HomeMy WebLinkAbout227-10 RESOLUTIONRESOLUTION NO. 227-10
A RESOLUTION AUTHORIZING A CONTRACT WITH MICHAEL
MCBRIDE IN THE AMOUNT OF $20,000.00 TO PROVIDE OPERATION OF
THE LAKE SEQUOYAH BAIT SHOP
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
FAYETTEVILLE, ARKANSAS:
Section 1. That the City Council of the City of Fayetteville, Arkansas hereby authorizes a
contract with Michael McBride in the amount of $20,000.00 to provide operation of the Lake
Sequoyah Bait Shop. A copy of the contract is attached to this Resolution as Exhibit "A."
PASSED and APPROVED this 21St day of December, 2010.
APPROVED:
ATTEST:
By:
SONDRA E. SMITH, City Clerk/Treasurer
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Lake Sequoyah Bait Shop Operator Contract
CITY OF FAYETTEVILLE, ARKANSAS
OPERATING CONTRACT FOR LAKE SEQUOYAH BAIT SHOP
For the total amount of $20,000 to be paid in monthly installments, Michael McBride
(the "Contractor") agrees to provide the list of services and requirements to the City of
Fayetteville beginning January 1, 2011 and ending December 31, 2011. Either party may
cancel this contract by giving the other party sixty (60) days written notice of
cancellation. The Contractor further certifies possession of the initial capital monies to
commence Bait Shop operations.
The City agrees to pay the Contractor in current funds for the performance of the listed
services and requirements by making payments to the contractor no later than the 15th
of each month.
CONTRACTED SERVICES AND REQUIREMENTS
1. Contractor shall operate and manage the Lake Sequoyah Bait Shop. Contractor
shall be an independent contractor not an employee of the City. The Lake
Sequoyah Bait Shop is closed each year from December 24, through January 14.
The operator is responsible for supervising the Bait Shop during this time.
2. Contractor shall open and close the gate at the Bait Shop seven days a week at
Sunrise and Sunset. Contractor is required to respond to City Central Dispatch
requests 24 hours a day to provide assistance to citizen lock -ins at secured Lake
Sequoyah gates.
3. Contractor shall collect fishing permits and boating permits. These fees are
submitted to the Parks and Recreation Office on a weekly basis or as otherwise
approved by the Parks and Recreation Director during the slow season.
4. Contractor shall prepare reports and keep records as required by the Parks and
Recreation Director.
5. Contractor shall enforce lake rules and regulations as adopted by the Fayetteville
Code of Ordinance Chapter 97, Section 97.070 and 97.999. Contractor is to act in
the best interest of city property or public safety in response to ordinance
violations.
6. Contractor shall provide proof of liability insurance with a minimum coverage
of:
Workers' Compensation: Statutory Amount.
$300,000.00 for one person involved in death or injury.
$500,000.00 for two or more persons involved in death or injury.
For any work subcontracted, the contractor shall require the subcontractor
similarly to provide worker's compensation insurance. In case any employee
engaged in work on the project under this contract is not protected under
Worker's Compensation Insurance, Contractor shall provide and shall cause each
Subcontractor to provide adequate employer's liability insurance for the
protection of such of his employees as are not otherwise protected. The
premiums for all insurance and the bond required herein shall be paid by the
Contractor.
7. Contractor shall provide a $1,000 bond for performance and payment of items in
relation to this contract.
8. Contractor shall receive prior approval from the Parks and Recreation Director
for any special event conducted at Lake Sequoyah.
9. Contractor shall mow and manicure within the secured confines of the Lake
Sequoyah Bait Shop area. Grounds must be maintained according to park
standards. Contractor shall provide all equipment necessary for the maintenance
of these grounds.
10. Contractor shall pick up trash and clean the office and restroom on a daily basis.
Contractor is to supply cleaning and restroom supplies. This is a public restroom
which will be used by park patrons utilizing the trails and other park features.
11. Contractor shall attend a citizen service workshop administered by the Parks and
Recreation Department and adhere to the public relation policies and
procedures.
