2007 Skyfire Service AgreementDEPARTMENT OF FINANCE TELEPHONE (785) 309 -5735
AND ADMINISTRATION FAX (785) 309 -5738
Rodney Franz, Director P TDD (785) 309 -5747
300 West Ash, P.O. Box 736 hlldis E -MAIL rod.franz @salina.org
Salina, Kansas 67402 -0736 u
Sd��11d Vvebsite: wvvw.salina- ks.gov
Service Agreement
This agreement entered into on the 1st, day of January, 2007 is made by and between the City of Salina, Kansas,
whose address is 300 West Ash Street, Salina, Kansas, referred to as "City ", AND the Salina Ambucs, whose address is
645 Sylvan Place, Salina, Ks 67401, referred to as "Provider."
Section 1: Services. The company hereby employs the provider to perform the following services in accordance with the
terms and conditions set forth in this agreement:
The Salina Ambucs will provide a public fireworks display in celebration of Independence Day, on or about
July 4, 2007
Section 2: Term of Agreement. This agreement will begin on the 1st day of January, 2007 and will end on the 31st
day of December, 2007 . Either party may cancel this agreement upon thirty (30) days notice to the other party in writing,
by certified mail or personal delivery.
Section 3: Amount of Agreement: The amount of the agreement is: $2,500.00
Section 4: Payment to Provider. The provider will be paid pursuant to the following terms and conditions:
Payment will be issued upon request of provider
Section 5: Status of provider: The provider is a: Not for profit organization
Section 6: Performance Reporting. The provider shall file performance reports as noted:
Other. Pleas specify By March 31, a request for renewal funding is due to be submitted to the City Clerk's
Office
Section 7: Financial Reporting. The provider shall file financial reports as noted:
No Report Required
Section 8: Nonperformance. In the event of provider non - performance or non- compliance with any section in this
agreement, this agreement may be cancelled with 30 days written notice, or in lieu thereof the City may elect to reduce
payments to provider.
Section 9: Compliance with applicable law. Provider shall comply with all applicable Federal, State, and Local law and
regulation.
Section 10: City indemnified. Provider shall indemnify and save harmless the City, its officials, agents, servants, officers,
directors and employees from and against all claims, expenses, demands, judgments and causes of action for personal
injury, death, and /or damage to property where and to the extent to which such claims, expenses, demands, judgments
and causes of action arise from the Provider's negligent acts. Provider shall notify the City upon the receipt of any claim in
excess of $1,000 in connection with this contract. Provider shall file with City, prior to any payment being made, proof of
insurance as follows:
❑ No proof of insurance required ❑ Other (Please specify):
® Commercial General Liability Comments:
❑ Automobile Liability
❑ Professional Liability- Errors and Omissions All insurance is to provide a minimum of $500,000 single
❑ Workers Compensation Insurance limit coverage.
(statutory).
® City if Salina required as additional named
insured on policy.
Print Name
I
City of Salina Standard Contract for Service; Page 1 o 2
Print Name
Section 11: Equal Opportunity /Affirmative Action. For agreements in which the value exceeds $20,000, provider shall
comply with the Equal Opportunity /Affirmative Guidelines attached.
Section 12: Independent Contractor. Both the City and the provider agree that the provider will act as an independent
contractor in the performance of its duties under this contract. Accordingly, the provider shall be responsible for payment of
all taxes including Federal, State and local taxes arising out of the provider's activities in accordance with this contract,
including by way of illustration but not limitation, Federal and State income tax, Social Security tax, Unemployment
Insurance taxes, and any other taxes or business license fees as required.
Section 13: Attachments incorporated. The following attachments and supplemental documents are incorporated herein
and made an integral part of this agreement.:
❑ Equal Opportunity /Affirmative Action Requirements ❑ Other: Please Specify
® Provider Proposal
❑ Certificates of Insurance
❑ W -9 Form
® Proof of Non - profit status (501c3 letter)
Section 14: Official contacts for the City and the provider are:
City:
Name:
Name:
Lieu Ann Elsey
Title:
City Clerk
Address:
300 West Ash, P. O. Box 736
City, State, Zip
Salina, KS 67401
Telephone:
785- 309 -5735
Fax: 785 - 309 -5738
E -mail
LieuAnn.Elsey @salina.org
Section 15: Executed on the 1s' day of January, 2007 .
