HomeMy WebLinkAboutCity Council Meeting - Council - Agenda - 06/03/1997.................. ..
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City of Kent
City Council Meeting
Agenda
CITY OF
Mayor Jim White
Council Members
Christi Houser, President
Jim Bennett Jon Johnson
Tim Clark Leona Orr
Connie Epperly Judy Woods
June 3, 1997
3
Office of the City Clerk
CITY OF ZQ AKIT
SUMMARY AGENDA
KENT CITY COUNCIL MEETING
June 3, 1997
Council Chambers
7 : 00 p.m.
MAYOR: Jim White COUNCILMEMBERS: Christi Houser, President
Jim Bennett Tim Clark Connie Epperly
Jon Johnson Leona Orr Judy Woods
CALL TO ORDER
FLAG SALUTE
ROLL CALL
1. PUBLIC COMMUNICATIONS
A. Introduction of Mayor's Appointee
B. Employee of the Month
C. Regional Justice Center Update
D. Kiwanis Club/Park Landscape Site Development Award
2 . PUBLIC HEARINGS
A. Del Mar Annexation - Ordinance
3 . CONSENT CALENDAR
A. Approval of Minutes
B. Approval of Bills
C. Sole Source Vendor for Protective Clothing (Fire) -
Authorization
D. Street Legal Drag Racing Program - Set Budget and
Authorize Expenditures
E. Transit Advisory Board - Appointment
F. Transportation Improvement Board Grant - Authorization
and Establishment of Budget
G. Surplus Vehicles - Authorization
H. Group Health Cooperative Contract - Renewal
I. Banking Services Contract - Approval
J. Del Mar Annexation Census Contract - Authorization
K. Puget Sound Pipe & Supply - Bill of Sale
4 . OTHER BUSINESS
A. Meridian West Preliminary Plat - Approval
5. BIDS
A. South 200th Street Green River Bridge
6. CONTINUED COMMUNICATIONS
7 . REPORTS
EXECUTIVE SESSION - Property Negotiations
8 . ADJOURNMENT
NOTE: A copy of the full agenda packet is available for perusal in
the City Clerk's Office and the Kent Library.
An explanation of the agenda format is given on the back of
this page.
Any person requiring a disability accommodation should contact the
City in advance for more information. For TDD relay service call
1-800-635-9993 or the City of Kent (206) 854-6587 .
PUBLIC COMMUNICATIONS
Citizens wishing to address the Council will, at this time,
make known the subject of interest, so all may be properly
heard.
A) Introduction of Mayor' s Appointee
r �j�I�lscrY IX
B) Employee of the Month
C) Regional Justice Center Update
D) Kiwanis Club/Park Landscape Site Development Award
Kent City Council Meeting
Date June 3 . 1997
Category Public Hearings
1. SUBJECT: DEL MAR ANNEXATION - ORDINANCE
2. SUMMARY STATEMENT: This date has been set as the hearing
date for the proposed Del Mar Annexation. The City has
received a sufficient and valid property owner petition on the
proposed Del Mar Annexation, and the King County Boundary
Review Board approved the annexation proposal on May 19, 1997.
This annexation contains approximately 578 acres and is located
on the southwestern edge of the City. The annexation area is
generally bounded south of the current City boundary at South
252nd Street, east of Pacific Highway South, north of South
272nd Street, and west of the existing City boundary along
Military Road, South 268th Street and South 272nd Street. The
proposed ordinance would annex the Del Mar area effective
July 1, 1997 .
EXHIBITS: Ordinance, memo, map
4 . RECOMMENDED BY: Staff
(Committee, Staff, Examiner, Commission, etc. )
5. UNBUDGETED FISCAL/PERSONNEL IMPACT: NO YES X
6. EXPENDITURE REQUIRED: $
SOURCE OF FUNDS:
OPEN HEARING: \wf'
PUBLIC INPUT•
CLOSE HEARING: ���.�-tJt,Wk�. �1;j,
7. CITY COUNCIL ACTION:
Councilmember 'lid-' moves, Councilmember seconds
to adopt Ordinance No. �� annexing the Del Mar Annexation
area effective July 1, 1997 .
DISCUSSION:
ACTION•
Council Agenda
Item No. 2A
CITY OF �11V :S
Jim White, Mayor
Planning Department (206) 859-3390/FAX (206) 850-2544
James P. Harris, Planning Director
MEMORANDUM
June 3, 1997
MEMO TO: MAYOR JIM WHITE AND CITY COUNCIL MEMBERS
FROM: JAMES H. HARRIS, PLANNING DIRECTOR
SUBJECT: DEL MAR ANNEXATION AN-97-1. PUBLIC HEARING TO
CONSIDER ANNEXING THE DEL MAR AREA
MEETING DATE: TUESDAY, JUNE 3, 1997.
I. Background
On February 4, 1997 the City Council accepted the 10 percent annexation petition for the
- Del Mar annexation area and authorized the circulation of the 60 percent petition.
The 60 percent petition has received by the and the notice of intent has cleared the
Boundary Review Board.
H. Location
The proposed annexation is located on the western edge of the City and generally lies
between South 252nd Street and South 272nd Street and between Military Road and Pacific
Highway South. South of South 268th Street at Military Road, the annexation follows the
existing City boundary easterly along South 268th Street to just west of 37th Avenue S.
and then south to South 270th Street and easterly along South 270th Street to 42nd Avenue
S. and then southerly along 42nd Avenue S. to South 272nd Street.
III. Size of Proposed Annexation
The proposed annexation contains approximately 578 acres. The estimated population is
3,500 to 4,000 persons.
IV. Future Co=rehersive Plan and Implementing 7oning
Upon annexation to the City, the Land Use and Planning Board will hold hearings
concerning the application of a Comprehensive Plan designation for the annexed area and
zoning designations to implement the plan. The Board's recommendation on the
Comprehensive Plan and.zoning will be forwarded to the City Council for final action.
'In1r61VF C(1 1KFNT WA1 H IN(1T(1N(WO I' ag05 i TEl P PHI IN r. Inniaso.zun i i I:4 Y d"0.:111
Del Mar Annexation AN-97-1
June 3, 1997
Page 2
V. Financial Information
The assessed valuation of the Del Mar annexation is $114,338,144.. The total estimated
revenue is $1,241,711.
A separate financial report will be presented to the Council at the June 3rd public hearing.
VI. Annexation Policies
The annexation satisfies the recently Council adopted Annexation Policies (adopted on
April, 1, 1997).
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ORDINANCE NO.
AN ORDINANCE of the City Council of the City
of Kent, Washington, annexing to the City certain
contiguous lands, comprising approximately 578 acres,
generally bounded on the north and east by the City's
existing corporate limits, on the west by Pacific Highway
South(Hwy. 99)and on the south by South 272nd Street, all
generally referred to as the "Del Mar Annexation"; making
the property annexed subject to the City's proportionate
share of its existing indebtedness and to its interim zoning
regulations for newly annexed lands; adjusting the City's
1997 annual budget to accommodate changes in revenues
and expenditures related to the annexation; making July 1,
1997 the effective date of the annexation; and authorizing
the City Clerk to determine the resident population within
the annexation area and to deliver required annexation
information to the State Office of Financial Management
and to the Metropolitan King County Council.
WHEREAS, in accordance with Chapter 35A.14 RCW, the owners of not
less than 60 percent of the assessed valuation for general taxation of certain real property,
the "Del Mar Annexation" area, which is more particularly described in Exhibit A to this
ordinance (map attached as Exhibit B), have petitioned the Kent City Council to annex the
Del Mar Annexation Area to the City of Kent; and
WHEREAS,the City has determined the Del Mar Annexation area petition
to be sufficient in all respects; and
WHEREAS, in accordance with Chapter 35A.14 RCW various proceedings
were had; and
WHEREAS, the City filed a Notice of Intention document with the
Washington State Boundary Review Board for King County("BRB")on April, 1997;and
WHEREAS, on May 19, 1997, the BRB approved the City's Notice of
Intention and annexation proposal; and
WHEREAS, the City has published and posted notice of a public hearing
on the proposed Del Mar Annexation in accordance with RCW 35A.14.130 so that
interested persons could voice their approval or disapproval of the annexation: and
WHEREAS,the City Council of the City of Kent held a public hearing on
the Del Mar Annexation in the City Council Chambers at a regularly scheduled meeting of
the Kent City Council at 7:00 p.m. on June 3, 1997; and
WHEREAS, it appears to the City of Kent that the Del Mar Annexation
meets all requirements specified by law, that the land to be annexed is contiguous to the
City of Kent, and that the annexation area has not heretofore been incorporated in or as a
city or town; NOW THEREFORE,
THE CITY COUNCIL OF THE CITY OF KENT,WASHINGTON,DOES
HEREBY ORDAIN AS FOLLOWS:
SECTION]. The foregoing recitals are incorporated by this reference and
made a part hereof.
SECTION2. Effective July 1, 1997, there shall be annexed to the City of
Kent, Washington, certain property situated in King County, Washington, commonly
known as the "Del Mar Annexation" area, which property is legally described in Exhibit
A, attached and incorporated by this reference, and having the boundaries indicated in the
2
map attached as Exhibit B, which is incorporated by this reference.
SECTIONS. In accordance with the Del Mar Annexation property owners'
petition,the property hereby annexed shall be subject to its proportionate share of the City's
existing indebtedness and shall be assessed and taxed at the same rate and on the same basis
that other property within the City of Kent is assessed and taxed to pay for any outstanding
general indebtedness of the City, if that indebtedness has been approved by the voters,
contracted for, or incurred prior to, or existing at the effective date of this annexation.
SECTION4. Until the City completes its final zoning determination for the
annexation area, the Del Mar Annexation area shall be subject to the interim zoning
regulations for newly annexed areas established in Title 15 of the Kent City Code, as now
enacted or hereafter amended.
SECTIONS. This annexation will become effective July 1, 1997, and on
that date,the annexation area shall become a part of the City of Kent, subject to all the laws
and ordinances of the City except as otherwise provided by law.
SECTION 6. Based on the additional revenue and expenditures that this
annexation is anticipated to generate, the City's 1997 budget is adjusted to establish a Del
Mar Annexation budget as shown on Exhibit C, attached and incorporated by this
reference.
SECTION 7. Within thirty (30) days from the effective date of this
annexation as provided by law, the City Clerk of the City of Kent shall, under the direction
of the Mayor of the City of Kent, determine the resident population of the annexed
territory, which population determination shall consist of an actual enumeration of the
population that shall be made in accordance with the practices and policies and subject to
approval of the State of Washington's Office of Financial Management and which
3
population shall be determined as of the effective date of this annexation as specified in this
ordinance.
SECTION 8. The City Clerk of the City of Kent, pursuant to RCW
35A.14.700, shall prepare a certificate signed by the Mayor and attested by the City Clerk
in such form and containing such information as shall be prescribed by the State Office of
Financial Management, and the City Clerk shall thereafter submit that certificate in
triplicate to the Office of Financial Management together with the population determination
of the annexed territory.
SECTION 9. Upon passage of this annexation ordinance, the City Clerk
of the City of Kent,pursuant to RCW 35A.14.140, shall send to the Office of the Clerk of
the County Council a certified copy of this ordinance together with a copy of a letter from
the BRB's Executive Secretary of the King County Boundary Review Board that declares
the BRB's decision relating to this annexation.
SECTION 10. If any one or more sections, subsections, or sentences of
this Ordinance are held to be unconstitutional or invalid, such decision shall not affect the
validity of the remaining portion of this Ordinance and the same shall remain in full force
and effect.
SECTION 11. This Ordinance shall take effect and be in force five (5)
days after passage and publication as provided by law.
JIM WHITE, MAYOR
4
ATTEST:
BRENDA JACOBER, CITY CLERK
APPROVED AS TO FORM:
ROGER A. LUBOVICH, CITY ATTORNEY
PASSED: day of 11997.
APPROVED: day of 11997.
PUBLISHED: day of 1997.
I hereby certify that this is a true copy of Ordinance No. passed
by the City Council of the City of Kent, Washington, and approved by the Mayor of the
City of Kent as hereon indicated.
(SEAL)
BRENDA JACOBER, CITY CLERK
P:VLA W\ORDINANCMELMAR-ORD
5
.Y
Del Mar Annexation Legal Description
That portion of Sections 21, 22, 27, 28 and 33 in Township 22 North, Range 4 East
W.M., described as follows:
Commencing at the southeast comer of the southwest quarter of said Section 27;
thence North 0°57'44" East along the cast line of said southwest quarter 42 feet to the
Point of Beginning;
thence continuing north along said east line to the southeast corner of the north half of
the southeast quarter of the southwest quarter of said Section 27 as described in City of
Kent Ordinance No. 1904;
thence west along the south line of said subdivision to the southwest comer of said north
half;
thence north along the west line of said north half to the northwest corner thereof;
thence west along the south line of the northwest quarter of the southwest quarter of
said Section 27 to the southwest comer of said subdivision as described in City of Kent
Ordinance No. 1078;
thence north along the west line of said southwest quarter to the northwest corner
thereof, also being a point on the centerline of Military Road South as described in City
of Kent Ordinance No. 1002; thence northeasterly along the former centerline of
Military Road South as described in said Ordinance, being a line parallel with and 30
feet easterly/southeasterly of the westerly margin of said road, to intersect the northerly
margin of J. L. Reith Road as described in City of Kent Ordinance No. 2564;
thence southwesterly along said northerly margin to the east line of the west 180 feet of
the east 495 feet of the northwest quarter of the northwest quarter of said Section 27;
thence north along the east line of said west 180 feet to the south line of the north 620
feet of the northwest quarter of the northwest quarter of said section;
thence west along the south line-of said north 620 feet to the west line of the east 495
feet of said northwest quarter of the northwest quarter;
thence north along said west line, also being the east line of the plat of Alderview
recorded in Volume 63 of plats, page 27 as described in City of Kent Ordinance No.
1625, to the south line of the southwest quarter of the southwest quarter of Section 22;
thence North 89°02'52" west along said south line as described in City of Kent
Ordinance No. 1363 to the southwest comer of said southwest quarter;
thence North 01°07'45" east along the west line of said southwest quarter to its
intersection with the easterly margin of Interstate Highway No. 5 (Primary State
Highway No. 1) as conveyed to the State of Washington by deed recorded under
Auditors File No. 5041196;
1 EXHIBITS.,
thence northeasterly along said easterly margin as described in City of Kent Ordinance
No. 1363 to the north line of the southwest quarter of the southwest quarter of said
Section 22;
thence west along the north line of said subdivision and along the south line of the
northeast quarter of the southeast quarter of Section 21, as described in City of Kent
Ordinance No. 1002, to the southwest corner of the northeast quarter of the southeast
quarter of said section;
thence south along the east line of the southwest quarter of the southeast quarter of said
Section 21 to the south line of the north 400 feet of said subdivision as described in City
of Kent Ordinance No. 1002;
thence west along said south line to the westerly margin of Pacific Highway So. (State
Road No. 1) (US 99) as described in City of Des Moines Ordinance No. 1166;
thence southwesterly along said westerly margin to its intersection with the southerly
margin of So. 272nd Street;
thence easterly along said southerly margin to its intersection with the easterly margin
of Interstate Highway No. 5 (Primary State Highway No. 1);
thence north along said easterly margin to the northerly margin of So. 272nd Street;
thence easterly along said northerly margin to the Point of Beginning.
2
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EDERAL WAY CITE'/LIMITS
Vicinity leap EXHIBIT 13
CITY OF KENT
DELMAR ANNEXATION
FOR THE YEAR 1997-SLY MONTHS
Total Acres 16,110 578
Total Number Of Parcels 16,555 594
Total Number Of Res Units 25,363 U I,m
Total Estimated Population 60380 P 4,000
Total Assessed Valuation 4,942360,082 A 114,339,144
CR1M.
CITY WIDE GENERAL C1P STREET JUSTICE STORM WAT OTHER
REVENUE: BUDGET FUND FUND FUND FUND FUND FUND FUND TOTAL
Prop.Tax Q 2.84008(1) 12,717,322 A
Voted Excess Levy Q.36276(1) 1,624,368 A
205
Prop.Tax-Annexed Street Q1.73594 95,205 05,677
Sales Tax(2) 14,464357 O 79,258 26,419 159,837
Utility Tax(3)
539"" U 59,837 54,307
Utility Tax-Environmental(3) 270,018 U 4,956 5,956
Utility Tax-Youth Teen Center(3) SM435 U 15,956 19,946
Utility TaxStreet 1%(3) 1,709,113 U 19,9." 19,946
Special Assessments 1,166,901
7 094 1,084
Rail Estate Excise600+� A
Gambling and Leasehold Taxes 439,000
13,708
Business Licensesand Permits 1,161,062 A 13,708
Grants 1,023,732
Sate Shared Revenue(4) 3,235,149 P 19,760 30,000 360 50,120
Local Sales Tax Criminal Justice 802.010 P =139 22,138
Fire Insurance Premium Tau. 106,380
Fire Protection District A37(5) 2,419,146 A
JaillInargoveromenal Revenue 1,934,760
000
King County Medial Service Levy 664,517 10,000 30, 36
Fine and ForForfeituresr
918,855 P 30,436 0,436
Parks 2305,916
Miscellaneous Fees(6)
618,112 O 7,726 7,726
Interest Income•Ge seral and Others 3,986,511
Water Utility 6,069,981
Sewer Utility 11,455,105
22,156 22,156
Drainage Utility(') 5,995,627 O
Drainage Buin Adjustment
Golf 2,596,628
Other Revenues 2,239,625
Estimated Total Revenue 86,284,020 220,725 33,503 145,151 22,498 22,156 20,263 464,296
EXPENDITURES: FT RPT
General Government(8) 6,722,670 3.00 (1-60) 36,132 16A" 52'996
Public Safety(9) 28,498,415 11.00 154,304 36,960 22,498 213,762
Public WorksiStreet(10) 7,891,659 1.00 35,000 10,000 80,730 2,600 4,307 132,07
Leisure Services(ll) 6,166,115 1.00 28,915 15,956 44,871
Planning and Code Enfonament(12) 2381,647 1.00 30,795 37,150 67,945
Debt Service 10,903,013
Water Utility -5,773,410
Sewer Utility 13,779,510
Drainage Utility(10) 7,036,052
Golf 2,081,334
Estimated Total Expenditure 91,233,825 17.00 (1.60) M146 $4,110 80,730 22,498 19364 20,263 512,111
Transfer(In)Out (64,421) 64,421
Fund Balance (50,607) 2,792 (47,3M
Net Impact Income(Loa)&Net FTE 15.40
P."NE=Et.MA976.WB1 22-May-97 EXH 1 B IT
A _r A
CITY OF KENT
DELMAR ANNEXATION-NOTES
FOR THE YEAR 1M-SIX MONTHS
I)PROPERTY TAXES: -
Assessed Valuation 114,138,144 114a38,141
Less Tax Exampt Properties 4,657,100 052,100
Less Senior Reduced Rate Property 800267 WA
Adjusted Assessed Valuation 108,885,677 109,68044 Excess Lett'Assessed Valuation
•.007 Average Per County Records
Regular Levy:
Adjusted Assessed Valuation
Multiplied By The Regular Levy Rate
Divided By 1000. 94,510
Regular Senior Reduced Levy:
Senior Assessed Valuation
Multiplied By The Senior Levy Rate
Divided By 1000. 6"
Voted Excess Levy:
Excess Levy Assessed Valuation
Multiplied By Excess Levy Rate
Divided By 1000. NA
Total Property Tax 95,205
2)SALES TAX:
Estimated Fmv Of Construction 400,000
Estimated Number Built 3
Total Value Per Year 1,200,000
Local Sales Tax Rate 0.8415%
Sales Tax From Construction 10,098
Sales Tax From Annexed Businesse 95,579
105,677
3)UTILITY TAX: Estimated 3.00% 3.00% 0.30% 1.00% _.
Avenge Billing General Environment TM Street Total
Drainage 42,268 1,763 338 423 2,029
Electricity 1210,605 3018 9,685 12,106 Al"
Garbage 143,550 4,307 4,307 1,148 1,436 11,198
Sewer NA 785 3981 28,710
Telephone 598,125 17,941 4.
Water NA
1,994,548 59,837 4,307 15956 19946 100,046
4)STATE SHARED REVENUE: Amount
Criminal Per
General Street Justice Total Person
Mobile Trailer And Camper Tax 280 230 0.02
Motor Vehicle Excise Tax 11,360 11,360 0.71
Liquor Excise Tax 2,880 2,880 0.18
liquor Profits Tax 5240 5,740 0.33
Local Vehicle License Fee 3,230 8280 M2
Motor Vehicle Fuel Tax-Streat 14,300 14,800 0.93
Motor Vehicle Fuel Tit:-Arterial 020 6920 0.43
Criminal Justice Funding 360 360 0.02
19.760 30,000 360 50.120 3.13
5)FIRE PROTECTION DISTRICT 039:
Proposed Annexation Assessed Valuation Divided By 1000,
Multiplied By County Rate,Multiplied By Ninety Percent.
6)MISCELLANEOUS FEES: Budget
Planning And Engineering Misc.Fe 59%008
General Government Misc,Fees 20,104
619,112
Planning:
Proposed Assessed Valuation Divided By Total Assessed Valuation
Multiplied By Budgeted Planning And Engineering MisceWneoaa Revalues. 7,060
General Government.
Proposed Population Divided By Total Population Multiplied By General
Government Miscellancous Revenues. - 6"
7,726 ���sss //'`
P:WNNEXIDELMA976.WBl 22-LtayA raj.7 4
7)DRAINAGE UTILITY:
Residential:
Residential Units Multiplied By Basie'W Mootbly
Charge Multiplied By Six.
Commercial Dtaiaage Charges 22.156
.. Total Drainage � W56
8)GENERAL GOVERNMENT:
Allocable To Utilities FTE RPT TOTAL START UP NET ►IRE DATE
Utility Baling 1 22,920 22,920 MY97
Reg Pat Time (1) (15,656) (15,656)JMY97
ComptnedDesk 3,650 3.650
Operating Costs 5930 5930
Drainage I (1) FTE&RPT 16,864 3.650 13314
Drainage Net 1 FTE NET
Allocable To Finance 23,111 R1LY97
Businm Li-, Full That I 23,111
Less Regular Pan-Time (1) (12.787) (12,787)NLY97
ComP WA)Csk 3,650 3.650
OPenting Cis 4312 4352
Finance 1 (1) FTEA RPT IE326 3,610 14.676
Finance Net I FIE NET
Allocable To Employee Services 9 606
Human Resource Tech I (1) FTE&RPT 9,606
Employee Services Net 0 FTE NET 9.6 16 9•606
Allocable to Administration
Maps woo woo
Publication 2,500 2,500
Election Cons 3.700 3,200
9,200 2,500 5,700
Other Funds .
Debt Service
Total General Government 3 (2) FTE&RPT 52,996 9.800 43.1%
Total General Gov cm Net � FTE NET
(9)PUBLIC SAFETY:
Police 116,606 TWOMY97,TWOSEFT97&TWONOV97
S Police OBieewl Sergeant 6 116.606
Opetieglfniuing _ 11,169 11.169
startup Coats 22,200 22.200
n
Valley Communication Costs 17,500 17,500
Equipment 11,660 11.660
Equipment Deferred Until Year 2 38,312
Total Police 6 FTE 179.135 72.172 145,273
Fire
Fire Fighters
4 SAN98
openers Costs -
Start Up Costs/Uniformu'Radios
Administrative Sec 2 1 22,127 2ZI27 M,Y97
Valley Communication Costs 7.500 7,500
Operating 1.900 1,900
Composer 3,100 3,100
Total Fire 5 FTE 34,627 3,100 31.327
TOTAL PUBLIC SAFETY 11 213,762 73,272 176.03021
P.OWNEWEL MA976.WB122AtayA7
(10)PUBLIC WORKS:
Street
General Fund
Sweeping Coovact 2.500 2,5W
Operating Costs 5,000 5,000
TmfSc ControllSignal Mainz 7,500 7,500
Sign 10,000 10,000
Sheer Lighting 20,000 20,000
Transfa to General Fund 45,000 10.000 35.000
Staves
Reserve for Cap Imp. 90,730 90,730
Sew 80.730 80,730
Total Street And GF Transfer 125,730 10,000 115.730
Storm Drainage 1AN98
MWII 1
Operating Cis 2,500 2,500
Reserve for Cap.bmp.
1 FTE 2,500 2,500
EwArtn mental
Opexanng Cis 4,307 4.307
Reserve for Cap.Imp.
4,307 4.307
Total Public Works 1 FIE 132.537 10,000 122.537
(11)LEISURE SERVICES:
Fadities/Mainteamcc Worker 11I 1 22,915 n w NLY97
Operating Cost 15,956 15,956
52.00 Per Person For The Arts 4,000 4.000 -
Brochures 2.000 2,000
Total Leisure Services 1 FTE 44,871 44,971
(12)PLANNING
Plauner, 1 27.098 27.088 1DLY97
Comm 34,050 34,050
1%For Human Scrvim 2,207 2.207
Operating Costs 1.500 1,500
Equipment 3.100 3,100
I FTE 67,945 37.150 30,795
OVERALL 16 FTE&RPT 512,111
OVERALL NET �FTENET .
P.WMMOEtA4M'M.WB122dtry-g7 444
1• /1
CONSENT CALENDAR
3 . city council Action: i
Councilmember moves, Councilmember
seconds that Consent Calendar Items A through K b approved.
Discussion
Action
3A. Approval of Minutes.
Approval of the minutes of the regular Council meeting of
May 20, 1997, and correction of Item 3B in the minutes of
May 6, 1997 , as follows: The date shown for "Approval of
checks issued for vouchers" should be April 15, 1997 , rather
than April 1, 1997 .
3B. Approval of Bills.
Approval of payment of the bills received through May 15 and
paid on April 30, 1997 and May 15 , 1997 , after auditing by the
Operations Committee on May 27 , 1997 .
Approval of checks issued for vouchers:
Date Check Numbers Amount
4/30/97 183330-183637 $ 552 , 274 . 24
4/30/97 183638-183990 1, 652 , 592 . 74
$2 , 204 , 866. 98
5/15/97 183991-184220 $ 785, 306. 84
5/15/97 184221-184247 1 , 445 ,747 .20
$2 , 231, 054 . 04
$4 ,435, 921. 02
Approval of checks issued for payroll for May 1 through May 15
and paid on May 20, 1997 :
Date Check Numbers Amount
5/20/97 Checks 219695-220070 $ 261, 832 . 70
5/20/97 Advices 45917-46442 $ 654 , 685. 57
$ 916, 518 . 27
Council Agenda
Item No. 3 A-B
Kent, Washington
May 20, 1997
Regular meeting of the Kent City Council was called to order at
7 :00 p.m. by Mayor White. Present: Councilmembers Bennett,
Clark, Epperly, Johnson, Orr and Woods, Operations Director/Chief
of Staff McFall, Assistant City Attorney Brubaker, Planning
Director Harris, Public Works Director Wickstrom, Police Chief
Crawford, and Parks Director Hodgson. Council President Houser
was excused from the meeting. Approximately 25 people were
present at the meeting. The flag salute was led by Girl Scout
Troop 1552 .
PUBLIC Stand for Healthy Children Day. Mayor White read
COMMUNICATIONS a proclamation declaring June 1, 1997, as Stand
for Healthy Children Day in the City of Kent. He
noted that caring for the health of children must
be top priority for families, communities, and
the nation. He also noted that the commitment
must begin at the local level where all citizens
working together can make a difference in the
lives of children. The Mayor encouraged Kent
citizens to get involved and support efforts to
improve the health and quality of life for all
children.
CONSENT BENNETT MOVED that Consent Calendar Items A
CALENDAR through P, with the exception of Item L. be
approved. Woods seconded and the motion carried.
MINUTES (CONSENT CALENDAR - ITEM 3A)
Approval of Minutes. APPROVAL of the minutes of
the regular Council meeting of May 6 , 1997 .
HEALTH & (CONSENT CALENDAR - ITEM 3D)
SANITATION Harvest Industrial Park. AUTHORIZATION to accept
the bill of sale for Harvest Industrial Park sub-
mitted by Opus NW L.L.C. for continuous operation
and maintenance of 985 feet of watermains, 362
feet of sanitary sewers, 10 feet of storm sewers,
and release of bonds after the expiration period,
as recommended by the Public Works Director. The
project is located at West Valley Highway & 70th
Avenue South.
PUBLIC SAFETY (OTHER BUSINESS - ITEM 4C)
Criminal Code Amendments. RCW 39.34 . 180 requires
cities such as the City of Kent to prosecute all
misdemeanor and gross misdemeanor offenses
whether filed under state law or city ordinance.
This has resulted in the City' s inability to file
charges in the King County District Court for
certain offenses occurring within the City which
constitute a violation under state law, but not
1
Kent City Council Minutes May 20, 1997
PUBLIC SAFETY under the City's criminal code. The proposed
emergency ordinance adopts numerous provisions of
the Revised Code of Washington and repeals cer-
tain City criminal code provisions that duplicate
state provisions adopted in this ordinance. The
emergency ordinance would allow for immediate
enforcement of the ordinance. The adoption of
this emergency ordinance requires a unanimous
vote of the City Council.
Assistant City Attorney Brubaker explained that
the City of Kent has jurisdiction over mis-
demeanor and gross misdemeanor crimes but some of
these crimes, in the past, were charged under the
State Law (RCW) and filed through the Aukeen
District Court run by King County. He further
explained that a recent change in State Law
requires that the City charge, prosecute and
incarcerate all offenders of misdemeanor and
gross misdemeanor crimes. He explained that,
when putting the ordinance together, there was a
conflict between some RCW' s adopted and a couple
of existing City ordinances that should have been
repealed but that the changes are now included in
the corrected ordinance pages given to Council.
Brubaker noted that this ordinance has been
established as an emergency ordinance because it
poses an immediate threat to the public health
and safety, and without passage it will inhibit
the officers from charging for all the crimes
that need to be prosecuted. He clarified that
even though this is an emergency ordinance, it
may not necessarily require unanimous passage by
the State but that the recommendation is to pass
it unanimously.
BENNETT MOVED to adopt Ordinance No. 3350 as an
emergency ordinance amending the Criminal Code
and other related provisions. Orr seconded and
the motion carried unanimously.
PLATS (CONSENT CALENDAR - ITEM 3H)
Meridian West Preliminary Plat. AUTHORIZATION to
set June 3 , 1997, as the date for a public
meeting to consider the Hearing Examiner's recom-
mendation for a preliminary plat application
filed by Wally and Anne Mseitif for the Meridian
West Preliminary Plat. This plat is 4 . 86 acres
in size, consists of 25 single family lots, and
is located adjacent to 132nd Avenue SE, between
263rd and 266th Streets.
2
Kent City Council Minutes May 20, 1997
PLATS (OTHER BUSINESS - ITEM 4A)
Hillside Manor Preliminary Plat. This date has
been set to consider the Hearing Examiner' s
recommendation for conditional approval of an
application by Leonard Stanley and Robert Bennett
for a 23-lot single family residential pre-
liminary subdivision. This plat is 4. 3 acres in
size and is located at 24411 98th Avenue S.
ORR MOVED to accept the Findings of the Hearing
Examiner, and to adopt the Hearing Examiner' s
recommendation of approval of Hillside Manor
Preliminary Plat. Woods seconded and the motion
carried.
(OTHER BUSINESS - ITEM 4B)
Singh Preliminary Plat. This date has been set
to consider the Hearing Examiner's recommendation
for conditional approval of an application by
Shupe Holmberg, agent for H. Singh and S. Ram,
for a 2-lot single family residential preliminary
subdivision. This plat is .96 acres in size and
is located on the south side of SE 244th Street,
approximately 600 feet east of 104th Avenue SE.
ORR MOVED to accept the Findings of the Hearing
Examiner, and to adopt the Hearing Examiner's
recommendation of approval of Singh Preliminary
Plat. Woods seconded and the motion carried.
REZONE (CONSENT CALENDAR - ITEM 3C)
Van Doren's Landing Building J Rezone. ADOPTION
of Ordinance No. 3349 rezoning Van Doren's
Landing Building J. This rezone was approved on
May 6, 1997. The property is located at 22815
West Valley Highway.
ANNEXATION (CONSENT CALENDAR - ITEM 3P)
(ADDED BY OPERATIONS DIRECTOR MCFALL)
Del Mar Annexation. SET June 3 , 1997, as the
date for a public hearing on the Del Mar
Annexation.
PUBLIC WORKS (CONSENT CALENDAR - ITEM 3G)
Rent School District Wetland Mitigation.
AUTHORIZATION to direct staff to establish a
budget for $495, 216 received from the Kent School
District as a wetland mitigation fee and deposit
same into the Green River Natural Resource
Enhancement Project Fund (D36) , as recommended by
the Public Works Committee.
3
Kent City Council Minutes May 20, 1997
PUBLIC WORKS (CONSENT CALENDAR - ITEM 30)
House Relocation Contract. CONFIRM and RATIFY
the Public Works Director's award of the house
moving contract for Public Works to Emerald City
Building, in the bid amount of $93 , 000, as
recommended by the Public Works Committee.
HAZARDOUS (CONSENT CALENDAR - ITEM 3E)
WASTE Ring County Hazardous Waste Management Plan.
AUTHORIZE the Mayor to endorse, by letter, those
comments on the County' s Draft Hazardous Waste
Management Plan as submitted by the Public Works
Department, and as recommended by the Public
Works Committee. The City requested that the
Plan be amended to include siting of additional
permanent household hazardous waste collection
facilities, as recommended in the 1990 Plan, to
include a location serving the citizens of South
King County.
RECYCLING (CONSENT CALENDAR - ITEM 3F)
Department of Health Grant Agreement Special
Recycling Events. AUTHORIZE the Mayor to sign
the Department of Health Grant Agreement for two
special recycling events, and direct staff to
accept the grant and establish a budget for
$27, 014, as recommended by the Public Works
Committee.
PARKS & (CONSENT CALENDAR - ITEM 3I)
RECREATION Washington Athletic Club Donation. ACCEPTANCE of
a treadmill, valued at $3 ,500, which was donated
to Kent Commons Athletic Center by the Washington
Athletic Club.
(CONSENT CALENDAR - ITEM 3J)
IAC Grant Application Submittal. ADOPTION of
Resolution No. 1491 authorizing submittal of
three IAC grant applications to the Interagency
Committee for Outdoor Recreation for the
following priority projects which are eligible
for statewide grant funds:
1. Phase I: development of Salt Air Hills Park.
2 . Acquisition of land in the valley floor for
ball field development.
3 . Acquisition of land for wetland
preservation/wildlife habitat.
4
Kent City Council Minutes May 20, 1997
PARKS & (CONSENT CALENDAR - ITEM 3K)
RECREATION CDBG Application Sp
ringwood Park. AUTHORIZATION
to submit the CDBG application for funding trail
repairs at Springwood Park. The Springwood Park
asphalt trail was damaged during the storms in
February of 1996. FEMA funds did not cover the
cost of repair. A CDBG would cover these costs.
(CONSENT CALENDAR - ITEM 3L)
(REMOVED BY COUNCILMEMBER WOODS)
CDBG Applications Turnkey Park/Russell Road.
This item was removed from the agenda by
Councilmember Woods because it does not require
approval to go forward but will require approval
when it returns.
(CONSENT CALENDAR - ITEM 3M)
IAC Grant Land Acquisition Budget. ACCEPT and
AMEND the land acquisition budget in the amount
of $479,443 , and AUTHORIZE the Mayor to sign the
IAC grant contract. In 1996, staff was awarded
an IAC grant to purchase 13 . 1 acres in King
County to expand an existing site destined to
become a community park for the City of Kent' s
East Hill Neighborhood.
