.13 The DEPARTMENT or CITY may require that the PROVIDER not be permitted to utilize specific assistants, substitutes, or subcontractors of PROVIDER who have failed to follow any policies, procedures, rules or regulations applicable to the use of the facility. 2 1. 14 Although the CITY shall not control the PROVIDER's techniques, methods, procedures, or sequence of instruction, the PROVIDER will comply with the CITY's and DEPARTMENT's policies, rules, regulations and procedures, as well as those of the FULTON COUNTY BOARD OF EDUCATION, and shall not interfere with their operation, not harm or damage the equipment or facilities afforded to PROVIDER for his/her programs, nor otherwise disrupt the other on-site activities being offered at such public facilities. 1.15 The PROVIDER also acknowledges that he or she is primarily responsible for the conduct of the participants in all programs under the PROVIDER's charge. 1.16 If the PROVIDER will be providing services directly with minor children without parental supervision, the PROVIDER shall, prior to commencing services under this Agreement, comply with the CITY's policy regarding criminal background screening. The CITY will furnish the PROVIDER with a background release form (Exhibit "B") for all the provider's counselors, coaches, volunteers, subcontractors, employees or any other individuals that will come in contact with a child, at the PROVIDER's sole expense. A Consent and Release Form to conduct a criminal background must be executed by any of PROVIDER's employees or any individual who will come in contact with a child at the CITY through PROVIDER or at PROVIDER's direction, such form authorizing the CITY to conduct a search of each such individual's criminal background. The result of such inquiry may be deemed acceptable by the CITY in its sole and complete discretion, and the CITY may reject any individual from participating in any program based upon such results. If the PROVIDER has recently had a background screening conducted by another agency, the CITY, at its sole discretion, may accept that background screening and waive the requirement of a new background screening. PROVIDER and its employees must also execute a Waiver and Release of Liability holding the CITY and FULTON COUNTY BOARD OF EDUCATION harmless. 1.17 The CITY shall require all participants in all programs to sign a Waiver and Release of Liability. ARTICLE 2.0 Equipment & Materials 2.1 All program materials and equipment needed or pertaining to the above stated programs will be provided by the PROVIDER at his/her own cost and expense. However, PROVIDER may require participants to obtain certain materials required in the programs by providing a list of such materials (with approximate costs) to the participants. If PROVIDER makes such materials available to participants, they must be sold at PROVIDER's cost. All equipment provided by the PROVIDER shall be used in strict accordance with equipment manufacturer's instructions and in accordance with all applicable laws. PROVIDER shall coordinate storage of goal posts with the principal of the school located at the facility. 3 2.2 The sale of merchandise is restricted to those materials utilized in and for the programs. Fundraising activities conducted by the PROVIDER will not be permitted. The PROVIDER shall obtain the CITY's approval of any merchandise to be sold prior to its distribution or sale. 2.3 The CITY will provide no storage space to the PROVIDER, unless otherwise mutually agreed upon in a separate written agreement. 2.4 Any supplies or equipment left at the facility will be the responsibility of the PROVIDER. The CITY will not be responsible for any lost, stolen, or broken equipment or supplies. 2.5 The PROVIDER shall inspect the premises and equipment offered to him/her for his/her proposed activity and if he or she finds anything wrong with the premises or equipment before each program commences that cannot be corrected immediately by the DEPARTMENT, the program shall be canceled and the matter reported to the DEPARTMENT for correction. If the PROVIDER elects to hold his/her programs in the facility provided, it will be presumed that the PROVIDER has inspected the premises and facilities and equipment provided for such programs and has accepted same as being safe and suitable for the use intended. ARTICLE 3.0 Program Size Minimums: 3.1 ACTIVE: Program sizes shall meet the minimum numbers of participants for each program as designated in Exhibit "A." ARTICLE 4.0 Compensation and Method of Payment 4.1 In consideration of the releases and indemnities contained herein and of the PROVIDER's services in connection with the programs and activities described herein, the CITY shall be entitled to 20% of the registration fees paid by all program participants to the PROVIDER, and the PROVIDER shall be entitled to 80% of such fees paid, exclusive of the 50% non-resident surcharge. The 50% non-resident surcharge is fully payable to the CITY and shall not be included in PROVIDER's gross income calculation. PROVIDER shall be entitled to retain all non -registration fees paid by participants to PROVIDER, i.e. PROVIDER membership fees and costs for uniforms and pictures to participants. 4.2 The PROVIDER agrees to collect all fees from participants, and the PROVIDER agrees to provide CITY with schedules of fees to be charged to participants in conformance with Exhibit "A". It is agreed that the PROVIDER's sole obligation shall be to collect the fees from the participants and to remit the 20% of the fees collected as well as all 50% non-resident surcharge amounts to the CITY with a pay -out report of all monies collected. Payment will be made to the CITY within fourteen (14) business days of the end of each month or session or program, whichever occurs first. 4.3 It is the responsibility of the PROVIDER to pay all applicable local, state, and federal taxes associated with this Agreement, and to acquire and pay for all necessary permits, licenses, and insurance required for the execution of this Agreement. ARTICLE 5.0 Independent PROVIDER 5.1 This Agreement does not create an employee/employer relationship between the Parties. It is the intent of the Parties that the PROVIDER is an independent contractor under this Agreement and not a CITY employee for all purposes, including but not limited to, the application of the Fair Labor Standards Act minimum wage and overtime payments, Federal Insurance Contribution Act, the Social Security Act, the Federal Unemployment Tax Act, the provisions of the Internal Revenue Code, The State Workers Compensation Act, and the State unemployment insurance law. The PROVIDER shall retain sole and absolute discretion in the judgment of the manner and means of carrying out PROVIDER's activities and responsibilities hereunder. The PROVIDER agrees that it is a separate and independent enterprise from the CITY, that it had full opportunity to find other business, that it has made its own investment in its business, and that it will utilize a high level of skill necessary to perform the work required hereunder. This Agreement shall not be construed as creating any joint employment relationship between the PROVIDER and the CITY and the CITY will not be liable for any obligation incurred by PROVIDER, including but not limited to unpaid minimum wages or overtime premiums. 5.2 PROVIDER warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the PROVIDER to solicit or secure this Agreement, and that it has not paid or agreed to pay any person, company, corporation, individual or firm any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of this provision, the CITY shall have the right to terminate the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover the full amount of such fee, commission, percentage, gift or consideration. ARTICLE 6.4 Insurance 6.1 PROVIDER shall not provide any service until all insurance required under this paragraph has been obtained and approved by the CITY. 6.2 Certificates of Insurance. Certificates of Insurance reflecting evidence of the required insurance shall be filed with the CITY prior to the commencement of this 9 Agreement. These Certificates shall contain a provision that coverages afforded under these policies will not be cancelled until at least forty-five days (45) prior written notice has been given to the CITY. Policies shall be issued by companies authorized to do business under the laws of the State of Georgia. Financial Ratings must be not less than "A -VI" in the latest edition of "Best Ivey Rating Guide", published by A.M. Best Guide. 6.3 Insurance shall be in force until the obligations required to be fulfilled under the terms of the Agreement are satisfied. In the event the insurance certificate provided indicated that the insurance shall terminate and lapse during the period of this Agreement, then in that event, the PROVIDER shall furnish, at least thirty (30) days prior to the expiration of the date of such insurance, a renewed Certificate of Insurance as proof that equal and like coverage for the balance of the period of the Agreement and extension thereunder is in effect. The PROVIDER shall not provide any service pursuant to this Agreement unless all required insurance remains in full force and effect. 6.4 Commercial General Liability insurance to cover liability bodily injury and property damage. Exposures to be covered are: premises, operations, products/completed operations, and certain contracts. Coverage must be written on an occurrence basis, with the following limits of liability: $1,000,000 Combined Single Limit — each occurrence $2,000,000 Combined Single Limit — general aggregate $1,000,000 Personal Injury $1,000,000 Products/Completed Operations Aggregate PROVIDER shall have its insurer name the City of MILTON as an additional insured on its General Liability policy. 6.5 Worker's Compensation insurance shall be maintained during the life of this Agreement to comply with the statutory limits for all employees, and in the case any work is sublet, the PROVIDER shall require the subcontractor(s) similarly provide Workers Compensation Insurance for all the latter's employees unless and until such employees are covered by the protection afforded by the PROVIDER. The PROVIDER and his subcontractors shall maintain during the life of this Agreement Employers Liability Insurance. The following limits must be maintained: A. Workers Compensation Statutory B. Employer's Liability $100,000 each accident $500,000 Disease -policy limit $100,000 Disease -each employee If PROVIDER or its subcontractor claims to be exempt from this requirement, PROVIDER shall provide CITY proof of such exemption along with a written request for CITY to exempt PROVIDER, written on PROVIDER or subcontractor's letterhead. 6.6 PROVIDER shall also maintain Auto Liability and Directors and Officers insurance with limits reasonably acceptable to CITY during the term of this Agreement. 6.7 The CITY and the Fulton County Board of Education shall each be named as an additional insured and loss payee on all policies required by this Agreement. ARTICLE 7.0 Term and Termination 7.1 After a two (2) month trial period, the programs will be evaluated by the DEPARTMENT, and the remainder of this Agreement will either be terminated or continue in full force and effect. If at any time after the two (2) month evaluation, program enrollment should fall below the required minimum, the PROVIDER will be allotted four (4) weeks to bring enrollment up to the required minimum. The programs will be reevaluated and execution or termination of the contract will be determined by the DEPARTMENT. 7.2 The term of this Agreement shall commence upon the date of execution hereof and shall remain in effect for a period of one (1) year from the date of execution of this Agreement by the CITY, unless terminated sooner as provided in this Article. Renewal of this Agreement beyond the one (1) year term shall require the mutual written agreement of the CITY and PROVIDER. 7.3 This Agreement may be terminated by the CITY for convenience upon giving of at least thirty (30) days prior written notice of termination to the PROVIDER at the PROVIDER's address set forth herein at the sole and exclusive discretion of the CITY. This Agreement may be terminated by the City immediately by written notice to PROVIDER upon any willful, reckless, or grossly negligent act or omission by PROVIDER or any of its officers, agents, employees, or volunteers. 7.4 This Agreement may be terminated by PROVIDER upon giving at least thirty (30) days written notice of termination to the CITY. 7.5 PROVIDER must notify the DEPARTMENT in writing of any program cancellations at least ten (10) business days prior to the scheduled cancellation. 7.6 CITY reserves the right to cancel or reschedule any of the PROVIDER's programs, in the case of scheduling conflicts or other emergencies, as determined by the DEPARTMENT. ARTICLE 8.0 Indemnification 8.1 PROVIDER agrees to indemnify and hold harmless the CITY and the FULTON COUNTY BOARD OF EDUCATION, their trustees, elected and appointed officers, agents, servants and employees, from and against any and all claims, demands, or causes of action of whatsoever kind of nature, and the resulting losses, costs, expenses, reasonable attorneys' fees, including paralegal fees, liabilities, damages, orders, judgments, or decrees, sustained by the CITY, the FULTON COUNTY BOARD OF 7 EDUCATION, or any third party arising out of, or by reason of, or resulting from the will full or negligent acts, errors, or omissions of the PROVIDER or its agents, officers, volunteers or employees. 8.2 The Parties understand and agree that the covenants and representations relating to this indemnification provision shall survive the term of this Agreement and continue in full force and effect as to the PROVIDER's responsibility to indemnify. ARTICLE 9.0 Americans With Disabilities Act 9.1 PROVIDER shall not discriminate against any person in its operation and activities in its use or expenditure of the funds or any portion of the funds provided by this Agreement and, shall affirmatively comply with all applicable provisions of the Americans With Disabilities Act ("ADA"), in the programs while providing any services funded in whole or in part by the CITY, including Titles I and II of the ADA and all applicable regulations, guidelines, and standards. 9.2 PROVIDER's decisions regarding the delivery of services under this Agreement shall be made without regard to or consideration of race, age, religion, color, gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation, or any other factor which cannot be lawfully or appropriately used as a basis for delivery of service. ARTICLE 10.0 Miscellaneous 10.1 No modification, amendment, or alteration of the terms and conditions contained shall be effective unless contained in a written document executed with the same formality and equal dignity herewith. 10.2 This Agreement is non -transferable or assignable, and PROVIDER agrees not to transfer or assign the performance of services called for in the Agreement. 10.3 This Agreement sets forth the full and complete understanding of the Parties as of the effective date, and supersedes any and all negotiations, agreements, and representations made or dated prior to this Agreement. 10.4 The PROVIDER shall pay reasonable attorney's fees to the City should the City be required to incur attorney's fees in enforcing the provisions of this Agreement. 10.5 Time is of the essence of this Agreement. 10.6 Each of the individuals who executes this Agreement agrees and represents that he is authorized to execute this Agreement on behalf of the respective entity. :3 Accordingly, the City and PROVIDER both waive and release any right to contest the enforceability of this Agreement based upon the execution and/or approval thereof. 