12. Contractor shall conduct the following at the Lake Sequoyah Bait Shop:
a. Sell concessions in compliance with all applicable State and Federal
Laws, Municipal Ordinances, Health Department Regulations and
the rules and regulations of all authorities having jurisdiction over
the performance of this project.
b. Sell related fishing equipment and supplies.
c. Provide other services which the Parks and Recreation Director
determines will enhance the operation of Lake Sequoyah.
d. All appliances and amenities related to the sale of equipment and
supplies must be provided by the contractor. The City of
Fayetteville will provide the microwave, refrigerator, and three
minnow tanks that are currently on site.
13. Contractor is hereby granted a temporary license to place and maintain a mobile
home in Lake Sequoyah Bait Shop area. Mobile homes style, condition, and
location site must be approved by the Parks and Recreation Director. Mobile
home shall be structurally sound and skirting shall be installed around the
perimeter.
a. Contractor agrees to accept financial responsibility for the electric
and natural gas at the mobile home site. In exchange therefore, the
City of Fayetteville agrees to be responsible for the municipal water
account at the site. City will be responsible for the telephone
utilities at the Bait Shop and the Contractor will be responsible for
the telephone utilities at the mobile home.
b. Contractor agrees to maintain the mobile home and the grounds
adjacent to the residence in good and orderly appearance, to
include grass, shrubs, and trees; place all trash or refuse in
appropriate containers; and assist in monitoring the property and
improvements owned by the City of Fayetteville.
c. Contractor understands and agrees that he/she must receive Parks
and Recreation Department staff approval prior to making any
improvements to the site, including but not limited to the
construction, installation, or placement of fencing, storage
buildings, or other facilities. Outdoor storage of any personal
property must be pre -approved by the Parks and Recreation
Director.
d. Contractor understands and agrees that he/ she shall be solely
responsible for insuring all personal property against any damage
or loss whatsoever, and that nothing herein shall be construed to
alter, limit or otherwise compromise that immunity afforded the
City of Fayetteville under the Constitution and Statutes of the State
of Arkansas.
e. Contractor understands and agrees that the property shall be used
for residential purposes only.
f. Contractor hereby agrees that upon termination of the Operating
Contract for Lake Sequoyah Bait Shop by expiration or by earlier
termination for any reason whatsoever, contractor will peacefully
deliver possession of the premises to the City of Fayetteville, and
remove his/her mobile home forthwith. In the event it should
become necessary for the City of Fayetteville to institute any action
of law to recover possession at the time of termination, whenever
and however termination may occur, Contractor agrees that he/she
will pay all costs and expenses of such action, including reasonable
attorneys' fees.
g. Contractor agrees not to violate any law, ordinance, rule or
regulation of any government authority having jurisdiction over
the premises.
14. It is agreed that the failure of the City of Fayetteville to invoke any of the
available remedies under this agreement or under lay in the event of one or more
breaches or defaults by contractor under the agreement shall not be construed as
a waiver of such provisions and conditions and shall not prevent the City of
Fayetteville from invoking such remedies in the event of any future breach or
default.
15. Each paragraph in this agreement is severable from all other paragraphs. In the
event any court of competent jurisdiction determines that any paragraph or
subparagraph is invalid or unenforceable for any reason, all remaining
paragraphs and subparagraphs will remain in full force and effect.
16. Contractor shall not act as a broker or facilitate sales of boats.
17. Upon budget approval by the City Council, the term of the Contract shall be for
one (1) year. However, said Contract may automatically renew for five (5)
consecutive one (1) year terms, with compensation being adjusted each renewal
period by three percent (3%) of the contracted amount for the prior year. Such
automatic renewal and increase shall be subject to budget approval by the City
Council.
18. Either party may terminate this contract at any time by giving the other party
sixty (60) days written notice of termination.
IN WITNESS WHEREOF, the parties to these presents have executed this
contract in three (3) counterparts, each of which will be deemed an original, on
this the Al tday of Lee.em be.r 2010.
ATTEST:
Sondra Smith, City Clerk
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CITY OF FAYETTEVILLE
L oneld j u+! n, Mayor
Pictfr
Michael McBride
Lake Sequoyah Contractor
Connie Edmonston
Submitted By
City of Fayetteville Staff Review Form
City Council Agenda Items
and
Contracts, Leases or Agreements
12/21/2010
City Council Meeting Date
Agenda Items Only
Division
Action Required:
Parks & Recreation
Department
A resolution awarding the Lake Sequoyah Bait Shop Operator Contract to Michael McBride in the amount of $20,000.