(CONSENT CALENDAR - ITEM 3N)
Linda Heights and Garrison Creek Contract.
AUTHORIZATION for the Mayor to sign a consultant
contract with Bruce Dees and Associates to pre-
pare construction bid plans and specifications
and perform related work as outlined in the scope
of work for Linda Heights Park and Garrison Creek
Park. Budgets for both projects were included in
the supplemental CIP budget approved May 6, 1997.
The Master Site Development Plan for Linda
Heights Park was approved on May 21, 1996 and for
Garrison Creek Park on August 20, 1996.
FINANCE (CONSENT CALENDAR - ITEM 3B)
_Approval of Bills. No checks were approved
because of schedule changes.
Approval of checks issued for payroll for
April 16 through April 30, 1997 and paid on
May 5 , 1997 :
Date Check Numbers Amount
5/5/97 Checks 219341-219694 $ 245,380.76
5/5/97 Advices 45388-45916 630 , 801.29
$ 876, 182 . 05
5
Kent City Council Minutes May 20, 1997
REPORTS Public Works Committee. Clark noted that the
next meeting will be held tomorrow at 3 :30 p.m.
He also noted that the next Regional
Telecommunications Meeting will be held on
Thursday at 3 : 00 p.m. for anyone wishing to
attend.
Planning Committee. Orr noted that the next
meeting will be held on June 17th at 4: 00 p.m.
Administrative Reports. Mayor White announced
that there are two openings on the Bicycle
Advisory Board and asked Council to submit any
nominees they may have who are interested in
serving on this Board.
ADJOURNMENT The meeting was adjourned at 7 : 13 p.m.
/ ,.- 'J",
Donna Swaw
Deputy City Clerk
6
Kent City Council Meeting
Date June 3 , 1997
Category Consent Calendar
1. SUBJECT: SOLE SOURCE VENDOR FOR PROTECTIVE CLOTHING (FIRE) -
AUTHORIZATION
2 . SUMMARY STATEMENT: Authorization for the Fire Department to
proceed with sole vendor purchase of replacement protective
clothing (bunker gear) from Securitex, Inc. over the next four
(4) years, with funding coming from the department's annual
budget. Staff will annually monitor the protective clothing
market to determine if acceptable alternatives become available
for further evaluation.
After analyzing current available equipment, it has been con-
cluded that Securitex is the only product on the market that
meets performance requirements and safety standards of the Fire
Department. Although the Securitex brand is $33 . 73 more than
the other brand which met required standards, except dura-
bility, it is staff' s opinion that the added cost would be well
offset by minimizing replacement and repair. The replacement
of the protective clothing will be phased in over a four (4)
year time span working within the existing budget at an
estimated cost of $50, 000. 00 a year.
3 . EXHIBITS: Executive summary
4 . RECOMMENDED BY: Fire Department Protective Clothina staff, Fire
Administration Public Safety Committee (3-0)
(Committee, Staff, Examiner, Commission, etc. )
5 . UNBUDGETED FISCAL/PERSONNEL IMPACT: NO X YES
6. EXPENDITURE REQUIRED: $
SOURCE OF FUNDS: Funded within existing clothing budget,
sub 'ect to inflationary ad 'ustments
7 . CITY COUNCIL ACTION:
Councilmember moves, Councilmember seconds
DISCUSSION:
ACTION•
Council Agenda
Item No. 3C
EXECUTIVE SUMMARY
JUNE 3, 1997
TO: MAYOR JIM WHITE,
COUNCIL PRESIDENT HOUSER,
COUNCILMEMBERS BENNETT, WOODS, CLARK, ORR, JOHNSON,
AND EPPERLY ,�!�
FROM: NORM ANGELO, FIRE CHIEF f Q
DALE ROBERTSON, BATTALION CHIEF/"B" SHIFT
RICK COX,-FIREFIGHTER/PROGRAM MANAGER
SUBJECT: PROTECTIVE CLOTHING PROGRAM
SUMMARY The current protective clothing that the Kent Fire Department is using needs to
be upgraded because of advancement in technology and safety standards. The newer
generation of protective clothing implements safer features and the current outer shell material
is no longer available to purchase. The goal of the protective clothing program is to find and
purchase safe and dependable protective clothing for the performance of emergency
operations. We have reviewed and tested several products that are available and our search
has led us to the Securitex Ultralite SMS series as an acceptable replacement for our current
protective clothing needs. Replacement of all uniformed members' protective clothing would
continue under our current cycle. This means the newer generation protective clothing would
be phased in as the older generation gear is retired due to contamination, damage or age.
Back;ound/Introduction: The protective clothing program of the Kent Fire Department is
currently managed at Station 76, "B" Shift. The lead person for the program is Rick Cox who
is assisted in the distribution of protective clothing by other members of Station 76. The
program is set up so that there is sufficient stock on hand to fulfill the minimum replacement
requirements of protective clothing for members of the Kent Fire Department. This
encompasses the keeping of records of protective clothing issuance, an inventory of clothing
that ensures all members have three (3) sets (due to the time needed to order protective
clothing), and monitoring of technology and new innovations in the protective clothing field.
The protective clothing program of the Kent Fire Department has been served well by
Securitex, Inc. for approximately the past twelve years. When the Kent Fire Department
decided to examine new bunker clothing a number of years ago, an extensive study was
conducted. We chose a leader in the field of protective clothing, Securitex. The durability
and quality of the bunker clothing and the quality customer service we have received from
Securitex has been excellent.
In the past year and a half, the protective clothing program has become aware that the nomex
filament that we are currently using as an outer shell material is no longer being manufactured
for this purpose by the textile mills. The reason the material has been discontinued is the lack
of demand and the advancement in technology with new materials.
Mayor White, Councilmembers
June 3, 1997
Page 2
We have examined the bunker clothing of several manufacturers that have applied new
material and technology to the design of their bunker clothing. With the unavailability of our
current bunker material, we must decide the direction that the Kent Fire Department will go to
ensure safe and dependable protection for its members.
Specifications: The protective clothing program has determined requirements for the purchase
of future bunker gear research and actual testing. First, the gear will be lighter in weight than
what has traditionally been used. Second, we will move away from a non-breathable moisture
barrier and require that a breathable moisture barrier be used. Third, the bunker gear will
have improved freedom of movement. Fourth, reduction of retained body heat through the
elimination of the bib pants. Fifth, the gear must meet all NFPA and WISHA standards.
Sixth, the protective clothing that we purchase will be of good quality and durability. The
protective clothing program realizes that not all manufacturers can meet the above demands, so
we are in search of an ensemble of protective clothing that will best meet our needs. There
were only two (2) vendors who could meet the total specified ensemble. We tested both.
gam: The protective clothing program field tested bunker clothing that was manufactured
by Lion Apparel. This clothing also used new material and technology in their development.
During the testing period and interviews with other departments that have used the same style
of outer shell, a concern was raised about the durability and quality control of the garment.
We experienced the loss of buckles from both sets of pants in the first few months. Another
department had also experienced poor quality in the sewing of seams of the bunker clothing
requiring repair when it was new. This had resulted in bunker clothing that was out of service
when it should have been issued to firefighters. With this information, the field testing of the
Lion Apparel has been suspended.
Another brand of protective clothing we tested was manufactured by Securitex, Inc.
Securitex, Inc. has developed the Ultralite SMS series of bunker clothing that has implemented
new materials (nomex/kevlar multi-filament blend), and technology (breathable moisture
barriers and lighter thermal protection) that will make the firefighters safer and more
comfortable when performing their duties. The clothing has been proven to be a quality
product through interviews with surrounding fire departments and departments in the Portland,
Oregon area as well as a repair facility in Oregon that repairs many styles of protective
clothing. The Kent Fire Department has also purchased four (4) sets of the Ultralite SMS
bunker clothing for testing. This clothing, through testing, has proven its durability, ease of
movement, and comfort that is essential to performing safely at an emergency scene. Finally,
Securitex, Inc. has been a reliable manufacturer that has provided a high quality of protective
clothing and customer service for the Kent Fire Department.
Mayor White, Councilmembers
June 3, 1997
Page 3
There are several reasons that the Ultralite SMS manufactured by Securitex, Inc. will improve
freedom of movement, reduce fatigue, and improve the comfort of firefighters at an
emergency scene; which in turn makes the fire scene safer:
✓ Less weight: technology has produced lighter materials that provide thermal
protection as well or better than more traditional clothing. This will reduce the
weight that a firefighter must carry while working at an emergency scene.
✓ Breathable moisture barriers: this style of moisture barrier allows heat and
moisture generated by the wearer to move away from the body. The bunker
clothing will also be able to dry in a matter of hours instead of days when it has
become wet. This will reduce heat related fatigue and stress that is a common
dilemma at the emergency scene.
✓ "Slick" liners: the slick liner is a new innovation that is made with nomex
filament and has a slippery feel to it. This liner allows for a greater ease of
movement that benefits the wearer. The liner has eliminated the need for bib
pants, but still allowing for a short coat. This is accomplished because the coat
does not rise when the arms are lifted, exposing the firefighter. This will
reduce the weight of the clothing and heat retention which translates to less
fatigue for the firefighter.
Implementing the Ultralite SMS in future purchases, the firefighter's overall safety will be
improved through the freedom of movement, reduction of heat related stress, and improved
comfort while performing at emergency scenes. Therefore, it is our recommendation that all
future purchases of bunker clothing be the Ultralite SMS series manufactured by Securitex,
Inc. because it best meets the requirements that we have set for protective clothing. The
protective clothing program believes this bunker clothing will be a prudent choice for the
members of the Kent Fire Department.
Significance: There is a necessity to make a timely decision so that bunker clothing can be
purchased and received in a timely manner. As we have been researching and testing new
protective clothing, which started in the fall of 1995, our stock has fallen below the minimum
requirements. With the purchase of the Ultralite SMS clothing to replace our current supply
of bunker clothing, as it is retired from service, we will be providing a safer environment for
our firefighters as well as a durable product that the Kent Fire Department can rely on.
Uniform Distribution: The goal of the protective clothing program is to maintain two (2) sets
of bunker clothing and a replacement set from the stock on hand for all uniformed members of
the department.
Mayor White, Councilmembers
June 3, 1997
Page 4
All uniformed personnel currently carry two (2) sets of bunker clothing with them while they
are at work for health and decontamination reasons. The Zone 1 personnel carry their third
set of bunker clothing with them so that they also can be called in from off duty and have all
their protective clothing.
Recommended Action: The protective clothing program believes the Securitex SMS protective
clothing is a prudent choice for the Kent Fire Department and recommends that it be purchased
under sole source authorization. The clothing complies with the most current NFPA Standards
and Washington State Vertical Standards for Firefighters. This is requested because of the
durability and superior qualities of the Securitex SMS, and also the unacceptable performance
of other products currently available.
Alternatives: The alternative to sole source purchasing of the Securitex SMS would be to go
to bid for protective clothing. This could result in the purchase the Lion Apparel protective
clothing. We anticipate this would result in a lessor quality of clothing that may need repairs
sooner or require earlier retirement. In the beginning it may be cheaper, but in the long run
the costs will be higher due to replacing clothing sooner.
BudgetImpact: The phase in of the Securitex SMS protective clothing will be implemented
over a number of years as clothing is retired. The protective clothing program will try to
perform this within the annual budget as much as possible. As necessary, budget adjustments
would be requested if the annual budget was unable to cover the costs.
Pricing: The current pricing of protective clothing for an order of 25 sets of gear with
flashlight pockets and microphone label loops is as follows:
Securitex SMS Lion Apparel Rebound
$849.73 $816.00
Recognizing that there is a $34.00 difference on price quotes, it is our conclusion that, based
on our research, the required repair and maintenance for the Lion brand would exceed the
initial price significantly. We estimate spending approximately $50,000.00 from our annual
budget on this type of protective clothing.
tcn
Kent City Council Meeting
Date June 3 , 1997
Category Consent Calendar
1. SUBJECT: STREET LEGAL DRAG RACING PROGRAM - SET BUDGET AND
AUTHORIZE EXPENDITURES
2 . SUMMARY STATEMENT: Approval to set up a budget account for
the Street Legal Drag Racing Program and authorization for
expenditures to be made.
The Kent Police Department has entered into a partnership with
Seattle International Raceway (SIR) to promote Street Legal
Drag Racing. This program allows for the opportunity to
compete with another driver and vehicle in a safe and con-
trolled environment, and will hopefully help to move this type
of racing from the street to the track.
All operating expenses for the Street Legal Drag Racing Program
will be covered by donations received from local sponsors. In
conjunction with these activities, staff plans to sell team
t-shirts and other promotional items to help support the
program.
3 . EXHIBITS: Program summary
4 . RECOMMENDED BY: Staff & Public Safety Committee 5/20/97 (3-0)
(Committee, Staff, Examiner, Commission, etc. )
5. UNBUDGETED FISCAL/PERSONNEL IMPACT: NO X YES
6. EXPENDITURE REQUIRED: $
SOURCE OF FUNDS: Donations and Fundraising
7 . CITY COUNCIL ACTION:
Councilmember moves, Councilmember seconds
DISCUSSION•
ACTION:
Council Agenda
Item No. 3D
To : Public Safety Committee
From: Lt . W.H. Mitchell, Police Department .
Subject : Street Legal Racing Program.
Date : 05/16/97
The Kent Police Department has entered into a partnership with
Seattle International Raceway (SIR) to promote Street Legal Drag
Racing. SIR has seventeen events scheduled May 7th. through Aug.
27th. for Street Legal Racing. All dates are on Wednesday nights
with the exception of the annual High School Drags to be held on
Friday, May 9th. This class of racing targets the young enthusiast
who wants to know how his or her vehicle will perform in a measured
quarter mile . It also allows for the opportunity to compete with
another driver and vehicle in a safe and controlled environment .
KPD is very much in favor of SIR' s program to move this type of
racing from the street to the track .
KPD will be supporting Street Legal Racing in a number of ways .
First , we will be racing our own 1988 Corvette in the Street Legal
class at all seventeen events . A group of interested officers has
formed the Kent Police Racing Team and it will be their task to
keep the car running and present at each event . The Corvette is a
drug seizure vehicle and the officers are donating their time . The
Corvette will be clearly marked as a KPD vehicle, light bar
included, and will carry the names of all businesses supporting our
effort .
The officers. accompanying the car to the track will wear jackets
and shirts identifying them as Kent Police Racing Team members .
They will work to get the message across that the track is the safe
place to race, not the street . They will also promote safe, legal
driving where alcohol and other drugs do not belong.
This will be the first time in the history of the department a
police vehicle will be raced at a local drag strip . The potential
of the program is unlimited at this point . Aside from racing, the
car can be used in numerous ways in support of community education
programs . We have already received requests for appearances at one
of our sponsor' s events and possible use in the Special Olympics
Torch Run. The car will be on display during Cornucopia Days with
our Public Education Unit as well as the City' s annual open house .
All operating expenses would be covered by donations received from
local sponsors . In conjunction with these activities we would also
like to consider the sale of team t-shirts and other promotional
items . The money raised would be used to support the program.
This will be our first effort at this type of program and we feel
that it is way overdue . SIR offers a first class National Hot Rod
Assoc . sanctioned racing facility in our own back yard and we feel
it can be put to good use in a program such as this .
Contact persons : Dave Santos, 859-3303 , or Bill Mitchell , 850-4786 .
Kent City Council Meeting
Date June 3 , 1997_
Category Consent Calendar
1. SUBJECT: TRANSIT ADVISORY BOARD - APPOINTMENT
2 . SUMMARY STATEMENT: Confirmation of the Mayor' s appointment
of Bill Boyce to serve as a member of the Kent City Transit
Advisory Board. Mr. Boyce is a Kent resident, serves as a
member of the Kent School Board and is a Kent Rotarian. He
feels that with the growth the City has experienced,
transportation issues will play a major role in the next few
years and he feels he can bring a new perspective to the
Transit Advisory Board.
Boyce will replace Rick Wellenberger, whose term expired, and
his new appointment will continue until 4/30/99 .
3 . EXHIBITS: Memorandum
4 . RECOMMENDED BY: Mayor White
(Committee, Staff, Examiner, Commission, etc. )
5. UNBUDGETED FISCAL/PERSONNEL IMPACT: NO X YES
6. EXPENDITURE REQUIRED: $
SOURCE OF FUNDS•
7 . CITY COUNCIL ACTION:
Councilmember moves, Councilmember seconds
DISCUSSION•
ACTION:
Council Agenda
Item No. 3E
MEMORANDUM
TO: CHRISTI HOUSER, CITY COUNCIL PRESIDENT
CITY COUNCIL MEMBERS
FROM: JIM WHITE, MAYOR
DATE: MAY 27, 1997
SUBJECT: APPOINTMENT TO KENT CITY TRANSIT ADVISORY BOARD
I have appointed Mr. Bill Boyce to serve as a member of the Kent City Transit Advisory Board.
Mr. Boyce is a Kent resident who is employed as a Compensation Manager at the Boeing Company
where he has worked for 17 years. He is a member of the Kent School Board and is a Kent Rotarian.
As the City continues to grow, Mr. Boyce feels that transportation issues will play a major role in
the next 3 to 5 years and he feels he can bring a different perspective to the Transit Advisory Board.
Mr. Boyce will replace Rick Wellenberger, whose term expired, and his appointment will continue
until 4/30/99.
1 submit this for your confirmation.
JWJb
Kent City Council Meeting
Date June 3 . 1997
Category Consent Calendar
1. SUBJECT: TRANSPORTATION IMPROVEMENT BOARD (TIB) GRANT -
AUTHORIZATION AND ESTABLISHMENT OF BUDGET
2 . SUMMARY STATEMENT: As recommended by the Public Works
Committee, authorization for the Mayor to sign the TIB Grant
Agreement in the amount of $2, 059, 200 for the construction
phase of the 196th Street Corridor project, and direct staff to
accept the grant and establish a budget for same.
3 . EXHIBITS: TIB Agreement, Public Works Committee minutes, and
Public Works Director memorandum
4 . RECOMMENDED BY: Public Works Committee
(Committee, Staff, Examiner, Commission, etc. )
5 . UNBUDGETED FISCAL/PERSONNEL IMPACT: NO X YES
6 . EXPENDITURE REQUIRED: $
SOURCE OF FUNDS:
7 . CITY COUNCIL ACTION:
Councilmember moves, Councilmember seconds
DISCUSSION:
ACTION:
-
Council Agenda
Item No. 3F
Transportation Improvement Account (TIA)
V� Project Agreement for Construction Proposal
Lead Agency
City of Kent
Project Number Authority Number
9P-106(002)-2 9725019P
Project Title &Description
192/1961200 Streets -stage 2
Green River Bridge to West Approach
Total Amount Authorized Authorization to Proceed Effective From
$2,059,200 May 7, 1997
IN CONSIDERATION of the allocation by the Transportation Improvement Board of Transportation Improvement
Account (TIA) funds to the project and in the amount set out above, the agency hereby agrees that as condition
precedent to payment of any TIA funds allocated at any time to the above referenced project. it accepts and will
comply with the terms of this agreement, including the terms and conditions set forth in RCW 47.26; the applicable
rules and regulations of the Transportation Improvement Board, and all representations made to the Transportation
Improvement Board upon which the fund allocation was based; all of which are familiar to and within the knowledge
of the agency and incorporated herein and made a part of this agreement, although not attached. The officer of the
agency, by the signature below hereby certifies on behalf of the agency that local matching funds and other funds
represented to be committed to the project will be available as necessary to implement the projected development of
the project as set forth in the CONSTRUCTION PROSPECTUS, acknowledges that funds hereby authorized are for
the development of the construction proposal as defined by Chapter 167. Laws of 1988.
If the costs of the project exceed the amount of TIA funds authorized by the Transportation Improvement Board, set
forth above, and the required local matching funds represented by the local agency to be committed to the project,
the local agency will pay all additional costs necessary to complete the project as submitted to the Board. This shall
not prevent the local agency from requesting an increase in the amount of trust funds pursuant to applicable rules of
the Board.
Projects in clean air non-attainment areas are subject to air quality conformity requirements as specified in RCW
70.94. The lead agency certifies that the project meets all applicable Clean Air Act requirements.
IN CONSIDERATION of the promises and performance of the stated conditions by the agency, the Transportation
Improvement Board hereby agrees to reimburse the agency from allocated TIA funds and not otherwise, for its
reimbursable costs during the above referenced quarter year not to exceed the amount specified. Such obligation to
reimburse TIA funds extends only to project costs incurred after the date of the Board's allocation of funds and
authorization to proceed with the project.
LEAD AGENCY TRANSPORTATION IMPROVEMENT BOARD
Signature of Mayor/Chairman Date Executive Director Date
TIB Grant - 196th St. Corridor -
Wickstrom noted that this is an acceptance of a grant we received from the
Transportation Improvement Board for the 196th St Corridor. The grant is $2,059,200
and is for the construction phase of the Corridor project. Wickstrom noted that right
now we have a fill contract subject to working out the details with the property owners
but we have secured all the permits. We are bidding the bridge right now. That will be
awarded in July which is a big element of this project. This bridge is for the Green River;
that will tie West Valley to Orillia Road; we still have to do the road portions.
Wickstrom said the phase we are working on now and will be under construction this
year and next year will be Orillia Road to West Valley Highway. He said that in '98 we
may be in a position to do the middle-leg bridge between West Valley Highway and East
Valley Highway. Wickstrom said that at the same time we are working on 277th
Corridor and hopefully that will be open for traffic in 1999. Wickstrom said that 196th
Street between Orillia & West Valley will be the first of our corridor projects to be
opened.
Committee unanimously recommended authorizing the Mayor to sign the TIB Grant
Agreement and direct staff to accept the grant and establish a budget for $2,059,200.
Surplus Vehicle - Authorization
Wickstrom stated that we have equipment to be surplused based on the condition, age
and use of the equipment. We are requesting that this equipment be sold at the next
state auction.
Committee unanimously declared this equipment as surplus and authorized the sale
thereof at the next State of Washington auction.
Meeting adjourned: 4:00 p.m.
3
DEPARTMENT OF PUBLIC WORKS
May 21, 1997
TO: Public Works Committee
FROM: Don Wickstro
RE: Transportation Improvement Board Grant
We have received a grant of $2,059,200 from the Transportation Improvement
Board for the construction phase of the 196th Street Corridor project. We are
requesting authorization for the Mayor to sign the Grant Agreement and establish a
budget for same.
ACTION: Recommend authorizing the Mayor to sign the TIB Grant Agreement
and direct staff to accept the grant and establish a budget for
$2,059,200.
Kent City Council Meeting
Date June 3 , 1997
Category Consent Calendar
1. SUBJECT: SURPLUS VEHICLES - AUTHORIZATION
2 . SUMMARY STATEMENT: As recommended by the Public Works
Committee, authorization to declare certain Equipment Rental
vehicles no longer needed by the City as surplus and authorize
the sale thereof at the next State auction.
3 . EXHIBITS: Public Works Committee minutes and Public Works
Director memorandum
4 . RECOMMENDED BY: Public Works Committee
(Committee, Staff, Examiner, Commission, etc. )
5. UNBUDGETED FISCAL/PERSONNEL IMPACT: NO X YES
6 . EXPENDITURE REQUIRED: $
SOURCE OF FUNDS:
7 . CITY COUNCIL ACTION:
Councilmember moves, Councilmember seconds
DISCUSSION:
ACTION•
Council Agenda
Item No. 3G
TIB Grant - 196th St. Corridor
Wickstrom noted that this is an acceptance of a grant we received from the
Transportation Improvement Board for the 196th St Corridor. The grant is $2,059,200
and is for the construction phase of the Corridor project. Wickstrom noted that right
now we have a fill contract subject to working out the details with the property owners
but we have secured all the pernuts. We are bidding the bridge right now. That will be
awarded in July which is a big element of this project. This bridge is for the Green River;
that will tie West Valley to Orillia Road; we still have to do the road portions.
Wickstrom said the phase we are working on now and will be under construction this
year and next year will be Orillia Road to West Valley Highway. He said that in '98 we
may be in a position to do the middle-leg bridge between West Valley Highway and East
Valley Highway. Wickstrom said that at the same time we are working on 277th
Corridor and hopefully that will be open for traffic in 1999. Wickstrom said that 196th
Street between Orillia &- West Valley will be the first of our corridor projects to be
opened.
Committee unanimously recommended authorizing the Mayor to sign the TIB Grant
Agreement and direct staff to accept the grant and establish a budget for $2,059,200.
Surplus Vehicle - Authorization
Wickstrom stated that we have equipment to be surplused based on the condition, age
and use of the equipment. We are requesting that this equipment be sold at the next
state auction.
Committee unanimously declared this equipment as surplus and authorized the sale
thereof at the next State of Washington auction.
Meeting adjourned: 4:00 p.m.
3
DEPARTMENT OF PUBLIC WORKS
May 21, 1997
TO: Public Works Committee
FROM: Don Wickstrom
RE: Surplus Vehicle Authorization
Attached is a list of Equipment Rental vehicles which are no longer needed by the
City. As such, we are requesting that they be declared as surplus and sold at the next
State auction.
ACTION: Declare this equipment as surplus and authorize the sale thereof at the
next State of Washington auction.
Public Works Operations
MEMORAND UVf
Phone: 859-3395 Fax: 359-3664
Date : May 14 , 1997
To : Don Wickstrom, Pub c Works Director
From: Steve HennesseY et Superintendent
�
Thru: Eddy Chu, Operations Managerop-11i
Subject : Surplus Vehicles Authorization Request
I am requesting authorization to surplus the following vehicles
that have been replaced with the 97 purchases and are no longer
needed by Fleet Services . These vehicles will be sold at the next
James G. Murphy Vehicle and Equipment Auction on June 14 , 1997 .
UNIT# YR SERIAL# MILEAGE DESCRIPTION
#1001 * 87 150047 106, 000 Chevrolet , Caprice sedan
#1012 87 259370 66 , 300 Dodge, Aries sedan
Needs engine repairs , body
& interior needs refurbishing
#5388 * 77 188953 59 , 500 Dodge , 3/4 Ton Pickup
#6506 83 217254 48 , 250 Chevrolet , Malibu wagon
Bcdv needs refurbishing
#6507 86 165623 50 , 650 Chevrolet , 3/4 Ton Pickup
Heavy use Parks Dept, needs body
& motor work
#7619 90 852674 71, 350 Dodge, Sprit sedan
Heav-, use in Fire Dept & vehicle
has been in a malor accident
* Meets Fleet Services point system of 20
( 1.) point per year
(1) point per 10K
CC : Frank Olson
Bill Price
Dianne Sullivan
Kent City Council Meeting
Date June 3 . 1997
Category Consent Calendar
1. SUBJECT: GROUP HEALTH COOPERATIVE CONTRACT - RENEWAL
2 . SUMMARY STATEMENT: Authorization for the Mayor to sign the
Group Health Cooperative Contract for 1997 . The overall cost
increase for purchasing coverage is approximately 5. 26% over
last year.
3 . EXHIBITS: Contract
4 . RECOMMENDED BY: Operations Committee
(Committee, Staff, Examiner, Commission, etc. )
5. UNBUDGETED FISCAL/PERSONNEL IMPACT: NO X YES
6. EXPENDITURE REQUIRED: $
SOURCE OF FUNDS: Medical Fund
7 . CITY COUNCIL ACTION:
Councilmember moves, Councilmember seconds
DISCUSSION:
ACTION:
Council Agenda
Item No. 3H
CITY OF KENT
DATE: May 23, 1997
TO: Council Operations Committee
FROM: Becky Fowler, Senior Employee Services Analyst
SUBJECT: Group Health Cooperative Contract for 1997
Attached for your review is the Group Health contract renewal for 1997. Group Health is
the City's direct service provider,providing coverage to approximately ten percent of our
employees. The renewal lists the 1997 State Mandated Benefit Program changes that the City
shall be incorporating into our program.
The overall cost increase for purchasing coverage from Group Health to the City is
approximately 5.26% over last year. The Group Health Program is funded through the City's self-
insured program I, hereby, request authorization for the mayor to sign the Group Health
Cooperative Contract for 1997.
If you have any fiuther questions regarding this program please feel free to contact me
directly at 859-65.77.
cc: Sue Viseth, Employee Services Director
Group
Cooperative
otPugetSound
GROUP MEDICAL COVERAGE
AGREEMENT
Group Health Cooperative of Puget Sound (also referred to as "GHC" or"the Cooperative") is a non-profit health
maintenance organization furnishing health care primarily on a prepayment basis. As a direct service provider, the
Cooperative is dedicated to providing to its Members quality health care,including preventive medical services.
This Agreement states the terms of enrollment,payment and coverage under which a Group may secure GHC health
benefits. The Schedule of Benefits lists the benefits to which those enrolled under this Agreement are entitled.
Words with special meaning are capitalized. They are defined in Section I.
MEMBERS ARE ENTITLED TO COVERED SERVICES ONLY AT GHC FACILITIES AND FROM GHC
PROVIDERS,UNLESS THE MEMBER HAS BEEN REFERRED BY A GHC PRIMARY CARE PROVIDER OR
HAS RECEIVED EMERGENCY SERVICES ACCORDING TO SECTION X.I. OF THE SCHEDULE OF
BENEFITS.
Female Members may see a participating General and Family Practitioner, Physician's Assistant, Gynecologist,
Certified Nurse Midwife, Doctor of Osteopathy, Obstetrician and Advanced Registered Nurse Practitioner who
provides women's health care services directly,without a Referral from their Primary Care Provider, for medically
appropriate maternity care, covered reproductive health services, preventive care and general examinations,
gynecological care, and medically appropriate follow-up visits for the above services. If your chosen provider
diagnoses a condition that requires more extensive covered care outside the practice scope of your women's health
care provider, and requires referral to other specialists or hospitalization,you or your chosen;provider must contact
your Primary Care Provider for authorization and care coordination. Women's health care services are covered as if
your Primary Care Provider had been consulted, subject to any applicable Copayments and/or Coinsurance as set
forth in the Copayments and Allowances Schedule. For more information on women's health care providers,
contact Group Health Customer Service Center.
Limited direct access to providers within GHC's defined network is also available for manipulative therapy as set
forth in Section X.B.
0036900-CO3046 4
GROUP HEALTH COOPERATIVE OF PUGET SOUND
By: g /. Ilvl/
Title: Senior Director_Health Insurance Services
GROUP
City of Kent, #0369
By:
Title:
This Agreement will become effective January 1, 1997 and will continue
in effect until terminated as herein provided for.
PA-1133-Basic Agreement
0036900-CO3046 5
Group
Health
Cooperative
of Puget Sound
GROUP MEDICAL COVERAGE
AGREEMENT
Group Health Cooperative of Puget Sound (also referred to as "GHC" or "the Cooperative") is a non-profit health
maintenance organization furnishing health care primarily on a prepayment basis. As a direct service provider, the
Cooperative is dedicated to providing to its Members quality health care,including preventive medical services.
This Agreement states the terms of enrollment,payment and coverage under which a Group may secure GHC health
benefits. The Schedule of Benefits lists the benefits to which those enrolled under this Agreement are entitled.
Words with special meaning are capitalized. They are defined in Section 1.
MEMBERS ARE ENTITLED TO COVERED SERVICES ONLY AT GHC FACILITIES AND FROM GHC
PROVIDERS,UNLESS THE MEMBER HAS BEEN REFERRED BY A GHC PRIMARY CARE PROVIDER OR
HAS RECEIVED EMERGENCY SERVICES ACCORDING TO SECTION X.I. OF THE SCHEDULE OF
BENEFITS.
Female Members may see a participating General and Family Practitioner, Physician's Assistant, Gynecologist,
Certified Nurse Midwife, Doctor of Osteopathy, Obstetrician and Advanced Registered Nurse Practitioner who
provides women's health care services directly,without a Referral from their Primary Care Provider, for medically
appropriate maternity care, covered reproductive health services, preventive care and general examinations,
gynecological care, and medically appropriate follow-up visits for the above services. If your chosen provider
diagnoses a condition that requires more extensive covered care outside the practice scope of your women's health
care provider, and requires referral to other specialists or hospitalization, you or your chosen provider must contact
your Primary Care Provider for authorization and care coordination. Women's health care services are covered as if
your Primary Care Provider had been consulted, subject to any applicable Copayments and/or Coinsurance as set
forth in the Copayments and Allowances Schedule. For more information on women's health care providers,
contact Group Health Customer Service Center.
Limited direct access to providers within GHC's defined network is also available for manipulative therapy as set
forth in Section X.B.
0036900-CO3046 4
GROUP HEALTH COOPERATIVE OF PUGET SOUND
Title: Senior Director.Health insurance Services
GROUP
City of Kent, #0369
By:
Title:
This Agreement will become effective January 1, 1997 and will continue
in effect until terminated as herein provided for.
PA-1133-Basic Agreement
0036900-CO3046 5
t,
GROUP HEALTH COOPERATIVE OF PUGET SOUND
CONTRACT REVISIONS
Effective 1/1/97
CONTRACT
LANGUAGEBENEFIT CHANGE EXPLANATION
Signature Page New Contract Officer Signature/Title
Edward M.Denning, Senior Director
Service Area The definition of Service Area has been
revised to include Mason County(see
Section I.).
COBRA Section IV.has been revised in accordance
with the 1997 Federal COBRA regulations.
Enrollment and Eligibility Schedule Section IX.B.has been revised and reads as
follows: Temporary Coverage for Ineligible
Newborns. A child born to a covered
Member which does not otherwise qualify
as an eligible dependent as set forth in this
section will be entitled to the benefits set
forth in Section X.from birth through three
(3)weeks of age. After three(3)weeks of
age,no benefits are available unless the
newborn child qualifies as a Dependent
and is enrolled under this Agreement. All
contract provisions,limitations,and
exclusions will apply except Section IV
Continuation of Coverage,Conversion,and
Transfer.
In regard to temporary coverage,
continuation of coverage benefits set forth
in Section IV. will not apply.
This is a clarification in the basic contract:
Subscribers and covered dependents who
are eligible for Medicare(as set forth below)
must,effective the date that Medicare
becomes primary payor,enroll in Medicare
Parts A&B,and must participate in GHC's
Medicare Plan.For purposes of this section,
an individual shall be deemed eligible for
Medicare when he or she has the option to
receive part A Medicare benefits,
irrespective of whether the individual elects
to enroll in Part B coverage under the
Federal regulations.
0036900-CO3046 2
Smoking Cessation A clarification has been made to denote that
the Smoking Cessation Program addressees
other forms of tobacco.
Certificate of Coverage The detailed description of benefits(benefit
grid)available to those Members that are
Medicare-eligible and still covered under a
group contract changed in location. This
change in location was prompted by
numerous concerns and questions regarding
the location of this grid(and questioning of
benefits).
General Information For Administrative purposes some
provisions have been moved to a more
appropriate location.
Business and Insurance Services Business and Insurance Services and the
Information and Service Line have been
combined. The new name is Group Health
Customer Service Center and the new phone
numbers are 901-4636 or 1-888-9014636
for general information and 901-4600 or
1-888-901-4600 for Medicare information.
0036900-CO3046 3
C B.
Group
Health
Cooperative
of Puget Sound
GROUP MEDICAL COVERAGE
AGREEMENT
Group Health Cooperative of Puget Sound (also referred to as "GHC" or "the Cooperative") is a non-profit health
maintenance organization furnishing health care primarily on a prepayment basis. As a direct service provider, the
Cooperative is dedicated to providing to its Members quality health care, including preventive medical services.
This Agreement states the terms of enrollment,payment and coverage under which a Group may secure GHC health
benefits. The Schedule of Benefits lists the benefits to which those enrolled under this Agreement are entitled.
Words with special meaning are capitalized. They are defined in Section I.