10.7 It is the policy of City that unauthorized aliens shall not be employed to perform work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the PROVIDER shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and "D" that it and its subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perform work on the City contract to ensure that no unauthorized aliens will be employed. The City Manager or his/her designee shall be authorized to conduct an inspection of the PROVIDER's and its subcontractors' verification process to determine that the verification was correct and complete. The PROVIDER and its subcontractors shall retain all documents and records of its verification process for a period of three (3) years following completion of the contract. This requirement shall apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. Compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 is mandatory. PROVIDER's compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300- 10-1-.02 shall be attested by the execution of the contractor's affidavit attached as Exhibit «C �, Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to O.C.G.A. § 16-10-71), a form of which is attached hereto as Exhibit "E", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A. § 50-36-1). IN WITNESS OF THE FOREGOING, the Parties have set their hands and seal the day and year first written above. ATTEST: SUDIE GORDON, CITY CLERK WITNESS: ril if&I'm BY: JOE LOCKWOOD, MAYOR PROVIDER: B E RIDDICK, PRESIDENT [AFFIX CORPORATE SEAL] 10 EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will he used for consideration of program proposals. Use one form per prc ram_ Name of Program Participant Ages: S- 141 _ _ Dayls of the week prois offered: YAR Ll) Time of Program: < -M - l to Program Dates: tc ,.Al -pct Program Fee: cl _ Program Enrollment: Minimum Maximum Materials to be supplied by participants: _ilf�j- )ac,k, Materials to be supplied by PRMIDER: Materials to be supplied by the City of MILTON: hQ Ili Additional Program Requirements: PROVIDER (`s}Nay Address: City/State/Zip Code: Phone Number. {Da (I -mail): (Evening) Use Only. Rate:$ # of programs in Session: Fee/Program: Subsidy/Pr*nnr $ New Fee/Program: $ New Program Rate: $ EXHIBIT "A" PROGRAM REQUEST EQRM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form xer proemm. Name of Program: Participant Ages: Dayls of the week program is offered: I R Time of Program: & ?n -'I: I e� 1 _ny to Program Dates: to Program Fee: Program Enrollment Minimum _ 10 Maximum Materials to be supplied by partici ants: r -- ...._ A 7tl.6eJr -2 - Materials to be supplied by PROVIDER: Materials to be supplied by the City of MILTON: Additional Program Requirements: PROVIDER (`s)Name: Address: �e4w City/State/Zip Code: Phone Number: (Day). (Ermaii): (Evening) (Fax)_ Use Only: Rate: $ # of programs in Session: Fee/Program: SubsidylPrograin: $ New Fm/Program: $ New Program Rate $ EXHIBIT "A" PROGRAM REQUEST -FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter ofInterest. Interest. This information will be used for consideration ofprogram program proposals. Name of Prx Participant Ages: 061 t ftfz� " ' Day/s of the week program is offered: Time of Program: 1, 16 - ':X: 30 c--t•c -'to -_to Program Dates: Q4Ckr f'Q_LrzJ_ - _to Program Fee: C Program Enrollment: Minimum Maximu Materials to be supplied by participants: S�a bl Materials to be supplied by PROVIDER: Materials to be supplied by the City of MILTON: Additional Program Requirements: PROVIDER (`s)Name: Address: CitylStatelZip Code: I Phone Nbe . (Day) _ (E-mail): C (Evening) Use Only. Rates$ # of programs in Session: Fee/Program: Notes: Subsidy/Program: New Fee/Program: New Program Rate: $ EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per 13rogram. Name of Program:U Participant Ages: Ckd Dayls of the week program is offered: Time of Program: _=;'Afff a -AW to l QA Program Dates: LjeCu I g A to Program Fee: k X -% l wnffk_ CZC7 V_ Program, Enrollment: Minimum Maximum Materials to be supplied byparticipants: LL- " Com, 4., tck. rv"-+ Materials to be supplied by PROVIDER: Materials to be supplied by the City of MILTON: rOYA-e Additional Program Requirements: PROVIDER C s)Name: Address: 4 o Q ]gym U�'�a..xe � _ City/State/Zip Code: Phone Number: (Da (E-mail): koi l= 19t (Fax) I�l.�111.�YIV� Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will he used for consideration of program proposals. Use one form per program_ Name of Program: Participant Ages: Dayis of the week pro ram is offered: Time of Program: : �o aA-4 to Program Dates: Lrea_r YOB►-ol. to Program Fee: I I QO %may a- gO_QK a ux, PA!_ Program Enrollment: Minimum Maximum Materials to be supplied by participants: t_ -)Q �� Materials to he supplied by PROVIDER: Materials to be supplied by the City of MILTON: Y Qn L_ Additional Program Requirements: PROVIDER (`s)Name: Address: e -he city/state/zip Code: Y1R..tJI�C ' Q-A Phone Number: (Day) S64 5�QS 9fjq,C (Evening) (E-mail): (Fax) EXHISI T "A" PROGRAM REQUEST FQRM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form = pro Name of Program: Participant Ages: Ci W-k- Dayls of the week program is offered:. Time of Program: "'. M Cid Program Dates: Yt�Llr Program Fee: 120-,% Q Program Enrollment Minimum Materials to be supplied by participants Materials to be supplied by PROVIDER: Maximum Materials to be supplied by the City of MILTON: r\I4-9- Additional Program Requirements: PROVIDER (`s)Namq Address: 44(Ac) CitylStatelZip Code: _ Phone Number: (Day) (Evening) (Fax) ffiae Use Only. katc $ # of programs in Session: Fee/Program: Suhsldy/Pmgranr $_ Notes: New FeeiProgram: $ New Program Rate: $ EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals Name of Program: Participant Ages: one form Der Droaram Day/s of the week program is offered:'—T V11, T . Time of Program: �u to {� —1 �1 Program Dates: L 'Lu L to)4QV L� �l Program Fee: l Program Enrollment: Minimum 10 Maximum 3C) Materials to be supplied by participants: Materials to be supplied by PROVIDER:y Materials to be supplied by the city of MILTON: Additional Program Requirements: 4 PROVIDER (`s)Name: irl C,f CJ Address: City/State/Zip Cede: Y vu— Phone Number: (Day) (Evening) (E-mail}: CCV (Fax) Minimum Reauirements: 1,000,000 General Liability Insurance Office Use Only: Program Rate:$ # of programs in Session: Fee/Program: EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: Participant Ages: ' r ! 4 Day/s of the week program is offered: Time of Program: . `2, -1 to _5 - 5 Program Dates: _ Program Fee: Program Enrollment: Minimum i MaximumV Materials to be supplied by participants: aj u-���IVAL) Materials to be supplied by PROVIDER: Materials to be supplied by the City of MILTON: Additional Program Requirements: PROVIDER Cs}Name: Address: 4--a(- N&A-nr i,Cws V l� City/State/Zip Code: 1 AL&Anc Lq ?--my Phone Number: (Day) - {Evening} (E-mail): Minimum Requirements: 1,000,000 General I-iaUlity Insurance Office Use Only. - Program Rate:$ # of programs in Session: S Fee/Program: EXHIBIT "C" STATE OF GEORGIA CITY OF MILTON CONTRACTOR AFFIDAVIT AND AGREEMENT By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm, or corporation which is contracting with the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. The undersigned further agrees that, should it employ or contract with any subcontractor(s) in connection with the physical performance of services pursuant to this contract with the City of Milton, contractor will secure from such subcontractor(s) similar verification of compliance with O.C.G.A. § 13-10-91 on the Subcontractor Affidavit provided in Rule 300-10-01-.08 in the form attached hereto as Exhibit "D." Contractor further agrees to maintain records of such compliance and provide a copy of each such verification to the City of Milton at the time the subcontractor(s) is retained to perform such service. EEV 1 Basic Pilot Program User Identification Number BY: Authorized Officer or Agent Date Core Physique C& �J Title jof Authoriz d ficer or Agent of ntfactcT Printed Name of Authorize Officer or Agent SUBSCRIBED AND SWORN BEF RE ME ON THIS E &f:)AY OF '201 Z.. Notary Public NLL Commission Expires: [,3 12 STATE OF GEORGIA CITY OF MILTON EXHIBIT "D" SUBCONTRACTOR AFFIDAVIT By executing this affidavit, the undersigned subcontractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services under a contract with Core Physique on behalf of the City of Milton has registered with and is participating in a federal work authorization program, in accordance with the applicability provisions and deadlines established in O.C.G.A. § 13-10-91. EEV 1 Ba c Pilot Program User Identification Number BY: Authorized Officer or Agent Date [INSERT SUBCONTRACTOR NAME] --y1K J Title of utharized Of cer or Agent of c tractor Printed Name of Authorized 0 icer or Agent SUBSCRIBED AND SWORN BEFQZE ME ON TH HE a SAY OF, 201 2— Notary Public My Com sion Ex ices: 13 EI'd 4�r Sid!' EA !a EXHIBIT "E" SAVE Affidavit By executing this affidavit under oath, and as an applicant for a public benefit, as referenced in O.C.G.A. § 50-3 b-1, from the City of Milton, the undersigned applicant verifies one of the following with respect to my application for a public benefit: 1) 1 am a United States citizen. 2) 1 am a legal permanent resident of the United States. 3) I am a qualified alien or non-immigrant under the Federal Immigration and Nationality Act with an alien number issued by the Department of Homeland Security or other federal immigration agency. My alien number issued by the Department of Homeland Security or other federal immigration agency is: The undersigned applicant also hereby verifies that he or she is 18 years of age or older and has provided at least one secure and verifiable document, as required by 0.C.G.A. § 50-36-1(e)(1), with this affidavit. The secure and verifiable document provided with this affidavit can best be classified as: 1n making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious, or fraudulent statement or representation in an affidavit shall be guilty of a violation of O.C.G.A. § I6-10-20, and face criminal penalties as allowed by such criminal statute. Executed in (city), A-- (state). Sign ur�eofAApplicant 1�• � Printed Name of Applicant SUBSCRIBED AND SWORN BEFORE ME O THIS THE 6L6 AY OF , 20_Q_ NOTARY PUBLIC My Commission Expires: WINNE 14 14 CERTIFICATE OF LIABILITY INSURANCEDATEIMMIDDNYYY) —' 04/23/12 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 POLICIES 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 tS 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 Robert Kuchefski NAME: Hoffman Insurance Services, Inc. 141 Linden Street PO Box 9002 Wellesley, MA 02482-9002 PHONE _ 877-235-0408 ext. 145 FF 781.235.6665 A1C No ADDRESS, robertk@hoffmaninsurance.cam PRODUCER Phone: 781-235-0087 USTOMER. ID.r.,._....... _ _._....... ... _ INSURER S AFFORDING COVERAGE NAIC 0 Fax, 781-235-6665 .. INSURED ........................ ._ INSURERA : Philadelphia Indemnity Company INSURERB: : Core Physique INSURER C 460 Champions View Dr. INSURER D: IN SURER E: Alpharetta GA 30004 INSURER F: COVERAGES CERTIFICATE; NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES 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, INSR TYPE OF INSURANCE OLICY EXP L DDlYYYY I LIMITS AOOL SVBR POLICY EFF POLICY NUMBER MNVQ IYYYYt1,0112,812013 ACCORDANCE WITH THE POLICY PROVISIONS. GENERAL LIABILITY AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ 5,000,000 AV X COMMERCIAL GENERAL LIA91LITY CLAWS -MADE XOCCUR X 15317 01MI2012 D'MOE TO RENTED pREMI E Ea occurrence s 100,000 MED EXP (Any aneperson) $ 1,000 PERSONAL &ADV INJURY $ 5,000,000 Prof Llab Ind GENERAL AGGREGATE $ 6,000,000 GEN'LAGGREGATELIMIT APPLIESPER: € PRODUCTS-COMPiOPAGG $ 6.000,000 POLICY PRD- LOC $ AUTOMOBILE LIABILSTY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) S ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE $ (Per accident) $ NON -OWNED AUTOS UMBRELLA LIAR HCLAIMS-MADE OCCUR EACH OCCURRENCE I $ AGGREGATE $ EXCESS LIAR DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION Tg STATU- OTH- f AND EMPLOYERS' LIABILnY YIN _ E.L. EACH ACCIDENT $ s ANY PROPRIETORIPARTNERlR>[ECUTIVE l OFFICERJMEMBER EXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If es, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (AttachACORD 701, Additlonal Remarks Schedule, FI more space is requiredl Policy #: 1$317 1 Master Policy #: PHPK805687 Program Information: ro&,&A (e.g. ACE) I Member M 1364958 For a complete listing of coverage forms, please visit to www.InsurePersonalTrainers_comlresoutces. NOTE? All premium is fully earned at inception of policy CFRTIFICATFHOLnFR SeeenctosedforAdditionallmured CANCELLATION © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD Ac"Rh® CERTIFICATE OF LIABILITY INSURANCE � DATE iMMroOrYrrYj U4123112 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 POLICIES 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 po€icy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsemenL A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Robert Kuchefski NAME: PHONE g77.235.04D6 ext. 145 FAC No : 181-2356665 Hoffman Insurance Services, Inc. 141 Linden Street PO Box 9002 Wellesley, MAD2482-9002 ADhREs : roberlk@hoffmaninsurance.com PRODUCER Phone: 781-235.0087 RJiL#: INSU RERISIAFFORDING COVERAGE NAIC # Fax: 781-2356665 INSURED INSURER A - Philadelphia Indemnity Company INSURER B- Core Physique INSURER C : 460 Champions View Dr. INSURER 0: 0112$12013 I SNSURER E Alpharetta GA 30004 INSURER F �/ x COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES 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. NSR TYPE OF INSURANCE ADDL SVBR POLICY NUMBER Y EFF � MMi POLICRIYYYY i MWDD rrrr I LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 rA x COMMERCIAL GENERAL LIABILITY 15317 01/28/2012 0112$12013 I �1- , NTI D — PREMISES occu rice $ 100,000 CLAWS -MADE � OCCUR �/ x MED EXP (Any one an $ 1,000 PERSONAL BADV INJURY $ 5,000,000 Prof Liab Incl GENERAL AGGREGATE $ 6,UDO,DOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ $.000,000 POLICY F PRO-LOCJEUT Ll 3 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BDDILY I NJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS ; PROPERTY DAMAGE (Per accident) $ $ NON -OWNED AUTOS I $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MAGE DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION WC STATU- DTH - TORY LIMIT_ 1, AND EMPLOYERS' LIASILnY Y I N ANY PROPRIETORIPARTNERIE(ECUTIVE❑ E.L. EACH ACCIDENT $ OFF I GERIM EM BER EXC LU DED? NIA E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) Policy #: 15317 I Master Policy #: PHPK805687 Program information: KPASI4 (e.g. ACE) I Member*: 1364958 For a complete listing of coverage farms, please Visit to XOM „I, nsurePersonailuiners,comJresoudces. NOTE: All premium is fully earned at inception of policy CERTIFICATE HOLDER See enclosed for Additional Insured CANCELLATION Bell Memorial Park 0412312012 @ 12:59 pm SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 15245 Bell Park Road THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Milton CA AUTHORIZED REPRESENTATIVE 300M �'I988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD ACC?R" CERTIFICATE OF LIABILITY INSURANCE -' DATE (h1MiOD YYYYI D4123I12 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: POLICIES 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 thls certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME:. RabertKuchefski Hoffman insurance Services, Inc. 141 Linden Street PO Box 9002 Wellesley, MA 02482-9002 PHONE 877.235 0408 ext. 145 FAx 787-23Fr6665 IA1C. N, o],,,,-_ ADDDRESS: rohertk@hoffmaninsuranrs.com PRODUCER Phone: 781-235-0087 INSURERS) AFFORDING COVERAGE NATC # Fax: 781-2355-6665.... .. .. ............ �....—.... INSURER A: Philadelphia Indemnity Company INSURED ENSURER 8: Core Physique INSURER C: 460 Champions View Dr. INSURER D: INSURER E: Alpharetta GA 30004 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES 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_ INSR ADDL SUBR ......................._ ..—...._._......_..-..� LTR TYPE OF INSURANCEUS& POLICY NUMBER MMJDDNYYY MMID EXP OIYYYY I LIMITS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN GENERAL LIABILITY ACCORDANCE WITH THE POLICY PROVISIONS. Milton GA AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ 5,000,000 AX COMMERC€AL GENERAL LIABILITY CLAIMS -MADE Fx_1 OCCUR X 15317 01/28/2012 07128!2013 1 PR AIS EaEoccu rants $ 100.000 MED EXP (Any one person} $ 1,000 PERSONAL & ADV INJURY $ 5,000,000 X Prof Liah Incl GENERAL AGGREGATE $ 6.000,000 GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS - COMPIOP AGG $ 5,000,000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALL OWNEDAUTps BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE $ (Per aoddent) $ NON -OWNED AUTOS UMBRELLA UAB HOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAO CLAIMS -MADE DEDUCTIBLE g $ RETENTION $ WORKERS COMPENSATIONWO STATU- OTH- LIMITS I FIR AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIAARTNERIE(ECUTIVE OFFICERIMEMBER EXCLUDED? ❑ N I A E.L. EACH ACCIDENT $ F.