For the City of Salina:
Jason Gage, Coi y Manager
For the Provider:
runt IN di
Cka.Tty�/Yy ikh�'r,z
Title
Provider:
Name:
John P. Ziegler
Title
Skyfire Ambucs
Address:
654 Sylvan Place
City, State, Zip
Salina, KS 67401
Telephone:
785- 823 -2336
E -mail:
Attest:
Penny Day, De Ity City Cler
Attest:
City of Salina Standard Contract for Service; Page 2of 2
Internal Revenue Service
National AMBUCS, Inc.
P.O. Box 5127
High Point, NC 27262
Internal Revenue Code:
Employer Identification Number:
Key District:
Service Center:
Accounting Period Ending:
Foundation Status Classification:
Form 990 Required:
Dear Applicant:
Department of the Treasury
Washington, DC 20224
Person to Contact: Ward L. Thomas
Telephone Number: (2 0 2) 622 -6142
Refer Reply to: CP : E : EO : T : 5
Date:
501 (c) (3)
58- 2152221
Southeast (Baltimore, MD)
Atlanta, GA
May
509 (a) (2)
Yes
We have considered your application for a group exemption
letter recognizing your subordinates as exempt from federal
income tax under section 501(a) of the Internal Revenue Code as
organizations described in section 501(c)(3).
Our records show that you are recognized as exempt from
federal income tax as an organization described in section
501 (c) (3) of the Code.
Based on the information supplied, and assuming the
operations of your subordinate organizations will be as stated in
your application for recognition of exemption, we have determined
that your subordinates are exempt from federal income tax under
the provisions of the Internal Revenue Code indicated above.
Exemption is effective as of December 27, 1994, as you have
agreed. This determination supersedes any prior exemption
letters issued to those subordinates which are included in this
group exemption; you should notify each such subordinate and the
key district director of each such subordinate that the
subordinate's individual exemption letter is superseded. This
determination is based in part on your representations that the
subordinates will amend their organizing documents to comply with
the organizational test of section 1.501(c)(3) -1(b) of the Income
Tax Regulations, and that you will merge with The National
Association of American Business Clubs, Inc. and be the surviving
entity.
We have further determined that your subordinate
organizations are not private foundations within the meaning of
section 509(a) of the Code, because they are organizations
described in the section indicated above.
request to city comm for 2006
To: Salina City Commision
From: Jahn Ziegler, Chairman skyfire Ambucs
Re: 2007 funding
This is a request for you to continue funding Salina's only public fireworks display
Skyfire
in 2007 at the current level of $2,500. If you have any questions I will be happy
to appear
and answer them.
Thank You
14n P Ziegl r fire Ambucs
654 sylvan Place
Salina Ks 67401
785 - 823 -2336
Page 1
Fireworks Display Permit
sauna
Date:
June 22, 2007
Name of Organization:
Salina Ambucs
Location of Display:
Salina Municipal Golf Course
Date of Display:
July 4, 2007
Time of Display:
10:00 p.m.
In accordance with the Salina Code, Chapter 14, Section 14 -51 through 14 -58. Approval is hereby granted for a
supervised public fireworks display to be conducted by the above named organization (the "permittee ") at the location and
date given.
The fireworks will be discharged by John Ziegler
who has furnished evidence of his or her competence in accordance with the Salina Code, Sections 14 -53 and 14 -54.
As required by Salina Code Section 14 -54g, the permittee has on file with the City Clerk proof o liability insurance in
the minimum amount of $500,000.00 for the payment of any and all damages which may be caused either to persons or
property by reason of the permitted display, and arising from any act of the permittee, his agents, employers or
subcontractors.
It is agreed that the permittee will indemnify, hold harmless, and defend the City of Salina from all liability from loss,
damage, or injury to persons or property in any manner arising out of or incident to the fireworks display permitted by his
agreement, including without limitation all consequential damages.
June 22, 2007
Fire Marshal (Signature) Date
City of Salina Approval
� A
Fi hief (Signature) J
lice Chief (Signature)
"X ��t--" -L'
Risk Managem nt (Signature)
Date
7
Date
Date
I
STATE KANSAS
LICENSE #: SAFOS001
ZIEGLER JOHN P
654 SYLVAN PLACE
SALINA KS 67401
Is Granted This License As: Fireworks - Public Display Operator
To perform duties asa Public Fireworks Display Operator as granted by
the Kansas Fire Prevention Code and adopted National. Standard NFPA
1123, 2006 Edition within the State of Kansas.