MEMBERS ARE ENTITLED TO COVERED SERVICES ONLY AT GHC FACILITIES AND FROM GHC
PROVIDERS,UNLESS THE MEMBER HAS BEEN REFERRED BY A GHC PRIMARY CARE PROVIDER OR
HAS RECEIVED EMERGENCY SERVICES ACCORDING TO SECTION X.I. OF THE SCHEDULE OF
BENEFITS.
Female Members may see a participating General and Family Practitioner, Physician's Assistant, Gynecologist,
Certified Nurse Midwife, Doctor of Osteopathy, Obstetrician and Advanced Registered Nurse Practitioner who
provides women's health care services directly, without a Referral from their Primary Care Provider, for medically
appropriate maternity care, covered reproductive health services, preventive care and general examinations,
gynecological care, and medically appropriate follow-up visits for the above services. If your chosen provider
diagnoses a condition that requires more extensive covered care outside the practice scope of your women's health
care provider, and requires referral to other specialists or hospitalization, you or your chosen provider must contact
your Primary Care Provider for authorization and care coordination. Women's health care services are covered as if
your Primary Care Provider had been consulted, subject to any applicable Copayments and/or Coinsurance as set
forth in the Copayments and Allowances Schedule. For more information on women's health care providers,
contact Group Health Customer Service Center.
Limited direct access to providers within GHC's defined network is also available for manipulative therapy as set
forth in Section X.B.
0036900-CO3046 4
A
GROUP HEALTH CfOOPERATIVE OF PUGET SOUND
/ /
Title: Senior Director.Health Insurance Services
GROUP
City of Kent, 40369
By:
Title:
This Agreement will become effective January 1, 1997 and will continue
in effect until terminated as herein provided for.
PA-1133-Basic Agreement
0036900-CO3046 5
GROUP MEDICAL COVERAGE
AGREEMENT
Table of Contents
I. Definitions
II. Dues,Fees and Copayments
III. Termination
IV. Continuation Coverage,Conversion,and Transfer
V. Coordination of Benefits
VI. Subrogation
VII. Grievance Procedures
VIII. Miscellaneous Provisions
IX. Enrollment and Eligibility Schedule
X. Schedule of Benefits
XI. Exclusions and Limitations
XII. Claims
• Medicare Endorsements
• Copayments and Allowances Schedule
• Dues Schedule
• Service Area Map
0036900-003046 6
Section I. Definitions
AGREEMENT: This Medical Coverage Agreement, including the Schedule of Benefits, Enrollment and
Eligibility Schedule, Dues Schedule, Copayments and Allowances Schedule, Service Area Map, and Medicare
endorsements.
ALLOWANCE: The maximum amount payable by GHC for certain Covered Services under this Agreement, as
set forth in the Copayments and Allowances Schedule.
COINSURANCE: An amount the Member is required to pay for Covered Services received under this Agreement,
which is a percentage of the Allowance for such services,as set forth in the Copayments and Allowances Schedule.
COPAYMENT: The specific dollar amount required to be paid by a Member for certain Covered Services under
this Agreement as set forth in the Copayments and Allowances Schedule.
COVERED SERVICES: The services and benefits to which a Member is entitled under this Agreement.
DEDUCTIBLE: A specific maximum amount paid by a Member for certain Covered Services before benefits are
payable under this Agreement. The applicable Deductible amounts are set forth in the Copayments and Allowances
Schedule.
DIRECTORY OF SERVICES: A fee-for-service schedule adopted by GHC,setting forth the fees for medical and
hospital services not covered by a GHC prepayment agreement.
EMERGENCY: The sudden,unexpected onset of a medical condition that in the reasonable judgment of a prudent
person is of such a nature that failure to render immediate care by a licensed medical provider would place the
Member's life in danger, or cause serious impairment to the Member's health.
FAMILY DEPENDENT: Any member of a Subscriber's family who meets all applicable eligibility requirements,
is enrolled hereunder,and for whom the dues prescribed in the Dues Schedule have been paid.
FAMILY UNIT: A Subscriber and all his/her Family Dependents.
GHC DESIGNATED FACILITY: A facility, not including a GHC Facility, which the GHC Board of Trustees
has specified to provide health care services to its Members. (See Service Area Map.) Designated Facilities may be
changed by GHC upon appropriate notice.
GHC FACILITY: A hospital or medical center owned and operated by Group Health Cooperative of Puget Sound.
(See Service Area Map.)
GHC MEDICARE PLAN: A plan of coverage for persons enrolled in Medicare Part A (hospital insurance) and
Part B(medical insurance),or Part B only.
GHC PRIMARY CARE PROVIDER: A provider who is employed by or contracted with GHC to provide
primary care services to Members and is selected by each Member to provide or arrange for the provision of all
non-emergent Covered Services, except for services set forth in this Agreement which a Member can access without
referral. Primary Care Providers must be capable of and licensed to provide the majority of primary health care
services required by each Member.
GHC PROVIDER: The Medical Staff,Clinic Associate Staff,and Allied Health Professionals employed by GHC,
and any other health care professional with whom GHC has contracted to provide health care services to persons
enrolled under this Agreement, and who at such time is providing services which have been authorized in advance
by GHC, including, but not limited to, podiatrists, nurses, physician assistants, social workers, optometrists,
0036900-003046 7
!° JIL
psychologists, physical therapists and other professionals engaged in the delivery of healthcare services who are
licensed or certified to practice in accordance with Title 18 RCW.
GROUP: An empl)yer, union, welfare trust, or association which has entered into a Group Medical Coverage
Agreement with GHC.
HOSPITAL CARE: Those Medically Necessary services generally provided by acute general hospitals for
admitted patients which a GHC Provider has prescribed, directed, or authorized. Hospital care does not include
convalescent or custodial care which can, in the opinion of the GHC Provider, be provided by a nursing home or
convalescent care center.
MEDICAL CONDITION:A medical condition is a disease,an illness or an injury.
MEDICALLY NECESSARY: Required for the diagnosis or treatment of illness or injury, as determined by a
GHC Provider,and consistent with professionally recognized standards of health care.
MEDICARE: The federal health insurance program for the aged and disabled.
MEMBER: Any Subscriber or Family Dependent covered by this Agreement.
OPEN ENROLLMENT: An annual period, specified by the Group and GHC, during which an eligible person
may apply for coverage.
PRE-EXISTING CONDITION: A condition for which there has been diagnosis, treatment(including prescribed
drugs),or medical advice within the three(3)month period prior to the effective date of coverage, or a condition for
which symptoms existed within the three (3) month period prior to the date of coverage and for which a prudent
person would have ordinarily sought treatment.
REFERRAL: A written temporary referral agreement authorized in advance by a GHC Provider and approved by
GHC, which entitles a Member to receive Covered Services from a specified non-GHC health care provider.
Entitlement to such services shall not exceed the limits of the Referral and is subject to all terms and conditions of
the Referral and this Agreement.
SERVICE AREA: Clallam; Island, King, Kitsap, Lewis, Mason, Pierce, San Juan, Skagit, Snohomish, Thurston,
and Whatcom Counties,and any other areas designated by GHC. (See Service Area Map.)
SKILLED HOME HEALTH CARE: Reasonable and necessary care for the treatment of an illness or injury
which requires the skill of a nurse or therapist, based on the complexity of the service and the condition of the
patient,and which is performed directly by an appropriately licensed professional provider.
STOP LOSS: The maximum amount of Copayments,and expenses incurred and paid, during the calendar year for
Covered Services received by the Subscriber and his/her Family Dependents within the same calendar year. The
Stop Loss amount is set forth in the Copayments and Allowances Schedule.
SUBSCRIBER: A person employed by or belonging to the Group who meets all applicable eligibility
requirements, is enrolled hereunder,and for whom the dues specified in the Dues Schedule have been paid.
URGENT CONDITION: The sudden, unexpected onset of a medical condition that is of sufficient severity to
require medical treatment within twenty-four(24)hours of its onset.
USUAL,CUSTOMARY,AND REASONABLE: A term used to define the level of benefits which are payable by
GHC when expenses are incurred from a non-GHC physician or provider. Expenses are considered Usual,
Customary, and Reasonable if (1) the charges are consistent with those normally charged by the provider or
0036900-003046 8
organization for the same services or supplies; and(2)the charges are within the general range of charges made by
other providers in the same geographical area for the same service or supplies.
Section Ti_ Dues. Fees, and Copayments
A. MONTHLY DUES PAYMENTS. The Group shall submit to GHC for each Member the monthly dues set
forth in the current Dues Schedule and a verification of enrollment,on or before the due date, subject to a grace
period of ten(10)days. Dues are subject to change by GHC upon thirty(30)days written notice.
In the event the group increases enrollment at least twenty-five percent (25%) or more through acquisition or
merger,GHC reserves the right to require re-rating of the group.
B. COPAYMENTS AND COINSURANCE.
1. Copayments. At the time of service, Members shall be required to pay Copayments as set forth in the
Copayments and Allowances Schedule. Failure to pay for services and/or Copayments at the time of
service may result in a billing fee. Failure to cancel a scheduled appointment at least 24 hours prior to the
appointment may result in a billing for the value of the service.
Payment of a Copayment does not exclude the possibility of an additional billing if the service is
determined to be a non-Covered Service.
Total out-of-pocket Copayment expenses incurred during the same calendar year shall not exceed the
aggregate maximum amount (Stop Loss) as set forth in the Copayments and Allowances Schedule. Those
Copayment categories which apply toward the aggregate maximum amount are set forth in the Copayments
and Allowances Schedule.
If Copayments have been billed, any applicable billing fees shall not be considered in calculating total
out-of-pocket expenses for Copayments made.
2. Coinsurance. Members shall be required to pay Coinsurance for certain Covered Services as set forth in
the Copayments and Allowances Schedule.
C. SUBSCRIBER'S LIABILITY. The Subscriber is liable for (1) payment to the Group of his/her contribution
toward the monthly dues, if any; (2) payment to the Cooperative of Copayments and/or Coinsurance amounts
for Covered Services provided to the Subscriber and his/her Family Dependents, as set forth in the Copayments
and Allowances Schedule; and (3) payment to the Cooperative of any fees charged for non-Covered Services
provided to the Subscriber and his/her Family Dependents.
Payment of an amount billed and any applicable billing fee must be received within thirty (30) days of the
billing date.Amounts paid for billing fees do not apply toward the Stop Loss.
D. SELF-PAYMENTS DURING A STRIKE, LOCK-OUT, OR OTHER LABOR DISPUTE. In the event of
suspension or termination of employee compensation due to a strike, lock-out, or other labor dispute, a
Subscriber may continue uninterrupted coverage under this Agreement through payment of monthly dues
directly to the Group. Coverage may be continued for the lesser of the term of the strike, lock-out, or other
labor dispute,or for six(6)months after the cessation of work.
If the Group Agreement is no longer available,the Subscriber shall have the opportunity to apply for individual
Group Conversion or, if applicable, continuation coverage (see Section IV.), or an Individual and Family
Medical Coverage Agreement at the duly approved rates.
THE GROUP IS RESPONSIBLE FOR IMMEDIATELY NOTIFYING EACH AFFECTED SUBSCRIBER OF
HIS/HER RIGHTS OF SELF-PAYMENT UNDER THIS PROVISION.
0036900-CO3046 9
Section III. Termination
A. TERMINATION OF ENTIRE AGREEMENT. This Agreement may be terminated in the following
circumstances:
1. Termination on Notice. This is a guaranteed renewable contract and cannot be terminated without the
mutual approval of each of the parties except as set forth below(subsection 2.and 3.).
2. Nonpayment. Failure to make any monthly dues payment in accordance with Section II.A. shall result in
termination of this Agreement as of the due date.
3. Misrepresentation to Obtain Insurance. Group Health Cooperative may terminate this Agreement upon
written notice in the event of material misrepresentation, fraud, or omission of information in order to
obtain Group Coverage.
4. The Group may terminate this Agreement by giving thirty(30)days written notice to GHC.
B. TERMINATION OF SPECIFIC MEMBERS. This Agreement may be terminated as to a specific Member
for any of the following reasons:
1. Lcss of Eligibility. If a Member no longer meets the eligibility requirements set forth in Section IX.B.,and
is not enrolled for continuation coverage as described in Section N.A., coverage under this Agreement will
terminate at the end of the month during which loss of eligibility occurs, unless otherwise specified by the
Group as set forth in Section IX.Enrollment and Eligibility Schedule.
2. For Cause.Coverage of a Member may be terminated upon written notice for:
a. Material misrepresentation, fraud, or omission of information in order to obtain coverage. This
includes failure to answer fully and correctly all questions contained in the application forms. In such
event,the Cooperative may,within two(2)years from the date of the application, refuse to cover any
service for a condition(s)to which such question was relevant, or may rescind or cancel the Member's
coverage upon ten(10)working days written notice.
b. Permitting the use of a GHC identification card by another person, or using another person's
identification card to obtain care to which one is not entitled.
c. Failure to comply with the rules and regulations of the Cooperative.
d. Nonpayment of charges as set forth in Section II.C.
3. Nonpayment of dues for a specific Member by the Group.
4. In no event will a Member be terminated solely on the basis of their physical or mental condition provided
they meet all other eligibility requirements set forth in this Agreement.
5. The Member may appeal the termination decision through GHC's grievance process as set forth in Section
vII.
C. PERSONS HOSPITALIZED ON THE DATE OF TERMINATION. A Member who is a registered bed
patient receiving Covered Services in a GHC Facility or GHC Designated Facility on the date of termination
shall continue to be eligible for Covered Services for the condition for which the Member was hospitalized,
until discharge from the facility. This continued coverage will also apply to a Member hospitalized in a
non-GHC Designated Facility as a result of an Emergency or Referral as set forth in Section XI.B.1.
D. SERVICES PROVIDED AFTER TERMINATION. Any services provided by GHC after the effective date
of termination(except those services covered under Section III.C.)shall be charged according to the Directory
0036900-003046 10
of Services. The Subscriber shall be liable for payment of all such charges for services provided to the
Subscriber and all Family Dependents.
Section IV Continuation Coverage, Conversion, and Transfer
A. CONTINUATION COVERAGE.
This subsection A. only applies to employer groups who must offer continuation coverage under the applicable
provisions of the Consolidated Omnibus Budget Reconciliation Act of 1985 ("COBRA"),as amended,and only
applies to grant continuation of coverage rights to the extent required by federal law.
To the extent required by federal law, if the Subscriber or Family Dependent loses eligibility under this Group
Agreement,group coverage may be continued under the circumstances described below. Except as set forth in
Section IV.A.12., below, this provision applies only to Subscribers and Family Dependents enrolled under this
Agreement prior to the date of eligibility for continuation coverage who would otherwise lose coverage as a
result of one of the qualifying events listed below in subsections(1.),(2.),and(3.).
1. Subscribers and Family Dependents are eligible for continuation coverage for a maximum period of up to
eighteen(18)months commencing at the date that:
• The Subscriber's employment is terminated(unless terminated for gross misconduct);or
• the Subscriber experiences a reduction in work hours resulting in loss of eligibility for group benefits.
2. Family Dependents are eligible for continuation coverage for a maximum period of up to thirty-six (36)
months commencing at the date that:
• The Subscriber is divorced or legally separated;
• the Subscriber dies;
• the Subscriber becomes entitled to Medicare;or
• a Dependent child ceases to qualify as a Family Dependent under Section IX.B.2.(b)or(c).
3. A COBRA eligible beneficiary who is disabled prior to or on the date he/she loses coverage due to
termination of employment (other than for the beneficiary's gross misconduct) or reduction of hours, or
becomes disabled at any time during the first sixty (60) days of COBRA coverage, may extend his/her
coverage under COBRA from eighteen (18) months up to twenty-nine (29) months, so long as the
beneficiary provides notice of his/her Social Security disability determination within sixty (60) days of
such determination and before the end of the eighteen (18) month coverage period. Social Security
Administration certification of total disability is required. The period of extended coverage provided under
this subsection shall terminate on the first day of the first month which begins more than thirty (30) days
after the date of the Social Security Administration's final determination that the qualified beneficiary is no
longer disabled. Non-disabled dependents of a disabled Subscriber who are eligible for continuation
coverage are entitled to continue their dependent coverage for the duration of the disabled Subscriber's
disability extension.
4. In the event the group has retirees,the Subscriber who is a retiree or the spouse or Dependent of a retiree,
may continue coverage hereunder if the Subscriber and /or Family Dependent would otherwise lose
coverage hereunder within one year of the date a proceeding under Title 11 of the United States Code is
commenced with respect to the Group. Coverage under this Section IV.A.4., continues only upon payment
of applicable monthly charges to the Group at the time specified by the Group.The terms and conditions of
this coverage are governed by COBRA.
5. If an individual enrolled for continuation coverage experiences a second qualifying event as set forth in
subsection (2.) above, continuation coverage may be extended for up to thirty-six (36) months, beginning
from the date of the first qualifying event. Where the Subscriber becomes entitled to Medicare, the period
0036900-CO3046 11
I i ' k
of continuation coverage for Family Dependents as a result of the Subscriber's Medicare entitlement or any
later event described in Section IV.A.2. above shall extend up to a maximum of thirty-six (36) months
from the date the Subscriber becomes entitled to Medicare.
6. In addition to the conditions set forth in Section III. Termination,continuation coverage may be terminated
prior to the prescribed period set forth in subsections(1.), (2.), and(3.)above if:
• there is a failure to make timely payment of any monthly dues required under this Agreement;
• the Member becomes covered under any other group health plan, unless such plan contains an
exclusion or limitation on coverage for any pre-existing condition which may apply to the Member;
• the Member becomes enrolled under Medicare;
• the employer ceases to maintain any group health plan;or
• the Member is no longer disabled as determined by the Social Security Administration.
7. In the event a child is born to, or is placed with the covered Subscriber for adoption, during a period of
COBRA continuation coverage,such child will also be considered a qualified beneficiary.
8. Notice. The Group is responsible for assuring compliance with COBRA and that Members are given
timely notice of their continuation coverage option. The Group is also responsible for notifying GHC in a
timely fashion of the election to continue coverage and the applicable coverage period.
The Subscriber or Family Dependent must notify the Group,or plan administrator, if any,within sixty(60)
days following a divorce, legal separation, or when an enrolled dependent child no longer meets the
eligibility requirements set forth in Section IX.B.2., or within sixty (60) days following the date coverage
ends in accordance with the termination provisions under this Agreement,whichever is later.
9. Application. Written application for continuation coverage must be made within sixty (60) days of the
termination date of coverage, or the date that the Member receives specific notice of his/her right to
continuation coverage, whichever is later. For the purposes of this Agreement, "receives" means that
written notice was mailed by the Group to the Member's most recent address as recorded with the Group.
No lapse in coverage prior to continuation coverage is permitted, except as provided above. The
application shall be deemed by GHC to include all Family Dependents eligible for continuation coverage
unless specifically stated otherwise.A physical examination or statement of health is not required.
10. Monthly Dues. Monthly dues must be paid directly to the Group. The Group is responsible for submitting
such dues with its regular monthly dues payment to GHC.
Payment of the initial dues payment, which includes the period from the election retroactive to the
qualifying event, and any regular dues payment that becomes due prior to the initial dues payment date,for
continuation coverage under COBRA is due forty-five(45) days after the date of the election. Subsequent
dues payments are due on a monthly basis. Dues for persons extending COBRA coverage from eighteen
(18) months to twenty-nine (29) months because of total disability may be charged at one hundred fifty
percent(150%)of the Group's dues rate that would otherwise apply to them.
11. Group Conversion. In addition to Group Conversion rights as set forth in Section IV.B.,the Subscriber or
Family Dependent enrolled for continuation coverage is entitled to convert to GHC's Group Conversion
Plan within a 180-day period prior to termination of continuation coverage, if his/her coverage under this
Agreement is terminated for any reason other than nonpayment or cause. See Section IV.B.2. GHC Group
Conversion Plan-Application.
12. Open Enrollment and Adding Dependents. To the extent required under COBRA, a qualified
beneficiary under COBRA may add Family Dependents during the Group's Open Enrollment period and
newly eligible persons according to the procedures specified in Section IX.A.
0036900-CO3046 12
B. GHC GROUP CONVERSION PLAN.
1. Eligibility. Any Subscriber or Family Dependent is entitled to convert to GHC's Group Conversion Plan if
his/her coverage under this Agreement is terminated for any reason other than cause. (See Section III.B.2.)
Following termination of marriage or death of the Subscriber, all Family Dependents are entitled to make
such a conversion.
2. Application. Application for conversion must be made within thirty-one (31) days following termination
under this Agreement. Coverage under the GHC Group Conversion Plan is subject to all terms and
conditions of such plan, including dues payment. A physical examination or statement of health is not
required for enrollment in the Group Conversion Plan.
Section V. Coordination of Benefits
A. BENEFITS SUBJECT TO THIS PROVISION: As described in subsection H., benefits provided under this
Agreement do not duplicate other group coverage for medical care or treatment. If a Member is entitled to
receive benefits or services for medical care or treatment under another individual, group or governmental plan,
GHC may recover the reasonable cash value of services provided under this Agreement so that benefits and
services under all plans do not exceed one hundred percent(100%)of allowable expenses (except copayments,
coinsurances and deductibles)as set forth in this section.
B. PLAN: The definition of a"Plan"includes the following sources of benefits or services:
1. Group or blanket disability insurance policies and health care service contractor and health maintenance
organization group agreements, issued by insurers, health care service contractors and health maintenance
organizations;
2. Labor-management trusteed plans, labor organization plans, employer organization plans or employee
benefit organization plans;
3. Governmental programs; and
4. Coverage required or provided by any statute.The term "Plan" shall be construed separately with respect to
each policy, agreement or other arrangement for benefits or services, and separately with respect to the
respective portions of any such policy, agreement or other arrangement which do and which do not reserve
the right to take the benefits or services of other policies, agreements or other arrangements into
consideration in determining benefits.
C. ALLOWABLE EXPENSE: "Allowable Expense" means any necessary, reasonable and customary items of
expense at least a portion of which is covered under at least one of the Plans covering the person for whom the
claim is made. When a Plan provides benefits in the form of services rather than cash payments,the reasonable
cash value of each service rendered shall be considered as both an Allowable Expense and a benefit paid.
D. CLAIM DETERMINATION PERIOD: "Claim Determination Period" means a period beginning with any
January I and ending with the next following December 31 except that the first Claim Determination Period
with respect to any person shall begin on the effective date of coverage under this Agreement with respect to
such person and end on the following December 31. In no event will a Claim Determination Period for any
person extend beyond the last day on which such a person is covered under this Agreement.
E. RIGHT TO RECEIVE AND RELEASE INFORMATION: For the purpose of determining the applicability
of and implementing this provision and any provision of similar purpose in any other Plan, the Cooperative
may,with such consent as may be necessary,release to or obtain from any other insurer, organization or person
any information,with respect to any person which the insurer considers necessary for such purpose.Any person
0036900-003046 13
claiming benefits under this Agreement shall fumish to the Cooperative the information necessary for such
purpose.
F. FACILITY OF PAYMENT: Whenever coverage which should have been provided under this Agreement in
accordance with this provision has been provided or paid for under any other Plan, the Cooperative shall have
the right, exercisable alone and in its sole discretion,to pay over to any Plan making such other payments any
amounts it shall determine to be warranted in order to satisfy the intent of this provision, and amounts so paid
shall be considered to be coverage or benefits paid under this Agreement and, to the extent of such payments,
the Cooperative shall be fully discharged from liability under this Agreement.
G. RIGHT OF RECOVERY: Whenever benefits have been provided by the Cooperative with respect to
Allowable Expenses in total amount, at any time, in excess of the maximum amount of payment necessary at
that time to satisfy the intent of this provision, the Cooperative shall have the right to recover the reasonable
cash value of such benefits,to the extent of such excess, from one or more of the following, as the Cooperative
shall determine: any persons to or for or with respect to whom such benefits were provided, any other insurers,
any service plans or any other organization or other Plans.
H. EFFECT ON BENEFITS:
1. This provision shall apply in determining the benefits for a person covered under this Agreement for a
particular Claim Determination Period if, for the Allowable Expenses incurred as to such person during
such period,the sum of:
a. The reasonable cash value of the benefits that would be provided under the Agreement in the absence
of this provision,and
b. The benefits that would be payable under all other Plans in the absence therein or provisions of similar
purpose to this provision would exceed such Allowable Expenses.
2. As to any Claim Determination Period with respect to which this provision is applicable, the reasonable
cash value of the benefits provided under this Agreement in the absence of this provision for the Allowable
Expenses incurred as to such person during such Claim Determination Period shall be reduced to the extent
necessary so that the sum of the reasonable cash value of benefits and all benefits payable for such
Allowable Expenses under all other Plans, except as provided in subparagraph (3)of this Section, shall not
exceed the total of such Allowable Expenses. Benefits payable under another Plan include benefits that
would have been payable had a claim been duly made therefor. In determining liability under this
paragraph,the Plan is not required, and will not take into consideration, deductibles, copayments, or other
cost-sharing provisions.
3. If
a. another Plan which is involved in subparagraph (2) of this Section and which contains a provision
coordinating its benefits with those of this Agreement would, according to its rules, determine its
benefits after the benefits of this Plan have been determined;and
b. the rules set forth in subparagraph (4) of this Section would require this Agreement to determine its
benefits before such other Plan, then the benefits of such other Plan will be ignored for the purposes of
determining the benefits under this Agreement.
4. For the purposes of subparagraph (3) of this Section, the rules establishing the order of benefit
determination are:
a. The benefits of a Plan which covers the person on whose expenses a claim is based other than as a
dependent shall be determined before the benefits of a Plan which covers such person as a dependent.
0036900-003046 14
b. In the case that a dependent is covered under both parents'medical Plan,the benefits of the Plan of the
parent whose birthday falls earlier in the year are determined before those of the Plan of a parent
whose birthday falls later in the year. This birthdate will refer only to the month and day, not the year
in which a person was born. If both parents have the same birthday, the benefits of the Plan which
covered the parent longer are determined before those that covered the other parent for a shorter period
of time,except that in the case of a person for whom claim is made as a dependent child,
i. when the parents are separated or divorced and the parent with custody of the child has not
remarried,the benefits of a Plan which covers the child as a dependent of the parent with custody
of the child will be determined before the benefits of a Plan which covers the child as a dependent
of the parent without custody;and
ii. when the parents are divorced and the parent with custody of the child has remarried, the benefits
of a Plan which covers the child as a dependent of the parent with custody shall be determined
before the benefits of a Plan which covers that child as a dependent of the stepparent, and the
benefits of a Plan which covers that child as a dependent of the stepparent will be determined
before the benefits of a Plan which covers that child as a dependent of the parent without custody.
Notwithstanding items (i) and (ii) above, if there is a court decree which would otherwise establish
financial responsibility for the medical, dental or other health care expenses with respect to the child,
the benefits of a Plan which covers the child as a dependent of the parent with such financial
responsibility shall be determined before the benefits of any other Plan which cover the child as a
dependent child.
c. When rules(a)and(b)do not establish an order of benefit determination,the benefits of a Plan which
has covered the person on whose expenses claim is based for the longer period of time shall be
determined before the benefits of a Plan which has covered such person the shorter period of time,
provided that:
i. The benefits of a Plan covering the person on whose expenses claim is based as a laid off or
retired employee, or dependent of such person shall be determined after the benefits of any other
Plan covering such person as an employee,other than a laid off or retired employee, or dependent
of such person;and
ii. If either Plan does not have a provision regarding laid off or retired employees, which results in
each Plan determining its benefits after the other,then the provisions of(i)of this subsection shall
not apply.
d. If none of the above rules determines the order of benefits, the benefits of the Plan which covered an
employee or Subscriber for the longer period of time shall be determined before those of the Plan
which covered that person for the shorter time period.
5. When this provision operates to reduce the total amount of benefits otherwise to be provided to a person
covered under this Agreement during any Claim Determination Period, the reasonable cash value of each
benefit that would be provided in the absence of this provision shall be reduced proportionately, and such
reduced amount shall be charged against any applicable benefit limit of this Agreement.
Section VI. Subrogation
"Injured person" under this section means a Member covered by this Agreement who sustains compensable injury.
"GHC's medical expenses" means the expense incurred and the reasonable value of the services provided by the
Cooperative for the care or treatment of the injury sustained.
If the injured person was injured by an act or omission of a third party giving rise to a claim of legal liability against
the third party, GHC shall have the right to recover from the third party GHC's medical expenses. This right is
commonly referred to as "subrogation."GHC shall be subrogated to and may enforce all rights of the injured person
0036900-CO3046 15
to the extent of GHC's medical expenses. GHC's equitable and contractual rights of subrogation are limited(only as
required)by Washington law.
The injured person and his or her agents must cooperate fully with GHC in its efforts to collect GHC's medical
expenses. This cooperation shall include supplying GHC with information about any defendants and/or insurers
related to the injured person's claim. The injured person and his or her agents shall permit GHC, at GHC's option, to
associate with the injured parry or to intervene in any action filed against any third party.The injured person and his
or her agents shall do nothing to prejudice GHC's subrogation rights. The injured person shall not settle a claim
without protecting GHC's interest.
GHC shall be subrogated to and may enforce all rights of the injured person to the extent of its medical expense.
GHC's right of subrogation shall be limited to the excess of the amount required to fully compensate the injured
person for the loss sustained. Full compensation shall be measured on an objective, case-by-case basis, but is
subject to a presumption that a settlement which does not exhaust the third parry's reachable assets is full
compensation to the injured person. If the Member fails to cooperate fully with GHC in recovery of medical
expenses as described above,the Member shall be responsible for reimbursing GHC for such medical expenses.
GHC shall not pay any attorney's fees or collection costs to attorneys representing the injured person where it has
retained its own legal counsel or acts on its own behalf to represent its interests and unless there is a written fee
agreement signed by GHC prior to any collection efforts. When reasonable collection costs have been incurred with
GHC's prior written agreement, to recover GHC's medical expenses, there shall be an equitable apportionment of
such collection costs between GHC and the injured person subject to a maximum responsibility of GHC equal to
one-third of the amount recovered on behalf of GHC.
Section VII Grievance Procedure
The Member Services Program is designed to help a Member resolve formal complaints and concerns about medical
and business service. GHC will record,research,and respond in a timely manner to a Member's concern. A concern
should initially be registered at the Member's area medical center. If not satisfied, the Member should then contact
the regional Member Services Department, which will arrange for review by appropriate Medical Staff,
management,and/or GHC consumers.
For grievances following denial of claims for experimental/investigational procedures, see Section XI.A.
Section VIII Miscellaneous Provisions
A. DISSEMINATION OF INFORMATION. The Group is responsible for disseminating to Subscribers written
information concerning this Agreement which is provided by the Cooperative.
B. IDENTIFICATION CARDS. The Cooperative will furnish cards, for identification only, to all persons
enrolled under this Agreement.
C. ADMINISTRATION OF AGREEMENT. GHC may adopt reasonable policies and procedures to help in the
administration of this Agreement.
D. MODIFICATION OF AGREEMENT. Except as required by Washington state law, this Agreement may not
be modified without agreement between both parties..
E. Group Health Cooperative reserves the right to construe the provisions of this Medical Coverage Agreement,
and to determine any and all questions pertaining to benefit entitlement and coverage.
No oral statement of any person shall modify or otherwise affect the benefits, limitations,and exclusions of this
Agreement, convey or void any coverage, increase or reduce any benefits under this Agreement or be used in
the prosecution or defense of a claim under this Agreement.
0036900-003046 16
F. INDEMNIFICATION. GHC agrees to indemnify and hold the Group harmless against all claims, damages,
losses, and expenses, including reasonable attorney's fees, arising out of GHC's failure to perform or negligent
performances of its express obligations under the Group Medical Coverage Agreement. GHC further agrees to
indemnify and hold the Group harmless against claims, damages, losses or expenses, including reasonable
attorney's fees, for injury or damage caused to any person which is the result of or is alleged to be the result of
the failure to provide or the negligent provision of medical services or supplies specified under this contract by
any health care provider who is employed by, is an agent of or who has a direct contractual relationship with
GHC.Provided,however,that the Group notifies GHC in writing promptly of any such claims,that it will assist
GHC (at GHC's expense) in the defense of same, and that GHC has the right to direct and arrange the defense
of the case.
The foregoing shall not in any way be construed as applying to any claim, demand or loss arising out of
negligent acts or omissions of the Group, its agents, officers or employees, or failure by the Group to carry out
any of its responsibilities under this Agreement.
G. The Medical Coverage Agreement is entered into and governed by the laws of Washington State, except as
otherwise pre-empted by ERISA and other Federal laws.
Group Health Cooperative of Puget Sound does not discriminate on the basis of physical or mental handicaps in
its employment practices and services.
Section IX. Enrollment and Efildbility Schedule
A. ENROLLMENT
1. Application for Enrollment. Application for enrollment shall be made on an application form furnished
and approved by GHC. No person shall be enrolled or dues accepted until this completed application has
been received and approved by GHC.The Group is responsible for submitting completed application forms
to GHC.
a. Newly Eligible Persons. Newly eligible Subscribers may make written application for enrollment to
the Group within thirty-one (31) days of eligibility. If the Subscriber wishes to enroll his/her eligible
Dependents,application must be made during this same thirty-one(31)day period.
Written application for enrollment for a newly dependent person, other than a newborn or newborn
adopted child,must be made to the Group within thirty-one(31)days after the dependency occurs.
A Subscriber's newbom child shall be automatically enrolled when born:
i. at a GHC Facility or GHC Designated Facility;or
ii. at a non-GHC Facility due to an Emergency,provided that all the requirements of Section X.I. of
this Agreement are met, including notification of GHC by way of the GHC Notification Line
within twenty-four (24) hours following inpatient admission, or as soon thereafter as medically
possible.
GHC shall provide notice of such enrollment to the Subscriber and the Group. It is the Subscriber's
responsibility to complete and submit a revised application form to the Group. If the Subscriber does
not want the newborn child enrolled, he/she must notify GHC within sixty (60) days of the date of
birth.
If subsequent to enrollment it is discovered that the newborn child is not eligible or if the Group does
not initiate dues payments on or before sixty(60) days from the date of birth, GHC shall disenroll the
child retroactive to the effective date of coverage.
0036900-003046 17
c _
Children who are born in a non-GHC Facility on a nonemergency basis will not be automatically
enrolled. In the event there is a change in the monthly dues payment as a result of the addition of a
newborn child,the Subscriber must make written application for enrollment to the Group within sixty
(60)days following the date of birth.
In the event there is a change in the monthly dues payment as a result of the addition of an adoptive
child,including adopted newborns,the Subscriber must make written application for enrollment within
sixty (60) days from the day that the child is physically placed with the Subscriber for the purpose of
adoption and the Subscriber assumes financial responsibility for the medical expenses of the child.
b. If the spouse and/or eligible Family Dependents of a GHC Subscriber loses eligibility under a
comparable medical plan they may be added to the GHC Subscriber's plan.There must be no more than
a three (3) month lapse of coverage between plans, and application must be made prior to the
expiration of this three(3)month period.
c. Open Enrollment. A person not enrolled as a Subscriber or Family Dependent when newly eligible,
as described above,may make written application during the Group's Open Enrollment period.
2. Limitation on Enrollment. This Agreement will be open for application as set forth in Section IX.A.1.
GHC may limit enrollment, establish quotas, or set priorities for acceptance of new applications if it
determines that its capacity, in relation to its total enrollment, is not adequate to provide services to
additional persons.
3. Effective Date of Enrollment.
a. Provided application is made as set forth in Section IX.A.La. (above), enrollment for a newly eligible
Subscriber and listed Dependents will begin on the date of hire.
Subscribers who return to work from a leave without pay status within ninety (90) days, shall be
eligible for enrollment on the first of the month following their date of return to work.