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below _ t, DISEASE -POLICY LIMIT i I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Policy #: 15317 1 Master Policy 5-k PHPK805687 Program Information: �K_c&A (e,g. ACE) I Member#: 1364958 For a complete listing of coverage forms, please Visit to www.InsurePersonalTrainers.comlresources. NOTE: Al premium is fully earned at inception of policy CERTIFICATE HOLDER See enclosed For Additional Insured CANCELLATION Bethwell Community Center 44/2312012 @ 1;00 pm SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL -LED BEFORE 2695 Hopewell Road THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Milton GA AUTHORIZED REPRESENTATIVE 30004�� O 1888-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD i�csJio� CERTIFICATE OF LIABILITY INSURANCE DATE IMMI°DIYYYY' 04/23/12 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 POLICIES 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 aNT'e' T Kuchefski NAME: Robert PHONE677-235-0406 ext. 145 FAX 781.235-6665 _ A1C Nol: Hoffman Insurance Services, Inc, 141 Linden Street PO Bax 9002 Wellesley. MA02482.9002 E-MAILrobertk@hoffmaninsurance.com PRODUCER Phone: 781-235-0087 INSURER(S) AFFORDING COVERAGE NAIC 0 Fax: 781-235-6665 ._.......— INSURED .._....... . . ........ INSURER A : Philadelphia Indemnity Company ` INSURER 8: Core Physique INSURERC : 460 Champions View Dr. INSURER D: 01/2W013 INSURER E: Alpharetta GA 30004 PERSONAL &ADV INJURY $ $,000,000 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES 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- INSR TR TYPE OF INSURANCE AORL S116R POLICY NUMBER POLICY EFF MMID POLICY EXP M IO --- - - LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 A x COMMERCIAL GENERAL LIABILITY��// CLAIMS -MADE OCCUR x 15317 01/28/2012 01/2W013 DAMAGE TO RENTE PREMI E s occurrence $ 100,000 MED EXP A one arson $ 1.00D PERSONAL &ADV INJURY $ $,000,000 Prof Liab Incl GENERAL AGGREGATE $ 6,01DO.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG I $ 6.000,000 $ POLICY � PRO- LOC1 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY [Per person] $ ALL OWNED AUTOS BODILY INJURY [Per accident] $ SCHEDULEDAUTOS HIRED AUTOS PROPERTY DAMAGE $ [Per accident] $ NON -OWNED AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE I DEDUCTIBLE $ $ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY },1 N ANY PROPRIETOWPARTNERIEXECUTIVE WC STATU- I OTH- lTORY LIMITS FIR = E.L. EACH ACCIDENT 5 OFFICERIMEMBER EXCLUDED? ❑ N f A ; = E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) IF es, describe under DESCRIPTION OF OPERATIONS below = E.L. DISEASE - POLJCY LIMIT S DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Add MonaI Remarks Schedule, if more space is required) Policy #: 15317 1 Master Policy #: PHPK805687 Program Information: N,ASM (e.g. ACEI 1 Member#: 1354958 For a complete listing of coverage forms, please visit to www. IDsu rePersona ITrame rs. co mire sources. NOTE: All premium is fully earned at inception of policy CERTIFICATE HOLDER See enclosed for Adddonalinsured CANCELLATION Hopewell Middle School 0412 312 01 2 @ 1:01 pm SHOULB ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 13060 Cogbum Road THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Alpharetta CA AUTHORIZED REPRESENTATIVE 30004 p 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD atcar� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 4/23/12 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 POLICIES 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 Robert Kuchefski NAME: Hoffman insurance Services, Inc. PHONE 877-235-0408 ext. 145 FAX 781.235.6665 (A1C, No, Ext)• A1C No 141 Linden Street AIL ADDRESS: roloertk@hoffmaninsurance.com PO Bax 9002 Wellesley, MA02482-9002 PRODUCER Phone: 781-235.0087 C U 5 T DIKE R.tP _ INSURER Sj AFFORDING COVERAGE NAIC # Fax; 781-235.6665 INSURED INSURER A • Philadelphia Indemnity Company INSURER B Core Physique INSURER C 460 Champlons View Dr, INSURER a 0112812013 PREMISES Ea occurrence $ 100,000 URER 1R; Alpharetta GA 30004 ,IN ..... INSURER F - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES 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 - NSR €NSR LTR TYPE OF INSURANCE +ADOL SDBR �. POLICY NUMBER MMIDDDIYYYY MMiDD/YY Y LIMITS 30004�� GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 A�/ GENERAL LIABILITY 15317 DAMAGE TD RENTED /\ COMMERCIAL FX-1 01/28/2012 0112812013 PREMISES Ea occurrence $ 100,000 CLAIMS -MADE OCCURX MED EXP [Any one person] $ 1,000 V A PI'of Llal] Incl PERSONAL &ADV INJURY $ 5,000,000 GENERAL AGGREGATE $ 6,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COM PIOPAGG $ 6.000,000 POLICY PRG LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accidem) ANY AUTO BODILY INJURY (Per Person) $ ALL OWNED AUTOS BODILY INJURY [Per accident) S SCHEDULEDAUTOS PROPERTY DAMAGE HIRED AUTOS $ (Per acadent) MON-OWNED AUTOS $ S UMBRELLA LAB HOCCUR = EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE S QE.UCTIBLE $ RETENTION $ _ $ WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS' LIABILITY Y 1 N =TORY LIMITS FIR ANY PROPRIE70WPARTNERIEXECUTiVE = E.L. EACH ACC€PENT $ OFFICE RIMEMBEREXCLUDED7 NIA (Mandatory in NN) € E. L. DISEASE - EA EMPLOYEE 4 IP yes, describe under ' ❑ESCRIPTION OF OPERATIONS below E. L. DISEASE - POLICY LIMIT $ 4 I DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES lAttach ACORD 101, Additional Remarks Schedule, If more Space is required) Policy #: 15317 1 Master Policy #: P1-1PK805687 Program Information; n DSM (e.g-ACE) 1 Member#: 1364956 For a Complete listing of coverage forms, please visit to www.insurePersonalTrainf rm.com/resources. NOTE: All premium is fully earned at Inception of policy CERTIFICATE HOLDER See enclosed for Additional Insured CANCELLATION Birmingham Falls Elementary 0 412 312 01 2 @ 1:02 pm SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 14885 Birmingham Highway THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Milton GA AUTHORIZED REPRESENTATIVE 30004�� © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and Ingo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE IM?&oomrry 04/23/12 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 POLICIES 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 1S 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 Robert Kuchefski NAME: Hoffman Insurance Services, Inc, 141 Linden Street PO Bax 9002 PHONE 877-235-0406 ext. 145 FAX 781-235-6665 (A1C, No, Ext); AIC NO AIL ADDRESS: robertk@hoffmaninsurance.com Wellesley, MA02482.9002 PRODUCER Phone- 781-235-0087 C $T INSURER 5 AFFORDING COVERAGE NAIL # Fax: 781-235-6665 INSURED INSURER A: Philadelphia Indemnity Company INSURER B: T Core Physique INSURER C: 460 Champions View Dr. INSURER D CLAIMS -MADE OCCUR LNSURFR E Alpharetta GA 30004 INSURER F - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N07WTHSTANDING 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- ..... .....---..-............................................ . -- NSR )ILD- SUBR POLICY EFF r POLICY E%P T TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIODIYYYY LIMITS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN GENERAL LIABILITY ACCORDANCE WITH THE POLICY PROVISIONS. Alpharetta GA AUTHORIZED REPRESENTATIVE I EACH OCCURRENCE $ 5,000,000 A X 15317 DAMAGERENTED COMMERCIAL GENERAL LIABILITY �/ 5-/X �/ X 01/28/2012 01/28/2013 I PREMISESS ( Ea occurrence $ 100,000 CLAIMS -MADE OCCUR I MED EXP (Any one person) $ 1,000 X Prof Liab Incl PERSONAL &ADV INJURY $ 5,000,000 GENERAL AGGREGATE $ 6,000,000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS -COMPIOPAGG $ 6,000,000 PRO- POLICY LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY I NJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Peraccident) $ SCHEDULEDAUTOS PROPERTY DAMAGE $ H I RED AUTOS (Per accident) NON -OWNED AUTOS $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE S $ EXCESS LIAR CLAIMS -MADE :AGGREGATE $ DEDUCTIBLE S RETENTION 5 ; $ WORKERS COMPENSATION I OTH-f VVC STA"Y AND EMPLOYERS' LIABILITY YIN LIMTU- FR i ANY PROPRIETOWPARTNERIEXECUTIVE❑ E. L. EACH ACCIDENT $ OFPICEWMEMBER EXCLUDED? N I A (Mandatary In NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS Below E. L. DISEASE -POLICY LIMIT $ t l DESCRIPTION OF OPERATIONS f LOrAT1CNSI VEHICLES (AtlachACORD 101, Additional Remarks Schedule, If more space Is required) Policy*: 15317 I Master Policy #: PHPK805687 Program Information: n„iocna (e.g. ACEI I IJ+ember #: 1364958 For a oomplete listing of coverage forms, please visit to www.lnsurePersonalTrainers.comlresources. NOTE: Al premium is fully earned at inception of policy CFRTIFICATFHOLDFR SeeencIGsedforAddllipnallnsured CANCFLLATION Cog hurn Woods Elementary School 0412312012 @ 1:03 pm SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 13080 Cogburn Road THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Alpharetta GA AUTHORIZED REPRESENTATIVE 30004�� © 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE-ATE(MM1-i3fYYYY) �...-�" 04/23/12 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 POLICIES 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 Robert Kurnefski NAME: Hoffman insurance Services, Inc. PHONE 877.235-0406 ext. 145 FAX 781 -235-6665 141 Linden Street AfC No : _ PO Box 9002 E-roertkhoffmaninsurance.com A-MAILDRE b� _ Wellesley, MA 02482-9002 PRODUCER Phone' 781-235-0087 C MER ID u: Fax: 781-235.6665 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Philadelphia Indemnity Company Core Physique 460 Champions View Dr. Alpharetta GA 30004 INSURER F rK.lva.i_lei = i I: I:ir1a[al'I11: IkiUI1711M:11 1ATJrJrel aJ.nJ►,I:�x THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVATHSTANDING 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. NSR LTR ............._.. TYPE OF INSURANCE ADDL .._POLICY SVBRI POLICY NUM9ER EFF MMfD6lYYYY POLICY ElW MMIDD _.. LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 5,000,000 AXV COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX] OCCUR �/ X 15317 01/2802012 � 0 3 12 812 61 3 111 DAMA E RENTED PREMISES Ea occurrence $ 100.000 MED EXP (Any one person) $ 1,000 PER SONAL&AOVINJURY $ 5,000,000 Prof Liah Incl GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COM PIOP AGO $ 6,000,000 POLICY F7 PRC- F7 LOC $ AUTOMOBILE LIABILITY COMB€NED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY 1 NJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per acddent) $ SCHEOULED AUTOS HIRED AUTOS PROPERTY DAMAGE I (Per accident] $ $ MON-OWNED AUTOS $ UAB HOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR (^,CRINIS-MAf]E JUMBRELLA DEDUCTIBLE $ $ RETENTION S WORKERS COMPENSATION VVC STATU- I OTH- TORY LIMITS I7R AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOWARTNERIEXECUTIVE E.L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? r7 NIA E.L. DISEASE - EA EMPLOYE $ IMandatory, in NH) If es, describe under DESCRIPTION OF OPERATIONS nelow E.L. DISEASE - POLICY LIMIT $ I DESCRIPTION OF OPERATIONS lLOCAMONS1 VEHICLES (Attach ACORD tai, Additional Remarks Schedule, if more space Is required) Policy #: 15317 I Master Policy #: PHPK805687 Program Information: NAcna (e.g. ACE) I Member* 1364958 For a complete listing of coverage forms, please visit to www.lnstlreiersonalTralners.comlresources. NOTE- All premium is fully earned at inception of policy TFRTIrIr'❑TF HIST 1`1FP See enclosed for Addi tional Ins ured f Ar4r'FI I ❑Tlr)NI Summit Hill Elementart 04/23/2012 g 1:04 pm SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 13855 Providence Road THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Milton GA AUTHORIZED REPRESENTATIVE 30004 © 1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD ro 02, CL 99 LU V 1.� L�( 0 z z a I -- LU 0 LU J J_ LL J D LL LI 0 U LUm 0 z LLI E LI IY ma j, N LL J J Heartsaver American Trajn TCIf?H Heart CPR �t � E � Contar Name Cent a -_ — - - _.�oC�ining__XVA04015 Association. TO --ar h1a i.>�d, WA 98499233-5 646 PEES. _.................—_._._ ........................... .................. w, ....... KoMen Riddick HERE caixw C'S'R Training School. Alpharetta. GA ....__...w......... ...... Lomimw _................ _ _ Maw in mr €3r tWftwdInt MMD ChristilleNccI 770-365- " dkpsi txtte �s adc a r _--_._.._.... _................................ .................... _..._- _ 9128" 1r CPR» MwCM d2WN Hal6er's ..... ...................... ............................. .__....................... .......__......._...__............................ 5rgrwa ,Im _ —.._�_ _..... 149U& t1rs �BCAI[stTk6n�(Bd Ra1m V.'a� (]y5i9 C 23 F .,fit , Strike through the modules NOT Completed. This card contains unique security Features to protect against forgw 90-1813 3111 Al Brian P. Kemp Secretary of State Entity Control No. 08060647 CORE PHYSIQUE, LLC 460 Champions View Drive Milton, GA 30004 Control No: 08060647 Date Filed: 04/2312012 03:25 PM Brian P. Kemp STATE OF GEORGIA Secretary of State 2012 Limited Liability Company Annual Registration OFFICE OF SECRETARY OF STATE Annual Registration Filings P.O. Bax 23438 Columbus, Georgia 31942-3038 Information on record as of: 4123/2012 3:25:19 PM Amount Due: $50.00 Amount Due AFTER April 1, 2012: $50,00 Each business entity registered orfiled with the Office of Secretary of State is required to file an annual registration. Amount due for this entity is indicated above and below on the remittance form. Annual fee is $50. It amount is more than $50, the total reflects amount(s) due from previous year(s) and any applicable late fee(s). Renew by April 1, 2(WiBur Annual Registration must be postmarked by April 1, 2012. If your registration and payment are not postmarked by April 1, 2012, you will be assessed a $25.00 late filing penaltyfee. For faster processing, we invite you to file your Annual Registration online with a credit card at vv ww.tleorgiacarporations.or(I The Corporations Division accepts Visa, MC, Discover, American Express and ATMIDebit Cards with the Visa or MC logo for online filings only. Annual Registrations not processed online require payment with a check, certified bank check or money order. We cannot accept cash for payment. You may mail your registration in by submitting the bottom portion of this remittance with a check or money order payable to "Secretary of State". All checks must be pre-printed with a complete address in order to be accepted by our offices for your filing. Absolutely, no counter or starter checks will be accepted. Failure to adhere to these guidelines will delay or possibly reject you rfiling. Checks that are dishonored by your bank are subject to a $30 00 NSF charge. Failure to honor your payment could result in a civil suit filed against you andfor your entity may be Administratively Dissolved by the Secretary of State. [See 0,C.G.A. § 13-6-15 and Title 14, respectively.] Registered Agent information currently of record is listed below. Pie ase verify "cc unty of registered office." If correct and complete, detach bottom portion, sign, and return with payment. Or, enter changes as needed and submit. Note: Registered Agent address must be a street address in Georgia where the agent may be served personally. A mail drop or P.O. Box does not comply with Georgia law for registered office. P.O. Boxes maybe used for principal office and officers' add resses. Any person authorized by the entity to do so may sign and file registration (including online filing). Additionally, a person who signs a document submits an electronic filing he or she knows is false in any material respect with the intent that the document be delivered to the Secretary Of State for filing shall be guilty of a misdemeanor and, upon conviction thereof, shall be punished to the highest degree permissible by law. jO.C,G.A. § 14-2-129-1 Please return ONLY the original form below and applicable fee(s). For more information on Annual Registrations or to file online, visit www.georpiaccrporations.org. Or, call 404-556-2817. PLEASE PRINT LEGIBLY. Current information printed below. Review and update as needed. Detach original coupon and return with payment. .......................................................................................................................................................................................................... LIMITED LIABILITY CO PANYNAME ADDRESS CITY STATE ZIP CORE PHYSIQUE, LLC 460 Champions View Drive Alpharetta GA 34004 AGT: Riddick, Kolleen 460 Champions View Drive Alpharetta GA 30004 IF ABOVE INFORMATION HAS CHANGED, TYPE OR PRINT CORRECTIONS BELOW: Limited Liability Company Address 460 Champions view Drive Milton GA 30404 AGT: GA I CERTIFY THAT IAM AUTHORIZED TO SIGN THIS FORM AND THAT THE IN FORMATION IS TRUE AN D CORRECT. P. O.BOXNOTACCEPTABLEFOR REGIFTEPED AGENT'S ADDRESS COUNTYOF REGISTERED OFFICE: Fulton COUNTYCHANGE OR CORRECTION: AUTHORIZED SIGNATURE: Killeen Marie Riddick DATE: 412312012 Total Due: TITLE: Filer EMAIL: kolleenriddiok@oomcast.net $50.00 FF?39 7072 LimtedUi Itm lily compHnyAnnual Registration 126 06OL06475 0050009 C4REPHYSIQUELLC000047 201304©16 0050009 h11N inalviauai xequest - untine Appitcatlon EIN Assistant Your Progress: 1. Identity 2, Authenticate 3. Addresses Congratulations! Your EIN has been successfully assigned. EIN Assigned: 26-3378373 Legal Name: CORE PHYSIQUE LLC IMPORTANT: Save andlor print this page and the confirmation letter below for your permanent records. Page 1 of i 4. Details 5. EIN [ The confirmation letter below is your official IRS notice and contains important information regarding your EIN. CLICK HERE for Your EIN Confirmation Letter Help with saying. and printing..your letter Once you have saved or printed your letter, click "Continue" to get additional information about using your new EIN. Continue » Help Topics What if I C access to time? Can I acc later date' }httns:llcgl .www4 irc qnvlmnr1iPin/indivichinl/rnnfirmatinn 1cn 0/170AnR ti LO . l N C�7 Q rel MI NLO o tD °' L x O. w cuo C .