$
20,000.00
Cost of this request
1010.5250.5315.00
Account Number
Project Number
Budgeted Item
x
20,000.00
Category / Project Budget
$
Contract Services
Program Category / Project Name
Lake Maintenance
Funds Used to Date Program / Project Category Name
20,000.00 General Fund
Remaining Balance Fund Name
Budget Adjustment Attached
nande and Internal
0- 0 Previous Ordinance or Resolution #
D to
Original Contract Date:
//-12-1OOriginal Contract Number:
Date
ervices Director Dat
to
D to
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Received in City 11-22_1OMp2:32 RCVD
Clerk's Office
Comments:
vale .vide
THE CITY OF FAYETTEVILLE, ARKANSAS
PARKS AND RECREATION DEPARTMENT
113 West Mountain
Fayetteville, AR 72701
P (479) 444-3471 F (479) 521-7714
ARKANSAS
www.accessfayetteville.org
CITY COUNCIL AGENDA MEMO
To: Mayor Jordan and City Council
Thru: Don Marr, Chief of Staff
From: Connie Edmonston, Parks and Recreation Director
Date: November 19, 2010
Subject: Approval of a resolution awarding the Lake Sequoyah Boatdock Operator Contract to
Michael McBride in the amount of $20,000.
RECOMMENDATION
Parks and Recreation recommends approval of a resolution awarding the Lake Sequoyah Boatdock
Operator Contract to Michael McBride in the amount of $20,000.
BACKGROUND
Dixie L. Smith has been the Boatdock Operator at Lake Sequoyah for the past six years. Her contract
terminated effective December 31, 2010.
A Selection Committee was formed according to the Professional Selection Policy to select a contractor.
Two bids for the RFP were received. The Committee interviewed the applicants on November 18, 2010.
DISCUSSION
The Committee selected Michael McBride to be the Lake Sequoyah Boatdock Operator in the amount of
$20,000. These were the lowest of the two bids, which were submitted at $20,000 and $35,000. The
term of these contracts are on an annual basis pending upon budget approval by City Council. The
Contract may be automatically renewed for four consecutive one year terms with compensation adjusted
annually by three percent of the contracted amount for the prior year upon approval in the Annual
Budget process.
BUDGET IMPACT
This contract is within the 2011 proposed budget.
Attachments:
Contract Lake Sequoyah
Purchase Requisition
Telecommunications Device for the Deaf TDD (479) 521-1316 113 West Mountain - Fayetteville, AR 72701
RESOLUTION NO.
A RESOLUTION AUTHORIZING A CONTRACT WITH MICHAEL
MCBRIDE IN THE AMOUNT OF $20,000.00 TO PROVIDE OPERATION OF
THE LAKE SEQUOYAH BAIT SHOP
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
FAYETTEVILLE, ARKANSAS:
Section 1. That the City Council of the City of Fayetteville, Arkansas hereby authorizes a
contract with Michael McBride in the amount of $20,000.00 to provide operation of the Lake
Sequoyah Bait Shop. A copy of the contract is attached to this Resolution as Exhibit "A."
PASSED and APPROVED this 21St day of December, 2010.
APPROVED: ATTEST:
By: By:
LIONELD JORDAN, Mayor SONDRA E. SMITH, City Clerk/Treasurer
I xpected Delivery Date:
Quotes Attached
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Bond No BO 7900675917
ARKANSAS STATUTORY PERFORMANCE AND PAYMENT BOND
wE, Michael McBride
227-I0
as Principal,
hereinafter called Principal, and
Nationwide Mutual Insurance Company as Surety, hereinafter
called the Surety, are held and firmly bound unto City of Fayetteville (Owner) amount of
One Thousand and No/100 Dollars
($ 1,000.00
) for the payment whereof Principal and Surety bind
themselves, their heirs, personal representatives, and successors, and assigns, jointly and
severally, and firmly by these presents.
Principal has by written agreement dated January 1, 2011
entered into a contract with Owner for Gate Attendant
which contract is by reference made a part hereof, and is hereinafter referred to as the Contract.