Enrollment for newly dependent persons,other than newborns and adopted children,will begin on the
first(1 st)of the month following application.
Provided newborns are enrolled as specified in Section IX.A.l.a. (above),enrollment is effective from
the date of birth.
For adopted children, enrollment is effective from the date that the adopted child is physically placed
with the Subscriber for the purpose of adoption and the Subscriber has assumed financial
responsibility for the medical expenses of the child.
b. Persons Hospitalized on Effective Date. If a person, other than a newborn or adoptive child, is
confined in a hospital on the date enrollment would otherwise become effective, the effective date of
enrollment for the person(s)hospitalized will not begin until discharge from the facility.
4. Effective Date of Services and Benefits. Services provided to Enrollees, including newborns and adoptive
children, are subject to all terms and conditions of the Group Agreement including the requirement that all
services must be received at a GHC or GHC Designated Facility under the medical management of a GHC
physician unless the Enrollee has been Referred by a GHC physician or has received Emergency services
according to Section X.I.
B. ELIGIBILITY
In order to be accepted for enrollment and continuing coverage under the Group Agreement, individuals must
meet all applicable requirements set forth below.The Group is responsible for determining eligibility.
0036900-CO3046 18
Subscribers and Family Dependents must reside in the GHC Service Area(as defined in Section 1.) in order to
be eligible for enrollment under this Agreement, except for temporary residency outside the Service area for
purposes of attending school, court-ordered coverage for Dependents, or when approved in advance by GHC,
other unique family arrangements. All non-urgent/emergent care must be provided at GHC Facilities or GHC
Designated Facilities.
1. Subscribers.Bona fide employees and LEOFF II employees who are employed on a regularly scheduled
basis of not less than twenty(20)hours per week shall be eligible for enrollment.
Elected officials and council members shall be eligible for enrollment.
LEOFF I employees will not be covered under this plan.
2. Family Dependents.The Subscriber may enroll any of the following:
a. The Subscriber's legal spouse;
b. Unmarried dependent children who are under the age of twenty-one (21), provided they reside
regularly with the Subscriber or are chiefly dependent on the Subscriber for support and maintenance,
provided proof of such dependency is furnished to GHC.
"Children" means the children of the Subscriber including adopted children, stepchildren, foster
children, children for whom the Subscriber has a qualified court order to provide coverage, and any
other children for whom the Subscriber is the legal guardian.
c. Enrollment may be extended past the limiting age for an unmarried person enrolled as a Family
Dependent on his/her twenty-first(21st)birthday if:
i. the Dependent is a full-time registered student at an accredited secondary school, college, or
university and under the age of twenty-three(23); or
ii. the Dependent is totally incapable of self-sustaining employment because of a developmental
disability or a physical handicap incurred prior to attainment of the limiting age as set forth in
Section IX.B.2.b., or prior to attainment of the student limiting age as set forth in Section
IX.B.2.c., and is chiefly dependent upon the Subscriber for support and maintenance. Enrollment
for such a Dependent may be continued for the duration of the continuous total incapacity,
provided enrollment does not terminate for any other reason. Medical proof of incapacity and
proof of financial dependency must be furnished to the Cooperative upon request, but not more
frequently than annually after the two(2)year period following the Dependent's attainment of the
limiting age.
d. Dependents of LEOFF I employees are eligible for coverage under this contract.
e. Temporary Coverage for Ineligible Newborns. A child born to a covered Member which does not
otherwise qualify as an eligible dependent as set forth in this section will be entitled to the benefits set
forth in Section X. from birth through three (3) weeks of age. After three (3) weeks of age, no
benefits are available unless the newborn child qualifies as a Dependent and is enrolled under this
Agreement. All contract provisions, limitations, and exclusions will apply except Section IV.
Continuation of Coverage,Conversion,and Transfer.
In regard to temporary coverage, continuation of coverage benefits set forth in Section IV. will not
apply.
0036900-003046 19
Ineligible Persons. GHC reserves the right to refuse enrollment to any person whose coverage under the Group
Agreement or any other Medical Coverage Agreement issued by Group Health Cooperative of Puget Sound has
been terminated for cause.
C. CONTINUATION OF ENROLLMENT
While on a group approved leave of absence, the Subscriber and listed Dependents will continue to receive
services and benefits under this Agreement for up to one hundred eighty (180) days, provided the employer or
Group continues to remit dues to GHC for the Subscriber and such Dependents.
While on a group approved leave of absence the Subscriber and listed Dependents can continue to be covered
under this Agreement, provided they remain eligible for coverage, such leave is in compliance with the
employer's established leave of absence policy consistently applied to all employees, the employer's leave
policy is in compliance with the Family and Medical Leave Act when applicable, and the employer or Group
continues to remit dues for the Subscriber and Dependents to the Cooperative.
D. PERSONS ENTITLED TO, OR ELIGIBLE TO PURCHASE MEDICARE. Except as defined by federal
regulations, all Members entitled to, or eligible to purchase Medicare must be enrolled in the GHC Medicare
Plan upon such entitlement or eligibility. A condition of coverage under the GHC Medicare Plan requires that a
Member be continuously fully qualified and enrolled fro the hospital (Part A)and medical(Part B)benefits, or
Part B only, available from the Social Security Administration, and sign any papers that may be required by
GHC or Medicare. Subscribers and covered dependents who are eligible for Medicare (as set forth below)
must,effective the date that Medicare would become the primary payor,enroll in Medicare Parts A &B, and
must participate in GHC's Medicare Plan. For purposes of this section, an individual shall be deemed
eligible for Medicare when he or she has tire option to receive part A Medicare benefits, irrespective of
whether the individual elects to enroll in Part B coverage under the federal regulations. All applicable
provisions of the GHC Medicare Plan are fully set forth in the Medicare Endorsement(s) attached to this
Agreement.
E. PERSONS AGE SIXTY-FIVE (65) OR OLDER WHO ARE NOT ENTITLED TO, OR ELIGIBLE TO
PURCHASE MEDICARE. Upon reaching age sixty-five (65), if not entitled to, or eligible to purchase
Medicare, Members may continue coverage under this Agreement upon payment of the applicable dues as set
forth in the Dues Schedule.
Section X. Schedule Of Benefits
Subject to all provisions of this Group Medical Coverage Agreement, including the Copayments and
Allowances Schedule, Members are entitled to receive the benefits and services that are Medically Necessary
for the treatment of a Medical Condition as determined by GHC's Medical Director or his/her designee,and
as described in this Schedule of Benefits.
A. HOSPITAL CARE
Hospital care is provided when approved by a GHC Provider, limited to the following services:
1. Room and board, including private room when prescribed, and general nursing services.
2. Hospital services(including use of operating room, anesthesia, oxygen,x-ray, laboratory, and radiotherapy
services).
3. As a cost-effective alternative in lieu of otherwise covered, Medically Necessary hospitalization or other
covered, Medically Necessary institutional care, alternative care arrangements may be covered.
0036900-CO3046 20
N
Alternative care arrangements in lieu of covered hospital or other institutional care must be determined
appropriate and Medically Necessary based upon the patient's medical condition. Such determination of
medical appropriateness and necessity, and authorization of coverage must be made in advance by GHC.
For additional coverage,see Section X.E. Skilled Home Health Care Services and Section X.F.Hospice.
For Skilled Nursing benefits other than as set forth in this Section,see Section X B.
4. Drugs and medications which are listed as covered in the GHC Drug Formulary(approved drug list).
5. Special duty nursing(when prescribed as Medically Necessary).
If a Member is hospitalized in a non-GHC Facility, GHC reserves the right to require transfer of the Member to
a GHC Facility, upon consultation with a GHC Provider. If the Member refuses to transfer to a GHC Facility,
all further costs incurred during the hospitalization are the responsibility of the Member.
B. MEDICAL AND SURGICAL CARE
Medical and surgical services are provided, limited to the following,when prescribed by a GHC Provider:
1. Surgical services.
2. Diagnostic x-ray,nuclear medicine,ultrasound, and laboratory services.
3. Family planning counseling services.
4. Hearing examinations to determine hearing loss.
5. Blood derivatives and the administration of blood and blood derivatives. The cost of blood is not covered.
6. Preventative services for health maintenance, including routine mammography screening, physical
examinations in accordance with criteria established by GHC for the detection of disease, and
immunizations and vaccinations which are listed as covered in the GHC Drug Formulary (approved drug
list). A fee may be charged for health education programs.
7. Radiation therapy services.
8. The following services are covered by GHC when performed by a GHC Provider or GHC oral surgeon:
reduction of a fracture or dislocation of the jaw or facial bones; excision of tumors or cysts of the jaw,
cheeks, lips,tongue,gums,roof and floor of the mouth;and incision of salivary glands and ducts.
9. Nonexperimental implants, limited to the following: cardiac devices,artificial joints,and intraocular lenses.
Artificial or mechanical hearts are excluded.
10. Respiratory therapy.
11. Dietary formula for the treatment of phenylketonuria (PKU) when determined Medically Necessary by
GHC's Medical Director, or his/her designee. Coverage for this formula is not subject to a Pre-existing
Conditions waiting period, if any.
Outpatient total parenteral nutritional therapy, when Medically Necessary and in accordance with medical
criteria as established by GHC, is covered including supplies necessary for its administration. Outpatient
enteral therapy is excluded.
0036900-003046 21
G
Dietary formulas and special diets, except for treatment of phenylketonuria (PKU) and total parenteral
nutritional therapy as set forth above,are excluded.
12. Visits by GHC Providers(including consultations and second opinions by a GHC Provider) in the hospital
or office.
13. Routine eye examinations and refractions are covered, limited to once every twelve (12) months, except
when Medically Necessary. Services for routine eye examinations must be received at a GHC Facility and
in accordance with GHC medical criteria in order to be covered.
Evaluations and surgical procedures to correct refractions which are not related to eye pathology are not
covered. Complications related to such surgery are also excluded.
Contact lens fittings and related examinations are not covered except as set forth below. Contact lens
examinations and fittings for eye pathology are provided in full. When dispensed through GHC Facilities,
one contact lens per diseased eye in lieu of an intraocular lens, including exam and fitting, is covered for
Members following cataract surgery performed by a GHC Provider, provided the Member has been
continuously covered by GHC since such surgery. Replacement of a covered contact lens will be provided
only when needed due to change in the Member's medical condition but may be replaced only one time
within any twelve(12)month period.
14. Maternity care, including care for complications of pregnancy and prenatal and postpartum visits.
Prenatal testing for the detection of congenital and heritable disorders when Medically Necessary as
determined by GHC's Medical Director,or his/her designee.
Hospitalization and delivery services and voluntary (not medically indicated and non-therapeutic)
termination of pregnancy are not covered unless indicated in the next paragraph of this section.
Additional Maternity Care Services
Hospitalization and delivery, including home births for low risk pregnancies when approved in advance
and provided by a GHC Provider,is covered.
Voluntary (not medically indicated and nontherapeutic) or involuntary termination of pregnancy is
covered.
15. Transplants. When authorized as medically appropriate by GHC's Medical Director or his/her designee,
and in accordance with criteria established by the Cooperative, for heart, heart-lung, single lung, double
lung, kidney, simultaneous pancreas/kidney, cornea, bone marrow, and liver transplants, limited to the
following:
• evaluation testing to determine recipient candidacy;
• transplantation, limited to costs for the surgery and hospitalization related to the transplant, and
medications; and
• follow-up services for specialty visits,re-hospitalization,and maintenance medications.
High dose chemotherapy and stem cell (obtained from the peripheral blood or marrow as medically
appropriate) support is covered when authorized as medically appropriate by GHC's Medical Director, or
his/her designee.
Transportation expenses,except as set forth under Section X.M. of this Agreement, and living expenses are
excluded.
0036900-CO3046 22
Donor costs for a covered organ recipient are covered, limited to procurement center fees,travel costs for a
surgical team, excision fees, and matching tests. GHC shall exclude coverage for donor costs to the extent
that the donor costs are reimbursable by the organ donor's insurance.
Except for children who have been continuously enrolled at GHC since birth, coverage for all transplants
and any related services, items, and drugs shall be excluded until such time as the Member has been
continuously enrolled under this Agreement, or any prior GHC Medical Coverage Agreement, for twelve
(12) consecutive months without any lapse in coverage, unless the Member requires a transplant as the
result of a condition which had a sudden unexpected onset after the Member's effective date of coverage.
16. Self-referrals for manipulative therapy of the spine and extremities by GHC Providers are covered up to a
maximum of 10 visits per calendar year,subject to the office visit Copayment.
The medical necessity for manipulative therapy must meet GHC protocol.
17. Medical and surgical services and related hospital charges, including orthognathic Qaw) surgery for the
treatment of temporomandibular joint (TMJ) disorders, are covered as set forth in the Copayments and
Allowances Schedule when determined to be Medically Necessary and referred in advance by GHC. Such
disorders may exhibit themselves in the form of pain, infection, disease, difficulty in speaking, or difficulty
in chewing or swallowing food. TMJ appliances are covered as set forth under orthopedic appliances
(Section X.H.1.).
Orthognathic (jaw) surgery, radiology services and TMJ specialist services, including fitting/adjustment of
splints,is subject to the benefit limit set forth in the Copayments and Allowances Schedule.
The following services including related hospitalizations,are excluded regardless of origin or cause:
• orthognathic(jaw)surgery in the absence of a TMJ diagnosis,
• treatment for cosmetic purposes,and
• all dental services(except as noted above), including orthodontic therapy.
18. When authorized as medically appropriate by GHC's Medical Director, or his/her designee, and in
accordance with criteria established by the Cooperative, treatment of growth disorders by growth
hormones.
Growth hormone treatment shall be excluded until such time as the Member has been continuously
enrolled under this Agreement or any prior GHC Medical Coverage Agreement for twelve(12)consecutive
months without any lapse in coverage.
19. Pre-existing conditions are covered in the same manner as any other illness.
20. Skilled Nursing Facility care in a GHC-approved skilled nursing facility up to a maximum of thirty (30)
days per condition when full-time skilled nursing care is necessary in the opinion of the attending GHC
Provider.
When prescribed by a GHC Provider, such care may include board and room; general nursing care; drugs,
biologicals, supplies, and equipment ordinarily provided or arranged by a skilled nursing facility; and
short-term physical therapy,occupational therapy,and restorative speech therapy.
Excluded from coverage are personal comfort items such as telephone and television; and rest cures,
custodial, domiciliary or convalescent care.
C. CHEIVHCAL DEPENDENCY TREATMENT
0036900-003046 23
a
Subject to all terms and conditions of this Agreement, care is provided as set forth below at a GHC Facility,
GHC Designated Facility, or GHC-approved treatment facility, subject to the Benefit Period Allowance and
Lifetime Maximum Benefit as described below and as shown in the Copayments and Allowances Schedule.
1. Chemical Dependency Treatment Services.
a. All alcoholism and/or drug abuse treatment services must be: (1) provided at a facility as described
above and must be authorized in advance, except for acute chemical withdrawal as described in
Section X.C.2.b.; and (2) deemed Medically Necessary by GHC's ADAPT Director or his/her
designee. Chemical dependency treatment may include the following services received on an inpatient
or outpatient basis: diagnostic evaluation and education, organized individual and group counseling,
detoxification services,and prescription drugs and medicines.
b. Court-ordered treatment shall be provided only if determined to be Medically Necessary by GHC's
ADAPT Director or his/her designee.
2. Emergency Care.
a. Coverage for medical Emergencies incident to the abuse of alcohol and/or drugs is subject to the
Emergency care benefit as set forth in Section X.L.
b. Coverage for acute chemical withdrawal is provided without prior approval. If a Member is
hospitalized in a non-GHC Designated Facility, coverage is subject to payment of the Deductible
shown in the Copayments and Allowances Schedule, and notification of GHC by way of the GHC
Notification Line within twenty-four(24)hours following inpatient admission, or as soon thereafter as
medically possible. Furthermore, if a Member is hospitalized in a non-GHC Designated Facility, GHC
reserves the right to require transfer of the Member to a GHC Facility upon consultation with a GHC
Provider. If the Member refuses transfer to a GHC Facility, all further costs incurred during the
hospitalization are the responsibility of the Member.
For the purpose of this section, "acute chemical withdrawal"means withdrawal of alcohol and/or drugs
from a person for whom consequences of abstinence are so severe as to require medical/nursing
assistance in a hospital setting, and which is needed immediately to prevent serious impairment to the
Member's health.
3. Benefit Period and Benefit Period Allowance.
a. Benefit Period. For the purpose of this section, "Benefit Period" shall mean a twenty-four (24)
consecutive calendar month period during which the Member is eligible to receive covered chemical
dependency treatment services as set forth in this section. The first Benefit Period shall begin on the
first day the Member receives covered chemical dependency services under this or any other group
insurance, health care service contractor, health maintenance organization, self-insured plan or any
combination thereof, hereinafter referred to as "group plans," and shall continue for twenty-four (24)
consecutive calendar months, provided that coverage under this Agreement remains in force. All
subsequent Benefit Periods thereafter will begin on the first day Covered Services are received after
expiration of the previous twenty-four(24)month Benefit Period.
b. Benefit Period Allowance. The maximum allowance available for any Benefit Period shall be the
total of all chemical dependency benefits provided and payments made for chemical dependency
treatment under any group plan(s), not to exceed the Benefit Period Allowance shown in the
Copayments and Allowances Schedule during the Member's Benefit Period.
4. Lifetime Maximum Benefit.
0036900-CO3046 24
Chemical dependency services are not covered after the Member has reached his/her Lifetime Maximum
Benefit amount as shown in the Copayments and Allowances Schedule. All such benefits provided or
payments made by:
a. GHC under any GHC Group Medical Coverage Agreement,plus
b. all amounts paid on an. individual's behalf under any carrier or plan maintained by the Group,
including self-insured plans,shall be applied toward this Lifetime Maximum Benefit amount.
Any Deductibles or Copayments which may be bome by the Member under the terms of this Agreement shall
not be applied toward the Benefit Period Allowance or Lifetime Maximum Benefit.
In regard to this section, the Benefit Period(s), Benefit Period Allowance(s), and Lifetime Maximum Benefit
shall include only alcoholism treatment services received on or after January 1, 1987 and alcoholism and/or
drug abuse services received on or after January 1, 1988.
D. PLASTIC AND RECONSTRUCTIVE SERVICES are covered:
1. to correct a congenital disease or congenital anomaly as determined by a GHC Provider; or to correct a
Medical Condition following an injury or incidental to surgery covered by GHC which has produced a
major effect on the Member's appearance,provided:
• the Member has been continuously enrolled with GHC since the date of such injury or surgery;and
• when in the opinion of a GHC Provider, such services can reasonably be expected to correct the
condition.
In the case of a congenital condition which affects appearance,an anomaly will be considered to exist if the
Member's appearance resulting from such condition is not within the range of normal human variation.
Complications of noncovered surgical services are excluded.
2. for reconstructive surgery and associated procedures following a mastectomy provided Members are
medically suitable candidates,as determined by GHC's Medical Director, or his/her designee,regardless of
when the mastectomy was performed. Internal breast prostheses required incident to the surgery will be
provided.
A Member will be covered for all stages of one reconstructive breast reduction on the nondiseased breast to
make it equivalent in size with the diseased breast after definitive reconstructive surgery on the diseased
breast has been performed.
3. for women who have not undergone breast reconstruction,external breast prostheses following mastectomy
and post-mastectomy bras limited to one external breast prosthesis per diseased breast every two years,and
two post-mastectomy bras every six (6) months, up to four (4) in any twelve (12) consecutive month
period. Coverage for post-mastectomy bras is subject to the Coinsurance as set forth in the Copayments
and Allowances Schedule.
E. HOME HEALTH CARE SERVICES, as set forth in this section, shall be provided by GHC Home Health
Services or by a GHC-authorized home health agency when Referred in advance by a GHC Provider for
Members who meet the following criteria:
1. The Member is unable to leave home due to his or her health problem or illness (unwillingness to travel
and/or arrange for transportation does not constitute inability to leave the home);
2. the Member requires intermittent Skilled Home Health Care services,as described below;and
0036900-003046 25
y
3. a GHC Provider has determined that such services are Medically Necessary and are most appropriately
rendered in the Member's home.
Covered Services for home health care may include the following when prescribed by a GHC Provider and
when rendered pursuant to an approved home health care plan of treatment: nursing care, physical therapy,
occupational therapy, respiratory therapy, restorative speech therapy, and medical social worker and limited
home health aide services. Home health services are provided on an intermittent basis in the Member's home.
"Intermittent" means care that is to be rendered because of a medically predictable recurring need for Skilled
Home Health Care services.
Excluded are: custodial care and maintenance care, private duty or continuous nursing care in the Member's
home, housekeeping or meal services, care in any nursing home or convalescent facility, any care provided by
or for a member of the patient's family, and any other services rendered in the home which are not specifically
listed as covered under this Agreement.
F. HOSPICE
It is understood and agreed that the following fully sets forth the eligibility requirements and Covered Services
for a Member who elects to receive services through GHC's Hospice Program. Members who elect to receive
GHC Hospice Services do so in lieu of curative treatment for their terminal illness for the period that
they are in the GHC Hospice Program.
Hospice Program
1. Eligibility.Hospice Services, as set forth below, shall be provided to Members for as long as the following
criteria are met:
a. A GHC Provider has determined that the Member's illness is terminal and life expectancy is six (6)
months or less;
b. the Member has chosen a palliative treatment focus (emphasizing comfort and supportive services
rather than treatment aimed at curing the Member's terminal illness);
c. the Member has elected in writing to receive hospice care through GHC's Hospice Program;
d. the Member has available a primary care person who will be responsible for the Member's home care;
and
e. a GHC Provider and GHC's Hospice Director determine that the Member's illness can be appropriately
managed in the home.
2. Hospice care shall be defined as a coordinated program of palliative and supportive care for dying persons
by an interdisciplinary team of professionals and volunteers centering primarily in the Member's home.
3. Covered Services. Hospice services may include the following as prescribed by a GHC Provider and
rendered pursuant to an approved hospice plan of treatment:
a. Home Services
i. Intermittent care by a hospice interdisciplinary team which may include services by a physician,
nurse, medical social worker, physical therapist, speech therapist, occupational therapist,
respiratory therapist, and limited services by a Home Health Aide under the supervision of a
Registered Nurse.
ii. One period of continuous care service per Member in the Member's home when prescribed by a
GHC Provider, as set forth in this paragraph. A continuous care period is defined as "skilled
nursing care provided in the home during a period of crisis in order to maintain the terminally ill
patient at home." Continuous care may be provided for pain or symptom management by a
Registered Nurse, Licensed Practical Nurse, or Home Health Aide under the supervision of a
0036900-CO3046 26
A I i '
Registered Nurse. Continuous care is provided for four(4)or more hours per day for a period not
to exceed five (5) days, or a total of seventy-two (72) hours, whichever first occurs. Continuous
care is covered only when a GHC Provider determines that the Member would otherwise require
hospitalization in an acute care facility.
b. Inpatient Hospice Services shall be provided in a facility designated by GHC's Hospice Program
when Medically Necessary and authorized in advance by a GHC Provider and GHC's Hospice
Program. Inpatient hospice services shall be provided according to the provisions set forth in Section
X.of this Agreement.
4. Hospice Exclusions: All services not specifically listed as covered in this section including:
a. Financial or legal counseling services.
b. Housekeeping or meal services.
c. Custodial or maintenance care in the home or on an inpatient basis.
d. Services not specifically listed as covered by this Medical Coverage Agreement.
e. Any services provided by members of the patient's family.
f. All other exclusions listed in Section XI., Exclusions and Limitations of this Medical Coverage
Agreement,apply.
G. REHABILITATION SERVICES are covered as set forth in this section, limited to the following: physical
therapy; occupational therapy; and speech therapy to restore function following illness, injury, or surgery.
Services are subject to all terms,conditions,and limitations of this Agreement,including the following:
1. All services must be provided at GHC or a GHC-approved rehabilitation facility and must be prescribed
and provided by a GHC-approved rehabilitation team that may include medical, nursing, physical therapy,
occupational therapy and speech therapy providers.
2. The Member must be referred for rehabilitation services in advance by a GHC Provider.
3. Services are limited to those necessary to restore or improve functional abilities when physical,
sensori-perceptual and/or communication impairment exists due to injury or illness. Such services are
provided only when GHC's Medical Director, or his/her designee, determines that significant, measurable
improvement to the Member's condition can be expected within a sixty(60)day period as a consequence of
intervention by covered therapy services described in paragraph one(1)above.
4. Coverage for inpatient and outpatient services is limited to the allowance set forth in the Copayments and
Allowances Schedule.
Services excluded under this benefit include the following: specialty rehabilitation programs not provided by
GHC; long-term rehabilitation programs; physical therapy, occupational therapy, and speech therapy services
when such services are available (whether application is made or not) through governmental programs;
programs offered by public school districts; therapy for degenerative or static conditions when the expected
outcome is primarily to maintain the Member's level of functioning (except for neurodevelopmental therapies);
implementation of home maintenance programs; programs for treatment of learning problems; any other
treatment not considered Medically Necessary by GHC;any services not specifically included as covered in this
Section;and any services that are excluded under Section XI.
Neurodevelopmental Therapies for Children Age Six (6) and Under. When determined to be Medically
Necessary by GHC's Medical Director, or his/her designee, physical therapy, occupational therapy, and speech
therapy services for the restoration and improvement of function for neurodevelopmentally disabled children
age six (6) and under shall be covered. Coverage includes maintenance of a covered Member in cases where
significant deterioration in the Member's condition would result without the services. Coverage for inpatient
and outpatient services is limited to the allowance set forth in the Copayments and Allowances Schedule.
0036900-003046 27
Services excluded under this benefit include: specialty rehabilitation programs; long-term rehabilitation
programs;physical therapy,occupational therapy,and speech therapy services when such services are available
(whether application is made or not) through governmental programs; programs offered by public school
districts; except as set forth above, therapy for degenerative or static conditions when the expected outcome is
primarily to maintain the Member's level of functioning; implementation of home maintenance programs; any
treatment not considered Medically Necessary;any services not specifically included as covered in this Section;
and any services that are excluded under Section Xl.
H. APPLIANCES,DEVICES AND SUPPLIES
1. Orthopedic Appliances. When Medically Necessary, orthopedic appliances, which are attached to an
impaired body segment for the purpose of protecting the segment or assisting in restoration or
improvement of its function, are covered. Medically Necessary repair, adjustment or replacement of an
orthopedic appliance is covered when authorized in advance by a GHC Provider. Covered Services are
subject to the Coinsurance set forth in the Copayments and Allowances Schedule. Excluded are arch
supports; orthopedic shoes that are not attached to an appliance; or any orthopedic appliances that are not
listed as covered in GHC's Orthopedic Appliance Formulary.
2. Ostomy Supplies. Ostomy supplies necessary for the removal of bodily secretions or waste are covered.
3. Oxygen and Oxygen Equipment. When medical criteria as established by GHC are met, and upon
Referral,oxygen and oxygen equipment for home use is covered.
4. Nasal CPAP Device. When Medically Necessary, the purchase of a nasal CPAP device, and the initial
purchase of associated supplies, is covered. The initial one-month rental of the device prior to purchase,
which is required to establish compliance, is also covered. Medically Necessary repair or replacement of a
nasal CPAP device is covered when authorized in advance by a GHC Provider. Covered Services are
subject to the Coinsurance as set forth in the Copayments and Allowances Schedule. Coverage for
replacement of supplies is excluded.
Replacement or repair of appliances, devices and supplies that are due to loss, breakage from willful damage,
neglect or wrongful use,or due to personal preference are excluded.
I. TOBACCO CESSATION. When provided through GHC, services related to tobacco cessation are covered,
limited to:
1. participation in one individual and/or group program per calendar year;
2. educational materials;and
3. one course of nicotine replacement therapy per calendar year, provided the Member is actively
participating in the Group Health Free and Clear Program.
Covered Services are subject to the Allowances set forth in the Copayments and Allowances Schedule.
J. LEGEND (PRESCRIPTION) DRUGS AND MEDICINES FOR OUTPATIENT USE as prescribed by a
GHC Provider for conditions covered by this Agreement, including off-label use of FDA-approved drugs
(provided that such use is documented to be effective in one of the standard reference compendia;a majority of
well-designed clinical trials published in peer-reviewed medical literature document improved efficacy or
safety of the agent over standard therapies, or over placebo if no standard therapies exist; or by the federal
secretary of Health and Human Services).
All drugs, supplies, medicines, and devices must be obtained at a GHC pharmacy. The prescription drug
copayment as set forth in the Copayments and Allowances Schedule applies to each 30-day supply.
Copayments for single and multiple 30-day supplies of a given prescription are payable at the time of delivery.
0036900-CO3046 28
I I
"Standard reference compendia" means the American Hospital Formulary Service-Drug Information; the
American Medical Drug Evaluation; the United States Pharmacopoeia-Drug Information, or other authoritative
compendia as identified from time to time by the federal secretary of Health and Human Services. "Peer-
reviewed medical literature" means scientific studies printed in healthcare journals or other publications in
which original manuscripts are published only after having been critically reviewed for scientific accuracy,
validity, and reliability by unbiased independent experts. Peer-reviewed medical literature does not include in-
house publications of pharmaceutical manufacturing companies.
Excluded are: over-the-counter drugs, medicines, and devices not requiring a prescription under state law or
regulations; dietary formulas and special diets, except as set forth in Section X.B.; contraceptive drugs and
devices and their fitting unless otherwise noted in this section; medicines and injections for anticipated illness
while traveling; and any other drugs, medicines and injections not listed as covered in the GHC Drug
Formulary(approved drug list).
The Member will be charged for mailing drugs, medicines or devices, and replacing lost or stolen drugs,
medicines or devices.
K. MENTAL HEALTH CARE SERVICES
1. Outpatient Services. Mental health care services are provided on an outpatient basis at GHC in individual,
family, couple, and group therapy formats. Services provided place priority on restoring social and
occupational functioning,such as evaluation, crisis intervention,managed psychotherapy, intermittent care,
psychological testing, and consultation services. The length and type of the treatment program and the
frequency and modality of visits shall be determined by the Director of GHC's Mental Health Service, or
his/her designee.
Coverage for each Member is provided according to the Outpatient Mental Health Care Allowance set
forth in the Copayments and Allowances Schedule. Psychiatric medical services including medical
management and medications are covered as set forth in Sections X.B. and X.J. All individual, family,
couple, and group visits of one and one-half (1-1/2) hours or less are regarded as one full visit per
individual. A missed appointment will be considered a "visit" unless GHC's Mental Health Service is
notified at least twenty-four(24)hours in advance of a scheduled session.
2. Inpatient Services. Usual, Customary, and Reasonable charges for services described in this section,
including psychiatric Emergencies resulting in inpatient services, shall be covered to the maximum benefit
as set forth in the Copayments and Allowances Schedule. This benefit shall include coverage for acute
treatment and stabilization of psychiatric emergencies in GHC-approved hospitals. When medically
indicated, outpatient electro-convulsive therapy (ECT) is covered in lieu of inpatient services. Payment of
bills incurred at non-GHC facilities shall exclude any charges that would otherwise be excluded for
hospitalization within a GHC Facility.
When authorized in advance by the Director of GHC's Mental Health Service, or his/her designee, partial
hospitalization and outpatient electro-convulsive therapy programs are covered subject to the maximum
inpatient benefit limit described in the Copayments and Allowances Schedule. Every two (2) partial
hospitalization days or two (2) electro-convulsive therapy treatments are equivalent to one inpatient
hospital day. The total maximum annual benefit under this section shall not exceed the number of inpatient
days described in the Copayments and Allowances Schedule.
Subject to the maximum Inpatient Mental Health Care Allowance as set forth in the Copayments and
Allowances Schedule, services provided under involuntary commitment statutes shall be covered at
facilities approved by GHC. Services for any court-ordered treatment program beyond the seventy-two
(72)hours shall be covered only if determined to be Medically Necessary by the Director of GHC's Mental
Health Service,or his/her designee.
0036900-CO3046 29
Coverage for voluntary/involuntary Emergency inpatient psychiatric services is subject to the Emergency
care benefit as set forth in Section X.L-., including the twenty-four (24) hour notification and transfer
provisions. All other voluntary psychiatric care must be authorized in advance by the Director of GHC's
Mental Health Service,or his/her designee;the facility must be approved by the Cooperative. All voluntary
care not authorized in advance by GHC's Mental Health Service is not covered.
3. Exclusions and Limitations for Outpatient and Inpatient Mental Health Treatment Services. Covered
Services are limited to those considered to be Medically Necessary by the Director of GHC's Mental Health
Service, or his/her designee. Covered Services are limited to those provided for covered conditions for
which,in the opinion of the Director of GHC's Mental Health Service,or his/her designee, improvement or
stabilization can be expected.
Partial hospitalization programs and electro-convulsive therapy are covered only under subsection K.2.
(Inpatient Services).
Excluded are all forms of extensive psychotherapy; day treatment; custodial care; treatment of sexual
disorders; specialty programs for mental health therapy which are not provided by GHC; court-ordered
treatment which is not specifically described above; or any other services not specifically listed as covered
in this section.All other provisions,exclusions and limitations under this Agreement also apply.
L. EMERGENCY/URGENT CARE
Emergency Care(See Section I. for a definition of Emergency):
1. At a GHC Facility or GHC Designated Facility. GHC will cover Emergency care for all Covered
Services as set forth in the Copayments and Allowances Schedule.
2. At a Non-GHC Designated Facility. Usual, Customary, and Reasonable charges for Emergency care for
Covered Services are covered subject to:
a. payment of the Emergency Care Deductible shown in the Copayments and Allowances Schedule;
and
b. notification of GHC by way of the GHC Notification Line within twenty-four (24) hours
following inpatient admission,or as soon thereafter as medically possible.
Outpatient medications prescribed by a non-GHC Provider are excluded.
3. Waiver of Emergency Care Copayment/Deductible.
a. Waiver for Multiple Injury Accident. If two or more members of the Family Unit require
Emergency care as a result of the same accident, only one Emergency Care Copayment/Deductible
will apply.
b. Emergencies Resulting in an Inpatient Admission. If the Member is admitted to a GHC or GHC
Designated Facility directly from the emergency room, the Emergency Care Copayment is waived.
However,the first day's Hospital Care Copayment,if any,will be charged.
4. Transfer and Follow-up Care.If a Member is hospitalized in a non-GHC Facility,GHC reserves the right
to require transfer of the Member to a GHC Facility, upon consultation with a GHC Provider. If the
Member refuses to transfer to a GHC Facility, all further costs incurred during the hospitalization are the
responsibility of the Member.
Follow-up care which is a direct result of the Emergency must be obtained at GHC,unless a GHC Provider
has authorized such follow-up care in advance.
Urgent Care(See Section I.for a definition of Urgent Condition):
0036900-CO3046 30
rA
5. Urgent Care. Care for Urgent Conditions received inside the GHC Service Area is covered only at GHC
medical centers, GHC urgent care clinics, or network providers' offices. Urgent care received at any
hospital emergency department is not covered unless authorized in advance by a GHC Provider.
M. AMBULANCE SERVICES are covered as set forth below, provided that the service is authorized in advance
by a GHC Provider or meets the definition of an Emergency. (See Section I.)
1. Emergency Transport to a GHC Facility,GHC Designated Facility,or non-GHC Designated Facility.
Each Emergency is covered as set forth in the Copayments and Allowances Schedule.