� U o— s e dl��n N 0 � �� • Q) O - to o Ln= 4 CD Q j U CL d �roV i 0 -0 euo��� 0D 0- (D i U 8 u mo ♦♦ii u L V 0 L+ -- E'j E o � Co 7D a N � Q d ¢ yz � s a ....... ° . .. z M 72, > Z _ > o c C 0 0 0 m 1 (1) ou) 'r Z M r k m r C m r mj Il m .. m 1 r U) 0r rn 0 D z 9 D Copy of Personal Identification Documents Held in City Clerk’s Office City of Milton 13000 Deerfield Parkway Suite 107C Milton, Georgia 30004 To: Honorable Mayor and City Council Members From: John Rebar, Parks and Recreation Director Submission Date: April 25, 2012 Meeting Date: May 7, 2012 Agenda Item: Approval of a Parks and Recreation Agreement for Outside Providers between the City of Milton and Eagle Stix Lacrosse Inc. Background: The Parks and Recreation Department is eager to continue offering programs and additional services to the citizens of Milton. Many of these programs may be offered by outside providers through an agreement with the City of Milton based on a submitted program proposal rather than offering these programs through a paid independent contractor or a paid employee of the City. Discussion: The Parks and Recreation Department recommends entering into agreement with Eagle Stix Lacrosse Inc. to provide girls lacrosse for our residents and visitors. A commission of 10% of all registration fees will be paid to the City of Milton two weeks following the end of registration. Non-resident fees will be collected by the provider and paid to the City at a rate of 50% more. Legal Review: Contract Template - Paul Higbee, Jarrard & Davis on February 23, 2012 Attachments: A Parks and Recreation Department Agreement between the City of Milton and Eagle Stix Lacrosse Inc. CITY OF MILTON PARIS & RECREATION DEPARTMENT AGREEMENT FOR OUTSIDE PROVIDERS THIS IS AN AGREEMENT, made this day of , 2012, between: THE CITY OF MILTON, a municipal corporation organized and operating under the laws of the State of Georgia, with a business address of 13000 Deerfield Parkway, Suite 107 A, MILTON, Georgia 30004, hereinafter referred to as the "CITY." and EAGLE STIR LACROSSE INC. hereinafter referred to as "PROVIDER". CITY and PROVIDER may hereinafter collectively be referred to as "the Parties". In consideration of the mutual obligations of the Parties and for good and valuable consideration, the adequacy and receipt of which are hereby acknowledged, the Parties agree as follows: ARTICLE 1.0 PROVIDER's Services and Responsibilities 1.1 PROVIDER shall conduct services generally described as Girls LaCrosse at the following location: Northwestern Middle School, 12805 -Birmingham Hwy, Milton GA 30004. 1.2 The PROVIDER's services shall be performed during the days and hours described in Exhibit "A," attached hereto and incorporated herein by reference. 1.3 The PROVIDER and The Director of the Parks & Recreation Department or his designee, hereinafter referred to as the "DEPARTMENT", will agree upon program schedules. PROUDER agrees to submit a Program Request Form to the Coordinator for each program being proposed eight (S) weeks prior to the beginning of each session. 1.4 The fees charged to each participant will be as described in Exhibit "A" for residents of MILTON and a surcharge of 50% more for non-residents of MILTON. The entire balance of this surcharge_for non-residents shall be paid to the CITY. 1.5 The PROVIDER warrants to CITY that it is not insolvent, it is not in bankruptcy proceedings or receivership, nor is it engaged in or threatened with any litigation or other legal or administrative proceedings or investigations of any kind which would have an adverse effect on its ability to perform its obligations under this Agreement. 1.6 The PROVIDER agrees that it shall be solely responsible for all costs and/or expenses associated with, or as a result of its operation under this Agreement. The PROVIDER stipulates and certifies that it is qualified to provide the programs it is hired to provide, maintains the education and required licenses or permits necessary to provide 1 the: programs, and shall continue to maintain such licenses or permits during the term of this Agreement_ 1.7 This Agreement is considered a non. -exclusive Agreement between the Parties. The CITY shall have the right to purchase the smut kind of services to be provided by the PROVIDER from other sources during the term of this Agreement_ The PROVIDER is not precluded from providing the same or similar services for other parties so long as such other engagements do not interfere with the PROVIDER'S provision of services to the CITY. 1.8 The .DEPARTMENT must approve any promotional material, flyers, and posters advertising the programs prior to its release. The following content and topics shall specifically be prohibited: sexually explicit materials, profanity, child pornography, alcoholic beverages, tobacco products, adult movies, adult book/video stores, adult entertainment establishments, massage parlors, pawn shops, and tattoo parlors or shops 1.9 The PROVIDER shall not promote any privately owned business in a CITY park/facility or solicit any participant in a CITY parka€acility activity for any privately owned business. The PROVIDER may not use said facilities to conduct personal business including workshops, clinics, seminars, camps, or any other activities that are outside the scope of service described in (Exhibit "A"). It is further understood that such action{s} may result in immediate termination of the Agreement and the forfeiture of all compensation due to the PROVIDER. 1.10 The PROVIDER shall abide by the policies, procedures, rules and regulations of the DEPARTMENT, the CITY, and the FULTON COUNTY BOARD OF EDUCATION as promulgated from time to time. PROVIDER understands and arrees that the DEPARTMENT shall have first priority for use 9L CITY Lac lllties, notwithstanding- ai2y other provisions of this Agreement 1.11 All assistants, substitutes, and subcontractors utilized by the PROVIDER must have prior written approval of the DEPARTMENT. 1.12 PROVIDER shall provide necessary supervisory personnel to ensure that the participants of the programs obey all applicable policies, procedures, Rules and Regulations. 1.13 The DEPARTMENT or CITY may require that the PROVIDER not be permitted to utilize specific assistants, substitutes, or subcontractors of PROVIDER who have failed to follow any policies, procedures, rules or regulations applicablc to the use of the facility. 1.14 Although the CITY shall not control the PROVIDER's techniques, methods, procedures, or sequence of instruction, the PROVIDER will comply with the CITY's and DEPARTMENT's policies, rules, regulations and procedures, as well as those of the FULTON COUNTY BOARD OF EDUCATION, and shall not interfere with their 2 operation, nor harm or damage the equipment or facilities afforded to PROVIDER for his/her programs, nor otherwise disrupt the other on-site activities being offered at such public facilities. 1.15 The PROVIDER also acknowledges that he or she is primarily responsible: for the conduct of the participants in all programs under the PROVIDER's charge. 1.16 If the PROVIDER will be providing services directly with minor children without parental supervision, the PROVIDER shall, prior to commencing services under this Agreement, comply with the CITY's policy regarding criminal background screening. The CITY will furnish the PROVIDER with a background release form (Exhibit "B") for all the provider's counselors, coaches, volunteers, subcontractors, employees or any other individuals that will come in contact with a child, at the PROVIDER's sole expense. A Consent and Release Form to conduct a criminal background must be executed by any of PROVIDER's employees or any individual who will come in contact with a child at the CITY through PROVIDER or at PROVIDER's direction, such form authorizing the CITY to conduct a search of each such individual's criminal background. The result of such inquiry may be deemed acceptable by the CITY in its sole and complete discretion, and the CITY may reject any individual from participating in any program based upon such results. If the PROVIDER has recently had a background screening conducted by another agency, the CITY, at its sole discretion, may accept that background screening and waive the requirement of u new background screening. PROVIDER and its employees must also execute a Waiver and Release of Liability holding the CITY and FULTON COUNTY BOARD OF EDUCATION harmless. 1.17 The CITY shall require all participants in all programs to sign a Waiver and Release of Liability. ARTICLE 2.0 Eguiymeut & Materials 2.1 All program materials and equipment needed or pertaining to the above stated programs will be provided by the PROVIDER at his/her own cost and expense. However, PROVIDER may require participants to obtain certain materials required in the programs by providing a list of such materials (with approximate costs) to the participants. If PROVIDER makes such materials available to participants, they must be sold at PROVIDER's cost. All equipment provided by the PROVIDER shall be used in strict accordance with equipment manufacturer's instructions and in accordance with all applicable laws. PROVIDER shall coordinate storage of goal posts with the principal of the school located at the facility. 2.2 The sale of merchandise is restricted to those materials utilized in and for the programs. Fundraising activities conducted by the PROVIDER will not be permitted. The PROVIDER shall obtain the CITY's approval of any merchandise to be sold prior to its distribution or sale. 2.3 The CITY will provide no storage space to the PROVIDER, unless otherwise mutually agreed upon in a separate written agreement. 2.4 Any supplies or equipment left at the facility will be the responsibility of the PROVIDER. The CITY will not be responsible for any lost, stolen, or broken equipment or supplies. 2.5 The PROVIDER shall inspect the premises and equipment offered to him/her for his/her proposed activity and if he or she finds anything wrong with the premises or equipment before each program commences that cannot be corrected immediately by the DEPARTMENT, the program shall be canceled and the matter reported to the DEPARTMENT for correction. If the PROVIDER elects to hold his/her programs in the facility provided, it will be presumed that the PROVIDER has inspected the premises and facilities and equipment provided for such programs and has accepted same as being safe and suitable for the use intended. ARTICLE 3.0 Program Size Minimums: 3.1 ACTIVE: Program sizes shalt meet the minimum numbers of participants for each prvgran as designated in Exhibit "A." AW14CLE 4.0 Com2ensation and Method of Payment 4.1 In consideration of the releases and indemnities contained he cin and of the PROVIDER's services in connection with the programs and activities described herein, the CITY shall be entitled to 10% of the registration fees paid by all program participants to the PROVIDER, and the PROVIDER shall be entitled to 90% of such fees paid, exclusive of the 50% non-resident surcharge. The 50% non-resident surcharge is fully payable to the CITY and shall not be included in PROVIDER's gross income calculation. PROVIDER shall be entitled to retain all non -registration fees paid by participants to PROVIDER, i.e. PROVIDER membership fees and costs for uniforms and pictures to participants. 4.2 The PROVIDER agrees to collect all fees from participants, and the PROVIDER agrees to provide CITY with schedules of fees to be charged to participants in conformance with Exhibit "A". It is agreed that the PROVIDER's sole obligation shall be to collect the fees from the participants and to remit the 10% of the fees collected as well as all 50% non-resident surcharge amounts to the CITY with a pay -out report of all monies collected. Payment will be made to the CITY within fourteen (14) business days of the end of each month ar session nr program, whichever occurs first. 4.3 It is the responsibility of the PROVIDER to pay all applicable local, state, and federal taxes associated with this Agreement, and to acquire and pay for all necessary permits, licenses, and insurance required for the execution of this Agreement. ARTICLE 5.0 Independent PROVIDER 5.1 This Agreement does not create an employee/employer relationship between the Parties. It is the intent of the Parties that the PROVIDER is an independent contractor under this Agreement and not a CITY employee for all purposes, including but not limited to, the application of the Fair Labor Standards Act minimum wage and overtime payments, Federal Insurance Contribution Act, the Social Security Act, the Federal Unemployment Tax Act, the provisions of the Internal Revenue Code, The State Workers Compensation Act, and the State unemployment insurance law. The PROVIDER shall retain sole and absolute discretion in the judgment of the manner and means of carrying out PROVIDER's activities and responsibilities hereunder. The PROVIDER agrees that it is a separate and independent enterprise from the CITY, that it had full opportunity to find other business, that it has made its own investment in its husiness, and that it will utilize a high level of skill necessary to perform the work required hereunder. This Agreement shall not be construed as creating any joint employment relationship between the PROVIDER and the CITY and the CITY will not be liable for any obligation incurred by PROVIDER, including but not limited to unpaid minimum wages or overtime premiums. 5.2 PROVIDER warrants that it has not employed or retained any company or person, other than a bona fide employee working solely for the PROVIDER to solicit or secure this Agreement, and that it has not paid or agreed to pay any person, company, corporation, individual or firm any fee, commissiwi, percentage, gift, or oilier consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of this provision, the CITY shall have the right to terminate the Agreement without liability at its discretion, to deduct from the contract price, or otherwise recover the full amount of such fee, commission, percentage, gift or consideration. ARTICLE 5.0 Insurance 6.1 PROVIDER shall not provide any service until all insurance required tinder this paragraph has been obtained and approved by the CITY. 6.2 Certificates of Insurance. Certificates of Insurance reflecting evidence of the required insurance shall be filed with the CITY prior to the commencement of this Agreement. These Certificates shall contain a provision that coverages afforded under these policies will not be cancelled until at least forty-five days (45) prior written notice has been given to the CITY. Policies shall be issued by companies authorized to do business under the laws of the State of Georgia. Financial Ratings must be not less than "A-V I" in the latest edition of"Best Ivey Rating Guide", published by A.M. Best Guide. 6.3 Insurance shall be in force until the obligations required to be fulfilled under the terms of the Agreement are satisfied. In the event the insurance certificate provided indicated that the insurance shall terminate and lapse during the period of this Agreement, then in that event, the PROVIDER shall furnish, at least thirty (30) days prior to the expiration of the date of such insurance, a renewed Certificate of Insurance as proof that equal and like coverage for the balance of the period of the Agreement and extension thereunder is in effect. The PROVIDER shall not provide any service pursuant to this Agreement unless all required insurance remains in full force and effect. 