As granted under the authority of K.A. R'. 22- 1 -3(x)
and other provisions of the Kansas Prevention
This License is valid until 5/27/2011 unless suspended, revoked or refused
renewal in accordance with the provisions of KAR 22 -1 -5.
Effective Dater 5127/2007
Expiration Date: 5/27/2011 Rose Rozmiarek
Deputy State Fire Marshal
Chief Investigator
LICENSE #: SAFOS001
ZIEGLER JOHN P
654 SYLVAN PLACE
SALINA KS 67401
Operators must carry this card. Please cut on solid line
State Fire Marshal. State of Kansas
LICENSE #: SAFOS001
As: Fireworks = Public Display Operator
TO: ZIEGLER JOHN P
654 SYLVAN PLACE
SALINA KS 67401
ISSUED 5/2712007 EXPIRES' /2711
r
Deputy State Ere Marshal
Chief Investigator
ACORD- CERTIFICATE OF LIABILITY INSURANCE
DATE(MWDD/YYYY)
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE
6/21/2007
PRODUCER Phone: 440- 248 -4711 Fax: 440 -248 -5406
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Britton - Gallagher and Associates, Inc.
6240 SOM Center Rd.
Cleveland OA 44139
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
POLICYEFFECTIVE
DAT M D
POLICY EXPIRATION
DATE M DD
LIMITS
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
J & M Displays, Inc.
18064 170th Avenue
INSURER&Lexington Insurance Co
1/15/2007
INSURERS. Granite State Insurance Co.
EACH OCCURRENCE
INSURERC:Arch Sipecialty Ins Co
PREMISES aoccurence
Yarmouth th IA 52660
INSURER D:
X COMMERCIALGENERALLIABILITY
CLAIMS MADE � OCCUR
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
OTWITHSTANDING 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR,
N
POLICY NUMBER
POLICYEFFECTIVE
DAT M D
POLICY EXPIRATION
DATE M DD
LIMITS
A
GENERAL LIABILITY
6990167
1/15/2007
1/15/2008
EACH OCCURRENCE
$1,000,000
PREMISES aoccurence
$50,000
X COMMERCIALGENERALLIABILITY
CLAIMS MADE � OCCUR
MED EXP (Any one person)
$
PERSONAL& ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$2,000,000
POLICY X JERCT LOC
B
AUTOMOBILE
X
LIABILITY
ANYAUTO
CA93835136
1/15/2007
'1/15/2008
COMBINED SINGLE LIMIT
(Ea accident)
$1,000,000
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
$
X
X
HIREDAUTOS
NON- OWNEDAUTOS
B eracci ent)
(Per accident)
PROPERTYDAMAGE
(Peraccident)
$
GARAGELIABILITY
AUTO ONLY - EAACCIDENT
$
OTHER THAN EAACC
8i
ANYAUTO
$
AUTOONLY: AGG
C
EXCESS/UMBRELLALIABILITY
X OCCUR 1-1 CLAIMS MADE
ULP0004063
1/15/2007
1/15/2008
EACH OCCURRENCE
$9,000,000
AGGREGATE
$9,000,000
$
$
R DEDUCTIBLE
$
X RETENTION $10,000
IM PLOYS TUABILSATIONAND
RKERCOMPEN
EMPLOYERS LIABILITY
WCSTATU- OTH-
TORY LIMITS ER
E.L EACH ACCIDENT
$
ANYPROPRIETOR/PARTNER/EXECUTIVE
E.L. DISEASE -EA EMPLOYEE
$
OFFICERIMEMBEREXCLUDED?
Ifyes, describe under
E.L DISEASE -POLICY LIMIT
$
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES i EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
D'L INSUREDS: THE CITY OF SALINA, KANSAS, IT'S EMPLOYEES, VOLUNTEERS, OFFICERS, ELECTED OFFICIALS, PARTNERS,
IIBSIDIARIES, DIVISIONS & AFFILIATES, EVENT SPONSORS & LANDOWNERS AS THEIR INTEREST MAY APPEAR IN RELATION TO THIS
VIDRICKSON DISTRIBUTING (SPONSOR); SALINA MEDIA GROUP (SPONSOR).
FIREWORKS DISPLAY DATE: JULY 4, 2007
IN DATE- JULY 5, 2007
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
City of Salina BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE
654 Sylvan Place CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO
Salina KS 67401 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
25 (20011081 ....,a., ....,..