2. GHC-Initiated Transfers. GHC-initiated non-emergent transfers to or from a GHC Facility is covered.
Section K. Exclusions and Limitations
A. EXCLUSIONS
1. Blood for transfusions.
2. Unless otherwise noted as covered in Sections X.B., X.D., X.H., and X.J., corrective appliances and
artificial aids including: eyeglasses; contact lenses, including services related to their fitting; prosthetic
devices;diabetic supplies including insulin pumps;hearing aids and examinations in connection therewith;
take-home dressings and supplies following hospitalization; or any other supplies, dressings, appliances,
devices or services which are not for the specific treatment of disease or injury, or not specifically listed as
covered in Section X.
3. Cosmetic services, including treatment for complications of cosmetic surgery, except as provided in
Section X.D.
4. Convalescent or custodial care, including skilled nursing facility care,unless otherwise noted in Section X.
5. Durable medical equipment such as hospital beds,wheelchairs, and walk-aids, except while in the hospital
or as set forth in Section X.B.or X.H.
6. Services rendered as a result of work-incurred injuries, illnesses or conditions.
7. Those parts of an examination and associated reports and immunizations required for employment(unless
otherwise noted in Section X.B.), immigration, license, or insurance purposes that are not deemed
Medically Necessary by GHC for early detection of disease.
8. Procedures,services,and supplies related to sex transformations.
9. Regardless of origin or cause, diagnostic testing and medical treatment of sterility, infertility, and sexual
dysfunction,unless otherwise noted in Section X.B.
10. Services of practitioners whose licensing category is not represented by GHC Medical Personnel, unless
otherwise noted in Section X.B.
11. Services directly related to obesity,except for nutritional counseling provided by GHC staff.
12. Any services to the extent benefits are available to the Member under the terms of any vehicle,
homeowner's, property or other insurance policy, except for individual or group health insurance,whether
the Member asserts a claim or not, pursuant to: (1) medical coverage, medical "no fault" coverage,
Personal Injury Protection coverage, or similar medical coverage contained in said policy; and/or (2)
uninsured motorist or underinsured motorist coverage contained in said policy. For the purpose of this
exclusion, benefits shall be deemed to be "available" to the Member if the Member is a named insured,
0036900-003046 31
comes within the policy definition of insured, is a third-party donee beneficiary under the terms of the
policy,or otherwise has the right to receive benefits under the policy.
The Member and his or her agents must cooperate fully with GHC in its efforts to enforce this exclusion.
This cooperation shall include supplying GHC with information about any available insurance coverage.
The Member and his or her agents shall permit GHC at GHC's option, to associate with the Member or to
intervene in any action filed against any party related to the injury. The Member and his or her agents shall
do nothing to prejudice GHC's right to enforce this exclusion.
GHC shall not enforce this exclusion as to coverage available under uninsured motorist or underinsured
motorist coverage until the Member has been made whole, unless the Member fails to cooperate fully with
GHC as described above. In the event the Member fails to cooperate fully, the Member shall be
responsible for reimbursing GHC for such medical expenses.
GHC shall not pay any attorneys' fees or collection costs to attorneys representing the injured person where
it has retained its own legal counsel or acts on its own behalf to represent its interests and unless there is a
written fee agreement signed by GHC prior to any collection efforts.
13. Services or supplies not specifically listed as covered in the Schedule of Benefits.
14. Voluntary (not medically indicated and nontherapeutic) termination of pregnancy, unless otherwise noted
in Section X.B.
15. The cost of services and supplies resulting from a Member's loss of or willful damage to covered
appliances, devices, supplies, and materials provided by GHC for the treatment of disease, injury, or
illness.
16. Routine circumcision, including newborn circumcision,which is not considered Medically Necessary.
17. Orthoptic(eye training)therapy.
18. Specialty treatment programs that are not provided by GHC including weight reduction, rehabilitation, and
"behavior modification programs."
19. Services required as a result of war,whether declared or not declared.
20. Nontherapeutic sterilization (unless otherwise noted in Section X.B.) and procedures and services to
reverse a therapeutic or nontherapeutic sterilization.
21. Dental care, surgery, services, and appliances, including: treatment of accidental injury to natural teeth,
reconstructive surgery to the jaw incident to denture wear, periodontal surgery, and any other dental
services not specifically listed as covered in Section X. The Cooperative's Medical Director, or his/her
designee, will determine whether the care or treatment required is within the category of dental care or
service.
If a GHC Provider determines that an unrelated medical condition requires that a Member be hospitalized
for a dental procedure which is normally done in a dentist's office, GHC will cover associated hospital and
anesthesia costs at a GHC or GHC Designated Facility. GHC will not cover the dentist's or oral surgeon's
fees.
22. Drugs, medicines, and injections, except as set forth in Section X.J. Any exclusion of drugs, medicines,
and injections, including those not listed as covered in the GHC Drug Formulary (approved drug list), will
also exclude their administration.
0036900-003046 32
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23. Investigational or experimental treatment, including medical and surgical services, drugs, devices and
biological products, until formally approved by GHC for medical coverage. GHC's determination shall be
made in accordance with criteria for determining investigational status as established by GHC as generally
outlined below. Specific indications and methods of use shall be considered in GHC's review of evidence
provided by evaluations of national medical associations, consensus panels, and/or other technological
evaluations, including the scientific quality of such supporting evidence and rationale. Any investigational
or experimental treatment, including medical and surgical services, drugs, devices and biological products
not meeting GHC's determination pursuant to its criteria as outlined below are excluded.
a. Investigational or experimental drugs, devices and biological products until clinical trials have been
completed and approved by the U.S. Food and Drug Administration (FDA) as being safe and
efficacious for general marketing and permission has been granted by the FDA for commercial
distribution;
b. there is sufficient scientific evidence in published medical literature to permit conclusions concerning
the effect of the treatment on health outcomes;
c. there is conclusive evidence in published peer-reviewed medical literature that the treatment will result
in a demonstrable benefit for the particular injury, disease or condition in question, and that the
benefits are not outweighed by risks;
d. evidence that the new treatment is as safe and effective as all existing conventional treatment
alternatives;and
e. that treatment will satisfy(c)and(d)outside of a research setting.
Appeals regarding denial of coverage must be submitted to your regional Member Services Department, or
to GHC's Contracts and Coverage Department at 1730 Minor Avenue, Suite 1910, Seattle, WA 98101.
GHC will respond in writing within twenty(20)working days of the receipt of a fully documented request.
24. Mental health care, except as specifically provided in Section X.K.
25. See coverage for pre-existing conditions under Section X.B.
B. LIMITATIONS
1. Conditions and Extent of Coverage. ALL SERVICES AND BENEFITS UNDER THIS
AGREEMENT MUST BE PROVIDED BY GHC MEDICAL PERSONNEL AT A GHC FACILITY
UNLESS:
a. The Member has received a Referral from a GHC physician.
b. The Member has received Emergency services according to Section X.L.
2. Recommended Treatment. The Cooperative's Medical Director or his/her designee will determine the
necessity,nature,and extent of treatment to be provided in each individual case and the judgment,made in
good faith,will be final.
Members have the right to participate in decisions regarding their health care. A Member may refuse
recommended treatment or diagnostic plan to the extent permitted by law. In such case,GHC shall have no
further obligation to provide the care in question.Members who seek other sources of care because of such
a disagreement do so with the full understanding that GHC has no obligation for the cost,or liability for the
outcome,of such care.
3. Major Disaster or Epidemic. In the event of a major disaster or epidemic, GHC Medical Personnel will
provide Covered Services according to their best judgment,within the limitations of available facilities and
personnel. The Cooperative has no liability for delay or failure to provide or arrange Covered Services to
the extent facilities or personnel are unavailable due to a major disaster or epidemic.
0036900-003046 33
4. Unusual Circumstances. If the provision of Covered Services is delayed or rendered impossible due to
unusual circumstances such as complete or partial destruction of facilities, military action, civil disorder,
labor disputes, or similar causes, GHC shall provide or arrange for services that, in the reasonable opinion
of GHC's Medical Director, or his/her designee, are emergent or urgently needed. In regard to nonurgent
and routine services, GHC shall make a good faith effort to provide services through its then-available
facilities and personnel. GHC shall have the option to defer or reschedule services that are not urgent or
routine while its facilities and services are so affected.In no case shall the Cooperative have any liability or
obligation on account of delay or failure to provide or arrange such services.
Section XII. Claims
Members must submit claims for reimbursement of Covered Services to GHC within sixty (60) days of the service
date, or as soon thereafter as is reasonably possible. In no event, except in the absence of legal capacity, shall a
claim be accepted later than one (1) year from the service date. This section applies to Covered Services received
under Section X.L. and X.M.,or services for which the Member has received a Referral from a GHC physician.
0036900-CO3046 34
Medicare
Endorsement
For Persons Covered by Parts A and B of Medicare
THE PROVISIONS OF THE GROUP MEDICAL COVERAGE AGREEMENT SHALL REMAIN IN EFFECT
EXCEPT AS MODIFIED BY THE ADDITION OF THE PROVISIONS, EXCLUSIONS, AND LIMITATIONS
CONTAINED IN THIS MEDICARE ENDORSEMENT. IN NO EVENT SHALL THE BENEFITS UNDER THIS
ENDORSEMENT DUPLICATE THE BENEFITS UNDER THE GROUP MEDICAL COVERAGE
AGREEMENT. THE HIGHER LEVEL OF BENEFIT WILL APPLY. COVERAGE UNDER THIS GROUP
MEDICAL COVERAGE AGREEMENT IS INTEGRATED WITH THE MEDICAL AND HOSPITAL BENEFITS
ESTABLISHED BY TITLE 18 OF THE SOCIAL SECURITY ACT AS AMENDED, AND REFERRED TO AS
"MEDICARE." THE BENEFITS AND EXCLUSIONS DESCRIBED IN THIS ENDORSEMENT APPLY ONLY
TO MEMBERS WHO ARE COVERED UNDER BOTH PART A AND PART B OF MEDICARE.
Except as defined by Federal Regulations,all Members entitled to,or eligible to purchase Medicare must transfer to
the GHC Medicare Plan upon such entitlement or eligibility. A condition of enrollment under the GHC Medicare
Plan requires that a Member be continuously enrolled for the hospital (Part A) and medical (Part B) benefits
available from the Social Security Administration, and sign any papers that may be required by GHC or Medicare.
For additional information,the Member may refer to"The Medicare Handbook,"which can be obtained from your
local Social Security office.
NEITHER GHC NOR MEDICARE MAY PAY FOR SERVICES PROVIDED AT NON-GHC FACILITIES
UNLESS THE MEMBER HAS BEEN REFERRED BY GHC OR THE MEMBER HAS RECEIVED
EMERGENCY OR URGENTLY NEEDED SERVICES ACCORDING TO SECTION V.D. OF THIS MEDICARE
ENDORSEMENT.
Those enrolled under GHC's Medicare plan, as set forth in this Endorsement, all Copayments are waived except the
prescription drug Copayment.
This Endorsement does not constitute a Medicare supplemental contract.
Section I. DEFINITIONS
CUSTODIAL CARE: Care that is primarily for the purpose of meeting personal needs and could be provided by
persons without professional skills or training. Custodial Care includes help in walking, bathing, dressing, eating,
and taking medicine.
EMERGENCY SERVICES(Medicare defined): Inpatient or outpatient services that are rendered immediately by
an appropriate non-GHC provider because of an injury or sudden illness, and for which the time required to reach
GHC or a GHC Designated Facility would risk permanent damage to the Member's health.
HEALTH CARE FINANCING ADMINISTRATION (HCFA): The federal agency that administers the
Medicare program.
MEDICARE: The federal health insurance program for the aged and disabled.
MEDICARE GUIDELINES: Coverage rules and policies established by the Health Care Financing Administration
(HCFA),a federal agency.
MEDICARE HANDBOOK (Titled "The Medicare Handbook"): A pamphlet published by the Health Care
Financing Administration, which provides an easy-to-read explanation of Medicare benefits, and can be obtained
from your local Social Security office,or your Washington State Part B carrier's office.
0036900-CO3046 35
PERMANENT MOVE: An uninterrupted absence of more than ninety(90)days from GHC's Service Area.
REFERRAL: A written temporary referral agreement authorized in advance by a GHC physician and formally
approved in advance through GHC's Medicare medical coverage approval process, that entitles a Member to receive
Covered Services from a specified non-GHC health care provider. Entitlement to such services shall not exceed the
limits of the Referral and is subject to all terms and conditions of the Referral and this Agreement.
SERVICE AREA: The geographic area comprised of Island, King, Kitsap, Lewis, Pierce, San Juan, Skagit,
Snohomish, Thurston,and Whatcom Counties,and any other areas designated by GHC and approved by the Health
Care Financing Administration. (See Service Area Map.)
SKILLED NURSING FACILITY: A Medicare certified and licensed facility, as defined in Medicare regulations,
primarily engaged in providing skilled nursing care or rehabilitation and related services for which Medicare pays
benefits or qualifies to receive such approval.
URGENTLY NEEDED SERVICES (Medicare defined): Services needed in order to prevent a serious
deterioration of the Member's health due to an unforeseen illness or injury while temporarily absent from GHC's
Service Area,and which cannot be delayed until the Member returns to the Service Area.
USUAL,CUSTOMARY,AND REASONABLE: A term used to define the level of benefits which are payable by
GHC when expenses are incurred from a non-GHC physician or provider. Expenses are considered Usual,
Customary and Reasonable if (1) the charges are consistent with those normally charged by the provider or
organization for the same services or supplies; and(2)the charges are within the general range of charges made by
other providers in the same geographical area for the same services or supplies.
Section II. TERMINATION
Enrollment under the GHC Medicare Plan for a specific Member, may be terminated in the circumstances set forth
below.
Until such time as a Member's termination of enrollment is effective, neither GHC nor Medicare shall pay for
services provided at non-GHC Facilities unless the Member has been Referred by GHC or the Member has received
Emergency or Urgently Needed Services according to Section V.D. of this Medicare Endorsement.
A. Termination of Specific Members.
1. Loss of Medicare Part B Entitlement. If the Health Care Financing Administration(HCFA)advises GHC
that a Member's entitlement to Medicare coverage no longer exists, or the Member voluntarily terminates
Medicare enrollment, enrollment under the GHC Medicare Plan shall terminate the first of the month as
specified by HCFA.
2. Change of Permanent Residence Outside GHC's Service Area. If a Member makes a Permanent Move
as set forth in Section I. of this Medicare Endorsement, enrollment shall terminate the first day of the
month following the month in which GHC receives notification of such move.
3. For Cause.Enrollment may be terminated upon written notice for:
a. Knowingly providing fraudulent information to obtain coverage. In such event, GHC may rescind or
cancel enrollment upon ten(10)working days'written notice.
b. Permitting the use of a GHC identification card by another person.
c. Failure to comply with the rules and regulations of GHC including disruptive, unruly, abusive or
uncooperative conduct.
Such termination shall be subject to review and approval by HCFA.
0036900-CO3046 36
Al _ , r
B. Persons Hospitalized on the Date of Termination. A Member who is a registered bed patient receiving
Covered Services in a GHC Facility or GHC Designated Facility on the date of termination shall continue
to receive covered inpatient services, until discharge from the facility. This continued coverage will also
apply to a Member hospitalized in a Medicare-certified non-GHC Designated Facility as a result of
Emergency or Urgently Needed Services or Referral as set forth in Section VI.B. of this Medicare
Endorsement.
C. Services Provided After Termination. Any services provided by GHC after the effective date of
termination (except those services covered under Section II.B. of this Medicare Endorsement) shall be
charged according to the Directory of Services. The Subscriber shall be liable for payment of all such
charges for services provided to the Subscriber and all Family Dependents.
Section III. SUBROGATION
"Injured person" under this section means a Member covered by this Agreement who sustains compensable injury.
"GHC's medical expense"means the expense incurred by GHC for the care or treatment of the injury sustained.
If the injured person was injured by an act or omission of a third parry giving rise to a claim of legal liability against
the third party, GHC shall have the right to recover its cost of providing benefits to the injured person(subrogation)
from the third party as set forth in this Agreement and in compliance with Medicare regulations and guidelines.
GHC shall be subrogated to and may enforce all rights of the injured person to the extent of its medical expense.
After Medicare laws and regulations mandating recovery of Medicare payments have been satisfied, the
Cooperative's right of subrogation shall be limited to the excess of the amount required to fully compensate the
injured person for the loss sustained.Full compensation shall be measured on an objective, case-by-case basis,but is
subject to a presumption that a settlement which does not exhaust the third parry's reachable assets is full
compensation to the injured person.
The injured person and his or her agents must cooperate fully with GHC in its efforts to collect GHC's medical
expenses. This cooperation shall include, but is not limited to, supplying GHC with information about any
defendants and/or insurers related to the injured person's claim.The injured person and his or her agents shall permit
GHC, at GHC's option,to associate with the injured party or to intervene in any action filed against any third party.
The injured person and his or her agents shall do nothing to prejudice GHC's subrogation rights. The injured person
shall not settle a claim without protecting GHC's interest.
GHC shall not pay any attorney's fees or collection costs to attorneys representing the injured person where it has
retained its own legal counsel or acts on its own behalf to represent its interests and unless there is a written fee
agreement signed by GHC prior to any collection efforts.When reasonable collection costs have been incurred,with
GHC's prior written agreement, to recover GHC's medical expenses, there shall be an equitable apportionment of
such collection costs between GHC and the injured person subject to a maximum responsibility of GHC equal to
one-third of the amount recovered on behalf of GHC.
This provision does not apply to occupationally incurred disease,sickness,and/or injury.
Section IVGRIEVANCE PROCEDURES
A. GHC Member Services Program.
The Member Services Program is designed to help a Member resolve formal complaints and concerns about
medical and business service. GHC will record, resew and respond in a timely manner to a Member's
concern. A concern should be registered initially at th. Member's area medical center. If not satisfied, the
Member should then contact the regional Member Services Department, which will arrange for review by
appropriate medical staff,management and/or GHC consumers.
B. Reconsideration of Claims.
0036900-003046 37
` , 9
If GHC denies a request for payment of a claim, or declines to provide services which the Member believes should
be provided, the Member may file a request for reconsideration with GHC or a Social Security Administration
office. The request must be filed in writing within sixty (60) days of GHC's written notice of denial unless an
extension is specifically approved. If GHC does not overturn the denial in full, it will be referred by GHC to the
Health Care Financing Administration for reconsideration.
Section V. SCHEDULE OF BENEFITS
All benefits and services listed in this Schedule of Benefits:
• are subject to all provisions of this Agreement and Medicare Endorsement;
• must be approved in advance by GHC except for Emergency and Urgently Needed Services as set forth in
Section V.D.of this Medicare Endorsement;and
• must meet Medicare guidelines and limitations unless otherwise specified.
The booklet, "The Medicare Handbook" provides additional information about Medicare benefits, and can be
obtained from your local Social Security office,or your Washington State Part B carrier's office.
A. Skilled Nursing Facility. Upon Referral and following a Medicare-certified three (3) day hospital stay, GHC
will cover up to one hundred (100) days of care in a Skilled Nursing Facility, in accordance with Medicare
Guidelines,when Medically Necessary,as determined by GHC's Medical Director,or his/her designee.
B. Hospice.
Members with Part A and Part B of Medicare who elect to receive Medicare-covered hospice services may
select any Medicare-certified hospice program. Members who elect to receive services from the GHC Hospice
Program are entitled to hospice services as provided under the Medicare Hospice Program. Members who elect
to receive hospice services do so in lieu of curative treatment for their terminal illness for the period that
they are in the hospice program. To receive hospice services,the Member is required to sign the Hospice
Election Form.
Covered Services. In addition to the hospice services provided under the Group Medical Coverage Agreement,
the following hospice services shall be provided:
1. Home Services
Continuous care services per Member in the Member's home when prescribed by a GHC physician, as set
forth in this paragraph. Continuous care is defined as "skilled nursing care provided in the home during a
period of crisis in order to maintain the terminally ill patient at home." Continuous care may be provided
for pain or symptom management by a Registered Nurse, Licensed Practical Nurse, or Home Health Aide
under the supervision of a Registered Nurse. Continuous care may be provided up to twenty-four (24)
hours per day during periods of crisis. Continuous care is covered only when a GHC physician determines
that the Member otherwise would require hospitalization in an acute care facility.
2. Inpatient Hospice Services for short-term care shall be provided through a Medicare-certified Hospice
Program when Medically Necessary, and authorized in advance by a GHC physician. Respite care is
covered for a maximum of five (5) consecutive days per occurrence in order to continue care for the
Member in the temporary absence of the Member's primary care-giver(s).
3. Other hospice services may include the following:
a. drugs and biologicals that are used primarily for the relief of pain and symptom management;
b. medical appliances and supplies primarily for the relief of pain and symptom management;
c. counseling services for the Member and his/her primary care-giver(s);and
0036900-CO3046 38
d. bereavement counseling services for the family.
C. Mental Health Care,Alcoholism and Drug Abuse Treatment Services.
1. Outpatient mental health, alcoholism and substance abuse treatment services are covered for each
Member in accordance with Medicare Guidelines.
2. Inpatient mental health care services are covered in full up to a 190-day lifetime benefit when such
services are provided in a Medicare-certified mental health facility.
Inpatient alcoholism and drug abuse treatment services are covered in full when such services are
provided in a hospital-based treatment center.
3. Coverage for Medical Emergencies incident to alcoholism and drug abuse or for acute alcoholism or drug
abuse, including acute detoxification, is provided as set forth in Section V.D. of this Medicare
Endorsement.
D. Emergency/Urgently Needed Services. When an Emergency meets the Medicare definition for Emergency or
Urgently Needed Services as defined in Section I.of this Medicare Endorsement,services are covered.
DI. Out Of The Service Area Non-Emergent and/or Non-Urgently Needed Care. Non-Emergent and/or non-
urgently needed care will be covered outside GHC's defined Service Area, up to a maximum of$2,000.00
(GHC's Service Area is defined in Section 1. of this Agreement). Coverage under this benefit does NOT
include coverage of prescription drugs.
Services, as noted in this section, are available to Members traveling outside GHC's defined Service Area,
except when traveling primarily for the purpose of seeking medical care.
The services received under this benefit are subject to all limitations set forth in this Agreement.
All Medicare non-covered expenses, including hospital inpatient deductibles and inpatient and outpatient
Coinsurances, are the responsibility of the Member.
E. Medicare Ambulance Benefit. Medically Necessary ambulance transportation to or from a hospital or Skilled
Nursing Facility is covered in full only if transportation by any other vehicle could endanger the patient's health
and the ambulance,equipment, and personnel meet Medicare requirements.
F. Medical and Surgical Care. The following medical and surgical services are covered when prescribed by
GHC Medical Personnel,Medicare requirements are met:
1. Eye examinations and treatment for eye pathology.
Evaluations and surgical procedures to correct refractions which are not related to eye pathology are not
covered. Complications related to such surgery are also excluded.
2. One pair of eyeglasses or contact lenses, including examination and fitting, following cataract surgery, are
covered subject to UCR charges when required to replace the natural lens of the eye. Covered eyeglasses
and contact lenses must be dispensed through GHC Facilities. Replacements will be provided when needed
due to change in the Member's medical condition or when deemed appropriate by a GHC physician.
3. Blood,blood derivatives,and their administration.
4. 'Maternity and pregnancy-related services, including visits before and after birth;involuntary termination of
pregnancy;and care for any other complication of pregnancy.
0036900-CO3046 39
5. Organ transplants, limited to heart, kidney, cornea, bone marrow, and liver, when established criteria are
met.
6. Physician calls (including consultations and second opinions by a GHC physician) in the hospital, office,
home, Skilled Nursing Facility,nursing home,or convalescent center.
7. Restorative physical, occupational,and speech therapy following illness, injury,or surgery.
8. Immunizations and vaccinations that are listed as covered in the GHC Drug Formulary(approved drug list)
or approved by Medicare.
9. Services related to dysfunction of the jaw. When Referred by a GHC physician, evaluation and treatment
by a GHC-approved temporomandibular joint(TMJ)care provider.
All TMJ appliances,other than the occlusal splint and its fitting,are excluded.
Treatment of jaw dysfunction, including TMJ dysfunction, will NOT be provided when the dysfunction is
related to malocclusion or when TMJ services are needed due to dental work performed. All such services
and related hospitalization, including orthodontic therapy and orthognathic (jaw) surgery, are excluded
regardless of origin or cause.
(See Section X.B.17. of the Group Medical Coverage Agreement for Covered Services not meeting
Medicare guidelines).
10. Chiropractic care limited to spinal manipulations. Excluded are any other diagnostic or therapeutic
services, including x-rays,furnished by a chiropractor. Members who receive their primary care in portions
of the GHC Service Area where GHC-designated licensed practitioners are available must utilize GHC's
designated providers in order to be covered.
11. Podiatric care. Services are covered when all Medicare criteria are met and when authorized in advance by
your Primary Care Provider. Excluded is treatment of flat feet or other misalignments of the feet; removal
of corns and calluses; and routine foot care such as hygienic care, except in the presence of a nonrelated
medical condition affecting the lower limbs. Members who receive their primary care in portions of the
GHC Service Area where GHC designated licensed practitioners are available must utilize GHC's
designated providers in order to be covered.
12. Home intravenous(IV)drug therapy services.
13. Routine eye examinations and refractions, limited to once every twenty-four (24) months, except when
Medically Necessary. Services for routine eye examinations must be received at a GHC Facility and in
accordance with GHC medical criteria in order to be covered and are not subject to Medicare requirements.
Lenses. One pair of standard glass single vision, lenticular, or nonblended bifocal or trifocal lenses, or
contact lenses, will be covered subject to UCR charges once every twenty-four(24)months, and replaced
as specified below,when received at a GHC facility and in accordance with GHC medical criteria.
Frames. An Allowance of up to$100 per Member once every 24 months will be provided for frames.
Replacements. Lens replacement for any reason (including loss, breakage or change in prescription) will
be provided not more often than once every 24 months.
Replacement of frames will be provided subject to the frames Allowance set forth above not more often
than once every 24 months.
0036900-003046 40
14. Hearing examinations to determine hearing loss. Hearing aids, including examinations and fitting, must be
received at a GHC Facility and are covered up to a maximum of$250 per Member once every 24 months.
G. Prosthetic Devices, such as cardiac devices, intraocular lenses, artificial joints, breast prostheses, artificial
eyes, and braces, are covered. Excluded are: orthopedic shoes unless they are part of leg braces; dental
plates or other dental devices; and experimental devices.
H. Medical/Surgical Supplies, such as casts, splints, post-surgical dressings, and ostomy supplies, are
covered.
I. Rental or Purchase of Durable Medical Equipment,such as oxygen and oxygen equipment,wheelchairs
and other walk-aids,and hospital beds,is covered.
J. Respite Care.
1. Eligibility. Respite care is provided to chronically dependent persons for reasonable and necessary
in-home services,provided that such services are:
a. authorized in advance by a GHC physician;
b. provided by GHC Community Health Services or by a GHC-approved agency;and
c. that the Member has incurred no less than the equivalent of$6,870.00 in expenses for Medicare
Part B Covered Services during the calendar year in which respite benefits are to be provided.
2. Covered Services. Covered respite care services are provided up to a maximum of eighty (80) hours
for the twelve (12) month period following the date all eligibility requirements are met. Covered
respite services are limited to the following:
a. Services of a homemaker or home health aide;
b. Personal care services;and
c. Nursing care provided by a licensed professional nurse.
"Chronically dependent persons" under this section means persons who live with a voluntary care-giver;
are dependent upon the care-giver for assistance with at least two activities of daily living, such as eating,
bathing, dressing, toileting, or transferring in and out of a bed or chair; and who meet the eligibility
requirements described above.
Section VI EXCLUSIONS AND LIMITATIONS
A. Exclusions.
1. Investigational procedures, including medical and surgical services, drugs and devices until formally
approved by Medicare unless specifically provided herein (See Section XI.A.23. in the Group Medical
Coverage Agreement).
2. Supportive devices for the feet.
3. Services directly related to obesity except as provided by Medicare.
4. Services or supplies not specifically listed as covered by Medicare or GHC.
B. Limitations.
Conditions and Extent of Coverage. EXCEPT AS PROVIDED IN SECTIONS V.F.10. AND V.F.11., ALL
SERVICES AND BENEFITS UNDER THIS AGREEMENT MUST BE PROVIDED BY GHC MEDICAL
PERSONNEL AT A GHC OR GHC DESIGNATED FACILITY UNLESS:
0036900-CO3046 41
I i
1. the Member has received a Referral from GHC, including formal advance approval through GHC's
Medicare medical coverage approval process,or _
2. the Member has received Emergency or Urgently Needed Services as defined in Section I. and as set forth
in Section V.D.of this Medicare Endorsement.
Section VII. CLAIMS PROCEDURE.
Claims for services or supplies and explanation of Medicare benefits for services or supplies from providers other
than Group Health Cooperative should be sent to: Medicare Claims, Group Health Cooperative of Puget Sound. If
you must receive Emergency or Urgently Needed Services from a non-GHC provider, be sure to show your GHC
I.D.card and your red,white, and blue Medicare card.
A. The Member must file claims for services rendered during the first nine (9) months of a calendar year by
December 31 of the following calendar year.
B. The Member must file claims for services rendered in the last three(3)months of a calendar year the same
as if the services had been furnished in the subsequent calendar year. The time limit on filing claims for
services furnished in the last three (3)months of the calendar year is December 31 of the second calendar
year following the calendar year in which the services were rendered.
See "The Medicare Handbook" for additional information regarding filing claims, which can be obtained
from your local Social Security office, or your Washington State Part B carrier's office, or call 1-800-772-
1213.
GHC may obtain information which it deems necessary concerning the medical care and hospitalization for
which payment is requested.
0036900-003046 42
L r
Medicare
Endorsement
For Persons Covered by Part B only of Medicare
THE PROVISIONS OF THE GROUP MEDICAL COVERAGE AGREEMENT SHALL REMAIN IN EFFECT
EXCEPT AS MODIFIED BY THE ADDITION OF THE PROVISIONS, EXCLUSIONS AND LIMITATIONS
CONTAINED IN THIS MEDICARE ENDORSEMENT. IN NO EVENT SHALL THE BENEFITS UNDER THIS
ENDORSEMENT DUPLICATE THE BENEFITS UNDER THE GROUP MEDICAL COVERAGE
AGREEMENT. THE HIGHER LEVEL OF BENEFIT WILL APPLY. COVERAGE UNDER THIS GROUP
MEDICAL COVERAGE AGREEMENT IS INTEGRATED WITH THE MEDICAL BENEFITS ESTABLISHED
BY TITLE I8 OF THE SOCIAL SECURITY ACT AS AMENDED, AND REFERRED TO AS "MEDICARE."
THE BENEFITS AND EXCLUSIONS DESCRIBED IN THIS ENDORSEMENT APPLY ONLY TO MEMBERS
WHO ARE COVERED UNDER PART B ONLY OF MEDICARE.
Except as defined by Federal Regulations, all Members entitled to,or eligible to purchase Medicare must transfer to
the GHC Medicare Plan upon such entitlement or eligibility. A condition of enrollment under the GHC Medicare
Plan requires that a Member be continuously enrolled for medical (Part B) benefits available from the Social
Security Administration,and sign any papers that may be required by GHC or Medicare. For additional information,
the Member may refer to "The Medicare Handbook," which can be obtained form your local Social Security
office.
NEITHER GHC NOR MEDICARE MAY PAY FOR SERVICES PROVIDED AT NON-GHC FACILITIES
UNLESS THE MEMBER HAS BEEN REFERRED BY GHC OR THE MEMBER HAS RECEIVED
EMERGENCY OR URGENTLY NEEDED SERVICES ACCORDING TO SECTION V.C. OF THIS MEDICARE
ENDORSEMENT.
Those enrolled under GHC's Medicare plan,as set forth in this Endorsement,all Copayments are waived except the
prescription drug Copayment.
This Endorsement does not constitute a Medicare supplemental contract.
Section I. DEFINITIONS
CUSTODIAL CARE: Care that is primarily for the purpose of meeting personal needs and could be provided by
persons without professional skills or training. Custodial Care includes help in walking, bathing, dressing, eating,
and taking medicine.
EMERGENCY SERVICES (Medicare defined): Medicare Part B services that are rendered immediately by an
appropriate non-GHC provider because of an injury or sudden illness,and for which the time required to reach GHC
or a GHC Designated Facility would risk permanent damage to the Member's health.
HEALTH CARE FINANCING ADMINISTRATION (HCFA): The federal agency that administers the
Medicare program.
MEDICARE: The federal health insurance program for the aged and disabled.
MEDICARE GUIDELINES: Coverage rules and policies established by the Health Care Financing Administration
(HCFA),a federal agency.
MEDICARE HANDBOOK (Titled "The Medicare Handbook"): A pamphlet published by the Health Care
Financing Administration, which provides an easy-to-read explanation of Medicare benefits, and can be obtained
from your local Social Security office,or your Washington State Part B carrier's office.
0036900-CO3046 43
' S
PERMANENT MOVE: An uninterrupted absence of more than ninety(90)days from GHC's Service Area.
REFERRAL: A written temporary referral agreement authorized in advance by a GHC physician and formally
approved in advance through GHC's Medicare medical coverage approval process,that entitles a Member to receive
Covered Services from a specified non-GHC health care provider. Entitlement to such services shall not exceed the
limits of the Referral and is subject to all terms and conditions of the Referral and this Agreement.
SERVICE AREA: The geographic area comprised of Island, King, Kitsap, Lewis, Pierce, San Juan, Skagit,
Snohomish, Thurston, and Whatcom Counties, and any other areas designated by GHC and approved by the Health
Care Financing Administration.(See Service Area Map.)
URGENTLY NEEDED SERVICES (Medicare defined): Medicare Part B services needed in order to prevent a
serious deterioration of the Member's health due to an unforeseen illness or injury while temporarily absent from
GHC's Service Area,and which cannot be delayed until the Member returns to the Service Area.
USUAL,CUSTOMARY,AND REASONABLE: A term used to define the level of benefits which are payable by
GHC when expenses are incurred from a non-GHC physician or provider. Expenses are considered Usual,
Customary and Reasonable if (1) the charges are consistent with those normally charged by the provider or
organization for the same services or supplies; and(2)the charges are within the general range of charges made by
other providers in the same geographical area for the same services or supplies.
Section II. TERMINATION
Enrollment under the GHC Medicare Plan for a specific Member, may be terminated in the circumstances set forth
below.
Until such time as a Member's termination of enrollment is effective, neither GHC nor Medicare shall pay for
services provided at non-GHC Facilities unless the Member has been Referred by GHC or the Member has received -
Emergency or Urgently Needed Services according to Section V.C. of this Medicare Endorsement.
A. Termination of Specific Members.
1. Loss of Part B Medicare Entitlement. If the Health Care Financing Administration(HCFA)advises GHC
that a Member's entitlement to Medicare coverage no longer exists, or the Member voluntarily terminates
Medicare Part B enrollment, enrollment under the GHC Medicare Plan shall terminate the first of the
month as specified by HCFA.
2. Change of Permanent Residence Outside GHC's Service Area. If a Member makes a Permanent Move
as set forth in Section 1. of this Medicare Endorsement, enrollment shall terminate the first day of the
month following the month in which GHC receives notification of such move.
3. For Cause.Enrollment may be terminated upon written notice for:
a. Knowingly providing fraudulent information to obtain coverage. In such event, GHC may rescind or
cancel enrollment upon ten(10)working days'written notice.
b. Permitting the use of a GHC identification card by another person.
c. Failure to comply with the rules and regulations of GHC including disruptive, unruly, abusive or
uncooperative conduct.
Such termination shall be subject to review and approval by HCFA.
Section III. SUBROGATION
0036900-CO3046 44
. rl
"Injured person" under this section means a Member covered by this Agreement who sustains compensable injury.
"GHC's medical expense" means the expense incurred by GHC for the care or treatment of the injury sustained.