The condition of this obligation is such that if the Principal shall faithfully perform the Contract
on his part and shall fully indemnify and save harmless the Owner from all cost and damage
which he may suffer by reason of failure so to do and shall fully reimburse and repay the Owner
all outlay and expense which the Owner may incur in making good any such default, and, further,
that if the Principal shall pay all persons all indebtedness for labor or . materials furnished or
performed under said contract failing which such persons shall have a direct right of action
against the Principal and Surety jointly and severally under this obligation, subject to the
Owner's priority, then this obligation shall be null and void; otherwise it shall remain in full
force and effect.
00600.doc 1
No suit, action or proceeding shall be brought on this bond outside the State of Arkansas. No
suit, action or proceeding shall be brought on this bond except by the Owner after six months
from the date final payment is made on the Contract, not shall any suit, action or proceeding be
brought by the Owner after two years from the date on which the final payment under the
Contract falls due. Any Alterations which may be made in the terms of the contract or in the
work to be done under it, or the giving by the Owner of any extension of time for the
performance of the Contract, or any other forbearance on the part either of the Owner or Principal
to the other shall not in any way release the Principal and the Surety or Sureties, or either or any
of them, their heirs, personal representatives, successors, or assigns from their liability hereunder,
notice to the Surety of Sureties of any such alteration, extension, or forbearance being hereby
waived.
in no event shall the aggregate liability of the Surety exceed the sum set herein.
Executed on the 30th day of December 2010
By 6�,c4.09 yM(6
Michael McBride (Seal)
Principal
Witness: )
Attest:
Attorney -in -Fact
/Lat}Fa Cateron
Nationwide Mutual Insurance Company
Surety
This Bond is given in Compliance with Act 351 of 1953, as amended.
END OF SECTION 00600
00600.doc 2
(Seal)
KNOW ALL MEN BY THESE PRESENTS THAT:
Nationwide Mutual Insurance Company, an Ohio corporation
Farmland Mutual Insurance Company, an Iowa corporation
Nationwide Agribusiness Insurance Company, an Iowa corporation
Power of Attorney
AMCO Insurance Company, an Iowa corporation
Allied Property and Casualty insurance Company, an Iowa corporation
Depositors Insurance Company, an Iowa corporation
hereinafter referred to severally as the 'Company" and collectively as the "Companies," each does hereby make, constitute and appoint:
Sandra Alitz, Andy Andersen, Bill R. Breckenridge,Dixie D. Brown, Ronald L. Bruder, Anita R. Calderon, Laura Cateron, Kerry Christensen, Dana R. Clark,
Keith E. Clements, Morgan Collins, Jeff Cosa, JaneIle Duffy, Janet Dutcher, Paulette M. Dyson, Amy S Fine, Matthew Gilmer, Grant R. Goodenow, Cristopher Hansen,
David E. Harbeck, Jesse Huston, Aaron J. Jamison, Peter Kamey, Diana Kelly, Mike Kuper, Ben Lewis, John Linnenbach, Greg R. Lister, Nic Meyer,
Beth Miller, Jeff Mohr, Elizabeth Moore, Stephen Moore, Esma Musa, Becky Nichols, Michael Paez, Amy J. Palmer, Spencer Paris, Andy Roby, Joshua Severson,
Larry D. Slegh, Richelle L. Smith, Patricia M. Vemiace, Heath Weiland, Kim Wells, Carrion R. Wilson, Fayth Wingerter
each in their individual capacity, its true and lawful attorney-in-fact, with full power and authority to sign, seal, and execute on its behalf any and all bonds and undertakings,
and other obligatory instruments of similar nature, in penalties not exceeding the sum of
FIVE MILLION AND NO/100 DOLLARS (55,000.000.00)
and to bind the Company thereby, as fully and to the same extent as if such instruments were signed by the duly authorized officers of the Company; and all acts of said
Attorney pursuant to the authority given are hereby ratified and confirmed.
This power of attomey is made and executed pursuant to and by authority of the following resotution duly adopted by the board of directors of the Company:
'RESOLVED, that the president, or any vice president be, and each hereby is, authorized and empowered to appoint attomeys-in-fact of the Company, and to
authorize them to execute and deliver on behalf of the Company any and all bonds, forms, applications, memorandums, undertakings, recognizances, transfers,
contracts of indemnity, policies, contracts guaranteeing the fidelity of persons holding positions of public or private trust, and other writings obligatory in nature that the
business of the Company may require; and to modify or revoke, with or without cause, any such appointment or authority; provided, however, that the authority granted
hereby shall in no way limit the authority of other duly authorized agents to sign and countersign any of said documents on behalf of the Company.'