6.4 Commercial General Liability insurance to cover liability bodily injury and property damage. Exposures to be covered are: premises, operations, products/completed operations, and certain contracts. Coverage must be written on an occurrence basis, with the following limits of liability: $1,000,000 Combined Single Limit — each occurrence $2,000,000 Combined Single Limit— general aggregate $1,000,000 Personal Injury $1,000,040 ProductslCompleted Operations Aggregate PROVIDER shall have its insurer name the Pity of MILTON as an additional insured on its General Liability policy. 6.5 Worker's Compensation insurance shall be maintained during the life of this Agreement to comply with the statutory Iinits for all employees, and in the case any work is sublet, the PROVIDER shall require the subcontractor(s) similarly provide Workers Compensation Insurance for all the latter's employees unless and until such employees are covered by the protection afforded by the PROVIDER. The PROVIDER and his subcontractors shall maintain during the life of this Agreement Employers Liability Insurance. The following limits must be maintained: A. Workers Compensation Statutory R. Employer's Liability $100,000 each accident $500,000 Disease -policy limit $100,000 Disease -each employee If PROVIDER or its subcontractor claims to be rxrrrtpt from this requirement, PROVIDER shall provide CITY proof of such exemption along with a written request for CITY to exempt PROVIDER, written on PROVIDER or subcontractor's letterhead. 6.6 PROVIDER shall also maintain Auto Liability and Directors and Officers insurance with limits reasonably acceptable to CITY during the term of this Agreement. 6.7 The CITY and the Fulton County Board of Education shall each be named as an additional insured and loss payee on all policies required by this Agreement. ARTICLE 7.0 Term and Termination 7.1 After a two (2) month trial period, the programs will be evaluated by the DEPARTMENT, grid the remainder of this Agreement will either be terminated or continue in full force and effect. If at any time after the two (2) month evaluation, program enrollment should fall below the required minimum, the PROVIDER will be allotted four (4) weeks to bring enrollment up to the required minimum. The programs will be reevaluated and execution or termination of the contract will be determined by the DEPARTMENT. 7.2 The term of this Agreement shall commence upon the date of execution hereof and shall remain in effect for a period of one (1) year from the date of execution of this Agreement by the CITY, unless terminated sooner as provided in this Article. Renewal of this Agreement beyond the one (1) year term shall require the mutual written agreement of the CITY and PROVIDER. 7.3 This Agreement may he terminated by the CITY for convenience upon giving of at least thirty (30) days prior written notice of termination to the PROVIDER at the PROVIDER's address set forth herein at the sole and exclusive discretion of the CITY. This Agreement may be terminated by the City immediately by written notice to PROVIDER upon any willful, reckless, or grossly negligent act or omission by PROVIDER or any of its officers, agents, employees, or volunteers. 7.4 This Agreement may be terminated by PROVIDER upon giving at least thirty (30) days written notice of termination to the CITY. 7.5 PROVIDER must notify the DEPARTMENT in writing of any program cancellations at least ten (10) business days prior to the scheduled cancellation. 7.6 CITY reserves the right to cancel or reschedule any of the PROVIDEWs programs, in the case of scheduling conflicts or other emergencies, as determined by the DEPARTMENT. ARTICLE 8.0 Indemnification 8.1 PROVIDER agrees to indemnify and hold harmless the CITY and the FULTON COUNTY BOARD OF EDUCATION, their trustees, elected and appointed officers, agents, servants and employees, from and against any and all claims, demands, or causes of action of whatsoever kind of nature, and the resulting lasses, costs, expenses, reasonable attorneys' fees, including paralegal fees, liabilities, damages, orders, judgments, or decrees, sustained by the CITY, the FULTON COUNTY BOARD OF EDUCATION, or any third party arising out of, or by reason of or resulting from the will full or negligent acts, errors, or omissions of the PROVIDER or its agents, officers, volunteers or employees. 8.2 The Parties understand and agree that the covenants and representations relating to this indemnification provision shall survive the term of this Agreement and continue in full force and effect as to the PROVIDER's responsibility to indemnify. ARTICLE 9.0 Americans With Disabilities Act 9.1 PROVIDER shall not discriminate against any person in its operation and activities in its use or expenditure of the funds or any portion of the funds provided by this Agreement and shall affirmatively comply with all applicable provisions of the Americans With Disabilities Act ("ADA"), in the programs while providing any services funded in whole or in part by the CITY, including Titles I and II of the ADA and all applicable regulations, guidelines, and standards. 9.2 PROVIDER's decisions regarding the delivery of services under this Agreement shall be made without regard to or consideration of race, age, religion, color, gender, sexual orientation, national origin, marital status, physical or mental disability, political affiliation, or any other factor which cannot be lawfully or appropriately used as a basis for delivery of service. ARTICLE 10.0 Miscellaneous 10.1 No modification, amendment, or alteration of the terms and conditions contained shall be effective unless contained in a written document executed with the same formality and equal dignity herewith. 10.2 This Agreement is non -transferable or assignable, and PROVIDER agrees not to transfer or assign the performance of services called for in the Agreement. 10.3 This Agreement sets forth the full and complete understanding of the Parties as of the effective date, and supersedes any and all negotiations, agreements, and rcprescntations made or dated prior to this Agreement. 14.4 The PROVIDER shall pay reasonable attorney's fees to the City should the City be required to incur attorney's fees in enforcing the provisions of this Agreement. 14.5 Time is ufthe essence of this Agreement. 10.6 Each of the individuals who executes this Agreement agrees and represents that he is authorized to execute this Agreement on behalf of the respective entity. Accordingly, the City and PROVIDER both waive and release any right to contest the enforceability of this Agreement based upon the execution and/or approval thereof. 10.7 It is the policy of City that unauthorized aliens shall not be employed to perform work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the PROVIDER shall provide evidence on City -provided forms, attached hereto as Exhibits "C" and "D" that it and its subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perform work on the City contract to ensure that no unauthorized aliens will be employed. The City Manager or hisfher designee shall be authorized to conduct an inspection of the PROVIDER's and its subcontractors' verification process to determine that the verification was correct and complete. The PROVIDER and its subcontractors shall retain all documents and records of its verification process for a period of three (3) years following completion of the contract. This requirement shall apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. Compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300-10-1-.02 is mandatory. PROVIDER's compliance with the requirements of O.C.G.A. § 13-10-91 and Rule 300- 10-1-.02 shall be attested by the execution of the contractor's affidavit attached as Exhibit "C .11 Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to he sworn under oath under criminal pcnalty of false swearing pursuant to O.C.G.A. § 16-1D-71), a form of which is attached hereto as Exhibit "E", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A. § 50-36-1). 9 IN WITNESS OF THE FOREGOING, the Parties have set their hands and seal the day and year first written above. ATTEST: SUDIE GORDON, CITY CLERK CITY: BY: JOE LOCKWOOD, MAYOR PROXWINSNESS, BY: DAV PRESIDENT [AFFIX CORPORATE SEAL] to EXHIBIT "A" PROGRAM REQUEST FORM Individuals interested in proposing their programs and services must complete and return this form attached to the Letter of Interest. This information will be used for consideration of program proposals. Use one form per program. Name of Program: Eagle Stix Lacrosse Incorporated Participant Ages: 6 to 18 Day/s of the week program is offered: 5 Days Time of Program: Weekday:_5pm totem;_ Weekends Barn to 6pm Program Dates: Fail August -November; Spring: January_ May Program Fee: Fall = 225/player, Spring = $350/player Program Enrollment: Minimum 150, Maximum 250 Materials to be supplied by participants: LaCrosse Stick, Mouth Guard,-Gogles Materials to be supplied by PROVIDER: Balls Goals, Goalie Gear, Coaches, Officials, First Aide Kits, Field Paint Materials to be supplied by the City of MILTON: None Reguired Additional Program Requirements: None Required PROVIDER (`s)Name: Eagle Stix Lacrosse Inc (David Winsness, President) Address: 1 735 Windsor Cove City/State/Zip Code: Milton, GA 30004 Phone Number: (Day & Evening) 410-916-1800 (E-mail): dwinsness@areenshift.com Minimum Requirements: 1,000,000 General Liability Insuranoe Office use Only. Program Rate:$ _ # of programs in Session: Fee/Program: w, Control No. 11044164 STATE OF GEORGIA Secretary of State Corporations Division 31.5 West Tower 92 Martin Luther King, Jr. Dr. Atlanta, Georgia 31334-1530 CERTIFICATE OF INCORPORATION 1, -Brian P. Kemp, the Secretary of State and the Corporations Commissioner of the State of Georgia, hereby certify under the seal of my office that EAGLE STIR LACROSSE INCORPORATED a Domestic Profit Corporation has been duly incorporated tinder the laws of the State of Georgia on 06/07/20 11 by the filing of articles of incorporation in the Office of the Secretary of State and by the paying of fees as provided by 'ritle 14 of the official Code of'Georgi a Annotated, WITNESS my hand and official seal in the City of Atlanta and the State of Georgia on June 7, 2411 i Brian P. Kemp Secretary or State Control No. 1/044164 STATE OF GEORGIA Secretary of State Corporations Division 315 Wes# Tower 42 Martin Luther King, Jr. Dr. Atlanta, Georgia 30334-1534 Certified Copy 1, Brian P. Kemp, Secretary of dic State of Georgia, do hereby certify uncia the seal of my office that the attached documents are trice and correct copies of documents filed un& -,r the name of EAGLE STIR LACROSSE INCORPORATED Domestic Profit (:orpora#ion Said entity was formed in the jurisdiction set fcxth a Tuve and Has filed in the Office of secretary of State on the 7th day of .tune, 2011 its certificate of limited partnership, articles of incorporation, articles Of association, articles of organization or application for certificate of authority to transact busincsti ,� Georgia. This Certificate is issued pursuant to Title 1.4 of the Official Code of Georgia Annotated and is prima-facie evidence of the existence or nonexistence of the facts stated herein. WITNESS my hand and official sea! of the City of Atlanta and the State of Georgia on 1 st day of July, 2011 -Brian P. Kemp Sucretary of State certification Nuraber: 7536173-1 Reference: Verify this certiftcats online st httPylcsxp.sos.state.ga_ualcorplsoskblves:fy.asp (AI�C+ DFPARTTiS[� T of THE TRE Si)RY SW INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0023 Date of Chis notice. 06-15-2011 Employer Identification Number: 45-2540122 Form: SS -4 Nur ber of this notice : CP 575 R EAGLE STIR LACROSSE INCORPORATED 1735 WINDSOR CV MILTON, GA 30004 For assistance you may call us at: 1-800-829-4933 IF YOU WRITE, ATTACH 'THF. STUB AT THE MM OF THIS NOTICE_ WE ASSIMM YOU AN EMPLOYER IDR!TfIFICATION NUMBER Thank you fnr applyimj for an Employer Idertification Number (EIN). We assigned you EIN 45-2540122. This EIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. please keep this notice in your permanent records_ When filing tax documents, payments, and ra7at.Pd correspondence, it is very important that you use your EIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorxect information in your account, or even cause you to be assigned more than one SIN. If the information is not correct as Shown abovr, please make Lbe correcti.oil using the atcached tear otf Stub and return it to us. Assigning an EIN does not grant tax-exempt status to non-profit organizations. Publication 557, Tax ,Exempt Stacus for Your Oryanixation, has details on tho application process, as well as information on returns you may need to file. To apply for formal recognition of tax-exempt status, most organizaLiotis will meed to complete either Fo= 1023, Applicativa for Recognition of bxemption Under Section 501(c)(3) of the Intexnal Revenue code, or Form 1024, Application for Recognition of Exemption Under Section 501.(a). SLbmit the completed form, all applicable attachments, and the required user fee to: internal Revenue Service PO Box 12192 Covington, KFC 41012-0192 The Pension Protection Act of 2006 contains numerous chaSl9Pt to the tax law provisions affecting tax-exempt arganizations, including an annual electronic notification recVH rament (Form 990-N) for organiaationo not required to €i1e an aruruul information return (Form 990 or Form 990-8Z). Additionally, if you are required to file an annual information return, you nay be required to file it electronically. Please refer to the Charities & ikon -Profits page at www_irs.gov for the most current information on your filing requirements and on provisions of the Pension Protection Act of 2006 that may affect you. To Obtain tax forms and publications, including those referenced in this notice, visit ❑i_r Web site at www.irs.gov. If you do not have access to the Internet, call 1 800 029•aG7G ('rry1TC)U 1-800-929-4D59} or vlsic your local IRS ottice. (IRS USE ONLY) 575E 06-15-2011 EAGL 4 9999999999 SS -4 IMPORTANT REMINDERS: * Keep a raspy of tblq noticR in your permanent records. This notice is issued only one time and the IRS Will not be able to generate a duplicate copy for you- * Use this EIN and your name exactly as they appear at the top of this notice on all your tederal tax tormB. * Refer to this EIN on your tax -related correspondence and documents. * Provide future officers of your organization with a copy of this notice. If you have questions about your EIN, you can call us at the phone number or write to us at the address shown at the top of this notice. If you write, please tear off the stub at the bottom of this notice and send it along with your letter_ If ymi do not need to write us, do not complete and return the stub. Thank you for your cooperation. Keep this part for your records. CP 575 E (Rev. 7-2007) Return this part with any correspondence so we may identify your account. Please correct any errors in your name or address_ CP 575 E 9999999999 Your Telephone Number Seat Time to Call DATE OF THIS NUX-LUK: Ub-15-2011 t - EMPLOYER IDENTIF7rMTTCN NUMBER: 45-2540222 FORM- SS -4 20BOD INTERNAL REVENLih bSRVii:E: EAGLE STIR LACROSSE iNCORPORATEC CINCINNATI OR 45999-0023 1735 WINDSOR CV MILTON, GA 30004 v CERTIFICATE OF LIABILITY INSURANCE THIS C€RTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RfGHTS UPON T14ECERTIF"TE HOLDER. THIS C ERTIFICATE DOE S NOT AFFIR h1ATIVELY OR NfGATfVI=LY AI.9MG, EXTEND OR ALTER THE COVERAGE AFFORD ED BY THE POLH;ES RFI OW. THIS f_FRTIFH'ATF OF IN StIRANCF 40FS NOT CONST11`1ITF A MNTRACT BETWEEN THE 19SUINGINSURE RSSI, ALITHORIZE0 R E PRE SENTATIVE OR PROM CER, AND T14E CERTIFICATE H OL €}ER. IMPORTANT: N the certificate holder is an ADDMONAL IN SURER, the policy(ies) must 6e end orsed. If SUBR06ATION I S WAIVED, subject to the term sand conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certiftcate holder In heu of such end orsernenttsl. PROWtCER tMiTACT NAME: BOLLINGER. In PIIn1E Fiji 101 JFK PARICIVAY BILLS, M 07079 PHONE 1-SDD-328-'1379 ;:AX'Hi3-9 �'I X87?. I,s.C, rb. rAkj- U943 -52C•1375 973-921-2876 1!41SHORT iii: ADO INSURE$ AFFORDING COVERAGE MAIC# IftMADIVVVVVj grsilr+Elc Lark�f In LUra>tiA Camparlr SS�� INSURED W std N' VInc- S L A=E t e_ Inc. 113 113 West Uttiversity Pa&Na'r BattcRaar till} 21210 wsertlex �: xisuaErer: Rte Eagle Stix Lacrosse lnc. CLAIUS41ADE IXrCCUR COVERAGES CER H%ICA IL NUMBER: REVISION NUMBER: TM4ISTO Cr. R7 FY THAT TN6 PO01cIKS OF IN9URAIiCE iISnD gE1.D''Pd NAYS 6etTi ISSUEDTO THE INSVRED NAMED ABOVE FOR THE POLICY KPI10 S INWCATED. NOTMTHSTANLvNG ANY PEOUIRSUENT, TF -W OR CON DITiON OF ANN CONTRACTOR OrH ER DOCUUr-NT WITH RESPECT TO WHICH TH IS CERTIFICATE WAY BE ISSUED OR ANY PERTAIN. THE INSLIRAHC.E AFFORDED By THE POLICIE DESCRIBED HEREIN ISSWL-ECT TO ALLTHE TERMS. E(CLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHCW.N MAY HAVE BEEN REDUCED BY PAID CLAM. P19M TYPE. OF INSURANCE AODM SII POLICY NUUBER W -T FFF K9 "11�YY LIMITS LTR WI{ 7M IftMADIVVVVVj A GENERAL L4€t11LITS' �r COUIfERCIALGENERAL LU$ILITY x FAc- rx--- A—,F V s $1-WO.00D aAssAtfTon�r1� MOD,= CLAIUS41ADE IXrCCUR 8502AH221W9 0111)V2012 Ot1GIMI3 apsTrm• x Rodidpents Limb PL.SSx«ALLA.7� ti°3.