If the injured person was injured by an act or omission of a third party giving rise to a claim of legal liability against
the third party,GHC shall have the right to recover its cost of providing benefits to the injured person(subrogation)
from the third party as set forth in this Agreement and in compliance with Medicare regulations and guidelines.
GHC shall be subrogated to and may enforce all rights of the injured person to the extent of its medical expense.
After Medicare laws and regulations mandating recovery of Medicare payments have been satisfied, the
Cooperative's right of subrogation shall be limited to the excess of the amount required to fully compensate the
injured person for the loss sustained.Full compensation shall be measured on an objective, case-by-case basis,but is
subject to a presumption that a settlement which does not exhaust the third parry's reachable assets is full
compensation to the injured person.
The injured person and his or her agents must cooperate fully with GHC in its efforts to collect GHC's medical
expenses. This cooperation shall include, but is not limited to, supplying GHC with information about any
defendants and/or insurers related to the injured person's claim. The injured person and his or her agents shall permit
GHC, at GHC's option,to associate with the injured party or to intervene in any action filed against any third party.
The injured person and his or her agents shall do nothing to prejudice GV--"s subrogation rights. The injured person
shall not settle a claim without protecting GHC's interest.
GHC shall not pay any attorney's fees or collection costs to attorneys representing the injured person where it has
retained its own legal counsel or acts on its own behalf to represent its interests and unless there is a written fee
agreement signed by GHC prior to any collection efforts.When reasonable collection costs have been incurred,with
GHC's prior written agreement, to recover GHC's medical expenses, there shall be an equitable apportionment of
such collection costs between GHC and the injured person subject to a maximum responsibility of GHC equal to
one-third of the amount recovered on behalf of GHC.
This provision does not apply to occupationally incurred disease,sickness,and/or injury.
Section IV. GRIEVANCE PROCEDURES
A. GHC Member Services Program.
The Member Services Program is designed to help a Member resolve formal complaints and concerns about
medical and business service. GHC will record, research, and respond in a timely manner to a Member's
concern. A concern should be registered initially at the Member's area medical center. If not satisfied, the
Member should then contact the regional Member Services Department, which will arrange for review by
appropriate medical staff,management and/or GHC consumers.
B. Reconsideration of Claims.
If GHC denies a request for payment of a claim, or declines to provide services which the Member believes
should be provided, the Member may file a request for reconsideration with GHC or a Social Security
Administration office. The request must be filed in writing within sixty (60) days of GHC's written notice of
denial unless an extension is specifically approved. If GHC does not overturn the denial in full, it will be
referred by GHC to the Health Care Financing Administration for reconsideration.
Section V. SCHEDULE OF BENEFITS
All benefits and services listed in this Schedule of Benefits:
• are subject to all provisions of this Agreement and Medicare Endorsement;
• must be approved in advance by GHC except for Emergency and Urgently Needed Services as set forth in
Section V.C. of this Medicare Endorsement;and
0036900-003046 45
• must meet Medicare guidelines and limitations unless otherwise specified.
The booklet, "The Medicare Handbook" provides additional information about Medicare benefits, and can be
obtained from your local Social Security office.
A. Hospice.
It is understood and agreed that the following fully sets forth Covered Services for a Member with Part B
Medicare only who elects to receive hospice services. Members who elect to receive hospice services do so in
lieu of curative treatment for their terminal illness for the period that they are in the hospice program.
To receive hospice services,the Member is required to sign the Hospice Election Form.
Covered Services. Hospice services may include the following as prescribed by a GHC physician and rendered
pursuant to an approved hospice plan of treatment:
1. Home Services
Continuous care services per Member in the Member's home when prescribed by a GHC physician, as set
forth in this paragraph. Continuous care is defined as "skilled nursing care provided in the home during a
period of crisis in order to maintain the terminally ill patient at home." Continuous care may be provided
for pain or symptom management by a Registered Nurse, Licensed Practical Nurse, or Home Health Aide
under the supervision of a Registered Nurse. Continuous care may be provided up to twenty-four (24)
hours per day during periods of crisis. Continuous care is covered only when a GHC physician determines
that the Member otherwise would require hospitalization in an acute care facility.
2. Inpatient Hospice Services for short-term care shall be provided in a facility designated by GHC's
Hospice Program when Medically Necessary and authorized in advance by a GHC physician and GHC's
Hospice Program. Respite care is covered for a maximum of five (5) consecutive days per occurrence in
order to continue care for the Member in the temporary absence of the Member's primary care-giver(s).
3. Other hospice services may include the following:
a. drugs and biologicals that are used primarily for the relief of pain and symptom management;
b. medical appliances and supplies primarily for the relief of pain and symptom management;
c. counseling services for the Member and his/her primary care-giver(s);and
d. bereavement counseling services for the family.
B. Outpatient Mental Health Care, Alcoholism and Drug Abuse Treatment Services are covered for each
Member in accordance with Medicare Guidelines.
C. Outpatient Emergency/Urgently Needed Services. When an Emergency meets the Medicare definition for
Emergency or Urgently Needed Services as defined in Section I. of this Medicare Endorsement, services are
covered in ju1C
C1. Out Of The Service Area Non-Emergent and/or Non-Urgently Needed Care. Non-Emergent and/or non-
urgently needed care will be covered outside GHC's defined Service Area, up to a maximum of$2,000.00
(GHC's Service Area is defined in Section I. of this Agreement). Coverage under this benefit does NOT
include coverage of prescription drugs.
Services, as noted in this section, are available to Members traveling outside GHC's defined Service Area,
except when traveling primarily for the purpose of seeking medical care.
The services received under this benefit are subject to all limitations set forth in this Agreement.
0036900-CO3046 46
I I _ V
All Medicare non-covered expenses including hospital inpatient deductibles and inpatient and outpatient
coinsurances are the responsibility of the Member.
D. Medicare Ambulance Benefit. Medically Necessary ambulance transportation to or from a hospital or Skilled
Nursing Facility is covered in full only if transportation by any other vehicle could endanger the patient's health
and the ambulance,equipment,and personnel meet Medicare requirements.
E. Medical and Surgical Care. The following medical and surgical services are covered when prescribed by
GHC Medical Personnel, Medicare requirements are met:
1. Eye examinations and treatment for eye pathology.
Evaluations and surgical procedures to correct refractions which are not related to eye pathology are not
covered. Complications related to such surgery are also excluded.
2. One pair of eyeglasses or contact lenses, including examination and fitting, following cataract surgery, are
covered subject to UCR charges when required to replace the natural lens of the eye. Covered eyeglasses
and contact lenses must be dispensed through GHC Facilities. Replacements will be provided when needed
due to change in the Member's medical condition or when deemed appropriate by a GHC physician.
3. Blood,blood derivatives,and their administration.
4. Maternity and pregnancy-related services,including visits before and after birth; involuntary termination of
pregnancy;and care for any other complication of pregnancy.
5. Organ transplants, limited to heart, kidney, cornea, bone marrow, and liver, when established criteria are
met.
6. Physician calls (including consultations and second opinions by a GHC physician) in the hospital, office,
home,Skilled Nursing Facility,nursing home,or convalescent center.
7. Restorative physical,occupational,and speech therapy following illness, injury,or surgery.
8. Immunizations and vaccinations that are listed as covered in the GHC Drug Formulary(approved drug list)
or approved by Medicare.
9. Services related to dysfunction of the jaw. When Referred by a GHC physician,evaluation and treatment
by a GHC-approved temporomandibular joint(TMJ)care provider.
All TMJ appliances, other than the occlusal splint and its fitting, are excluded.
Treatment of jaw dysfunction, including TMJ dysfunction, will NOT be provided when the dysfunction is
related to malocclusion or when TMJ services are needed due to dental work performed. All such services
and related hospitalization, including orthodontic therapy and orthognathic (jaw) surgery, are excluded
regardless of origin or cause.
(See Section X.B.17. of the Group Medical Coverage Agreement for Covered Services not meeting
Medicare guidelines).
10. Chiropractic care limited to spinal manipulations. Excluded are any other diagnostic or therapeutic
services, including x-rays, furnished by a chiropractor. Members who receive their primary care in portions
of the GHC Service Area where GHC-designated licensed practitioners are available must utilize GHC's
designated providers in order to be covered.
0036900-003046 47
11. Podiatric care. Services are covered when all Medicare criteria are met and when authorized in advance by
your Primary Care Provider. Excluded is treatment of flat feet or other misalignments of the feet; removal
of corns and calluses; and routine foot care such as hygienic care, except in the presence of a nonrelated
medical condition affecting the lower limbs. Members who receive their primary care in portions of the
GHC Service Area where GHC designated licensed practitioners are available must utilize GHC's
designated providers in order to be covered.
12. Home intravenous(IV)drug therapy services.
13. Routine eye examinations and refractions, limited to once every twenty-four (24) months, except when
Medically Necessary. Services for routine eye examinations must be received at a GHC Facility and in
accordance with GHC medical criteria in order to be covered and are not subject to Medicare requirements.
Lenses. One pair of standard glass single vision, lenticular, or nonblended bifocal or trifocal lenses, or
contact lenses, will be covered subject to UCR charges once every twenty-four (24)months, and replaced
as specified below,when received at a GHC facility and in accordance with GHC medical criteria.
Frames. An Allowance of up to $100 per Member once every twenty-four (24) months will be provided
for frames.
Replacements. Lens replacement for any reason (including loss, breakage or change in prescription) will
be provided not more often than once every 24 months.
Replacement of frames will be provided subject to the frames Allowance set forth above not more often
than once every 24 months.
14. Hearing examinations to determine hearing loss. Hearing aids, including examinations and fitting, must be
received at a GHC Facility and are covered up to a maximum of$250 per Member once every 24 months.
F. Prosthetic Devices,such as cardiac devices,intraocular lenses,artificial joints,breast prostheses,artificial eyes,
and braces,are covered.Excluded are: orthopedic shoes unless they are part of leg braces;dental plates or other
dental devices;and experimental devices.
G. Medical/Surgical Supplies,such as casts,splints,post-surgical dressings,and ostomy supplies,are covered.
H. Rental or Purchase of Durable Medical Equipment,such as oxygen and oxygen equipment,wheelchairs and
other walk-aids,and hospital beds,is covered.
I. Respite Care.
1. Eligibility. Respite care is provided to chronically dependent persons for reasonable and necessary
in-home services,provided that such services are:
a. authorized in advance by a GHC physician;
b. provided by GHC Community Health Services or by a GHC-approved agency;and
c. that the Member has incurred no less than the equivalent of$6,870.00 in expenses for Medicare Part B
Covered Services during the calendar year in which respite benefits are to be provided.
2. Covered Services. Covered respite care services are provided up to a maximum of eighty (80) hours for
the twelve (12) month period following the date all eligibility requirements are met. Covered respite
services are limited to the following:
a. Services of a homemaker or home health aide;
b. Personal care services; and
c. Nursing care provided by a licensed professional nurse.
0036900-003046 48
"Chronically dependent persons" under this section means persons who live with a voluntary care-giver;
are dependent upon the care-giver for assistance with at least two activities of daily living, such as eating,
bathing, dressing, toileting, or transferring in and out of a bed or chair; and who meet the eligibility
requirements described above.
Section VI. EXCLUSIONS AND LIMITATIONS
A. Exclusions.
1. Investigational procedures, including medical and surgical services, drugs and devices until formally
approved by Medicare unless specifically provided herein (See Section XI.A.10. in the Group Medical
Coverage Agreement).
2. Supportive devices for the feet.
3. Services directly related to obesity except as provided by Medicare.
4. Services or supplies not specifically listed as covered by Medicare or GHC.
B. Limitations.
Conditions and Extent of Coverage. EXCEPT AS PROVIDED IN SECTIONS V.E.10. AND V.E.I I., ALL
SERVICES AND BENEFITS UNDER THIS AGREEMENT MUST BE PROVIDED BY GHC MEDICAL
PERSONNEL AT A GHC OR GHC DESIGNATED FACILITY UNLESS:
1. the Member has received a Referral from GHC, including formal advance approval through GHC's
Medicare medical coverage approval process,or
2. the Member has received outpatient Emergency or Urgently Needed Services as defined in Section I. and
as set forth in Section V.C. of this Medicare Endorsement.
Section VII. CLAIMS PROCEDURE
Claims for services or supplies and explanation of Medicare benefits for services or supplies from providers other
than Group Health Cooperative should be sent to: Medicare Claims, Group Health Cooperative of Puget Sound. If
you must receive Emergency or Urgently Needed Services from a non-GHC provider, be sure to show your GHC
I.D. card and your red,white,and blue Medicare card.
A. The Member must file claims for services rendered during the first nine (9) months of a calendar year by
December 31 of the following calendar year.
B. The Member must file claims for services rendered in the last three(3)months of a calendar year the same as if
the services had been furnished in the subsequent calendar year. The time limit on filing claims for services
furnished in the last three(3)months of the calendar year is December 31 of the second calendar year following
the calendar year in which the services were rendered.
See "The Medicare Handbook" for additional information regarding filing claims, which can be obtained from
your local Social Security office,or your Washington State Part B carrier's office.
GHC may obtain information which it deems necessary concerning the medical care and hospitalization for
which payment is requested.
0036900-CO3046 49
COPAYMENTS AND ALLOWANCES SCHEDULE
The benefits described in this schedule are subject to all provisions, limitations and exclusions set forth in the Group
Medical Coverage Agreement.
STOP LOSS:
Total out-of-pocket Copayment expenses for the following Covered Services:
Limited to an aggregate maximum of$750 per Member and$1,500 per family per calendar year.
• Outpatient Services
• Emergency Care at a GHC or GHC Designated Facility
INPATIENT HOSPITAL SERVICES:
HOSPITAL CARE: All inpatient medical and surgical hospital care services are subject to the stated Copayment.
• Chemical dependency treatment(see benefit limits under Chemical Dependency section of the Copayments and
Allowances Schedule)
• Rehabilitation Services. Inpatient physical, occupational and restorative speech therapy services combined,
including services for neurodevelopmentally disabled children age six (6) and under, plus associated hospital
services for the purpose of rehabilitation is covered up to 60 days per condition per calendar year.
• Pregnancy-related complications prior to delivery
• Other pregnancy-related services
No Copayment. Covered in full.
OUTPATIENT SERVICES: Diagnostic radiology and laboratory services and administration of injections
including covered immunizations and vaccinations are not subject to the outpatient Copayment. All other outpatient
medical and surgical services are subject to the stated Copayment.
• Medical and surgical care
• Office visits, including consultations
• Outpatient surgery
• Physical examinations,including well-child care and routine mammography screening
• Radiation therapy and chemotherapy
• Family planning counseling
• Audiological testing
• Routine eye exam/refraction;contact lens exams and fitting for eye pathology
• Chemical dependency treatment(see benefit limits under Chemical Dependency section of the Copayments and
Allowances Schedule)
• Prenatal and postpartum visits and prenatal testing
• Pregnancy-related services
• Outpatient physical, occupational and restorative speech therapy services combined, including services for
neurodevelopmentally disabled children age six (6) and under are covered up to 60 visits per condition per
calendar year
$5 Copayment per visit per Member.
0036900-CO3046 50
CHEMICAL DEPENDENCY:
• Benefit Period Allowance
$5,000 maximum per Member per any 24 consecutive calendar month period
• Lifetime Maximum Benefit
$10,000 per Member
TOBACCO CESSATION:
• Individual/Group Sessions
Covered at 50%of the total charges. Coinsurance does not apply to Stop Loss.
• Nicotine replacement therapy
Covered subject to the Outpatient Prescription Drug Copayment for each(30)day supply or less of a prescription or
refill when provided at GHC Facilities and prescribed by a GHC Provider. Copayment does not apply to Stop Loss.
PRESCRIPTION DRUGS - OUTPATIENT: Drugs and medicines (including injectables) which require a
prescription when provided at GHC Facilities and prescribed by a GHC Provider for a supply of thirty(30) days or
less of an outpatient prescription or refill is subject to the stated Copayment.
Covered subject to the lesser of GHC's charge or a$5 Copayment. Copayment does not apply to Stop Loss.
MENTAL HEALTH CARE:
• Outpatient Services
Twenty (20) visits covered per Member per calendar year subject to $20 Copayment per individual/family/couple
session and$10 per Member per group session;no coverage thereafter.
• Inpatient Services
Coverage Allowance up to 12 days at 80%per Member per calendar year at a GHC-approved mental health care
facility when authorized in advance by GHC.
Total expenses,Copayments and Coinsurance paid for mental health treatment do not apply to Stop Loss.
EMERGENCY CARE: All emergency care services are subject to the stated Copayment.
• At a GHC or GHC Designated Facility
$50 Copayment per Emergency visit per Member. Copayment is waived if Member is admitted directly from the
Emergency department.
• At a non-GHC Designated Facility
0036900-CO3046 51
$100 Deductible per Emergency visit per Member. Emergency Deductible does not apply to Stop Loss.
AMBULANCE SERVICES:
• Transport to a GHC Facility,GHC Designated Facility,or non-GHC Designated Facility.
Covered at 80%. Coinsurance amount does not apply to Stop Loss.
• Transfer to a GHC or GHC Designated Facility
No Copayment.
ORTHOPEDIC APPLIANCES:
• Orthopedic appliances when prescribed by a GHC Provider and listed as covered in the Orthopedic Appliance
Formulary.
Covered Services are subject to a 50%Coinsurance. Coinsurance amount does not apply to Stop Loss.
NASAL CPAP DEVICE:
• Nasal CPAP device when Medically Necessary and authorized in advance by GHC.
Covered Services are subject to a 50%Coinsurance. Coinsurance amount does not apply to Stop Loss.
POST-MASTECTOMY BRAS:
Covered Services are subject to a 50%Coinsurance. Coinsurance amount does not apply to Stop Loss.
TEMPOROMANDIBULAR JOINT(TM)SERVICES:
• Inpatient and outpatient TMJ services when Medically Necessary and authorized by GHC.
$1,000 maximum per Member per calendar year
• Lifetime Maximum Benefit
$5,000 per Member
SKILLED NURSING FACILITY:
• Care in a GHC-approved skilled nursing facility
Coverage allowance up to thirty(30)days per condition per Member.
PA-1133 -Basic Agreement
0036900-CO3046 52
1 C! L
PA-1117-Service Area Map
CA-174-Medicare A&B
CA-175-Medicare B Only
CA-66-M&A
DA420-MT-A
CA48-PEC(0)
CA-573 -IM-U
CA-61 -SN-A
0036900-CO3046 53
d C��erauv+e
Dues Schedule
PugFor attachment to Group Medical Coverage Agreement with:
KENT, CITY OF GROUP # 00369
This schedule reflects Group Health Cooperative monthly dues effective January 1, 1997
and guaranteed to January 1, 1998.
MONTHLY HEALTH CARE DUES
Subscriber only ................................................... $157.94 per month
Subscriber and Spouse............................................................................. $353.38 per month
Subscriber-and Child ren ................... $318.53 per month
( )......................................................Subscriber and Family.............................................................................. $505.90 per month
Spouseonly.............................................................................................. $195.44 per month
) Y
Child ren only ........... $160.59 per month
( ...............................................................................Spouse and Child(ren)................................................................... ......... $356.04 per month
COPAYMENT PROVISION
The following copayments apply to this plan. See Group Medical Coverage Agreement for
benefit details.
$5 Outpatient/Office Visit
$5 Outpatient Prescription Drugs
$0 Inpatient Co-pay
$50 Emergency Room
0 Month Pre-existing Condition
BILLING INFORMATION
Dues must be remitted on a calendar month basis on or before the first day of the coverage
month for which they become payable. Each remittance must be accompanied by a list of
subscribers for whom such dues are paid.
9.0 percent(9%) of each month's medical dues for each member and each family enrollee, as
scheduled above, is the budgeted prepayment for cost of all pharmaceuticals and prescription
to be dispersed on written orders of the Group Health Cooperative Medical Staff for the next
fiscal year under coverage of your medical coverage agreement
Group Health Cooperative of Puget Sound does not discriminate on the basis of physical or
mental handicaps in its employment practices or services.
BILLING INFORMATION, Continued
Regardless of the effective date of enrollment for a Subscriber and Family
Dependents, the Group will not be required to submit dues to the Cooperative
for the month of enrollment, and these Enrollees will appear on the subsequent
month's billing at the regular charge. When the Subscriber's enrollment
terminates, the group will submit the full amount of dues to the Cooperative
regardless of the specific date of termination for that month.
WashD
Where to get care at Group Health rr coopmiiw
rt
ofR)GOS«rd
Legend
e OHC Medical Centers
♦ OHCNlrginla Mason
Joint Medical Centers
♦ OHC 1peClalty Center aSumas
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Lynden
AFerndale"Verson
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Centers t Hospitals OHGS/S. --..aB�g�
Each symbol shows which
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t.rAM/IS.
type of facility is available. ` Conaete•
Refer to the list inside for Fridays ,.e Lopez aSedalwoolley
the tames and exact Harbor tOPErIS sAnacortes fkagK
locations of all facilities. aBurEngton
Services are availablea Oak Harbor
La er■ a Mt.Vernon
INSIDE the solid lines only. aCoupeville ■Darrington
eland aSt�wood aArlington
FortAngeks■ � `sMarysvllb'
Cdattam s a- 6*Evcmn lnehorntak'
aMomislt'e Mime
PouLsbo■ 'Lynnwood w
Kftoap Bainbrldge •Bothell "
Silverdale• Ialwd e1*Redmond
• [1���
Brrnnerton■ **A-elctlldarld ■Lttaquah
-Port 0 a•BelievttelFa�ttoria
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Mason Bur King
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Harbor
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Area of Detail
9/96
Kent City Council Meeting
Date June 3 , 1997
Category Consent Calendar
1. SUBJECT: BANKING SERVICES CONTRACT - APPROVAL
2 . SUMMARY STATEMENT: As recommended by the Operations
Committee at their May 27th meeting, authorization for the
Mayor to approve a five-year banking services contract with
U.S. Bank with optional two-year extensions. A four-month
evaluation. considered 43 items with focus on Cost, Service as
Providers, Customer Service, and Innovation/Technology. U. S.
Bank' s proposal was verified to provide full service at the
lowest cost to the City and at a high level of customer
satisfaction.
3 . EXHIBITS: Memo from May Miller, Director of Finance
4 . RECOMMENDED BY: Operations Committee (3-0)
(Committee, Staff, Examiner, Commission, etc. )
5 . UNBUDGETED FISCAL/PERSONNEL IMPACT: NO X YES
6. EXPENDITURE REQUIRED: $
SOURCE OF FUNDS:
7 . CITY COUNCIL ACTION:
Councilmember moves, Councilmember seconds
DISCUSSION:
ACTION:
Council Agenda
Item No. 31
Memo
Date: May 20, 1997
To: Operations Committee (�
From: May Miller, Director of Finance
Subject: Banking Services Contract
The City of Kent began the Banking RFP process in February 1997. Proposals were distributed to
local banks and a notice was published in the Daily Journal of Commerce on 2/12/97 and 2/26/97.
Two banks responded by the cutoff date of March 14, 1997. They were U.S.Bank, our current
banking services provider, and KeyBank.
A five-committee team including myself, John Hillman the Assistant Finance Director, Tom
Vetsch, the Customer Services Manager, Jim Huntington, Internal Auditor and Susan Narick,
Financial Analyst, extensively reviewed the proposals and evaluated 43 separate items using the
following criteria; 1) Cost, 2) Services provided, 3) Customer Service, and, 5)
Innovation/Technology.
Both banks presented excellent proposals which made the selection process very difficult. In
addition to the proposals, we made site visits and followed through with references calls. The
committee separately and jointly, rated the proposals, site visits and reference calls. Based on this
rating, we are recommending U.S. Bank to provide the City's Banking Serving for the next five
years.
In all evaluations, U.S. Bank provided the required service at the lowest cost. U.S. Bank's Proposal
will save the city approximately $1,000 a month over the Key Bank Proposal and, as part of their
initial proposal, U.S. Bank is also offering a$1,000 credit to be applied to our first month's analysis
charges. In addition, their references verify full-service at a high level of customer satisfaction and
we will not have any conversion costs.
Not only will a savings be achieved by a new contract with U.S. Bank, but their recent merger with
First Bank Systems will provide enhanced technological changes. The City will be able to achieve
balancing efficiencies as well as offer new Credit and Debit Cards and other new payment options.
Although both Banks rated high,U.S. Bank was able to offer a consistent high level of service at the
lowest cost to the City.
COUNCIL ACTION:
Authorize the Mayor to sign a five-year banking services contract, with U.S. Bank with optional
two (2)-year extensions.
Kent City Council Meeting
Date June 3 , 1997
Category Consent Calendar
1. SUBJECT: DEL MAR ANNEXATION CENSUS CONTRACT - AUTHORIZATION
2 . SUMMARY STATEMENT: Authorization for the Mayor to sign an
agreement with Cutting Edge Enterprises in the amount of
$38, 923 . 11 in a form substantially similar to the attached
proposed agreement for census services for the Del Mar
annexation. The annexation is to be effective July 1, 1997.
The State Office of Financial Management requires that a census
be conducted within 30 days of the effective date of the
annexation.
3 . EXHIBITS: Memo and contract
4 . RECOMMENDED BY: Operations Committee
(Committee, Staff, Examiner, Commission, etc. )
5. UNBUDGETED FISCAL/PERSONNEL IMPACT: NO YES
6. EXPENDITURE REQUIRED: $
SOURCE OF FUNDS:
7 . CITY COUNCIL ACTION:
Councilmember moves, Councilmember seconds
DISCUSSION:
ACTION:
Council Agenda
Item No. 3J
CITY OF �L!22
Jim White, Mayor
Planning Department (206) 859-3390/FAX (206) 850-2544
James P. Harris, Planning Director
MEMORANDUM
June 3, 1997
MEMO TO: MAYOR JIM WHITE AND CITY COUNCIL MEMBERS
FROM: MARGARET PORTER, ADMINISTRATIVE ASSISTANT III
SUBJECT: DEL MAR ANNEXATION CENSUS - AUTHORIZATION FOR THE MAYOR
TO SIGN THE CONTRACT
The Del Mar area will be annexed to Kent on July 1, 1997. The Office of Financial Management
(OFM)requires that a census be conducted within 30 days before or after the effective date. Per the
recommendation of the City Council Operations Committee, authorization is needed for the Mayor
to sign an agreement with Rob Scribner of Cutting Edge Enterprises in a form substantially similar
to the attached, proposed agreement for census services. I have negotiated the contract with Robert
Scribner to conduct a population census in the Del Mar annexation area for the amount of
$38,923.11.
Cutting Edge Enterprises will begin the census when the effective date of the ordinance is in effect,
approximately June 8th. In order to keep costs down, I have agreed to supply photo copies of the
required forms and miscellaneous supplies(see exhibit A). Also, a temporary secretary will be hired
to answer telephones lines during the census to take census information. This was the method used
successfully during the Meridian annexation to help with call backs.
MJP/mp:c:delmar.cen
Attachment
M. Brent McFall, Director of Operations
James P. Harris, Planning Director
220 4th AVE SO., /KENT WASHINGTON 98032-5895/TELEPHONE QW859-3300/FAX#859-3334
SERVICE AGREEMENT
This Asreement is made and entered into on the date fully executed below. by and
between the CITY OF KENT. a Washington municipal corporation. (hereinafter "City"), and
ROBERT SCRIBNER d/b/a CUTTING EDGE ENTERPRISES. a sole proprietor. (hereinafter
"Contractor"). located at 3302-5 Pacific Place. Black Diamond. Washington 98010.
RECITALS
WHEREAS, the City desires to retain services for the census project regarding the
Del Mar Annexation: and
WHEREAS, Contractor agrees to perform professional consultant services under
the terms and conditions set forth herein;
NOW, THEREFORE, in consideration of the mutual promises set forth herein, it
is agreed by and between the City and Contractor:
SECTION ONE
DESCRIPTION OF WORK
Contractor will perform services on behalf of the City and conduct a population census in
the Del Mar Annexation area. Contractor shall perform the work in accordance with all
applicable state, federal and City laws, consistent with accepted practices for other similar
services, and substantially in every respect to the direction and approval of the Planning Director,
within the time specified herein, and in accordance with any instructions and information
contained in this Agreement. Contractor shall perform the following duties in conjunction with
their services as outlined in the attached Exhibit A.
SECTION TWO
TERM
The term of this Agreement shall be for a period beginning on the date of execution
hereof until July 18. t 997, unless sooner terminated as provided for herein.
failure to pay. In the event of termination, the City shall pay for all services performed by the
Contractor to the effective date of termination. and the City may thereafter take possession of all
records and data pertaining to this project within Contractor's possession.
SECTION SEVEN
STATUS OF CONTRACTOR
This Agreement calls for the performance of the services of the Contractor as an
independent contractor and Contractor will not be considered an employee of the City for any
purpose. The Contractor and/or its subcontractor(s) shall secure at his own expense. and be
responsible for any and all payment of income tax, social security. state disability insurance
compensation, unemployment compensation, Worker's Compensation, and all other payroll
deductions for the Contractor and its officers, agents and employees and the costs of all business
licenses. if any, in connection with the services to be performed hereunder. Contractor will be
solely responsible for its acts and the acts of Contractor's agents, employees, servants, and
subcontractors during the performance of this contract.
SECTION EIGHT
DISCRIMINATION
In the hiring of employees for the performance of work under this Agreement or any
subcontract hereunder, the Contractor, its subcontractors or any person acting on behalf of such
Contractor or subcontractor shall not, by reason of race, religion, color, sex or national origin
discriminate against any person who is qualified and available to perform the work to which the
employment relates.
SECTION NINE
WORKER'S COMPENSATION
Contractor agrees to maintain, at Contractor's expense, Worker's Compensation at the
limits required by the State of Washington, to fully protect both Contractor and the City from any
and all claims for injury or death arising from the performance of this Agreement.
3
SECTION TEN
INDEMNIFICATION
The Contractor shall hold the City and its officers. agents. and employees harmless from
all costs. claims, or liabilities of any nature including attorney's fees, costs. and expenses for or
on account of injuries or damages sustained by any persons or property arising out of or in
connection with the activities or omissions of the Contractor, its agents or employees pursuant to
this Agreement, or on account of any unpaid wages or other enumeration for services. and if a
suit as described above be filed. the Contractor shall appear and defend the same at its own cost
and expense. and if judgment be rendered or settlement made requiring payment by the City, the
Contractor shall pay the same.
SECTION ELEVEN
INSURANCE
During the term of this agreement and during any extensions or renewals the Contractor
and any subcontractor of the Contractor shall procure and maintain a policy of automobile
liability insurance with no less than the minimum coverage required by the state of Washington
for bodily injury, including personal injury or death and property damage. The Contractor shall
submit to the City a copy of the insurance policy declaration page as evidence of insurance
coverage acceptable to the City.
SECTION TWELVE
OWNERSHIP OF RECORDS AND DOCUMENTS
Original documents. drawings, designs and reports developed under this Agreement shall
belong to and become the property of the City. All written information submitted by the City to
the Contractor in connection with the services performed by the Contractor under this Agreement
will be safeguarded by the Contractor to at least the same extent as the Contractor safeguards like
information relating to its own business. If such information is publicly available, is already in
Contractor's possession or known to it, or is rightfully obtained by the Contractor from third
parties, Contractor shall bear no responsibility for its disclosure, inadvertent or otherwise.
4
SECTION THIRTEEN
ENTIRE AGREEMENT
The written provisions and terms of this Agreement shall supersede all prior verbal
statements of any officer or other representative of the City. and such statements shall not be
effective or be construed as entering into or forming a part of. or altering in any manner
whatsoever, this Agreement or the Agreement documents. The entire agreement between the
parties with respect to the subject matter hereunder is contained in this Agreement. any addenda
attached hereto. and all bid related documents. if any. which may or may not have been executed
prior to the execution of this Agreement. All of the above documents are hereby made a pan of
this Agreement and form the Agreement document as fully as if the same were set forth at length
herein.
SECTION FOURTEEN
WAIVER AND MODIFICATION
No waiver, alteration or modification of any of the provisions of this Agreement shall be
binding unless in writing and signed by a duly authorized representative of the City or
Contractor.
SECTION FIFTEEN
ASSIGNMENT
Any assignment of this Agreement by the Contractor without the written consent of the
City shall be void.
SECTION SIXTEEN
WRITTEN NOTICE
All communications regarding this Agreement should be sent to the parties at the
addresses below, unless notified to the contrary.
Any written notice hereunder shall become effective on the date personally served or, if
mailed, as of the date of mailing, and shall be deemed sufficiently given if sent to the addressee
5
at the address stated in this Agreement or such other address as may hereafter be specified in
writing.
SECTION SEVENTEEN
GOVERNING LAW
This Agreement shall be governed by the laws of the State of Washington.
SECTION EIGHTEEN
RESOLUTION OF DISPUTES
Should any dispute. misunderstanding or conflict arise as to the terms and conditions
contained in this Agreement, the matter shall first be referred to the mayor for review and a
determination. If the dispute, misunderstanding or conflict between the City and Contractor
cannot be resolved by the City's determination within a reasonable time,jurisdiction of any
resulting litigation shall be with the Superior Court of King County, Washington.
IN WITNESS WHEREOF, the parties have executed this Agreement on the day and
year first above written.
CUTTING EDGE ENTERPRISES THE CITY OF KENT
i
ROBERT SCRIBNER JIM WHITE, MAYOR
33025 Pacific Place 220 Fourth Avenue South
Black Diamond WA 98010 Kent, Washington 98032
Date: S�zz�9� Date:
6
Approved as to form:
Roger A. Lubovich
City Attomev
Attest:
Citv Clerk
P'ILAWNCONTRACTCUTHDGIAGR
7
-\act -filar nrexancn sic
To: Margie Porte;"
From: Robert Scribner
Revision 1 Final
Attachment (1 )
4/22/97
The following bid is based on a 30 day annexation Period.
Bid expires 60 days of receipt. Firm fixed price.
COST BREAKDOWN
Expenditures Cost
Salaries 3 29.268.00
G & A 3 7.902.36
Map Development. Planning & Training 3 -
Copies & Supplies 3 -
Travel & Allowances 3 1 ,152.15
Total Bid Amount 3 38,923.1
Contact: Robert Scribner
33025 Pacific PI.
Black Diamond. Wa. 98010
Phone or Fax: (360) 886-7209
Daytime: 655-0101
EXHIBIT.L
K2rt CQ! -ar 'nrexar;ln �i-rciies �:eeCeC
1..1'v V!V ':aria C�- i�JLI�! it :..751 . .'.� •Li
=ocr_rianon Scneduies for Eni.imerpmrs data �-oiiertron _Inn
Call Back Sheets Used for Peocle missed to nail n 2CG0
Dock Summaries Used tC tally each Bieck *cc
Enumerator C'st. Summary Usec to tally I ricks =C
Special =oc Ca^ Summaries _sea to tally Annexation Data =naI)
Mavors Letter ;,iVen to eaCn anumerato' iC,bi r,to)
Ccor notices _eft at homes with Knewene ncme 2INC
Mileace Sheets Usec by enumerators to track mneace
Enumerator Car Signs Bnaht Color nstailed in Enumerators car wmcow N/A
Cars sicns ;:an ce .ised on =r annex sl
3" enders (Nmecock) "mite =a. Enumerator CFM ReCcrt : _-i^i
4. < '-" Macs Arnexat!cn Mac (Reeu;red By CF Al In
Noteccok Cmcers (5 sheetl .:sea to divide Biecks n netecccKS 0 sets
3" n.;pberbands - tn!n used to Hang door notice at homes ' Box
Clear-:astir, Envelopes Usec to hanr, door nonce !Find at Scene) _CCG
G?nr,!i5 lised r)v enumeratnr5 .anh czl.irr T-,irP5 toy
C-Nocearcis Used -v enumerators 3
Clear Piastic Sheet Frctectcrs jsed in Muster -ecc~ Summar.-s =CG
V' ;: '?" Macs annexation. Mao !Peou:red By CF'•,1) =^
Badces r=or Enumerators and Sueeroscrs Nl!A
"(0 =We will supply Master sheet
Contract wril ce%vith . Cutting Edge Enteronses
Pease set up , -none line each with voice mail (Cne line `or each Annexation)
We swill need to know the onone Numoers soon to create cccr notices)
JVe -Al need notebooks and dividers cght sway. 1
May%-✓e use veu;Temcerary Employee to answer pnones for the tlrst _� uays of?acn Annexaton?