'RESOLVED FURTHER, that such attorneys -in -fact shall have full power and authority to execute and deliver any and all such documents and to bind the Company
subject to the terms and limitations of the power of attorney issued to them, and to affix the seal of the Company thereto; provided, however, that said seal shall not be
necessary for the validity of any such documents.'
This power of attomey is signed and sealed under and by the following bylaws duly adopted by the board of directors of the Company.
Execution of Instruments. Any vice president, any assistant secretary or any assistant treasurer shall have the power and authority to sign or attest all approved
documents, instruments, contracts, or other papers in connection with the operation of the business of the company in addition to the chairman of the board, the chief
executive officer, president, treasurer or secretary; provided, however, the signature of any of them may be printed, engraved, or stamped on any approved document,
contract, instrument, or other papers of the Company.
IN WITNESS WHEREOF, the Company has caused this instrument to be sealed and duly attested by the signature of its officer the
al day of August 2009.
Gary A. Douglas, President and Chief Operating Officer of Nationwide Agribusiness Insurance Company
and Farmland Mutual Insurance Company; and Vice President of Nationwide Mutual Insurance Company,
AMCO Insurance Company, Allied Property and Casualty Insurance Company, and Depositors Insurance
Company
SEAL:
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ACKNOWLEDGMENT
STATE OF IOWA, COUNTY OF POLK: ss
On this 11"' day of August 2009, before me came the above-named officer for the Companies aforesaid, to
me personally known to be the officer described in and who executed the preceding instrument, and he
acknowledged the execution of the same, and being by me duly swom, deposes and says, that he Is the
officer of the Companies aforesaid, that the seats affixed hereto are the corporate seals of said Companies,
and the said corporate seals and his signature were duly affixed and subscribed to said Instrument by the
authority and direction of said Companies.
SANDVALITZ
Cenerdosixi lister 102/05
S� p
2r,
Notaryd-4 Public
My Commission Expires
CERTIFICATE March 24, 2011
I, Kathy R. Richards, Assistant Secretary of the Companies, do hereby certify that the foregoing is a full, true and correct copy of the original power of attorney issued by
the Company; that the resolution included therein is a true and correct transcript from the minutes of the meetings of the boards of directors and the same has not been
revoked or amended in any manner, that said Gary A. Douglas was on the date of the execution of the foregoing power of attomey the duly elected officer of the
Companies, and the corporate seals and his signature as officer were duly affixed and subscribed to the said instrument by the authority of said board of directors; and the
foregoing power of attorney is still in full force and effect.
IN WITNESS WHEREOF, I have hereunto subscribed my name as Assistant Secretary, and affixed the corporate seals of said Companies this 30th day
of December 20 10
This Power of Attomey Expires 08/11/2012
BDJ 1 (08/09)
Assistant Secretary
01/10/2011 13:35 FAX 4795215475 SHELTER INSURANCE
SHELTER INSURANCE COMPANIES
GENERAL LIABILITY
EVIDENCE OF INSURANCE
AS OF 01/10/2011
NAME AND ADDRESS OF NAMED INSURED:
MCBR1DE, MICHAEL
1238 N DEVILS DEN RD
WINSLOW. AR 72959-2601
Ij 001/001
22.1- I O
Mon tun 10 13:49:18 CST 2011
AGENT:
S SMITH INSURANCE AGENCY INC
2142 N COLLEGE
FAYETTEVILLE, AR 72703
(479) 521-4220
AGENT NUMBER 03.9146-70
POLICY NUMBER 03-31-7774417-2