+iY Sl,GG0,000 -yam y ,pe�7E T5,600,000 GEN'L AGGREGATE LIMIT APPLIES PER: PQLi CY ❑ PRO- K IAC JE:CT -'11.iJI1L..l s - wtn+.w tti:. 5 AUTOMOBILE L"LnY �OlIE `aED3tiCY4 L3AT,Ea ax7Jicc T ANY AUTO EasLY:k w 4Y':v'Y_-]A2�' S AU IED SCHEDULED Atfl-t'7S AUTOS HIRE AUTOS NON -OWNED v .STT=A.t:A,st f ATI S x UMiLREL LA URR I x CCCOR y EAC!+DGL4�'c,`k:E S1 50D;000 A44R ;T SF,400,000 n EXCESS LIAR -%-- 4802AH 221370 01101r2012 01/0/12013 i DEQ RETENTION S VKMKERS COMPENSATION YIN AND EMPLOYERS' LIABILITY NIA nc LINNAT -ai Tr T 4 AN'1 PP7P9sTOcLRA4T5ERS7T-CL.7.Ve ortcea+ree4 Etx:neat ACCIDC4 e L 5ACd ACCENT = Z 0*ZA5a-rn tW&QVtc S Q&dtK"LL4y ill NH) EL 0-SF"-PM4Cy1A= T r T6 CIWcroe Ener=eSCix">ati J° Ox LAT r3.�S i1¢4]W A ccidertt Medical 4102,VG25220 011G 112012 011111100'13 ccidenl Limit: EIOD.000 atrtatrootoAcc 4102AI130SW2 Q1P011201'�' 01TI12013 C--t-Ophm1-unit: S1,DDO.aOO DESCRIPTION OF OPE RATION S: LOCATIONS IYEHICLE5lArtsch ACORD 101. Additions! Remarks Schedule. H mare space rs requrrod I Coverage applies only to teams -leagues comprised of 100% US LaCrosse member participants during scheduled & supervised iacrO85e or -Wes. Cerblicate HMe IS named "Ad ddion al In5ts red "with respect to Eagle ShX Lac r45 se Inc.. CitF of %Oton 13000 Dee6eld PaA - av 'titan, CA 39004 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 9E CANCELLED BEFOK THE EXPIRATION DATE THEREOF, NOTICE 1YILL HE DELIVERED IN ACCORDANICL WIT€I TI HE POLICY PROVISIONS. AUTHORLZETT REPRESENTATIVE 0 ISH -2010 ACORD CORPORAT ION. All rights :eLe^.e. ACORD 25 The ACORD name and logo wo reglstrvw rrLsrk, GI ACORD 'O Ac o CERTIFICATE OF LIABILITY INSURANCE DAf*Mmi12012 THISCERTIFICATE IS ISSUED ASA MATTER Of INFORMATION ONLY AND CONFERS ND RIGHTS UPON THF CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIR UATIVE LY OR NEGATIVELYAFAEN1), EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE5 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CON S IIT UTE A CONTRACT BETWEEN THE ISSUING INSURERtSj,A1lTHORLZE0 REPRESENTATIVE OR PRODUCER. AND THE CERTIt-ICA TL HOLDER. IMPORTANT. tf the certificate holder is an ADDITIONAL INSURED, the policy{lesjmust 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 tothecertificate holder in lieu of such endorsemeslt(s], POLICY NUMBER MAME T HAMS: POLLINGER• Ina phow PAI 101 JFK PARKWAY $BORT HILLS, NJ 07079 PI-IONE: 7$QQ-52s1-7379 FAX. 973-421-2878 14Cr Mo. mt)-80O-32 1375 {lVC, llo-.1:97}925-2876 E-R- ADIPMU. YIkD'JIY'/1^-' IN SURER [Srj AFFORDIWO COVERAGE %me � --- «suREw +: ►a as— cm.p—y 3x9ra INSURED H sl3r E R a US L 3Cr0 a 5 B, Inn. W MM!"I C: 113 West LW%-essity Pa" -ay BalLmurr Mm 21214 xI nulteRD; 'Ie Re: Eagle StizLaaosse IThe IN WRIER P' COV006tS t;t:MIPLA IE NUMBER: RtVISKMIIUMBFW THIS IS 70 CERTIHY THAT THEPOLICIES CF INSURANCE LISTtO BELOW HAVE B6z"N ISSUED TO THE INSURED NAMED A64V£ FOR THE POLKY PERIOD INDICAT4D, N00WITH5TANtIl N iA.IdY R_�CU IPEVENT• TgAIJ OR CONDITION CF A%Y CONTRACT40R OY14fR OWLIUENT WITH RESPECT TO MICH TH3S CERTIFICATE WAY BE WUED GRIMY PERTAIN, THE IN SURkNCc AFFCRDED SY THE KXI IE DE SC Pt DED PERE IN IS Sk)3JEC[ 70 ALL THE TER US- EXCLUSIONS AND CONDITIONS OF SUCH Pr]LICIES. LI UITS SHOVr'N WAY u4A,4 WEN Ra 1i CELL BY F 0114$ 01M TYPE OF IN SL RA?rCE ADIPL I1J6R POLICY NUMBER pOL1CT EFF POUCVrEV LINERS. LTR INIR V," YIkD'JIY'/1^-' IIW GENERAL LIABILITY r EAClOCCUFiq@NCE 51,006,0 A L'Ul,7LrER�lAL3Er4cRALLIABILIrY �1RSAIGlTZ7l T 5166,CD: 116111118-xIlF �t3CtirR IX -a� �at5 e9 Q1161r2612 61/0712013 prEV�ESEeaOo ywok; uEDm o,r ss,cco Panidpanim Limb �q.snµ: ,%A--VN:.,WY 51,600.OD6 E An.REIwATE SS,LCG.iiW acMLAGGREGATE UsATAPPLIES PER: POLICY ❑ PRO- ❑LOC .1ECT P4jg'y^�'r3-cau+rvn Ano -P fi,LiEm,OOp I AUTOMOBILE LIABILITY ANY AUTO 00"5,AiEUELTf.R-aa S r�Dsr n�tv sbraorrul• f eor7Lr A tiny pffS ALL OWME7 SChED"ED AUTOS AUTOS HIR EDALITOSHON-Oih'NED, prlopo r t _ AUros = x 11MRRFI I A I IAR I X :x:'.I:R x EACngCo•,REyCY S1 -1106,0D0 g EXCESS LEAD 46020221370 51/0112012 0114//2013 S GEC RETE?Jl0ri5 WORKERS COMMSATION Y; N AND ENIPLOYERS'LIA6ILRY A WA csTATr as Ta ASY RROF'*..'ETp9.'Pr�Tj7FyE¢CFJT 9F a CE371E1,TE4 2ECC"Oeo7 E L. TACH ACCACCNT f ES D8649E-FA E]F10YIZ S Imandatery in NHj Cl D'SiICSE-�L1L1CY LdaT s 'tea QaYa Lc Y+lef 7E9GnPi{M 4° iPErv4Tip�3 tFlfrN csiasnt IAeaICal 41UAH025220 D1i6112012 01/010613 cddent Llmir S100,000 tastro"icAce 4...n11Dion 7 rf mi JnIa tasVcphecumft 51,060,000 DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES IR twh ACORD 701• Additional Remarks Schedule. i1Rlare 4P Is required) Coverage applies only to tea rnWeagaes comprised of 1 W4 U5 Lacrosse member participants during scheduled & supervised lacrosse actNftes. Cerblicate Holder is named "Additional Insured"with Tespettta Eagle SUA Lac r4S5e Inc. CERTIFICATE HOLDER CAWFLLATAON 0 IsAa-2010 ACORO CORF`0R-P.TEON AGI rlght3seserved A --ORD 25'.2i) 10,361 Tree AGOFi[1 rami Bra logo Soe regl;tered rWia of A:.ORD SHOULD ANY OF THE ABOVE DE5Clt1BE0 POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOi, NOTICE WALL BE DELIVERED IN Fukm Count%, Ro nd of Educations RCCbR[iANCF WITH THE POI ICY P7C}VISION 5. 12845 Birmingham Highway hfltvn- GR 309iDd AUTHORIZED REPRESENTATIVE 0 IsAa-2010 ACORO CORF`0R-P.TEON AGI rlght3seserved A --ORD 25'.2i) 10,361 Tree AGOFi[1 rami Bra logo Soe regl;tered rWia of A:.ORD I certify that the team, league, or event on whose behalf I am requesting this certificate mandates 100% membership in US Lacrosse. In addition, I have verified our team's or league's events roster and all participants are currently registered members of US Lacrosse. I certify that this is true and I understand that liability coverage is only extended to our team, league, or event if all participants are current members of US Lacrosse. Further; I acknowledge by clicking on this box that event liability claims may be denied for coverage if our tearrmlleaguelevent is not 100% registered with US Lacrosse. Name: David Winsness Organization: Eagle Stix Lacrosse Inc. Date: 04/1712012 Copy of Personal Identification Documents Held in City Clerk’s Office City of Milton 13000 Deerfield Parkway Suite 107C Milton, Georgia 30004 To: Honorable Mayor and City Council Members From: Carter Lucas, PE – Public Works Director Date: April 26, 2012 Council Meeting Date: May 7, 2012 Agenda Item: Approval of a Construction Services Agreement Between Hitson Construction, Inc. and the City of Milton for the Replacement of the Cogburn Road Bridge Discussion: Project Location---------------------------------------O Location Map The primary need for the project is to replace the narrow, structurally deficient bridge located on Cogburn Road that spans Cooper Sandy Creek between the road intersections of Bethany Bend Road to the north and Webb Road to the south. This bridge was identified as the top priority for replacement in the city's bridge inventory and assessment performed in 2009. The existing single-span bridge consists of adjacent precast concrete panels with an asphalt wearing surface. The precast panels are supported on pile end bents and wingwalls consisting of timber soldier piles and timber lagging. The existing clear span over the creek is approximately 12 feet and the clear bridge width is approximately 20 feet. The brid ge currently has no posted weight limit and the posted speed limit is 40 miles per hour. Cogburn Road is classified as a two-lane collector street which serves several schools and also provides direct connectivity to Windward Parkway and the major employment and retail centers at the Windward Parkway/SR 400 interchange. Based on 2007 traffic counts, there are approximately 10,260 vehicles per day using Cogburn Road. City of Milton 13000 Deerfield Parkway Suite 107C Milton, Georgia 30004 The proposed project will replace the existing bridge with an arch culvert spanning the cr eek to minimize stream impacts and avoid costly permitting requirements. The proposed culvert will span 20 feet with a rise of approximately 7 to 8 feet. Minor roadway improvements include raising the sag vertical profile grade approximately 1 foot, making minor horizontal improvements to the edge of pavement and tapers, and restriping the travel lanes and left turn auxiliary lanes into St. Francis School. During construction, the road will be closed at the bridge crossing and an off-site detour route will be provided. It is estimated the construction time will be approximately 3 months. Access to existing property owners will be maintained at all times. The typical roadway section over the culvert will consist of two, eleven -foot travel lanes with two foot paved shoulders, curb and gutter with an trail on the west side in conformance with the trail master plan and a rural grassed shoulder on the east side. In accordance with the city procurement procedures an invitation to bid was issued to secure a qualified contractor to complete this project. T he city received 4 bids on the project and Hitson Construction, Inc. was determined to be the lowest reliable bidder. Staff is recommending approval of a Construction S ervices Agreement with Hitson Construction in the amount of $478,020.39. Legal Review: Jarrard & Davis, LLP – Paul Higbee 4/18/2012 Financial: Funding for this project is available in the capital Bridge Replacement Program fund. Attachments: 1. Construction Services Agreement City of (Milton 115 CONSTRUCTION SERVICES AGREEMENT FOR COGBURN ROAD BRIDGE REPLACEMENT This Agreement (the "Agreement") to provide intersection pedestrian improvements is made and entered into this _ day of , 2012, by and between. the CITY OF MILTON, a municipal corporation of the State of Georgia, acting by and through its governing authority, the Milton City Council (hereinafter referred to as the "City"), Hitson Construction, Inc., a Georgia corporation with its principal place of business located at 25 Oxford West Court, Oxford, Georgia 30054 (hereinafter referred to as the "Contractor"). WITNESSETH: WHEREAS, the City issued a Request For Bid (Cogburn Road Bridge Replacement, 12- PW3) to solicit bids for drainage improvements at various locations within the City; and WHEREAS, based upon Contractor's bid to construct the improvements as required by the bid documents, the City has selected Contractor as the winning bidder, and WHEREAS, Contractor has agreed to perform such work as set forth in this Agreement, according to the terms and conditions provided in this Agreement; and WHEREAS, Contractor has familiarized itself with the nature and extent of the Contract Documents, the Project, and the Work, with all local conditions and federal, state and local laws, ordinances, rules and regulations in any manner that may affect cost, progress or performance of work, and Contractor is aware that he must be licensed to do business in the State of Georgia. NOW THEREFORE, the City and Contractor, in consideration of the mutual promises contained herein and other good and valuable consideration, the sufficiency of which is hereby acknowledged, agree as follows: Section 1 Contract Documents The following documents are incorporated herein by reference and constitute the Contract Documents: A. This Agreement ( 17 Pages); B. Request For Bid RFB and addenda (57 Pages), attached hereto as Exhibit "A"; C. Proposal and Bid from Contractor dated (16 Pages), attached hereto as Exhibit «B-. D. Performance and Other Bonds, attached hereto collectively as Exhibit "C"; E. Plans and specifications, attached hereto collectively as Exhibit "D," including reduced -size construction drawings. The parties agree that the full-sized construction drawings are contained in the files of the City of Milton Department of Public Works; F. Contractor Affidavit and Agreement, attached hereto as Exhibit "E"; G. Subcontractor Affidavit, attached hereto as Exhibit "F"; H. Save Affidavit, attached hereto as Exhibit "G"; I. The following which may be delivered or issued after the Effective Date of the Agreement and are not attached hereto: All Written Amendments and other documents amending, modifying, or supplementing the Contract Documents if properly adopted in writing and executed by the Parties; and J. City of Milton Code of Ethics. In the event of any discrepancy among the Contract Documents, that provision that inures most to the benefit of the City, as determined by the City in its sole discretion, shall govern. Section 2 Proiect Description This project generally consists of the removal of an existing timber and concrete bridge and replacement of this bridge with a pre -cast concrete culvert, with other associated roadway and shoulder work. The contractor is responsible for all erosion and sediment control measures and for re -shaping the shoulders and slopes, and re-establishing a vegetative ground cover. Section 3 The Work The Work is specified and indicated in the Contract Documents (the "Work"). In the event of any discrepancy among the Contract Documents, the provision operating most to the benefit of the City, as determined by the City in its sole discretion, shall govern. The Work previously described includes all material, labor, insurance, tools, equipment, and any other miscellaneous items necessary to complete the Work as described. Contractor shall complete the Work in strict accordance with the Contract Documents. Section 4 Contract Time This Contract shall take effect on May 8, 2012. Contractor agrees to complete the Project within 120 calendar days from the date of Notice to Proceed. Every effort will be made by Contractor to shorten this period. Section 5 Contractor's Compensation; Time and Method of Payment Contractor shall be paid in one lump sum for the full agreed -to contract amount of $478,020.39. The City shall pay Contractor upon Final Completion of the Project as such is determined by the City, net thirty (30) days from the date of invoice. No payments will be made for unauthorized work. Upon the City's certification of Final Completion of the Project, an invoice should be submitted to Rick Pearce (Budget and Procurement Coordinator), for approval. Payment will be sent to the designated address by U. S. Mail only; payment will not be hand - delivered. Section 5 Work Chan A. The City reserves the right to order changes in the Work to be performed under this Agreement by altering, adding to, or deducting from the Work. All such changes shall be incorporated in written change orders executed by the Contractor and the City. Such change orders shall specify the changes ordered and any necessary adjustment of compensation and completion time. if the Parties cannot reach an agreement on the terms for performing the changed work within a reasonable time to avoid delay or other unfavorable impacts as determined by the City in its sole discretion, the City shall have the right to determine reasonable terms and the Contractor shall proceed with the changed work. B. Any work added to the scope of this Agreement by a change order shall be executed under all the applicable conditions of this Agreement. No claim for additional compensation or extension of time shall be recognized, unless contained in a written change order duly executed on behalf of the City and the Contractor. C. The City Manager has authority to execute without further action of the Milton City Council, any number of change orders so long as their total effect does not materially alter the terms of this Agreement or materially increase the total amount to be paid under this Agreement. Any such change orders materially