'We would like to request a 3 10.00C.3.0 -avment on June 30. 1-0-07 ^nor to conolenon P'_vrcil Pccask OFT
Invoice will be due at delivery to City Cf Kent one Annexation and City Summary
Please clanfv Invoice processing time required by City of Kent (Payroll Purposes)
Please schedule 9adge pictures late in the day or early evening. (For part time employees)
You can Fax information to us. if needed at 360-886 =C9 (Smart Fax Svstem)
We will deliver Master copies 3 weeks prior to Annexation.
=!ease remember that this is only a work sheet to help i is r^Pet each others needs
`hanx voi.r for,/our hero and trust Robert Srnbner• 360-886-7103 or WorK 306�355 GZG1
Rev. 1
rrom: Robert Scribner
Subiect City of Kent _-1,nnexarinn Proposal
Attachment 11 ?: Cil, of Kent Anne ration Bid
Revision 1
Cite° of Kent annexation (Kent Del-Mar;
1 his bid is based on perter rninJ_ the constls anne,,-2non t6r ,he Cin- o -,Kent '1e"-ell?ned
ri•om the provided ;trey rn:in
This hid is submitted with the follmvin!Z reauirement.s frnm the Cit1v:
1. Area anproximateiv 5;R acres
2. Approsimateiv 423 Single units. and 1 _500 Mutt. t-nits Estimated:
�. Estimated population of 4000
4. 30 days between start and required completion t Mavhe Shorteri
-. Request phone with voice mail.
Provide required GIS maps or equivalent .
�r::ilable ,'orn, Illachine i Daik-oneratiuns i
?. COON' -en-ic, will he provided as reQUtred :is ?stlmated on lirzacjj ld :;i1DOl,,' list
S 10.000.ti0 pre ravment on .June '70. 190- (Pa-,roil Purr.oses i
10. Use of temporary employee for phone purposes.
' I- Strut Altne\at1Ull On .iunc 15th if approved i)v OF'M. ; \lavhe Eariieri
This hid will nrnvide the foilowina:
• Enumeration Sheets
• Completed Cailhack sheets
• All summary Sheets,
• Block maps based on GIS mans or equivalent.
• Trauk block ntups
• Required manpower
• Census Taker tools and.quipmern
• City of Kent Sumrnary Report
Formatted Annexation report for 0.F._I.
Computer generated documents
• Training session for enumerators.
Kent City Council Meeting
Date June 3 . 1997_
Category Consent Calendar
1. SUBJECT: PUGET SOUND PIPE & SUPPLY - BILL OF SALE
2 . SUMMARY STATEMENT: As recommended by the Public Works
Director, authorization to accept the bill of sale for Puget
Sound Pipe & Supply submitted by S & L Properties, L.L.C. for
continuous operation and maintenance of 274 feet of watermain
improvements and release of bonds after the expiration period.
The project is located at 7800 S. 202nd Street.
3 . EXHIBITS: Vicinity map
4 . RECOMMENDED BY: Public Works Director
(Committee, Staff, Examiner, Commission, etc. )
5. UNBUDGETED FISCAL/PERSONNEL IMPACT: NO X YES
6. EXPENDITURE REQUIRED: $
SOURCE OF FUNDS•
7 . CITY COUNCIL ACTION:
Councilmember moves, Councilmember seconds
DISCUSSION•
ACTION:
Council Agenda
Item No. 3K
FROM CITY" OF KENT ENGINEERING 206 B69 3S59 1997,05-30 09:32 #611 F.01i01
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Kent City Council Meeting
Date June 3 , 1997
Category Other Business
1. SUBJECT: MERIDIAN WEST PRELIMINARY PLAT SU-96-02 - APPROVAL
2 . SUMMARY STATEMENT: This date has been set to consider the
Hearing Examiner' s recommendation for conditional approval of
an application by Wally and Anne Mseitif for a 25-lot single
family residential preliminary subdivision. This plat is 4 . 86
acres in size and is located adjacent to 132nd Avenue SE,
between 263rd and 266th Streets.
3 . EXHIBITS: Staff report, Findings and Recommendations, and
preliminary plat map
4 . RECOMMENDED BY: Hearing Examiner
(Committee, Staff, Examiner, Commission, etc. )
5. UNBUDGETED FISCAL/PERSONNEL IMPACT: NO X YES
6. EXPENDITURE REOUIRED: $
SOURCE OF FUNDS:
7 . CITY COUNCIL ACTION:
Councilmember-lL_moves, Councilmember / Pr'� seconds
to accept/r-ejeettme&!4y- the Findings of the Hearing Examiner,
and to adopt/ the Hearing Examiner's
recommendation of approval of Meridian West Preliminary Plat.
DISCUSSION:
ACTION:
Council Agenda
Item No. 4A
CITY OF JWQ\-T2n'T
Jim White, Mayor
Planning Department (206)859-3390/FAX(206) 850-2544
James P. Harris,Planning Director
OFFICE OF THE LAND USE HEARING EXAMINER
(206) 859-3390 Theodore P. Hunter
Hearing Examiner
FINDINGS, CONCLUSIONS AND RECOMMENDATION
FILE NO: MERIDIAN WEST #SU-96-2
APPLICANT: Wally and Anne Mseitif
REOUEST: A request to subdivide 4.86 acres into 25 single family lots.
LOCATION: The property is located adjacent to 132nd Avenue SE, between 263rd and
266th Streets.
APPLICATION FILED: July 30, 1996
DETERMINATION OF
NONSIGNIFICANCE ISSUED: September 13, 1996
MEETING DATE: March 19, 1997
RECOMMENDATION ISSUED: April 2, 1997
RECOMMENDATION: APPROVAL WITH CONDITIONS
STAFF REPRESENTATIVE: Fred N. Satterstrom, Planning Department
Linda Phillips, Planning Department
Gary Gill, Public Works Department
Frank Spanjer, Public Works Department
PUBLIC TESTIMONY: Jeff Mann, Apex, for applicant
Other
Tony Fuoco
Bob Mandich
George Webb
WRITTEN TESTIMONY: None
1
220 4th AVE SO /KENT WASHINGTON 98032-5895 1 TELEPHONE (206)859-3300/FAX#859-3334 _
Hearing Examiner Findings and Recommendation
Meridian West
#SU-96-2
EXHIBITS: 1. Hearing Examiner file containing, application, public
notice and staff report.
2. Letter to Hearing Examiner, dated March 10, 1997,
from homeowners at Stillwater Greens.
3. Final Mitigation Report, dated October 29, 1996,
prepared by Bredberg and Associates.
4.1-7: Photographs of site.
INTRODUCTION
After due consideration of all the evidence presented at public hearing on the date indicated above,
and following an unaccompanied personal inspection of the subject property and surrounding area
by the Hearing Examiner at a time prior to the public hearing, the following findings, conclusions
and recommendation are entered by the Hearing Examiner on this application.
SUMMARY OF PROCEDURE
A public hearing was held on March 19, 1997, in the City of Kent Council Chambers. All present
were given an opportunity to testify and present evidence. The record is now closed and the
Hearings Examiner is required to issue Findings and Conclusions within 10 days of the close of the
record based on information provided to him.
FINDINGS
1. The owner of the property proposed for subdivision is Wally and Anne Mseitif of Kent,
Washington. Exhibit 1, Application. The applicant was represented at the public hearing by
Mr. Jeff Mann of Apex Engineering.
2. The property proposed for subdivision is located adjacent to 132nd Avenue SE, between
263rd Street and 266th Street. Exhibit 1, Staff Report.
3. The property is 4.86 acres. The applicant proposes twenty-five single family lots with the
smallest lot of 4000 square feet. The applicant submitted a site plan dated July 26, 1996,that
shows all lots in conformance with minimum lot size requirements. The proposed
subdivision would result in 24 buildable lots. An existing dwelling would remain on one of
the lots. Exhibit 1, Site Plan.
4. The property is zoned SR-8 with a 4,000 square foot minimum lot size. The Comprehensive
Plan Land Use Map designates the property as SF, Single Family Residential with eight
dwelling units per acre. Exhibit 1, Staff Report.
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5. Land use all around the property proposed for subdivision is single family residential. Site
View; Exhibit 1, Staff Report.
6. There are several significant trees on the property. A tree plan identifying all trees with a
caliper of six inches or greater is required prior to issuance of development permits. Exhibit
1, Staff Report.
7. A wetland area is located on the south portion of the site. A Wetland Delineation Report was
received by the Planning Department and approved for the site. A Wetland Mitigation Plan
was also received by the Planning Department and approved. Exhibit 1, Staff Report; Exhibit
43 A Final Mitigation Report.
8. There has been substantial concern in the community that the density of the proposed
subdivision is too high. In particular the traffic impacts of the new development and the
increased demand at the schools (which are already at capacity) are of concern. Additional
concerns include: the new development may cause flooding due to stormwater runoff;
wildlife in the area may be adversely impacted; and 130th and SE 263rd Place, which is
currently a play area for children, may be adversely affected by the development. A citizen
representing the Stillwater Greens Homeowners read a letter outlining these concerns which
was signed by 36 individuals. Exhibit 2; Testimony of Mr. Fuoco. The City Engineer
responded that a mitigation fee is imposed to address the increase demand on the schools.
The City Engineer stated that SE 263rd Place was supposed to be a through street when the
Stillwater plat was approved, and that it cannot remain a dead-end street and play area. He
also noted that, as part of the conditions of the project, 132nd street would be improved by
the developer to the full extent possible -- any further improvements would need to be
performed by the city as part of the capital improvement plan. Testimony of Mr. Gill, City
Engineer. The City Planner also noted that the project was consistent with Comprehensive
Plan goals and that no threatened or endangered species are known to exist in the area.
Testimony of Ms. Phillips, Planner.
9. A significant concern associated with this project is the potential increase in stormwater
overflow. A neighbor who owns property to the west noted that stormwater overflow goes
into his property. The pond located on this neighbors property at the edge of the proposed
subdivision is full December through April and currently overflows occasionally. His
concern is that the pond will overflow even more often after the development is constructed.
He was also concerned with regard to sewage and was curious about how that was to be dealt
with. Another neighbor also had concerns about stormwater drainage. His concern was that
the runoff might contaminate of his Class B well. Testimony of Mr. Bob Mandich;
Testimony of Mr. George Webb; Exhibit 4.1-4.7.
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10. The City Engineer noted that they were aware of the problem of flooding caused by
stormwater overflow, and he stated that a 70 %release rate was set to reduce the rate of flow
from existing conditions. This will be accomplished by controlling the flow rate allowed at
the gate of the detention pond. The stormwater plan must protect both Mr. Webb's well from
contamination and Mr. Mandich's pond from increased rates of overflow. Testimony of
Mr. Gill, City Engineer.
11. Access from the site to 132nd Avenue SE and to SE 263rd would be provided by a public
street which would be 130th Avenue SE at the west property line and SE 264th Street
running east west through the property. Vehicle access to the property does not present
constraints to the proposal. Exhibit 1, Staff Report.
12. A water system and sanitary sewer system from Water District#111 can be extended to each
lot. Exhibit ], Staff Report.
13. The environmental review for this application resulted in a conclusion by the City's
Responsible Official that the project has no probable significant adverse impacts on the
environment that cannot be mitigated. A final Mitigated Determination of Nonsignificance
(MDNS)was issued for the proposed subdivision on September 29th, 1996 pursuant to the
State Environmental Policy Act. It was not appealed by the applicant or any citizen. The
conditions of mitigation address several areas of environmental concern including traffic
impacts, mitigation of impacts to wetland areas and dedication of land for utilities and
streets. Exhibit 1, MDNS.
14. Public notice of this application was given by posting, publication and mailing. Exhibit 1,
Affidavit of Harris.
15. At the public hearing on March 19,the Planning Department recommended approval of this
application subject to specific conditions. Exhibit 1, Staff Report.
CONCLUSIONS
Jurisdiction
1. The Hearing Examiner has jurisdiction to hold a public hearing on this application; to
consider all evidence presented at the public hearing; and, based on that evidence,to present
a recommendation to the City Council to approve, disapprove or approve with conditions the
preliminary plat application. KCC 12.04.360, KCC 2.32.090.
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2. Notice of the public hearing on this application was properly given in accordance with
applicable state statutes and city ordinances including Chapter 58.17 RCW and KCC
12.04.360. Finding of Fact No. 14.
Criteria for Decision
1. The recommendation of the Hearing Examiner must be supported by the evidence presented,
as stated in the Findings of Fact of this recommendation, and must be consistent with the
standards and criteria for review specified in state statutes and city ordinances. The standards
and criteria for review of preliminary plat applications are found in Chapter 12.04 of the
Kent City Code (KCC) and Chapter 58.17 of the Revised Code of Washington (RCW).
These review criteria include:
(a) KCC 12.04.020 which provides that the purpose of the city's subdivision regulations
is to:
provide rules, regulations, requirements, and standards for
subdividing land in the City of Kent, ensuring that the highest
feasible quality in subdivision will be attained; that the public health,
safety, general welfare, and aesthetics of the City of Kent shall be
promoted and protected; that orderly growth, development, and the
conservation, protection and proper use of land shall be ensured; that
proper provisions for all public facilities (including circulation,
utilities, and services) shall be made;that maximum advantage of site
characteristics shall be taken into consideration;and that conformance
with provisions set forth in the City of Kent Zoning Code and Kent
Comprehensive Plans shall be ensured.
(b) KCC 12.04.330 which specifies eight requirements that must be shown on the
preliminary plat map including appropriate names and dates,proposed platted property lines,
contours and elevations, proposed public service areas, square footage calculations for
developed and open space, dimensions of each lot, statements of soil type and drainage
conditions, a description of existing land cover, and a description of wildlife present.
(c) KCC 12.04.370 which requires a written statement from the Seattle-King County health
department as to the general adequacy of the proposed means of sewage disposal and water
supply.
(d) KCC 12.04.430 which provides for the protection of valuable, irreplaceable
environmental amenities so that urban development may be as compatible as possible with
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the ecological balance of the area including preservation of drainage patterns, protection of
ground water supply, prevention of erosion and preservation of trees and natural vegetation.
(e) KCC 12.04.440 which specifies requirements for utilities including sanitary sewers, a
proper drainage plan and a proper water distribution system.
(f) KCC 12.04.450 which requires due consideration to the allocation of public service usage
areas and due regard for all natural features including large trees, water courses, historical
spots and other community assets that would add attractiveness and value to the property.
(g) KCC 12.04.490 which provides for mitigation of any adverse effects of development
upon the existing park and recreational facilities in the City of Kent.
(h) RCW 58.17.110 which requires an inquiry into the public use and interest proposed to
be served by the subdivision and a determination "that appropriate provisions are made for
public health, safety and general welfare and for such open spaces, drainage ways, streets or
roads, alleys, other public ways,transit stops, potable water supplies, sanitary wastes, parks
and recreation, playgrounds, schools and schoolgrounds and all other relevant facts,
including sidewalks and other planning features that assure safe walking conditions for
students who only walk to and from school."
Conclusion Based on Findings
1. Based on the Findings of Fact specified above, and with the specific conditions
recommended below, the Examiner concludes that this preliminary plat application is
consistent with the standards and criteria of applicable state statutes and city ordinances and
should be approved. Findings of Fact No. 3,4,5,6, 7,10,11,12, 13, 14 & 15.
RECOMMENDATION
The Hearing Examiner recommends that this preliminary plat application be APPROVED subject
to the following conditions:
A. GENERAL CONDITIONS OF APPROVAL:
1. The subdivider shall implement all mitigation measures required by the
Determination of Nonsignificance for SEPA checklist 4ENV-96-62 for the
MERIDIAN WEST Subdivision.
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Hearing Examiner Findings and Recommendation
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B. PRIOR TO RECORDATION OF THE SUBDIVISION:
1. The owner/subdivider shall provide a survey to be performed by a licensed land
surveyor of the subject property, 132nd Avenue Southeast, Southeast 264th Street,
Southeast 263rd Street, and adjacent affected properties, and shall clearly delineate
the existing public right-of-way, right-of-way centerlines, property lines, paving
limits, and-other public and private improvements.
2 The owner/subdivider shall execute an agreement to financially participate in and pay
a proportionate share in the cost of providing an off-site paved walkway between the
plat boundary and the elementary school serving the plat area. Monies therefrom
shall be deposited with the City prior to final plat approval of this subdivision.
3. A Wetland Delineation Report for this site has been received, and approved. A
Wetland Mitigation Plan shall be submitted to Kent Public Works for review and
approval prior to recording final plat.
4. The wetland boundaries shown in the approved Wetland Mitigation Report must be
surveyed and marked with permanent survey monuments. The survey shall be shown
on the face of the final plat. A licensed professional surveyor shall provide the
survey which shows the wetland boundary, the approved wetland buffers, the areas
of each, and the legal description for the Sensitive Area Tract for the Wetland.
Copies of these maps will be included in the approved Wetland Mitigation Report.
5. The entire approved, preserved and constructed wetland(s) and it's buffer(s), and the
25 foot undisturbed creek buffer shall be permanently protected as a separate
Sensitive Area Tract dedicated to the City of Kent in accordance with the Kent
Wetland Management Code. The legal description for the Sensitive Area Tract for
the creek buffer shall be prepared by a licensed land surveyor. The buffer areas shall
be isolated from intrusion and/or disturbance using landscaping, signs and/or other
appropriate screens, as well as an approved wildlife-passable fence. The following
wording shall appear on the face of the final plat:
SENSITIVE AREA TRACTS
DEDICATION OF A SENSITIVE AREA TRACT CONVEYS TO THE PUBLIC
A BENEFICIAL INTEREST IN THE LAND WITHIN THE TRACT. THIS
INTEREST INCLUDES THE PRESERVATION OF NATIVE VEGETATION FOR
ALL PURPOSES THAT BENEFIT THE PUBLIC HEALTH, SAFETY AND
WELFARE, INCLUDING CONTROL OF SURFACE WATER AND EROSION,
MAINTENANCE OF SLOPE STABILITY,VISUAL AND AURAL BUFFERING,
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AND PROTECTION OF WATER QUALITY, PLANT ECOLOGY AND
WILDLIFE HABITAT. THE SENSITIVE AREA TRACT IMPOSES UPON ALL
PRESENT AND FUTURE OWNERS AND OCCUPIERS OF THE LAND
SUBJECT TO THE TRACT THE OBLIGATION, ENFORCEABLE ON BEHALF
OF THE PUBLIC BY THE CITY OF KENT, TO LEAVE UNDISTURBED ALL
TREES AND OTHER VEGETATION WITHIN THE TRACT. THE
VEGETATION WITHIN THE TRACT MAY NOT BE CUT, PRUNED,
COVERED BY FILL, REMOVED OR DAMAGED WITHOUT APPROVAL IN
WRITING FROM THE CITY OF KENT.
THE COMMON BOUNDARY BETWEEN THE TRACT AND THE AREA OF
DEVELOPMENT ACTIVITY MUST BE MARKED OR OTHERWISE FLAGGED
TO THE SATISFACTION OF THE CITY OF KENT PRIOR TO ANY
CLEARING, GRADING, BUILDING CONSTRUCTION OR OTHER
DEVELOPMENT ACTIVITY. THE REQUIRED MARKING OR FLAGGING
SHALL REMAIN IN PLACE UNTIL ALL DEVELOPMENT ACTIVITIES IN
THE VICINITY OF THE SENSITIVE AREA TRACT ARE COMPLETED.
NO BUILDING FOUNDATIONS, STRUCTURES, FILL OR OBSTRUCTIONS
(INCLUDING, BUT NOT LIMITED TO DECKS, PATIOS, OUTBUILDINGS
AND OVERHANGS) ARE ALLOWED WITHIN 15 FEET OF THE SENSITIVE
AREA TRACT BOUNDARY, UNLESS OTHERWISE APPROVED BY THE
CITY.
6. The owner/subdivider shall provide engineering drawings for review and approval
by the City, and either construct or bond for the following:
a. A gravity sanitary sewer system to serve all lots, which shall be provided by
the City of Kent. The sewer system shall be extended from off-site, and shall
be sized to serve all off-site properties within the same service area. It
appears that the sanitary sewer service within the Stillwater Greens plat, to
the north, is too shallow to serve the subject property without extensive
grading and filling. If this is the case, then sewers will have to be extended
from the system located upon the west side of 132nd Avenue Southeast,
approximately 1000 feet to the south of the subject property, or from the
system located along 128th Avenue Southeast--requiring easements through
abutting properties to the south and west. This route could be severely
constrained by wetlands and a stream corridor. The owner/ subdivider's
Engineer shall prepare a design engineering report for review and approval
by the City to determine the appropriate design alternative to serve the
subject property and the surrounding area.
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Hearing Examiner Findings and Recommendation
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The existing residence on the property shall be connected to the public sewer
system prior to the issuance of any permits upon the plat. The existing septic
system shall be'as-built', and shown upon the approved engineering plans as
"to be abandoned". The system shall be abandoned in accordance with King
County Health Department rules and regulations.
b. A water system meeting domestic and fire flow requirements for all lots.
Water service to the subject property will be provided by Water District
Number 111. Contact the district for details on necessary improvements.
C. A storm drainage system meeting the applicable standards for conveyance,
detention, and water quality treatment. The minimum detention volume and
release standards to be met for this project shall be that for the Soos Creek
Drainage Basin, or the City of Kent Hill standards, whichever is more
restrictive. The detention/retention facility shall be an open pond with no
side slope being steeper than 2 Horizontal :l Vertical. The number of lots
and/or lot configuration may be required in order to provide the
retention/detention facility in a way that does not impact the adjacent wetland
and wetland buffer.
i Unless the owner/subdivider submits a drainage plan significantly
different than what was submitted with the application for this
subdivision,the owner/subdivider may be required to make extensive
off-site improvements. In addition, the owner/subdivider will also
have to obtain public stormwater easements for the entire conveyance
system outside of existing City right-of-way or drainage easements.
ii. The final Drainage Plan will clearly identify the existing and future
capacity of each link in the drainage system for the required
downstream analysis. The downstream analysis for this development
will include an analysis for capacity, erosion potential, and water
quality from the points of discharge from the subdivision site
downstream a distance of at least one-quarter mile, or to the point
where stormwater discharges through the maintained City of Kent
Meridian Meadows Detention Pond facility, whichever is further.
The owner/subdivider shall identify all reaches which do not have the
capacity for the peak flow from the 100-year, 24-hour design storm.
In addition, should existing downstream capacity be insufficient to
convey the 25-year, 24-hour peak flow rate, the owner/subdivider
shall either provide necessary off-site improvements (and wider
easements where necessary), OR further detain/retain stormwater and
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Hearing Examiner Findings and Recommendation
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restrict the release rate of stormwater to ensure that the capacity of the
existing conveyance system will not be exceeded. Similarly, should
an erosion problem be exacerbated by the proposed release
conditions,then the owner/subdivider will have to further restrict the
release of stormwater from this development. The downstream
analysis shall clearly identify any problems/impacts upon the existing
- detention facilities at Springbrook detention/wetland facilities and
may require level-pool routing to identify those impacts.
iii. Final Stormwater Drainage Plans for the plat will clearly show the
proposed conveyance route from the subdivision to the City of Kent
maintained Stormwater drainage system, and the appropriate public
easements that will be provided to use this route. Legal descriptions
for all easements shall be prepared by a licensed land surveyor.
iv. A 25 foot wide undisturbed creek buffer is required from the line of
ordinary high water for the unnamed tributary which discharges from
the largest on-site wetland. Stormwater management facilities shall
not be permitted within this buffer.
V. Roof downspouts for each house and garage shall be directed to
infiltration trenches meeting the requirements of the Stormwater
Management Manual for the Puget Sound Basin. The following
requirement shall be stated on the face of the final plat:
RESIDENCES CONSTRUCTED ON LOTS CREATED BY THIS
SUBDIVISION MUST PROVIDE ROOF DOWNSPOUT
INFILTRATION TRENCH SYSTEMS PER DETAILS SHOWN ON
THE APPROVED STORMWATER PLANS AS A CONDITION OF
BUILDING PERMIT ISSUANCE.
vi. The stormwater plan shall make provisions to ensure continued
wetland hydrology.
vii. The owner/subdivider shall submit a Landscape Plan for within and
surrounding the retention/detention facility to the Kent Planning
Department and the Department of Public Works for concurrent
review and approval prior to approval of the Detailed Drainage Plans.
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Hearing Examiner Findings and Recommendation
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4SU-96-2
viii. Surface water runoff along the edges of the plat shall be intercepted
and conveyed into the public storm drainage system to avoid adverse
off-site impacts.
ix. The final Stormwater Drainage Plan must include measures to protect
the Webb well from contamination by stormwater overflow and
measures to ensure that the Mandich poind does not overflow more
than presently is the case. The release rate from the property must be
lower than presently exists.
d. The owner/subdivider shall construct an open-to-the-air stormwater treatment
system in accordance with Kent Construction Standards to mitigate for
potential impacts to stormwater runoff quality. Acceptable stormwater
treatment facilities meeting this requirement in their preferred order include:
infiltration after pretreatment; biofiltration swales; wet ponds; extended
detention ponds; and constructed wetlands. Alternatives and experimental
treatment facilities will be evaluated on a case-by-case basis by the
Department of Public Works.
i. The stormwater treatment system shall be within the approved
retention/detention facility tract. Easements for biofiltration swales
across private lots will not be acceptable to meet this requirement.
ii. Stormwater treatment facilities shall not encroach within any
approved 25 foot wetland buffers, nor shall they encroach within the
25 foot undisturbed creek buffer along the south margin of the
proposed detention tract.
e. The owner/subdivider shall grade for streets, utilities and for house pads for
all lots. Grading and Temporary Erosion/Sedimentation Control Plans shall
meet the requirements of the City of Kent Construction Standards.
132nd Avenue Southeast is currently operating at level-of-service "F" with
segment traffic volumes near the intersection of Southeast 256th Street where
the roadway is only two lanes, exceeding 15,000 vehicles per day. South of
the subdivision, near the intersection of SR 516, the daily traffic volumes
along the three-lane section of roadway exceed 20,000 vehicles per day.
f. The owner/subdivider shall construct a half-street widening/ improvement
of 132nd Avenue Southeast across the entire frontage. This widened street
shall include an additional 14-foot wide strip, dedicated to the City of Kent,
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Hearing Examiner Findings and Recommendation
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across the entire property frontage, for the widening and improvement of
the west half of 132nd Avenue Southeast to City Standards for a Minor
Arterial roadway, augmented with bicycle lanes.
i. The paved half-street ( one half of a Minor Arterial roadway plus
a bicycle lane ) roadway width shall be a minimum of 29-feet as
measured from the right-of-way centerline to the face of curb or
future roadway centerline as determined by the City, based on
survey required in prior conditions, and shall include transitions to
match the current pavement widths adjacent to the subdivision as
well as street lighting; a 10-foot wide concrete sidewalk/bikeway
along the westerly side of 132nd Avenue Southeast; drainage
facilities; street channelization; utilities and appurtenances.
ii. In order to provide adequate safe access into the plat street, mitigate
the increased number of northbound left-turns created by the
subdivision of property, and the conflicts that these trips will create
with the existing traffic volumes and high travel speeds on 132nd
Avenue Southeast, these improvements shall also include sufficient
pavement to provide a 12-foot wide northbound left-turn lane into
the subdivision as well as a 12-foot wide northbound through lane
on the easterly side of the roadway centerline across the entire
frontage of the subdivision; and necessary pavement transitions to
the existing portion of 132nd Avenue Southeast to the north and
south of the project. The minimum storage and deceleration length
for this turn lane shall be 102 feet, not inclusive of a bay taper nor
a pavement transition designed to a 35 MPH design speed.
iii. In addition, the subdivider shall install "No Parking" signs across
the entire subdivision frontage on 132nd Avenue Southeast.
iv. The construction of this lane shall include the
relocation/reconstruction of the adjoining drainage systems, above-
ground utilities, and street lighting systems along the southerly
shoulder of 132nd Avenue Southeast, as well as the installation of
appropriate street channelization.
These improvements shall also include the relocation of any/ all
drainage catch basins, utilities, and appurtenances. The edge of the
existing pavement shall be saw-cut at least one ( 1 ) foot ( more, at
the sole discretion of the Director of Public Works, based upon the
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Hearing Examiner Findings and Recommendation
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condition of the existing roadway pavement ) inside the face of the
gutter. After the sawcut, and removal of the pavement, a minimum
four(4 )-foot wide section of the remaining pavement, adjoining the
cut shall be ground-down at least 1.5 inches. At the discretion of the
Director of Public Works, and depending upon the condition of the
existing roadway paving ( e.g. wheel-track rutting, substandard
crown,pavement/sub-base distress as demonstrated by alligatoring or
longitudinal cracking )the developer may be required to remove and
replace/overlay additional sections of the paving to provide a
improved roadway fronting the project.
After placement of the new structural section, the joint between the
new pavement and saw-cut line shall be sealed. Finally, these
owner/subdivider shall be responsible for a minimum 1.5 inch deep
( after the pre-level course ) asphaltic concrete overlay of the entire
length of the roadwakDavement through the widened area, as
necessary, to provide a 2% crown across the pavement; and, as
necessary to meet City Standards for roadway pavement section for
a Minor Arterial roadway.
Finally, the improvements shall include a relocation of the any
existing street lighting.
g. Construct the plat street ( 130th Avenue SE/SE 264th Street ) to City
Standards for a Residential Street.
i. The paved roadway width shall be a minimum of 32-feet as measured
from face of curb to face of curb, based on survey required in prior
conditions,and shall include an off-site transition to match the current
pavement widths along 130th Avenue Southeast to the north of the
subdivision as well as street lighting; five [ 5 ]-foot wide concrete
sidewalks along the both sides of the plat street; drainage facilities;
street channelization; utilities and appurtenances.
ii. In conjunction with these improvements, and to not require
pedestrians to cross 130th Avenue Southeast at a mid-block
location, the owner subdivider shall extend the five-foot wide
sidewalk along 130th Avenue Southeast, northerly to the
intersection of Southeast 263rd Place.
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Hearing Examiner Findings and Recommendation
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iii. The radius of the reverse horizontal curve located near the mid-
point of the subdivision does not meet the City Standards for a
Residential Street. In order to maintain acceptable sight distance
standards through this area, the owner/subdivider shall install "No
Parking Any Time" signs across the entire frontage of Lot 18, and
across the westerly and southwesterly frontage of Lot 7.
iv. The curb returns at the intersection of the Southeast 264th Street and
132nd Avenue Southeast shall be designed and built per the City's
"South 212th Street" -style design.
7. The owner/subdivider shall dedicate all necessary public right-of-way for the
improvements listed in Section A&B and provide all public and private easements
necessary for the construction, operation and maintenance of the required
improvements identified in Section A & B, above.
a. Unless otherwise provided for in a previous deed,the owner subdivider shall
quit-claim deed and/or dedicate sufficient right-of-way, across the entire
property frontage, for the construction of 132nd Avenue Southeast to City
Standards for a Minor Arterial Street, augmented with bicycle lanes street,
minimum half-street right-of-way width of 44 feet. This deed of right-of-way
shall be provided based upon the survey required, and performed by a
licensed land surveyor of the subject property, 132nd Avenue Southeast, and
adjacent affected properties, and shall clearly delineate the existing public
right-of-way, property lines, curb lines, paving limits, and other public and
private improvements. This right-of-way dedication shall include sufficient
property to construct 35-foot radius curb returns tangent to the future curb
lines on 132nd Avenue Southeast(at 29 feet west of right-of-way centerline)
and the plat street.
b. The owner/subdivider shall dedicate sufficient right-of-way to construct the
plat street to City Standards for a Residential street, minimum right-of-way
49 feet, and 35-foot radius curb returns at the intersection of the plat street at
132nd Avenue Southeast.
C. The owner/subdivider shall grant two 26-foot wide access tracts, each
designed to City Standards for a Private Access Tract Roadway, as shown
upon the tentative map. In order to consolidate the access along the plat
street, permit the required use of barrier curb and gutter, and maintain
acceptable safety levels at the reversing horizontal curve in the plat street,
the access tract serving Lots 9 and 10 shall be revised to provide access to
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#SU-96-2
Lot 8, as well. Abutters' access rights to Lot 18 shall be waived to restrict
access to the northerly frontage thereof, ONLY, along the plat street. Access
to Lot 7 shall be limited to the frontage along SE 264th Street, and abutter's
access rights waived across all remaining frontage,thereof Similarly, access
to Lots 8,9, and 10 shall be provided for by means of a Private Access Tract
Roadway, and abutter's access rights waived across the remaining frontage
onto the plat street.
d. The owner/subdivider shall waive abutter's access rights across the entire
subdivision frontage on 132nd Avenue Southeast.
e. Comply with the requirements of Water District#111 regarding construction
and extention of water lines.
f. The developer shall pay a fee-in-lieu of parks and open space according to the
requirements of Subdivision Code Section 12.04.490 prior to recording of the
subdivision.
C. PRIOR TO THE ISSUANCE OF ANY DEVELOPMENT PERMITS ON ANY LOT IN
THE 'MERIDIAN WEST' SUBDIVISION ( SU 96-02 ) THE OWNER/ SUBDIVIDER
SHALL:
1. Construct the improvements noted in Sections A and B, above.
2. "As-built" Drainage Plans for the entire site shall be prepared by a professional
land surveyor and submitted to the City for review and approval.
3. Submit a detailed tree plan to the Planning and Public Works Department for
concurrent review and approval.
Dated this 2nd day of April, 1997.
THEODORE PAUL HUNTER
Hearing Examiner
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Hearing Examiner Findings and Recommendation
Meridian West
#SU-96-2
APPEALS FROM HEARING EXAMINER RECOMMENDATION
ORDINANCE 3320 (excerpt): The action of the city council, approving, modifying, or rejecting
a recommendation or decision of the hearing examiner, shall be final and conclusive, unless within
twenty-one (21) calendar days of the city council action, an appeal is filed with the Superior Court.
16
CITY OF J Q„S1 CLSV
Jim White, Mayor
Planning Department (206) 859-33901FAX(206) 850-2544
James P. Harris, Planning Director
PLANNING DEPARTMENT
(206) 859-3390
STAFF REPORT
FOR HEARING EXAMINER MEETING OF
MARCH 19, 1997 2:00 PM
FILE NO: MERIDIAN WEST #SU-96-2
APPLICANT: WALLY AND ANNE MSEITIF
REQUEST: A REQUEST TO SUBDIVIDE 4.86 ACRES INTO 25
SINGLE FAMILY LOTS
STAFF
REPRESENTATIVE: LINDA PHILLIPS, PLANNER
STAFF
RECOMMENDATION: APPROVAL WITH CONDITIONS
1. GENERAL INFORMATION
A. Description of the Proposal The proposal is to subdivide 4.86 acres into twenty-five
residential lots. The minimum lot size is 4000 square feet. The southwest comer of
the subdivision is reserved for a water detention tract, an existing wetland and new
wetland area, and a wetland buffer.
B. Location The property is located ajacent to 132nd Avenue SE, between 263rd Street
and 266th Street.
