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Missing Data - ADMIN - 9/14/2014 11:00:14 PMDm Hz -u-zsu2 RECEIVED NOV 281012 ROUND ROCK, TEXAS City Manager Approval Form PURPOSE PION PROSPERITY Fun Time Ride Rentals (William Ritter) Contractor Item Caption: Approval Date: Department Name: Parks and Recreation Department Project Manager: Rick Atkins Assigned Attorney: Item Summary: Contractor to provide rides, food and Entertainment at Old Settlers Park for Dec. 1- 31, 2012 for the Rock'N Lights Village at the Rock'N Lights Holiday Light Tour. The first $1000.00 per day will be at 0% paid to City. The second $1000.00 and over per day will 20% paid to City. This event follows our Strategic Plan by providing a family -friendly community event that is safe and distinctive by design. No. of Originals Submitted: 1 Project Name: Fun Time Ride Rentals (William Ritter) Contractor/Rock'N Lights Holiday Light Tour Cost: $0 Source of Funds: Select Source Fund Source of Funds (if applicable): Select Source Fund Account Number: N/A Finance Director Approval: Date: Department Director Approval: Date: **Electronic signature by the Director is acceptable. Please only submit ONE approval form per item. ** CIP[II n Budget n n Purchasing 0 Accounting n n N/A OK N/A OK N/A OK N/A OK ITEMS WILL NOT BE PLACED ON THE COUNCIL OR CM AGENDA W/OUT PRIOR FINANCE AND/OR LEGAL APPROVAL REV. 6/20/11 INDEPENDENT CONTRACTOR AGREEMENT THIS INDEPENDENT CONTRACTOR AGREEMENT (the "Agreement") dated this day November 2012 Between City of Round Rock Parks and Recreation Customer -AND- Fun Time Ride Rentals (William Ritter ) Contractor BACKGROUND A. -* c Cus* mer ha& the Contractor has the necessary qualifications experience and abilities to provide services to the Customer. B. The contractor is agreeable to provide such services to the Customer on the terms and conditions set out in this Agreement. IN CONSIDERATION OF the matter described above and of the mutual benefits and hereby acknowledged the Customer and the Contractor (individually the "Party" and collectively the "Parties" to this Agreement) agree as follows: Services Provided 1. The Customer hereby agrees to engage the Contractor to provide the Customer with services (the "Services") consisting of: Rides, Food and Entertainment at Old Settlers Park for Dec. 2 thru Jan1,2013 Term of Agreement 1. The term of this Agreement (the Agreement) will begin on the date of the tei Agreement and will remain in full force and effect until Dee. 2, 2012,n . , 0015, subject to earlier termination as provided in this Agreement. The Term of this Agreement may be extended by mutual written agreement of the Parties. 2. Except as otherwise provided in this the obligations of the Contractor will terminate upon the earlier of the Contractor ceasing to be engaged by the Customer or the termination of this agreement by the Customer or Contractor. Performance 3. The Parties agree to do everything necessary to ensure that the terms of this Agreement take effect. Early Termination 4.If Fun time Ride Rental is not producing a profit after this first 7 days operating times may be adjusted or this Agreement may be terminated by ether one or both Parties provided by this Agreement. Currency 5. Exceptas otherwise provided in this agreement, all monetary amounts referred to in this Agreement are in USD (US Dollars) Compensation 6. For the services rendered by the Contractor as required by this Agreement, the Contractor will provide compensation to the Customer as follows: The first $1000.00 per day will be at 0% paid to Customer The second $1000.00 and over per day will 20% paid to Customer Signed Agent Fun Time Ride Rental (William Ritter) lJS From: Haas & Wilkerson Insurance To: 1-512-218-5548 Page: 2/2 Date: 111212012 10:21:23 AM Client#: 2557 WILLIREN RUUIWTM CERTIFICATE OF LIABILITY INSURANCE °ATE(MMN°/YYYY) 11/02/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. THIS POLICIES 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 Haas & Wilkerson Insurance 4300 Shawnee Mission Parkway Fairway, KS 66205 913 432-4400 CONTACT NAME: (A/C No, Ext): 913 4324400 FAX WC, No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC 0 INSURER A: ACE American Insurance Company 22667 INSURED William & Renee Ritter dba Fun Time Attractions PO Box 92 Fessenden, ND 58438 CfIVFRAGF4 rrr�m......- . ......� INSURERS: G2176386A INSURER C: 04/01/2013 INSURER D $1,000,000 INSURER E X INSURER F : - - --------•-• 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 LTR TYPE OF INSURANCE ADOLSUBR INSR WVD POLICY NUMBER (MMIDD/YEYFYY) (MM%OD/YYYPY) LIMITS A GENERAL LIABILITY G2176386A 04/01/2011 04/01/2013 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREM SES o¢ur (pEa ence) $100,000 CLAIMS -MADE X OCCUR _ MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: —I PRODUCTS - COMP/OP AGG 02 000,000 POLICY n ZS n LOC $ AUTOMOBILE UABILITY COMBINED SINGLE LIMIT (Ea acddent) ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per person) —0 $ AUTOS AUTOS NON -OWNED BODILY INJURY (Per accident) $ MIRED AUTOS _ AUTOS$ PROPERTY DAMAGE (Per accident) UMBRELLA UAB __ OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DED RETENT ON $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITYY / N WC STATU- TORY I IMITS OTH- FR ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N IA E.L. EACH ACCIDENT $ (Mandatory in NH) If yes, describe under E.L DISEASE - EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (Attach AC ORD 101, Additional Remarks Schedule, if more space is required) The Certificate Holder is listed as Additional Insured as respects to General Liability. CANCELLATION City of Round Rock 221 East Main Street Round Rock, TX 78664 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 © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S129416/M107606 SERVK