altering the terms of this Agreement or increasing the total amount to be paid under this Agreement in excess of $50,000, must be approved by resolution of the Milton City Council. Section 7 Covenants of Contractor. A. Ethics Code Contractor agrees that it shall not engage in any activity or conduct that would be in violation of the City of Milton Code of Ethics. B. Time is of the Essence Contractor specifically acknowledges that TIME IS OF THE ESSENCE for completion of the Project. C. Expertise of Contractor Contractor accepts the relationship of trust and confidence established between it and the City, recognizing that the City's intention and purpose in entering into this Agreement is to engage an entity with the requisite capacity, experience, and professional skill and judgment to provide the services in pursuit of the timely and competent completion of the Work undertaken by Contractor under this Agreement. D. Budizetau Limitations Contractor agrees and acknowledges that budgetary limitations are not a justification for breach of sound principals of Contractor's profession and industry. Contractor shall take no calculated risk in the performance of the Work. Specifically, Contractor agrees that, in the event it cannot perform. the Work within the budgetary limitations established without disregarding sound principals of Contractor's profession and industry, Contractor will give written notice immediately to the City. E. City's Reliance on the Work The Contractor acknowledges and agrees that the City does not undertake to approve or pass upon matters of expertise of the Contractor and that; therefore, the City bears no responsibility for Contractor's services performed under this Agreement. The Contractor acknowledges and agrees that the acceptance of Work by the City is limited to the function of determining whether there has been compliance with what is required to be produced under this Agreement. The City will not, and need not, inquire into adequacy, fitness, suitability or correctness of Contractor's performance. Contractor further agrees that no approval of designs, plans, specifications, or work by any person, body or agency shall relieve Contractor of the responsibility for adequacy, fitness, suitability, and correctness of Contractor's professional and industry standards or for performing services under this Agreement in accordance with sound and accepted professional and industry principals. F. Contractor's Reliance of Submissions by the Ci Contractor must have timely information and input from the City in order to perform the services required under this Agreement. Contractor is entitled to rely upon information provided by the City, but Contractor shall be required to provide immediate written notice to the City if Contractor knows or reasonably should know that any information provided by the City is erroneous, inconsistent, or otherwise problematic. G. Contractor's Representative �t r_ D r•try 1-1,'4 shall be authorized to act on Contractor's ehalf with respect to the Work as Contractor's designated representative. H. Assignment of Agreement The Contractor covenants and agrees not to assign or transfer any interest in, nor delegate any duties of this Agreement, without the prior express written consent of the City. 1. Responsibility of Contractor and Indemnification of Cit The Contractor covenants and agrees to take and assume all responsibility for the services rendered in connection with this Agreement. The Contractor shall bear all losses and damages directly or indirectly resulting to it on account of the performance or character of the services rendered pursuant to this Agreement. Contractor shall defend, indemnify and hold harmless the City, its officers, boards, commissions, elected and appointed officials, employees and agents from and against any and all claims, suits, actions, liability, judgments, damages, losses, and expenses, including but not limited to, attorney's fees, which may be the result of willful, negligent or tortuous conduct arising out of the Work, performance of contracted services, or operations by the Contractor, any subcontractor, anyone directly or indirectly employed by the Contractor or subcontractor or anyone for whose acts the Contractor or subcontractor may be liable, regardless of whether or not the negligent act is caused in part by a party indemnified hereunder. Such obligation shall not be construed to negate, abridge, or otherwise reduce any other right or obligation of indemnity which would otherwise exist as to any party or person described in this provision. In any and all claims against the City or any of its agents or employees, by any employee of the Contractor, any subcontractor, anyone directly or indirectly employed by the Contractor or subcontractor or anyone for whose acts the Contractor or subcontractor may be liable, the indemnification obligation set forth in this provision shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable by or for the Contractor or any subcontractor under workers' or workmen's compensation acts, disability benefit provide immediate written notice to the City if Contractor knows or reasonably should know that any information provided by the City is erroneous, inconsistent, or otherwise problematic. G. Contractor's Representative shall be authorized to act on Contractor's e alf with respect to the Work as Contractor's designated representative. H. Assignment of Agreement The Contractor covenants and agrees not to assign or transfer any interest in, nor delegate any duties of this Agreement, without the prior express written consent of the City. 1. Responsibility of Contractor and Indemnification of City The Contractor covenants and agrees to take and assume all responsibility for the services rendered in connection with this Agreement. The Contractor shall bear all losses and damages directly or indirectly resulting to it on account of the performance or character of the services rendered pursuant to this Agreement. Contractor shall defend, indemnify and hold harmless the City, its officers, boards, commissions, elected and appointed officials, employees and agents from and against any and all claims, suits, actions, liability, judgments, damages, losses, and expenses, including but not limited to, attorney's fees, which may be the result of willful, negligent or tortuous conduct arising out of the Work, performance of contracted services, or operations by the Contractor, any subcontractor, anyone directly or indirectly employed by the Contractor or subcontractor or anyone for whose acts the Contractor or subcontractor may be liable, regardless of whether or not the negligent act is caused in part by a party indemnified hereunder. Such obligation shall not be construed to negate, abridge, or otherwise reduce any other right or obligation of indemnity which would otherwise exist as to any party or person described in this provision. In any and all claims against the City or any of its agents or employees, by any employee of the Contractor, any subcontractor, anyone directly or indirectly employed by the Contractor or subcontractor or anyone for whose acts the Contractor or subcontractor may be liable, the indemnification obligation set forth in this provision shall not be limited in any way by any limitation on the amount or type of damages, compensation or benefits payable by or for the Contractor or any subcontractor under workers' or workmen's compensation acts, disability benefit acts or other employee benefit acts. This obligation to indemnify and defend the City, its members, officers, agents, employees and volunteers shall survive termination of this Agreement. Contractor shall not be required to indemnify the City or its officers, boards, commissions, elected or appointed officials, employees or agents against liability or claims for damages, losses, or expenses, including attorney fees, arising out of bodily injury to persons, death, or damage to property caused by or resulting from the sole negligence of the City or its officers, boards, commissions, elected or appointed officials, employees or agents. J. Independent Contractor Contractor hereby covenants and declares that it is engaged in an independent business and agrees to perform the services as an independent contractor and not as the agent or employee of the City. The Contractor agrees to be solely responsible for its own matters relating to the time and place the services are performed; the instrumentalities, tools, supplies and/or materials necessary to complete the services; hiring of Contractors, agents or employees to complete the services; and the payment of employees, including compliance with Social Security, withholding and all other regulations governing such matters. The Contractor agrees to be solely responsible for its own acts and those of its subordinates, employees, and subcontractors during the life of this Agreement. Any provisions of this Agreement that may appear to give the City the right to direct Contractor as to the details of the services to be performed by Contractor or to exercise a measure of control over such services will be deemed to mean that Contractor shall follow the directions of the City with regard to the results of such services only. The Contractor shall obtain and maintain, at the Contractor's expense, all permits, licenses, or approvals that may be necessary for the performance of the services. The Contractor shall furnish copies of all such permits, licenses, or approvals to the City of Milton Representative within ten (14) days after issuance. Inasmuch as the City of Milton and the Contractor are contractors independent of one another neither has the authority to bind the other to any third person or otherwise to act in any way as the representative of the other, unless otherwise expressly agreed to in writing signed by both parties hereto. The Contractor agrees not to represent itself as the City's agent for any purpose to any party or to allow any employee of the Contractor to do so, unless specifically authorized, in advance and in writing, to do so, and then only for the limited purpose stated in such authorization. The Contractor shall assume full liability for any contracts or agreements the Contract enters into on behalf of the City of Milton without the express knowledge and prior written consent of the City. K. Insurance (1 } Requirements: The Contractor shall have and maintain in full force and effect for the duration of this Agreement, insurance insuring against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the Work by the Contractor, its agents, representatives, employees or subcontractors_ All policies shall be subject to approval by the City Attorney to form and content. These requirements are subject to amendment or waiver if so approved in writing by the City Manager. (2) Minimum Limits of Insurance: Contractor shall maintain limits no less than: (a) Comprehensive General Liability of $1,000,000 combined single limit per occurrence for bodily and personal injury, sickness, disease or death, injury to or destruction of property, including loss of use resulting there from. (b) Comprehensive Automobile Liability (owned, non -owned, hired) of $1,000,040 combined single limit per occurrence for bodily and personal injury, sickness, disease or death, injury to or destruction of property, including loss of use resulting there from. (c) Professional Liability of $1,000,000 limit for claims arising out of professional services caused by the Contractor's errors, omissions, or negligent acts. (d) Workers' Compensation limits as required by the State of Georgia and employers Liability limits of $1,000,000 per accident. (3) Deductibles and Self Insured Retentions: Any deductibles or self-insured retentions must be declared to and approved by the City. (4) Other Insurance Provisions: The policy is to contain, or be endorsed to contain, the following provisions: (a) General Liability and Automobile Liability Coverage. (i) The City, its officials, employees, agents and volunteers are to be covered as insured as respects: liability arising out of activities performed by or on behalf of the Contractor; products and completed operations of the Contractor; premises owned, leased, or used by the Contractor; automobiles owned, leased, hired, or borrowed by the Contractor. The coverage shall contain no special limitations on the scope of protection afforded to the City, its officials, employees, agents or volunteers. (ii) The Contractor's insurance coverage shall be primary noncontributing insurance as respects to any other insurance or self-insurance available to the City, its officials, employees, agents or volunteers. Any insurance or self-insurance maintained by the City, its officials, employees or volunteers shall be excess of the Contractor's insurance and shall not contribute with it. (iii) Any failure to comply with reporting provisions of the policies shall not affect coverage provided to the City, its officials, employees, agents or volunteers. (iv) Coverage shall state that the Contractor's insurance shall apply separately to each insured against whore claim is made or suit is brought, except with respect to the limits of the insurer's liability. (v) Coverage shall be provided on a "pay on behalf' basis, with defense costs payable in addition to policy limits. There shall be no cross liability exclusion. (vi) The insurer agrees to waive all rights of subrogation against the City, its officials, employees, agents and volunteers for losses arising from work performed by the Contractor for the City. (vii) All endorsements to policies shall be executed by an authorized representative of the insurer. (b) Workers' Compensation Coverage: The insurer will agree to waive all rights of subrogation against the City, its officials, employees, agents and volunteers for losses arising from work performed by the Contractor for the City. (c} All Coverages: (i) Each insurance policy required by this clause shall be endorsed to state that coverage shall not be suspended, voided, canceled, reduced in coverage or in limits except after thirty (30) days prior written notice by certified mail, return receipt requested, has been given to the City. (ii) Policies shall have concurrent starting and ending dates. (iii) Policies shall include an endorsement incorporating the Indemnification obligations assumed by the Contractor under the terms of this Agreement, including but not limited to Section 7(1) of this Agreement. (iv) Policies shall include an endorsement incorporating the Indemnification obligations assumed by the Contractor under the terms of this Agreement, including but not limited to Section 7(l) of this Agreement. (S) AcceptabiiiV of Insurers: Insurance is to be placed with insurers with an A.M. Bests' rating of no less than A: VII. (6) Verification of Coverage: Contractor shall furnish the City with certificates of insurance and endorsements to the policies evidencing coverage required by this clause prior to the start of work. The certificates of insurance and endorsements for each insurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf. The certificate of insurance and endorsements shall be on a form utilized by Contractor's insurer in its normal course of business and shall be received and approved by the City prior to execution of this Agreement by the City. The City reserves the right to require complete, certified copies of all required insurance policies, at any time. The Contractor shall provide proof that any expiring coverage has been renewed or replaced at least two (2) weeks prior to the expiration of the coverage. (7) Subcontractors: Contractor shall include all subcontractors as insured under its policies or shall furnish separate certificates and endorsements for each subcontractor. All coverage for subcontractors shall be subject to all of the requirements stated in this Agreement, including but not limited to naming the parties as additional insured. ($} Claims -Made Policies: Contractor shall extend any claims -made insurance policy for at least six (6) years after termination or final payment under the Agreement, whichever is later. (9) City as Additional Insured and Loss Payee: additional insured and loss payee on Agreement. L. Emkioyment of Unauthorized Aliens Prohibited (1) E -Verify Affidavits The City shall be named as an all policies required by this It is the policy of the City of Milton that unauthorized aliens shall not be employed to perform work on City contracts