THIS POLICY IS FROM 1122 AM 01/10/2011 TO 01/10/2012 AT 12:01 A.M, STANDARD TIME AT THE ADDRESS OF THE NAMED INSURED AS STATED HEREIN,
AND SUBJECT TO THE CONSENT OF THE COMPANY FOR TERMS OF SUCH DURATION EACH THEREAFTER AS TETE REQUIRED RENEWAL PREMIUM IS
PAID BY THE INSURED AND RECEIVED BY THE COMPANY ON OR BEFORE THE EXPFRATTON DATE OF THE CURRENT TERM,
THE LOCATION OF THE DESCRIBED PREMISES TS 1238 N DEVILS DEN RD WINSLOW, AR 72959
BUSINESS OF THE NAMED INSURED 15: BAIT SHOP
THE NAMED INSURED I5: INDIVIDUAL
THE LIMIT OF THE COMPANYS LABILITY TS STATED IN THE POLICY AND APPLIES AS FOLLOWS:
I,imila of lnauranco_
General Aggmgetc (Other Than Rodin - Completed Operations)
5 500.000
Personal and Advertising !Nay Limit
Each Occurrence Limit
Flro Damage Limit 5100,000 (Any One Fire)
Medical Expense Limit (Any One Person)
Premium
ovem a Farm and of Ha�rrle
Code Key Description Premium Basis Premium
s - N FOOD OR MUNK - OMR THAN NOT -POR- PR 0 j -Er
$ 300,000
$ 300.000
a 300.000
T 5,000
S 100A0
THE FOLLOWING ENDORSEMENTS ARE A PART OF THIS POLICY AND ARE ATTACHED:
CG -00-01
CG -21-67
CG 00 68
CG -31-04
Lilalr
Commcrolal Comm] LiabiliryCovoropc Form
Fungi Or Bacteria Exclusion
Recording And Dislribuoon 01' Material Or information Zn Vi
Exclusion - Products - Completed Operations Flacards
ADDTTTONAL INSURED
THE CITY OF FAYETTEVI LLE ATTN A FOREN
113 W MOUNTAIN ST RM 306
FAYETTEVILLE, AR 72701.6069
TERM 12 MONTHS
ZONE CODE 00]
B-750.8
AGENT
Policy Issued By
SHELTER Shelter Mutual Insurance Co.
wSuuaN[t
1817 W Broadway
Columbia, MO 65218-0001
HOW • 1.6 1 -800 -SHELTER, 1-800-743-5837
a Namedt .1nUreth.
MICHAEL MCBRIDE
1238 N DEVILS DEN RD
WINSLOW AR 72959-2601
General Liability Insurance
Policy Declarations
Addl. Interest or Addl. Insured Copy
S SMITH INSURANCE AGENCY INC
2142 N COLLEGE
FAYETTEVILLE AR 72703
AGENT #: 03-09146-70
PHONE: 479-521-4220
Notice to the Additional Insured: Your interest will be
continuous until cancellation notice is mailed to you.
Policy Number: 03-31-007774417-0002 Effective Date: January 10, 2011, 01:43 PM Central Time
Policy Form Number: CG 00 01 12 07 Expiration Date: January 10, 2012, 12:01 AM Central Time
Policy and Endorsements are available upon request
Business of the Named Insured: BAIT SHOP The Named Insured is a(n): Individual
Audit Period: Annually
$500,000
Excluded
$300,000
$300,000
$100,000
$5,000
1;Description of Hazards
PREMISES & OPERATIONS -
18437 STORES - NO FOOD OR DRINK -
OTHER THAN NOT-FOR-PROFIT NOC
ITEM ZIP CODE: 72959
1238 N DEVILS DEN RD WINSLOW AR
Premium Adjusting Endorserrients
Additional Insured - Lessor Of Leased Equipment
THE CITY OF FAYETTEVILLE ATTN
Additional information on next page
(For Office Use Only)
Transaction: P.C.
H. O. CODE: 100.00
Policy Term: One Year
Date Issued: 01-10-2011
'01102011'
03-31-007774417-0002
'��tFier.��nao�s��;;�R� a►itacnea`:�a:TFils Policy:
Total for Term (This is Not a Bill): Minimum $100.00
ndorsement•
UM
Fungi Or Bacteria Exclusion
CG 21 67 12 04
Rec & Dist of Material or Info in Violation of Law Exclusion
CG 00 68 05 09
Exclusion - Products - Completed Operations Hazards
CG 21 04 11 85
Common Policy Conditions
IL 00 17 11 98
Arkansas Changes - Cancellation and Nonrenewal
IL 02 31 09 08
Nuclear Energy Liability Exclusion Endorsement
IL 00 21 09 08
Exclusion - Year 2000 Computer-related & Electronic Problems
CG 21 60 09 98
Arkansas Changes - Transfer Rights Of Recovery
IL 01 99 09 08
Arkansas Change - Non Binding Arbitration
CG 26 44 12 04
Employment-related Practices Exclusion
CG 21 47 12 07
Lead Poisoning Exclusion Endorsement
B -601-B
Asbestos Exclusion
AybL,f� URC} k�9M1
THE CITY OF FAYETTEVILLE ATTN
A FOREN
113 W MOUNTAIN ST RM 306
FAYETTEVILLE AR 72701-6069
G -2.9-G
B -559-B
Page 2
SHELTER
IN SU RAN I:!