C. Size of Property The size of the property is 4.86 acres.
D. Zoning The property is zoned Single Family Residential(SR-8),4000 foot minimum
permitted lot size, 8 residences per acre maximum permitted density.
1
220 J,h AVE.SO.. 1 KENT.WASHI'JGTON 98032-5895/TELEPHONE Q06/859-3300/FAX#859-3333
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E. Land Use The present land use is single family residential. An existing dwelling is
located on proposed Lot 5. Land use adjacent to the subject property and in the
general area is single family residential.
F. History
1. Site History
The subject property is located in the Meridian annexation area, which was
annexed to the City on December 19, 1995.
A tentative plat meeting was held for this project on January 24, 1996.
Comments and conditions generated at the tentative plat meeting were
considered in review of the preliminary plat application.
II. ENVIRONMENTAL CONCERNS
A. Environmental Assessment
A final Mitigated Determination of Nonsignificance (#ENV-96-62) was issued for
the proposal on September 29, 1996, a copy of which is included in the file of record.
B. Significant Physical Features-Topography and Hydrology_
1. Topography
The site slopes from north to south with an overall grade between the north
property line and proposed SE 264th Street of approximately 5%. The south
east corner of the property is relatively flat, and the southwest corner slopes
at an average 13 percent from SE 264th Street to the existing wetland area.
2. Trees
There are significant trees on site. A tree plan identifying all trees with a
caliper of six inches or greater is required prior to issuance of development
permits.
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3. Wetlands
The Department of Public Works has reviewed and approved a Wetland
Delineation Report for this site and the project plans reflect that approved
wetland boundary and buffer.
C. Significant Social Features
1. Street System
Access to 132nd Avenue SE and to SE 263rd Place is proposed to be
provided by a public street which would be 130th Avenue SE at the west
property line and SE 264th Street running east and west through the property.
Two private access roads are proposed to provide access to 8 of the proposed
25 lots.
2. Water System
The proposed subdivision is served by Water District I I I facilities. An on-
site distribution system is required.
3. Sanitaa Sewer System
A sanitary sewer line is available to serve the property.
4. Storm Water System
The Department of Public Works has reviewed the Preliminary Drainage Plan
and supporting calculations for the proposed plat and determined that the
Preliminary Drainage Plan will work and that the proposed drainage tract is
large enough to contain the required detention volume and stormwater
treatment facilities. Infiltration facilities are not required based on
information supplied by the Applicant.
5. LID'
No local improvement districts exist at this time.
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III. CONSULTED DEPARTMENTS AD AGENCIES
The following departments and agencies were advised of this application:
Chief of Staff City Clerk
City Administrator City Attorney
Director of Public Works Chief of Police
Parks and Recreation Director Fire Chief
Building Official
Midway Sewer District Water District#75
Kent Schood District King County Parks, Planning and Resource
Department
US West Communications Puget Sound Power and Light
Seattle-King County Health Dept. Washington Natural Gas
Washington Department of Transportation
U.S. Postmaster
In addition to the above, all persons owning property which lies within 300 feet of the site
were notified of the application and of the public hearing.
Staff comments have been incorporated in the staff report where applicable.
IV. PLANNING DEPARTMENT REVIEW
A. COMPREHENSIVE PLAN
In 1995, the Kent City Council adopted the Kent Comprehensive Plan, which
represented a complete revision to the City's 1977 Comprehensive Plan. The 1995
plan was prepared under the provisions of the Washington State Growth
Management Act. The Comprehensive Plan, through its goals and policies, presents
a clear expression of the City's vision of growth for citizent, the development
community,and other public agencies. The plan is used by the Mayor, City Council,
Land Use and Planning Board, Hearing Examiner, and City departments to guide
decisions on amendments to the City's zoning code and other development
regulations, which must be consistent with the plan, and also guide decisions
regarding the funding and location of capital improvement projects. The Land Use
Element of the plan contains a Land Use Map, which designates the type and
intensity of land uses throughout the City, as well as inthe intire potential annexaton
area.
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The City of Kent Comprehensive Plan is made up of eleven elements which contain
written goals and policies as well as a land use map.
1. LAND USE ELEMENT
a. Goal LU-9 Provide opportunities for a variety of housing types,
options, and densities throughout the City and the Potential
Annexation Area.
b. Goal LU-23 Protect and enhance water resources for multiple
benefits, including recreation, fish and wildlife resources and habitat,
flood protection, water supply, and open space.
C. Policy LU 23-1 Maintain the quantity and quality of wetlands via
current land use regulation and review; and increase the quality and
quantity of the City's wetlands resource base via incentives and
advance planning.
2. CAPITAL FACILITIES
a. Goal CFP-1 As the city of Kent continues to grow and develop,
ensure that an adequate supply and range of capital facilities are
available to provide satisfactory standards of public health, safety,
and quality of life.
3. HOUSING ELEMENT
a. Goal H-2 Provide sufficient, diverse, and affordable housing for the
existing and projected population of Kent.
4. ECONOMIC DEVELOPMENT ELEMENT
a. Goal ED-2 Maintain a strong policy toward balanced community
development
b. Policy ED 2.1 Encourage home ownership to foster stakeholders in
the community
5. COMPREHENSIVE PLAN MAP The Comprehensive Plan Map designates
the subject property as Single Family (SF-8). The proposed subdivision is
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Single Family Residential, and does not exceed the maximum permitted
density of eight residences per acre.
6. Planning Department Comment: The proposed subdivision as conditioned
is consistent with the above mentioned goals, objectives policies, and map
designations of the Comprehensive Plan.
B. STANDARDS FOR GRANTING A SUBDIVISION
1. Purpose of the City of Kent Subdivision code: To provide the rules, .
regulations requirements, and standards for subdividing land in the city of
Kent, ensuring that the highest feasible quality in subdivision will be
attained; that the public health, safety, general welfare, and aesthetics of the
city of Kent shall be promoted and protected; that orderly growth,
development, and the conservation, protection, and proper use of land shall
be ensured; that proper provisions for all public facilities (including
icrculation, utilities, and services) shall be taken into consideration; that
conformance with provisions set forth in the city of Kent Zoning Code and
Kent Comprehensive Plan shall be ensured.
2. Vehicle access Lots 4 and 5 areserved by a private access road. To reduce
the asphalt paving, the private access road length should be reduced to end
at the north edge of the existing driveway on Lot 5.
3. Fee in Lieu of Parks and Open Space Dedication The fee in lieu of land
dedication for parks and open space is determined by the method set forth in
Subdivision Code Section 12.04.490. The fee in lieu is held in a reserve
account and may only be expended to fund a capital improvement that has
been agreed upon by all parties to mitigate the identified, direct impact of the
development.
C. FEASIBILITY OF DEVELOPMENT ON PROPOSED LOTS
1. Development on all lots in the proposed subdivision is subject to Zoning
Code requirements for development in the SR-8, Single Family Residential
zoning district. All lots, as proposed, meet minimum lot size and width
requirements.
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D. PROPOSED FINDINGS: The Planning Department has reviewed this application
in relation to the comprehensive Plan, present zoning, land use, street system. flood
control problems and comments from other departments and finds that:
1. The City-wide Comprehensive Plan Map designates the site as SF, Single
Family Residential,eight residential units per acre, maximum density. This
proposal is for 5.14 units per acre.
2. The site is presently zoned SR 8, Single Family Residential. The minimum
permitted lot size is 4,000 square feet. The area of each proposed lot is at
least 4000 square feet.
3. Land uses in the area are predominantly single family residential. The
proposed single family development is compatible with existing
development.
4. A mitigated Determination of Nonsignificance was issued for the plat on
September 29, 1996. The applicant and the City have satisfied the
requirements of the State Environmental Policies Act (SEPA). The applicant
must fulfill the required mitigating measures set forth in the Determination
of Nonsignificance.
5. The site slopes generally from north to south, and the lowest point is an
existing wetland at the southwest corner.
6. There are trees of six inch caliper and greater on the property.
7. Vehicle access to the property does not present constraints to the proposal.
8. Water and sewer service are available from Water District#111. Availability
of water and sewer service do not present constraints to development.
9. A preliminary storm drainage system has been approved by the Department
of Public Works, and the area set aside in the proposed plat is adequate for
storm water detention.
10. Subdivisions which consist of five lots or more are subject parks and open
space requirements of the Subdivision Code. The proposed subdivision
consists of 25 lots.
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IL Upon reviewing the development plans/subdivision plat for the 'MERIDIAN
WEST' SUBDIVISION development, it has been determined that the
proposed development will cause incremental but cumulatively significant.
additional impacts to the regional and local transportation systems --
demonstrated, in part, as additional traffic congestion at the following
intersections:
132nd Avenue Southeast at Kent-Kangley Road [ SR 516
132nd Avenue Southeast at Southeast 256th Street
124th Avenue Southeast at Kent-Kangley Road [ SR 516
Additional incremental,but cumulatively significant, impacts will be created
to water quality, storm water detention and conveyance facilities, utility
transmission facilities, sanitary sewerage and domestic water conveyance
systems.
Compliance with City of Kent's 'Public Works Ordinance' and the State of
Washington's Growth Management Act will require concurrent improvement
--or the execution of binding agreements by the subdivider with the City of
Kent, for participation in future improvement projects -- of roadway,
intersection and intersection signalization, storm water detention, treatment,
and conveyance, utility, sanitary sewerage, and domestic water, systems.
VII. STAFF RECOMMENDATION
Upon review of the merits of this request and the Code criteria for granting a preliminary
subdivision, the City staff recommends APPROVAL of proposed MERIDIAN WEST
SUBDIVISION #SU-96-2 subject to the following conditions:
A. GENERAL CONDITIONS OF APPROVAL:
1. The subdivider shall implement all mitigation measures required by the
Determination of Nonsignificance for SEPA checklist#ENV-96-62 for the
MERIDIAN WEST Subdivision.
B. PRIOR TO RECORDATION OF THE SUBDIVISION:
1. The owner/subdivider shall provide a survey to be performed by a licensed
land surveyor of the subject property, 132nd Avenue Southeast, Southeast
264th Street, Southeast 263rd Street, and adjacent affected properties, and
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shall clearly delineate the existing public right-of-way, right-of-way
centerlines, property lines, paving limits, and other public and private
improvements.
2. The owner/subdivider shall execute an agreement to financially participate
in and pay a proportionate share in the cost of providing an off-site paved
walkway between the plat boundary and the Lake Meridian Elementary
School. Monies therefrom shall be deposited with the City prior to final plat
approval of this subdivision.
3. A Wetland Delineation Report for this site has been received, and approved.
A Wetland Mitigation Plan shall be submitted to Kent Public Works for
review and approval prior to recording final plat.
4. The wetland boundaries shown in the approved Wetland Mitigation Report
must be surveyed and marked with permanent survey monuments. The
survey shall be shown on the face of the final plat. A licensed professional
surveyor shall provide the survey which shows the wetland boundary, the
approved wetland buffers, the areas of each, and the legal description for the
Sensitive Area Tract for the Wetland. Copies of these maps will be included
in the approved Wetland Mitigation Report.
5. The entire approved, preserved and constructed wetland(s) and it's buffer(s),
and the 25 foot undisturbed creek buffer shall be permanently protected as a
separate Sensitive Area Tract dedicated to the City of Kent in accordance
with the Kent Wetland Management Code. The legal description for the
Sensitive Area Tract for the creek buffer shall be prepared by a licensed land
surveyor. The buffer areas shall be isolated from intrusion and/or disturbance
using landscaping, signs and/or other appropriate screens, as well as an
approved wildlife-passable fence. The following wording shall appear on the
face of the final plat:
SENSITIVE AREA TRACTS
DEDICATION OF A SENSITIVE AREA TRACT CONVEYS TO THE
PUBLIC A BENEFICIAL INTEREST IN THE LAND WITHIN THE
TRACT. THIS INTEREST INCLUDES THE PRESERVATION OF
NATIVE VEGETATION FOR ALL PURPOSES THAT BENEFIT THE
PUBLIC HEALTH, SAFETY AND WELFARE,INCLUDING CONTROL
OF SURFACE WATER AND EROSION, MAINTENANCE OF SLOPE
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STABILITY,VISUAL AND AURAL BUFFERING, AND PROTECTION
OF WATER QUALITY,PLANT ECOLOGY AND WILDLIFE HABITAT.
THE SENSITIVE AREA TRACT IMPOSES UPON ALL PRESENT AND
FUTURE OWNERS AND OCCUPIERS OF THE LAND SUBJECT TO
THE TRACT THE OBLIGATION, ENFORCEABLE ON BEHALF OF
THE PUBLIC BY THE CITY OF KENT, TO LEAVE UNDISTURBED
ALL TREES AND OTHER VEGETATION WITHIN THE TRACT. THE
VEGETATION WITHIN THE TRACT MAY NOT BE CUT, PRUNED,
COVERED BY FILL, REMOVED OR DAMAGED WITHOUT
APPROVAL IN WRITING FROM THE CITY OF KENT.
THE COMMON BOUNDARY BETWEEN THE TRACT AND THE AREA
OF DEVELOPMENT ACTIVITY MUST BE MARKED OR OTHERWISE
FLAGGED TO THE SATISFACTION OF THE CITY OF KENT PRIOR
TO ANY CLEARING, GRADING, BUILDING CONSTRUCTION OR
OTHER DEVELOPMENT ACTIVITY. THE REQUIRED MARKING OR
FLAGGING SHALL REMAIN IN PLACE UNTIL ALL DEVELOPMENT
ACTIVITIES IN THE VICINITY OF THE SENSITIVE AREA TRACT
ARE COMPLETED.
NO BUILDING FOUNDATIONS, STRUCTURES, FILL OR
OBSTRUCTIONS (INCLUDING, BUT NOT LIMITED TO DECKS,
PATIOS, OUTBUILDINGS AND OVERHANGS) ARE ALLOWED
WITHIN 15 FEET OF THE SENSITIVE AREA TRACT BOUNDARY,
UNLESS OTHERWISE APPROVED BY THE CITY.
6. The owner/subdivider shall provide engineering drawings for review and
approval by the City, and either construct or bond for the following:
a. A gravity sanitary sewer system to serve all lots, which shall be
provided by the City of Kent. The sewer system shall be extended
from off-site, and shall be sized to serve all off-site properties within
the same service area. It appears that the sanitary sewer service within
the Stillwater Greens plat, to the north, is too shallow to serve the
subject property without extensive grading and filling. If this is the
case, then sewers will have to be extended from the system located
upon the west side of 132nd Avenue Southeast, approximately 1000
feet to the south of the subject property, or from the system located
along 128th Avenue Southeast -- requiring easements through
abutting properties to the south and west. This route could be severely
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constrained by wetlands and a stream corridor. The owner/
subdivider's Engineer shall prepare a design engineering report for
review and approval by the City to determine the appropriate design
alternative to serve the subject property and the surrounding area.
The existing residence on the property shall be connected to the
public sewer system prior to the issuance of any permits upon the
plat. The existing septic system shall be'as-built',and shown upon the
approved engineering plans as "to be abandoned". The system shall
be abandoned in accordance with King County Health Department
rules and regulations.
b. A water system meeting domestic and fire flow requirements for all
lots. Water service to the subject property will be provided by Water
District Number 111. Contact the district for details on necessary
improvements.
C. A storm drainage system meeting the applicable standards for
conveyance, detention, and water quality treatment. The minimum
detention volume and release standards to be met for this project shall
be that for the Soos Creek Drainage Basin, or the City of Kent Hill
standards, whichever is more restrictive. The detention/retention
facility shall be an open pond with no side slope being steeper than
3 Horizontal A Vertical. The number of lots and/or lot configuration
may be required in order to provide the retention/detention facility in
away that does not impact the adjacent wetland and wetland buffer.
i_ Unless the owner/subdivider submits a drainage plan
significantly different than what was submitted with the
application for this subdivision, the owner/subdivider will be
required to make extensive off-site improvements. In
addition, the owner/subdivider will also have to obtain public
stormwater easements for the entire conveyance system
outside of existing City right-of-way or drainage easements.
ii. The final Drainage Plan will clearly identify the existing and
future capacity of each link in the drainage system for the
required downstream analysis. The downstream analysis for
this development will include an analysis for capacity,
erosion potential, and water quality from the points of
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discharge from the subdivision site downstream a distance of
at least one-quarter mile, or to the point where stormwater
discharges through the maintained City of Kent Meridian
Meadows Detention Pond facility, whichever is further. The
owner/subdivider shall identify all reaches which do not have
the capacity for the peak flow from the 100-year, 24-hour
design storm. In addition, should existing downstream
capacity be insufficient to convey the 25-year, 24-hour peak
flow rate,the owner/subdivider shall either provide necessary
off-site improvements (and wider easements where .
necessary), OR further detain/retain stormwater and restrict
the release rate of stormwater to ensure that the capacity of
the existing conveyance system will not be exceeded.
Similarly, should an erosion problem be exacerbated by the
proposed release conditions, then the owner/subdivider will
have to further restrict the release of stormwater from this
development. The downstream analysis shall clearly identify
any problems/impacts upon the existing detention facilities at
Springbrook detention/wetland facilities and may require
level-pool routing to identify those impacts.
iii. Final Stormwater Drainage Plans for the plat will clearly
show the proposed conveyance route from the subdivision to
the City of Kent maintained Stormwater drainage system, and
the appropriate public easements that will be provided to use
this route. Legal descriptions for all easements shall be
prepared by a licensed land surveyor.
iv. A 25 foot wide undisturbed creek buffer is required from the
line of ordinary high water for the unnamed tributary which
discharges from the largest on-site wetland. Stormwater
management facilities shall not be permitted within this
buffer.
V. Roof downspouts for each house and garage shall be directed
to infiltration trenches meeting the requirements of the
Stormwater Management Manual for the Puget Sound Basin.
The following requirement shall be stated on the face of the
final plat:
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#SU-96-2
RESIDENCES CONSTRUCTED ON LOTS CREATED BY
THIS SUBDIVISION MUST PROVIDE ROOF
DOWNSPOUT INFILTRATION TRENCH SYSTEMS PER
DETAILS SHOWN ON THE APPROVED STORMWATER
PLANS AS A CONDITION OF BUILDING PERMIT
ISSUANCE.
vi. The stormwater plan shall make provisions to ensure
continued wetland hydrology.
vii. The owner/subdivider shall submit a Landscape Plan for
within and surrounding the retention/detention facility to the
Kent Planning Department and the Department of Public
Works for concurrent review and approval prior to approval
of the Detailed Drainage Plans.
viii. Surface water runoff along the edges of the plat shall be
intercepted and conveyed into the public storm drainage
system to avoid adverse off-site impacts.
d. The owner/subdivider shall construct an open-to-the-air stormwater
treatment system in accordance with Kent Construction Standards to
mitigate for potential impacts to stormwater runoff quality.
Acceptable stormwater treatment facilities meeting this requirement
in their preferred order include: infiltration after pretreatment;
biofiltration swales; wet ponds; extended detention ponds; and
constructed wetlands. Alternatives and experimental treatment
facilities will be evaluated on a case-by-case basis by the Department
of Public Works.
i. The stormwater treatment system shall be within the approved
retention/detention facility tract. Easements for biofiltration
swales across private lots will not be acceptable to meet this
requirement.
ii. Stormwater treatment facilities shall not encroach within any
approved 25 foot wetland buffers, nor shall they encroach
within the 25 foot undisturbed creek buffer along the south
margin of the proposed detention tract.
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e. The owner/subdivider shall grade for streets, utilities and for house
pads for all lots. Grading and Temporary Erosion/Sedimentation
Control Plans shall meet the requirements of the City of Kent
Construction Standards.
132nd Avenue Southeast is currently operating at level-of-service "F"
with segment traffic volumes near the intersection of Southeast 256th
Street where the roadway is only two lanes, exceeding 15,000
vehicles per day. South of the subdivision,near the intersection of SR
516,the daily traffic volumes along the three-lane section of roadway
exceed 20,000 vehicles per day.
f. The owner/subdivider shall construct a half-street widening/
improvement of 132nd Avenue Southeast across the entire frontage.
This widened street shall include an additional 14-foot wide strip,
dedicated to the City of Kent, across the entire property frontage,
for the widening and improvement of the west half of
132nd Avenue Southeast to City Standards for a Minor Arterial
roadway, augmented with bicycle lanes.
i. The paved half-street ( one half of a Minor Arterial roadway
plus a bicycle lane ) roadway width shall be a minimum of
29-feet as measured from the right-of-way centerline to the
face of curb or future roadway centerline as determined by
the City, based on survey required in prior conditions, and
shall include transitions to match the current pavement
widths adjacent to the subdivision as well as street lighting;
a 10-foot wide concrete sidewalk/bikeway along the
westerly side of 132nd Avenue Southeast; drainage
facilities; street channelization; utilities and appurtenances.
ii. In order to provide adequate safe access into the plat street,
mitigate the increased number of northbound left-turns
created by the subdivision of property, and the conflicts that
these trips will create with the existing traffic volumes and
high travel speeds on 132nd Avenue Southeast, these
improvements shall also include sufficient pavement to
provide a 12-foot wide northbound left-turn lane into the
subdivision as well as a 12-foot wide northbound through
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#SU-96-2
lane on the easterly side of the roadway centerline across the
entire frontage of the subdivision; and necessary pavement
transitions to the existing portion of 132nd Avenue
Southeast to the north and south of the project. The
minimum storage and deceleration length for this turn lane
shall be 102 feet, not inclusive of a bay taper nor a
pavement transition designed to a 35 MPH design speed.
iii. In addition, the subdivider shall install "No Parking" signs
across the entire subdivision frontage on 132nd Avenue
Southeast.
iv. The construction of this lane shall include the
relocation/reconstruction of the adjoining drainage systems,
above-ground utilities, and street lighting systems along the
southerly shoulder of 132nd Avenue Southeast, as well as the
installation of appropriate street channelization.
These improvements shall also include the relocation of any/
all drainage catch basins, utilities, and appurtenances. The
edge of the existing pavement shall be saw-cut at least one (
1 ) foot(more, at the sole discretion of the Director of Public
Works, based upon the condition of the existing roadway
pavement ) inside the face of the gutter. After the sawcut,
and removal of the pavement, a minimum four(4 )-foot wide
section of the remaining pavement, adjoining the cut shall be
ground-down at least 1.5 inches. At the discretion of the
Director of Public Works, and depending upon the condition
of the existing roadway paving ( e.g. wheel-track rutting,
substandard crown, pavement/sub-base distress as
demonstrated by alligatoring or longitudinal cracking ) the
developer may be required to remove and replace/overlay
additional sections of the paving to provide a improved
roadway fronting the project.
After placement of the new structural section, the joint
between the new pavement and saw-cut line shall be sealed.
Finally, these owner/subdivider shall be responsible for a
minimum 1.5 inch deep (after the pre-level course ) asphaltic
- concrete overlay of the entire length of the roadway pavement
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Meridian West
4SU-96-2
through the widened area, as necessary, to provide a 2%
crown across the pavement, and, as necessary to meet City
Standards for roadway pavement section for a Minor Arterial
roadway.
Finally, the improvements shall include a relocation of the
any existing street lighting.
g. Construct the plat street( 130th Avenue SE/SE 264th Street ) to City
Standards for a Residential Street.
i. The paved roadway width shall be a minimum of 32-feet as
measured from face of curb to face of curb, based on survey
required in prior conditions, and shall include an off-site
transition to match the current pavement widths along 130th
Avenue Southeast to the north of the subdivision as well as
street lighting; five [ 5 ]-foot wide concrete sidewalks along
the both sides of the plat street; drainage facilities; street
channelization; utilities and appurtenances.
ii. In conjunction with these improvements, and to not require
pedestrians to cross 130th Avenue Southeast at a mid-block
location, the owner subdivider shall extend the five-foot
wide sidewalk along 130th Avenue Southeast, northerly to
the intersection of Southeast 263rd Place.
iii. The radius of the reverse horizontal curve located near the
mid-point of the subdivision does not meet the City
Standards for a Residential Street. In order to maintain
acceptable sight distance standards through this area, the
owner/subdivider shall install "No Parking Any Time" signs
across the entire frontage of Lot 18, and across the westerly
and southwesterly frontage of Lot 7.
iv. The curb returns at the intersection of the Southeast 264th
Street and 132nd Avenue Southeast shall be designed and
built per the City's "South 212th Street" -style design.
7. The owner/subdivider shall dedicate all necessary public right-of-way for the
improvements listed in Section A & B and provide all public and private
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#SU-96-2
easements necessary for the construction, operation and maintenance of the
required improvements identified in Section A & B, above.
a. Unless otherwise provided for in a previous deed, the owner
subdivider shall quit-claim deed and/or dedicate sufficient
right=of--way, across the entire property frontage, for the construction
of 132nd Avenue Southeast to City Standards for a Minor Arterial
Street, augmented with bicycle lanes street, minimum half-street
right-of-way width of 44 feet. This deed of right-of-way shall be
provided based upon the survey required, and performed by a
licensed land. surveyor of the subject property, 132nd Avenue
Southeast,and adjacent affected properties,and shall clearly delineate
the existing public right-of-way, property lines, curb lines, paving
limits, and other public and private improvements. This right-of-way
dedication shall include sufficient property to construct 35-foot radius
curb returns tangent to the future curb lines on 132nd Avenue
Southeast [ at 29 feet west of right-of-way centerline ] and the plat
street.
b. The owner/subdivider shall dedicate sufficient right-of-way to
construct the plat street to City Standards for a Residential street,
minimum right-of-way 49 feet, and 35-foot radius curb returns at the
intersection of the plat street at 132nd Avenue Southeast.
C. The owner/subdivider shall grant two 26-foot wide access tracts, each
designed to City Standards for a Private Access Tract Roadway, as
shown upon the tentative map. In order to consolidate the access
along the plat street, permit the required use of barrier curb and
gutter, and maintain acceptable safety levels at the reversing
horizontal curve in the plat street, the access tract serving Lots 9 and
10 shall be revised to provide access to Lot 8, as well. Abutters'
access rights to Lot 18 shall be waived to restrict access to the
northerly frontage thereof, ONLY,along the plat street. Access to Lot
7 shall be limited to the frontage along SE 264th Street, and abutter's
access rights waived across all remaining frontage,thereof. Similarly,
access to Lots 8, 9, and 10 shall be provided for by means of a
Private Access Tract Roadway, and abutter's access rights waived
across the remaining frontage onto the plat street.
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#SU-96-2
d. The owner/subdivider shall waive abutter's access rights across the
entire subdivision frontage on 132nd Avenue Southeast.
e. Comply with the requirements of Water District #111 regarding
construction and extention of water lines.
f. The developer shall pay a fee-in-lieu of parks and open space
according to the requirements of Subdivision Code Section
12.04.490 prior to recording of the subdivision.
C. PRIOR TO THE ISSUANCE OF ANY DEVELOPMENT PERMITS ON ANY
LOT IN THE 'MERIDIAN WEST' SUBDIVISION ( SU 96-02 ) THE OWNER/
SUBDIVIDER SHALL:
1. Construct the improvements noted in Sections A and B, above.
2. "As-built" Drainage Plans for the entire site shall be prepared by a
professional land surveyor and submitted to the City for review and
approval.
3. Submit a detailed tree plan to the Planning and Public Works Department
for concurrent review and approval.
KENT PLANNING DEPARTMENT
March 10, 1997
U:\CHRIS\SU962.RPT
18
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Kent City Council Meeting
Date June 3 , 1997
Category Bids
1. SUBJECT: SOUTH 200TH STREET GREEN RIVER BRIDGE
2 . SUMMARY STATEMENT: Bid opening for this project was held
on May 28th with 6 bids received. The low bid was submitted
by Mowat Construction Co. of Kirkland, in the amount of
$2 , 486, 385. The Engineer's estimate was $2 , 886, 646.
The project consists of the construction of a two-span concrete
bridge over the Green River at South 200th Street which is a
portion of the S. 196th Street Corridor project.
It is the recommendation of the Public Works Director that
upon receipt of all permits and approvals and Council' s con-
currence that a bid discrepancy is a minor informality, the
S. 200th Street Green River Bridge contract be awarded to Mowat
Construction Co. in the amount of $2 , 486, 385.
3 . EXHIBITS: Public Works Director memorandum
4 . RECOMMENDED BY: Public Works Director
(Committee, Staff, Examiner, Commission, etc. )
5. UNBUDGETED FISCAL/PERSONNEL IMPACT: NO X YES
6. EXPENDITURE REQUIRED: $2 , 486 , 385
SOURCE OF FUNDS: S 196th Street Corridor Project
7 . CITY COUNCIL ACTION:
Councilmember �I.L ZI __,_moves, Councilmember )�4'.v,wet - seconds
that the low bidder' s omission of one subcontractor on the
city's subcontractor list constitutes a minor informality in
the bid because the subcontractor was clearly listed on a
separate bid document, and because the contractor notified the
City within one hour of the bid opening time of the complete
subcontractor list; and further MOVE that the contract be
awarded to Mowat Construction on the condition that the City
first receive all necessary permits and approvals.
DISCUSSION:
ACTION:
Council Agenda
Item No. 5A
DEPARTMENT OF PUBLIC WORKS
Mav 29, 1997
TO: Mavor &City Council
FROM: Don Wickstromg
RE: S. 200th Street Green River Bridge
Bid opening for this project was held on May 28th with 6 bids received. The low bid
was submitted by Mowat Construction Co in the amount of $2,486,385.00. The
Engineer's estimate was 52,886,646.00. Said low bidder did omit one subcontractor
on the Citv's subcontractor list contained in the bid package. Because however that
subcontractor was clearly listed on a separate document of the bid package and
further, the low bidder notified the City within one hour of the bid opening time of
the complete subcontractor list, we are recommending that this omission constitute a
minor informality in the bid. As such, upon Council's concurrence therewith and
upon receipt of all necessary permits and approvals, it is the Public Works Director's
recommendation to award the S. 200th Street Green River Bridge contract to the low
bidder.
BID SUMMARY
Mowat Construction Company 2,486,385.00
Kulchin-Condon &Associates 2,701 ,068.00
MKB Constructors 2,996,280.00
Max J. Kunev Companv 3,077,625.00
Morrison ISnudsen Corp 3,091 ,984.00
Guv Atkinson Construction 3,155,305.00
Engineer's Estimate 2,886,646.00
MOTION:
Councilmember moves, Councilmember seconds that the Low
Bidder's omission of one subcontractor on the Citv's subcontractor list constitutes a
minor informality in the bid because the subcontractor was clearly listed on a separate
bid document and, because the contractor notified the Citv within one hour of the
bid opening time of the complete subcontractor list; and further MOVE that the
contract be awarded to Mowat Construction on the condition that the Citv first
receive all necessary permits and approvals.
. . ...............
CONTINUED COMMUNICATIONS
A.
R E P O R T S
A. COUNCIL PRESIDENT
B. OPERATIONS COMMITTEE
C. PUBLIC WORKS COMMITTEE
D. PLANNING COMMITTEE
E. PUBLIC SAFETY COMMITTEE
F. PARKS COMMITTEE
G. ADMINISTRATIVE REPORTS
EXECUTIVE SESSION: Property Negotiations
CITY OF KENT
PARKS COMMITTEE MEETING
MAY 1, 1997
Council Present: Chair Judy Woods, Connie Epperly,
Leona Orr for Connie Epperly
Jon Johnson
Staff Present: Lori Hogan, Tom Brubaker, John M. Hodgson, Teri Petrole-Stump
Others Present: Mr. & Mrs. Rod Saalfield
1 . Commons Playfield: This agenda item was pulled as Wayne Thuringer, a citizen
from the North Park neighborhood who was scheduled to speak could not attend the
meeting. John stated the property needs to be developed the way it should be; at
the discretion of Council, in conjunction with Downtown Plan, and finally,
development of a master plan. Chair Judy Woods asked to put this item on a future
agenda for discussion with Mr. Thuringer.
2. Washington Athletic Club Donation: In a unanimous vote of 3-0, Leona Orr moved
and Jon Johnson seconded to accept the treadmill donated to the Kent Commons
Athletic Center from the Washington Athletic Club as an asset, valued at $3,500.00.
3. IAC Application: Parks and Recreation Department has identified three priority
projects eligible for application to the Interagency Committee for Outdoor Recreation
(IAC) for statewide grant funds:
1. Phase I: development of Salt Air Hills Vista.
2. Acquisition of land in the valley floor for ballfield development.
3. Acquisition of land for wetland preservation/wildlife habitat.
In a unanimous vote of 3-0 Jon Johnson moved, and Leona Orr seconded to
authorize submittal of three IAC grant applications to the Interagency Committee for
Outdoor Recreation for three priority projects per attached Exhibits.
4. Springwood Park - CDBG Application: The asphalt trail at Springwood Park was
damaged during the storms in February of 1996. Federal Emergency Management
Association (FEMA) which is Government disaster funding, did not cover the cost of
repairs. Community Development Block Grant (CDBG) funds would cover the costs
of the repairs needed.
In a unanimous vote of 3-0, Jon Johnson moved and Leona Orr seconded to
authorize submittal of the CDBG application for funding trail repairs at Springwood
Park per attached exhibit.
5. Turnkey Park/Russell Road Park CDBG Application: Handicap accessibility is
necessary at Turnkey Park and Russell Road Park. A Community Development
Block Grant (CDBG) would fund the necessary renovations, per attached plan.
In a unanimous vote of 3-0, Leona Orr moved and Jon Johnson seconded to
authorized submittal of the CDBG application for creating handicap accessibility at
Turnkey Park and Russell Road Park per attached Exhibit.
6. IAC Contract: In 1996 staff was awarded an IAC grant to purchase 13.1 acres in
King County to expand an existing site destined to become a community park for the
City of Kent's East Hill neighborhood. This bill did not get passed in 1996 and was
considered a lost bill. It was put back into the legislature in 1997 and approved.
In a unanimous vote of 3-0, Jon Johnson moved and Leona Orr seconded to accept
and amend to the land acquisition budget in the amount of $479,443 and approval to
send the IAC grant contract to Mayor White for signature.
7. Target Issues: John Hodgson highlighted the teen program, in relation to the utilities
tax. Program statistics have been inventoried i.e. who, what, when, and where. The
next step is to meet with Council and find out what they expect, then compile with
current information and find out where we go from there.
Chair Judy Woods suggested conducting a workshop after gathering the necessary
information and discuss and review the program from the point of accountability to
the needs of the users. John stated that the City, Parks and Recreation staff, and the
user groups i.e. Kent Little League, Kent School District, need a partnership. He
added that the flooding fields need to be fixed, and the city needs to acquire land to
accomodate future ballfield needs. It is necessary for staff to meet with local boards
and discuss partnerships, possibly creating a committee. Council members agreed
that it is time to look into the future needs of the community, together with the
community.
Citizen, Rod Saalfield asked for a copy of the report be sent to the Chamber of
Commerce.
8. Riverbend Golf Complex RFP Update: John Hodgson stated the need for City
Council to appoint the RFP interview committee prior to the first council meeting in
July, and offer further direction for the interview process. Leona Orr announced that
Council is proposed interview committee members to Christi Houser. Judy Woods
expressed the need for expediency in getting the names to Christi Houser.
Add on: Informational.
Street Trees at Shafron Mobile Home Park: Over the years Russell Road Park trees
have been falling on to mobile home roofs. The City Risk Manager says the trees
need to go. They will be replaced with a fence to keep foul balls from hitting homes.
Staff recently received funds from an Urban Forestry Grant to conduct a tree study of
Kent Parks and street trees. When drainage is addressed at Russell Road Park in
the spring of 1998, the tree issue will be discussed.
Meeting adjourned to Executive Session 5:10 p.m.
Meeting adjourned 5:30 p.m.
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