involving the physical performance of services. Therefore, the City shall not enter into a contract for the physical performance of services within the State of Georgia, unless the Contractor shall provide evidence on City -provided forms, attached hereto as Exhibits "E" and 'Y' that it and Contractor's subcontractors have within the previous twelve (12) month period conducted a verification of the social security numbers of all employees who will perform work on the City contract to ensure that no unauthorized aliens will be employed. The City Manager or his/her designee shall be authorized to conduct an inspection of the Contractor's and Contractor's subcontractors' verification process to determine that the verification was correct and complete. The Contractor and Contractor's subcontractors shall retain all documents and records of its verification process for a period of three (3) years following completion of the contract. This requirement shall apply to all contracts for the physical performance of services where more than three (3) persons are employed on the City contract. The City Manager or his/her designee shall further be authorized to conduct periodic inspections to ensure that no City Contractor or Contractor's subcontractors employ unauthorized aliens on City contracts. By entering into a contract with the City, the Contractor and Contractor's subcontractors agree to cooperate with any such investigation by making its records and personnel available upon reasonable notice for inspection and questioning. Where a Contractor or Contractor's subcontractors are found to have employed an unauthorized alien, the City Manager or his/her designee may order the Contractor to terminate or require its subcontractor to terminate that person's employment immediately and to report same to the Department of Homeland Security. The Contractor's failure to terminate the employee, or otherwise cooperate with the investigation may be sanctioned by termination of the contract, and the Contractor shall be liable for all damages and delays occasioned by the City thereby. Compliance with the requirements of G.C.G.A. § 13-10-91 and Rule 300-10-1-.02 is mandatory. Contractor agrees that, in the event the Contractor employs or contracts with any subcontractor(s) in connection with this Agreement, the Contractor will secure from the subcontractor(s) such subcontractor(s) indication of the above employee -number category that is applicable to the subcontractor. Contractor's compliance with the requirements of G.C.G.A. § 13-10-91 and Rule 300-10-1-.02 shall be attested by the execution of the contractor's affidavit attached as Exhibit "E." The above requirements shall be in addition to the requirements of State and federal law, and shall be construed to be in conformity with those laws. (2) SAVE Affidavit and Secure Verifiable Document Pursuant to O.C.G.A. § 50-36-1, the City must obtain a SAVE Affidavit and a secure and verifiable document evidencing the Contractor's legal status in the Country each time that Contractor obtains a public benefit, including any contract, from the City. Contractor hereby verifies that it has, prior to executing this Agreement, executed a SAVE Affidavit (to be sworn under oath under criminal penalty of false swearing pursuant to O.C.G.A. § 16-10-71), a form of which is attached hereto as Exhibit "G", and submitted such affidavit to the City in person, electronically, or by mail. Further, Contractor verifies that it has, prior to executing this Agreement, submitted a secure and verifiable document, evidencing the Contractor's legal status, to the City either in person or electronically (in compliance with the Uniform Electronic Transactions Act). Contractor verifies that it is in compliance with the Residency Status of an Applicant for Public Benefit, as required by the Georgia Security and Immigration Compliance Act (O.C.G.A. § 50-36-1). M. Records, Reports and Audits (1) Records: (a) Records shall be established and maintained by the Contractor in accordance with requirements prescribed by the City with respect to all matters covered by this Agreement. Except as otherwise authorized, such records shall be maintained for a period of three years from the date that final payment is made under this Agreement. Furthermore, records that are the subject of audit findings shall be retained for three years or until such audit findings have been resolved, whichever is later. (b) All costs shall be supported by properly executed payrolls, time records, invoices, contracts, or vouchers, or other official documentation evidencing in proper detail the nature and propriety of the charges. All checks, payrolls, invoices, contracts, vouchers, orders or other accounting documents pertaining in whole or in part to this Agreement shall be clearly identified and readily accessible. (2) Reports and Information: Upon request, the Contractor shall furnish to the City any and all statements, records, reports, data and information related to matters covered by this Agreement in the forma requested by the City. (3) Audits and Inspections: At any time during normal business hours and as often as the City may deem necessary, there shall be made available to the City for examination all records with respect to all matters covered by this Agreement. The Contractor will permit the City to audit, examine, and make excerpts or transcripts from such records, and to audit all contracts, invoices, materials, payrolls, records of personnel, conditions of employment and or data relating to all matters covered by this Agreement. N. Conflicts of Interest Contractor agrees that it shall not engage in any activity or conduct that would result in a violation of the City of Milton Code of Ethics. Q. Confidentiality Contractor acknowledges that it may receive confidential information of the City and that it will protect the confidentiality of any such confidential information and will require any of its subcontractors, consultants, and/or staff to likewise protect such confidential information. The Contractor agrees that confidential information it receives or such reports, information, opinions or conclusions that Contractor creates under this Agreement shall not be made available to, or discussed with, any individual or organization, including the news media, without prior written approval of the City. The Contractor shall exercise reasonable precautions to prevent the unauthorized disclosure and use of City information whether specifically deemed confidential or not. P. Licenses, Certifications and Permits The Contractor covenants and declares that it has obtained all diplomas, certificates, licenses, permits or the like required of the Contractor by any and all national, state, regional, county, local boards, agencies, commissions, committees or other regulatory bodies in order to perform the services contracted for under this Agreement. All work performed by Contractor under this Agreement shall be in accordance with applicable legal requirements and shall meet the standard of quality ordinarily expected of competent professionals. Q. [RESERVED] R. Authorily to Contract The Contractor covenants and declares that it has obtained all necessary approvals of its board of directors, stockholders, general partners, limited partners or similar authorities to simultaneously execute and bind Contractor to the terms of this Agreement, if applicable. S. Ownership of Work All reports, designs, drawings, plans, specifications, schedules, work product and other materials prepared or in the process of being prepared for the services to be performed by the Contractor ("materials") shall be the property of the City and the City shall be entitled to full access and copies of all such materials_ Any such materials remaining in the hands of the Contractor or subcontractor upon completion or termination of the work shall be delivered immediately to the City. The Contractor assumes all risk of loss, damage or destruction of or to such materials. If any materials are lost, damaged or destroyed before final delivery to the City, the Contractor shall replace them at its own expense. Any and all copyrightable subject matter in all materials is hereby assigned to the City and the Contractor agrees to execute any additional documents that may be necessary to evidence such assignment. T. Meetings The Contractor is required to meet with the City's personnel, or designated representatives, to resolve technical or contractual problems that may occur during the term of the contract, at no additional cost to the City. Meetings will occur as problems arise and will be coordinated by the City. The Contractor will be given a minimum of three full working days notice of meeting date, time, and location. Face-to-face meetings are desired. However, at the Contractor's option and expense, a conference call meeting may be substituted. Consistent failure to participate in problem resolution meetings, two consecutive missed or rescheduled meetings, or to make a good faith effort to resolve problems, may result in termination of the contract. Section S Covenants of the City A. Right of Entry The City shall provide for equipment along the Bethany complete the Work. B. City's Representative right of entry for Contractor and all necessary Bend Road right-of-way, in order for Contractor to Jim Seeba shall be authorized to act on the City's behalf with respect to the Work as the City's designated representative Section 9 Warranty Except as may be otherwise specified or agreed, the Contractor shall repair all defects in materials, equipment, or workmanship appearing within one year from the date of Final Completion of the Project at no additional cost to the City. An inspection shall be conducted by the City or its representative{s} near the completion of the one-year general warranty period to identify any issues that must be resolved by the Contractor. Section 10 Termination A. The City may terminate this Agreement for convenience at any time upon written notice to Contractor. In the event of a termination for convenience, Contractor shall take immediate steps to terminate work as quickly and effectively as possible and shall terminate all commitments to third -parties unless otherwise instructed by the City. Provided that no damages are due to the City for Contractor's failure to perform in accordance with this Agreement, the City shall pay Contractor for work performed to date in accordance with Section 5 herein. The City shall have no further liability to Contractor for such termination. B. The City may terminate this Agreement for cause if Contractor breaches any material provision of this Agreement. The City shall give Contractor seven (7) days written notice of its intent to terminate the Agreement and the reasons therefore, and, if Contractor, or its Surety, fails to cure the default within that period, the termination shall take place without further notice. The City shall then make alternative arrangements for completion of the Project and deduct the cost of completion from the unpaid Contract Price. The City will make no payment to the Contractor or its Surety until all costs of completing the Project are paid. If the unpaid balance of the amount due the Contractor, according to this agreement, exceeds the cost of finishing the Project, the Contractor or its Surety will receive the applicable funds due. If the costs of completing the Project exceed the unpaid balance, the Contractor or its Surety will pay the difference to the City. C. If the City terminates this Agreement for cause, and it is later determined that the City did not have grounds to do so, the termination will be treated as a termination for convenience under the terms of this Section (A) above. D. Upon termination, the Contractor shall: (1) promptly discontinue all services affected, unless the notice directs otherwise; and (2) promptly deliver to the City all data, drawings, reports, summaries, and such other information and materials as may have been generated or used by the Contractor in performing this Agreement, whether completed or in process, in the form specified by the City. E. The rights and remedies of the City and the Contractor provided in this Section are in addition to any other rights and remedies provided under this Agreement or at law or in equity. Section 11 Miscellaneous A. Complete Agreement. This Agreement contains all of the understandings and agreements of whatsoever kind and nature existing between the parties hereto with respect to the subject matter contained herein. B. Governing Law. This Agreement shall be governed by and construed under the laws of the State of Georgia. C. Counterparts. This Agreement may be executed in any number of counterparts, each of which shall be deemed to be an original, but all of which together shall constitute one and the same instrument. D. Invalidity of Provisions. Should any part of this Agreement for any reason be declared by any court of competent jurisdiction to be invalid, such decision shall not affect the validity of any remaining portion, which remaining portion shall continue in full force and effect as if this Agreement had been executed with the invalid portion hereof eliminated, it being the intention of the parties that they would have executed the remaining portion of this Agreement without including any such part, parts or portions which may for any reason be hereafter declared invalid. E. Notice. All notices requests, demands and other communications hereunder shall be in writing and shall be deemed received, and shall be effective when personally delivered or on the third day after the postmark date when mailed by certified mail, postage prepaid, return receipt requested or upon actual delivery when sent via national overnight commercial carrier to the parties at the addresses given below, unless a substitute address shall first be furnished to the other parties by written notice in accordance herewith: NOTICE TO CITY shall be sent to: City of Milton Attn: City Manager 13000 Deerfield Parkway, Suite 107F Milton, Georgia 30004 NOTICE TO CONTRACTOR shall be sent to: Hitson Construction, Inc. Attn: Aubrey Hitson 25 Oxford West Ct Oxford, Georgia 30054 F. Sovereipn Immunity. Nothing contained in this Agreement shall be construed to be a waiver of the City's sovereign immunity or any individual's qualified good faith or official immunities. G. Force Majeure. Neither the City nor Contractor shall be liable for their respective non -negligent or non -willful failure to perform or shall be deemed in default with respect to the failure to perform (or cure a failure to perform) any of their respective duties or obligations under this Agreement or for any delay in such performance due to: (i) any cause beyond their respective reasonable control; (ii) any act of God; (iii) any change in applicable governmental rules or regulations rendering the performance of any portion of this Agreement legally impossible; (iv) earthquake, fire, explosion or flood; (v) strike or labor dispute, excluding strikes or labor disputes by employees and/or agents of Contractor; (vi) delay or failure to act by any governmental or military authority; or (vii) any war, hostility, embargo, sabotage, civil disturbance, riot, insurrection or invasion. In such event, the time for performance shall be extended by an amount of time equal to the period of delay caused by such acts and all other obligations shall remain intact. H. Headings. All headings herein are inserted only for convenience and ease of reference and are not to be considered in the construction or interpretation of any provision of this Agreement. IN WITNESS WHEREOF, the parties have caused this Agreement to be executed under seal as of the date first above written. [SIGNATURES ON FOLLOWING PAGE] Hitson Construction Inc. Signatur- 1L i j r D r V jr— ���•rJ Print Name 11, Pre .s r lien T Title [AFFIX CORPORATE SEAL] SIGNED, SEALED, AND DELIVERED In the presence of: an C �i itn �� C7o Go,rnlsso��`,,,��.•0 4A of 0� = otary PublicLLS�n CGrf'f�c �i 4 100 O;3 Obl is [NOTARY SEAL] 2T 20�� •'� ►► [�� •••..:.. tom, unG My Commission Ex ires: �1111 ► 11, %% �4 3a21�r5 SIGNED SEALED AND DELIVERED In the presence of: Witness Notary Public [NOTARY SEAL] My Commission Expires: MILTON CITY COUNCIL: Joe Lockwood, Mayor [CITY SEAL] Secretary of Owner should attest Give proper title of each person -executing affidavit. Attach seal as required. Copy of Personal Identification Documents Held in City Clerk’s Office