mar
03-31-7774417-2'
Shelter Mutual Insurance Company
1817 W Broadway
Columbia, MO 65218
1 -800 -SHELTER (743-5837)
Named Insured:
MICHAEL MCBRIDE
1238 N DEVILS DEN RD
WINSLOW AR 72959-2601
General Liability Insurance Policy Declarations
Notice to the Mortgagee/Loss Payee/Adds Insured: Your interest
will be continuous until cancellation notice is mailed to you.
Policy Number:
Effective Date:
Expiration Date:
Agent:
gar) to
***MANUAL DEC***
Lice., Setuot i'1`—
e A ' S1
03-31-7774417-2
01/10/2013 (12:01 A.M. CST)
01/10/2014 (12:01 A.M. CST)
S SMITH INSURANCE AGENCY INC
03-9146-70
2142 N COLLEGE
FAYETTEVILLE AR 72703
479-521-4220
Business of the Named Insured: BAIT SHOP The Named insured is a(n):
Audit Period:
Limits of Insurance
General Aggregate (Other Than Products — Completed Operations)
Products — Completed Operations Aggregate Limit (See Each Classification Below)
Personal And Advertising Injury Limit
Each Occurrence Limit
Rented To You Limit
Medical Expense Limit
Description of Hazards
Individual
Annually
$500,000
Excluded
$300,000
$300,000
$100,000 Any One Premises
$5,000 Any One Person
Premium_Bases7 Rates Advance
(Annual) Premium
PREMISES & OPERATIONS -
18437 STORES - NO FOOD OR DRINK -
OTHER THAN NOT-FOR-PROFIT NOC
ITEM ZIP CODE: 72959
1238 N DEVILS DEN RD
WINSLOW AR
GROSS SALES PR $1000
$10,000
.820 $8.00
Premium.Adjusting Endorsements
Additional Insured - Lessor Of Leased Equipment
Limits ,`Deductible
4-1:Number Premium
CG 20 28 07 04 $1.00
THE CITY OF FAYETTEVILLE ATTN
Total for Term (This is Not a Bill):
Policy forms and additional endorsements attached to this policy-,.:
Minimum $100.00
Number
Commercial General Liability Coverage Form
CG 00 01 12 07
Fungi Or Bacteria Exclusion
CG 21 67 12 04
Rec & Dist Of Material Or Info In Violation Of Law Exclusion
CG 00 68 05 09
Exclusion - Products - Completed Operations Hazards
CG 21 04 11 85
Common Policy Conditions
IL00171198
Arkansas Changes - Cancellation And Nonrenewal
IL02310908
Nuclear Energy Liability Exclusion Endorsement (Broad Form)
IL00210908
Exclusion - Year 2000 Computer -Related & Electronic Problems
CG 21 60 09 98
Arkansas Changes
CG 01 42 07 11
gl
03-31-7774417-2
Mutual Policy Notification S -18-S
Arkansas Changes - Transfer Rights Of Recovery IL 01 99 09 08
Arkansas Change - Non Binding Arbitration CG 26 44 12 04
Employment Related Practices Exclusion CG 21 47 12 07
Lead Poisoning Exclusion Endorsement B -601-B
Asbestos Exclusion
B -559-B
Excl Damage To Work By Subcontr On Your Behalf CG 22 94 10 01
Addl Insured
THE CITY OF FAYETTEVILLE
ATTN A FOREN
113 W MOUNTAIN ST RM 306
FAYETTEVILLE AR 72701-6069
(For Office Use Only)
Transaction: RENEW
H. O. CODE: 100.00
Policy ID: 80002600908
Policy Term: One Year
G -2.10-G
Date Issued: 11-20-2013
'01122012'
L
>`:End of Declarations
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